Ep 26 Doctorspeak Part 2

I don't think that insurance companies have had such a penetration amongst the general public.

So it's pretty much self-pay in India when you compare it with the West.

What I have seen happening is if somebody has insurance, the tendency for the hospital is to bill them a little rather extravagantly because they feel that they can get reimbursed.

So in that sense, I think from the income that a doctor earns, if somebody has insurance, there's a guaranteed payment.

As far as the TPAs, again, I feel that The TPAs may not be that much of a contributor in this scenario.

Working at Hinduja Hospital, we never had to bother about a patient's insurance.

The charges were all fixed according to the bed or room he took and this was given to the patient prior to admission.

Surgical charges, bed charges, all your investigations varied according to the type of room you took.

So the patient knew what his final budget was for a procedure as they were graded from grade 1 to grade 6 and they could choose what type of bed they took.

So the insurance didn't play a part on the hospital side, but the patient could decide depending on what insurance he has, what fits his budget.

Now, I've also heard that in some small nursing homes, the first question asked to a patient is what sort of insurance do you have? And accordingly, the charges are jacked up before certain surgeries or brought down for surgeries depending on what the insurance would cover most patients nowadays do have some sort of insurance because medical costs are going up the equipment and investigation are going up so it is good to have some sort of medical insurance but the negative to that is most insurance companies try and avoid paying the patient the money which is rightly theirs.

And unless your doctor cooperates and writes letters to the insurance company, sometimes the poor patient ends up getting nothing from this insurance company.

Insurance is just getting into the sector.

It is just getting into the healthcare sector in as far as our country is concerned.

You can still go to anyone and get it many people don't have insurance we take insurance because the cost of instruments the cost of surgeries generally the cost of living is going high and so we take the insurance for those purposes so that it can be but insurance has its own limits you know you can't get it doesn't matter for an existing disease it doesn't matter It doesn't count for any existing factor.

So those things are not there, but you can get anything you want without having to go.

I don't think in a country like ours, insurance will be helpful in the sense that people who are not able to take this facility, cannot afford treatment, would be benefited by it.

But as of now, I really don't think insurance has any much say.

We now come to my favourite beef.

insurance companies and TPAs.

In the first place, I don't know why there are TPAs.

Earlier, insurance companies used to directly deal with the hospital and make the payment.

Now, the TPAs have come in and they have got so big for their boots.

They are merely facilitators, financial facilitators.

When a patient doesn't have enough money, the TPA will pay and the patient pays the payment for the insurance.