Now, a health portal for patients

Since rates could vary depending on the customer profile, use it only as a starting point

Today, if you’re planning a holiday, you can check out the details of restaurants and hotels online. You can get ratings based on the type of rooms, services, prices and user reviews. But, what do you do if you have to get admitted to a hospital? You first ask your family doctor, then your friends and family, and then check if your insurance provider has a tie-up with that hospital for easier claim settlement. Wouldn’t a rating system for hospitals help you in your search for a hospital suitable for your requirements?

ICICI Lombard General Insurance recently launched a platform called Health Advisor, which offers a rating mechanism for around 1,000 hospitals across 10 cities. It provides information on hospitals’ location, services offered, cost of procedures and quality of care.

Read more from our special coverage on "HEALTH INSURANCE"

• Health insurance to see standardised rates, niche products
• New health scheme to reduce out of pocket expenses for BPL families
• Budget may unveil health insurance scheme for elderly

To determine treatment quality, ICICI Lombard worked jointly with Tata Institute of Social Sciences. A list of 20 parameters was finalised for the rating scale, based on inputs given by the hospitals. These include the number of doctors/nurses per bed, discharge process, length of stay, percentage of patients discharged against medical advice, and patients who acquired a surgical site infection.

The portal gives information about 30 common procedures based on claim experience. These include total knee replacement, cataract, hip replacement, appendectomy, tonsillectomy, etc. For the sake of comparison, the rates for a twin-sharing room have been used, because majority of the claims were in this category.

The rates are disclosed by the hospitals, but these could vary from patient-to-patient. For instance, if you are a corporate client, you might get a different rate under your employer-provided insurance scheme. Or, if you opt for a different kind of room, the rates will be different, says Sanjay Dutta, head of underwriting and claims at ICICI Lombard General Insurance.

Not all hospitals that are listed on the platform have mentioned rates because disclosure is voluntary. It was difficult to get rates from hospitals in Mumbai and Kolkata because most doctors are consultants, who work with different hospitals charging different rates. Against this, Delhi and South India have are more hospital chains, which tend to have fixed rates. These hospitals decide doctors’ rates and hence were more willing to disclose rates, says Bhargav Dasgupta, managing director and CEO at ICICI Lombard.

 
Rates might differ even at the same hospital depending on whether it’s a senior doctor who is performing the procedure / surgery or a junior doctor. The portal also has a mechanism to include patients’ feedback, which is posted only after verifying the patient’s discharge dates, etc with the hospital. The feedback is also sent to the hospital.

“Even if a hospital gets a poor rating on the portal based on the parameters or customer feedback, we do not blacklist it. We blacklist a hospital only if there is conclusive evidence of fraud,’’ says Dasgupta.

 
While the portal is a good beginning for comparing costs and services offered by hospitals, rating of hospitals is tricky, says Vivek Desai, managing director of HOSMAC, a hospital consultancy firm. Rating a hospital depends on factors like mortality rates, how many years of experience the doctors have, etc. Such information is difficult to get. Instead, a grading of hospitals can be done, based on the infrastructure and facilities.

For instance, a fully air-conditioned hospital or one with round-the-clock critical care can be graded higher. It can be similar to grading of hotels such as five star, four star, etc.

“Just like there are standards for grading of hotels, for hospitals, too, there should be conditions. For instance, a critical care unit cannot be managed by an ayurvedic or homoeopathy doctor. Until then, patients will continue to choose hospitals based on word-of-mouth, their family doctor’s advice of one that is recognised by their insurance company,’’ says Desai.