Health insurance reforms need to start with hospital reforms

The government must get into this murky business of pricing by hospitals as it has come in the way of coverage and cost of health insurance

- MADAN SABNAVIS

When one looks at the room rates in a hotel, there are different prices depending on the kind of accommodation. The starting price point would be, say, Rs 8000 a day, which can go up to Rs 30,000 or more depending on the size of the accommodation and the amenities and comforts that go with the same. However, all the extra charges for laundry or room services remain the same across all the customers. This is logical as the customer is already charged a certain rate for the accommodation chosen.

However, when one moves from the hospitality to hospital sector, the charges change dramatically to the point of being absurd. Let us look at the rate list of one of Mumbai's leading hospitals in the suburbs which is rated as a five-star facility. The rooms have different grades which include common, economy, twin, special, deluxe, super deluxe and suite. The room charges as of 2023 varied between Rs 2,250 and Rs 35,000 per day, with the special room having a tag of Rs 6,750. The last will be used as the mid-point reference for the purpose of illustration as this is normally the accommodation approved by health insurance policies when there are no sub-limit clauses in the policy.

Now, the surgeries that are conducted come as packages much like the hospitality sector provides exciting ones for a certain period of stay. The surgeries are listed under different grades which the surgeon decides. Again, for illustration, one can look at Grade 5, which is what most of them would put the patient through in the name of being the least invasive procedure. There are never details provided by the hospital on which procedures are included under these grades, and the prerogative is with the specialist.