April 7, 2024, New Delhi: The three years of the Covid pandemic brought to light, the several issues faced by people at hospitals but the issue of getting a hefty bill at the end of their treatment with limited details and clarifications left a poor impression about India’s private hospital system amongst many. Ahead of the World Health Day, citizens via LocalCircles have been discussing the subject of making healthcare billing more transparent.

In a very typical instance, parents of a young girl, who died of dengue in 2022, filed a complaint against a Hyderabad based hospital alleging that they were billed for an extra day after the death. The hospital defended itself stating the charges were for necessary procedures post the death of the patient at midnight. Many cases of overcharging or hidden charges periodically come to light particularly in cases where medical health costs are not covered through insurance or any other medical scheme. That is not to say that those with medical health cover are not overcharged. In the past, several cases of private hospitals overbilling to get benefits provided to the patient under various Government schemes have also come to light.

Given the constant conflict between private hospitals and patients/ caregivers over bills, LocalCircles sought the views of citizens on how they would like this issue to be resolved. The survey received nearly 23,000 responses from citizens located in 305 districts of India. 67% were men while 33% respondents were women. 45% respondents were from tier 1, 31% from tier 2 and 24% respondents were from tier 3, 4 & rural districts.

Only 47% of citizens surveyed who received a hospital bill for their self or family members say it had all charges broken down separately for consumables, services, facilities, etc.

The survey first asked citizens about their experience with hospital bills. It asked them, “When you or someone from your family was admitted to a hospital or nursing home in the last 3 years, how was the final bill presented to you?” Out of 12,000 who responded to this query, 47% were happy to state that “all charges had been broken down separately in detail for consumables, services, consultation, facilities, etc. Among the remaining respondents 43% indicated that while the charges were broken down, the bill did not have details about the consumables used and the various services availed; and 10% indicated that no details about the charges were mentioned in the bill, only “package charges” were mentioned. In essence, only 47% of citizens surveyed who received a hospital bill for their self or family members say it had all charges broken down separately for consumables, services, facilities, etc.

74% of the respondents want the government to create a mandatory BIS standard for hospital bills which requires all charges for consumables, services, facilities, etc., to be itemized

As majority of the respondents were not happy with the billing format and the lack of detailing in there, the survey next asked, “Should the government via BIS (Bureau of Indian Standards) create a common standard for hospital bills that requires mandatory itemized listing of all products, consumables, services, facilities, etc., with the associated costs?” This query received 11,603 responses with 74% of respondents wanting the Government to initiate action via BIS to help create a common billing format for all hospitals. However, 17% of respondents felt that the Government should not interfere, instead it would be better to “leave it to the hospital on how they want to present the bill” while 9% of those surveyed have no clear views on the issue. In essence, 74% of the respondents want the Government to create a mandatory BIS standard for hospital bills which requires all charges for consumables, services, facilities, etc., to be itemized.

In summary, the survey shows that while 47% of respondents were happy that the hospital bills they received had details about all the expenses whether products, consumable, services or facilities, the remaining 53% did not receive these details. This discontent is reflected in the response received to the next question with 74% of respondents wanting the Government to initiate action via BIS to help create a common billing format for all hospitals giving details of all the charges levied. Transparency in billing will help not only the consumers but also health insurance companies, employers who give reimbursement packages and even the government - both central and states, some of which are providing health care schemes.

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