International Journal of Research in Medical Sciences | May 2018 | Vol 6 | Issue 5 Page 1726
International Journal of Research in Medical Sciences
Garg R et al. Int J Res Med Sci. 2018 May;6(5):1726-1729
www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012
Original Research Article
Case study on reimbursement process and settlement of bills of patients
treated under package charges in super speciality public hospital
Ruchi Garg
1
*, Neeraj Garg
2
, Abhinav Wankar
3
, I. B. Singh
4
INTRODUCTION
The tertiary care super specialty hospital in north India
was established in 1956. Fifty-two departments and seven
super-speciality centres manage practically all types of
disease conditions with support from pre-clinical and
para clinical services. In this public hospital, because of
constraints of resources, patients are often asked to buy
certain items required for their treatment procedure. Such
demands from the hospital, which can be at odd hours,
depending on the treatment causes great inconvenience to
the patients or their attendants. Various feedback reports
received from the patients treated at this hospital have
suggested that the hospital should provide the items
required for the treatment, and the money for it can be
collected by the hospital from the patient in advance. This
tertiary care hospital is the premier medical institution in
the country, has been quick to understand the requirement
of user charges for medical treatment. Recovery of user
charges as package charges has been in operation at the
cardio thoracic centre since 1995.
1-2
Prior to this, the
system was functioning as a patient revolving fund in
which the patient has to deposit some money at the of
admission which is based on assumed expenditure for his
treatment. Adjustments were made at the time of
discharge. Detailed accounts had to be maintained for
each of the items of the treatment procedure resulting in
cumbersome accounting. The package service now
1
Department of Health and Hospital Management, IIHMR University, Jaipur, Rajasthan, India
2
Command Project Officer, Head Quarter South West Command, Ministry of Defence, Government of India, India
3
Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
4
Additional Medical Superintendent, Cardio Thoracic Neurosciences Centre, Department of Hospital Administration,
All India Institute of Medical Sciences, New Delhi, India
Received: 03 March 2018
Accepted: 03 April 2018
*Correspondence:
Dr. Ruchi Garg,
E-mail: gargruchi2000@yahoo.in
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: In the Government hospitals, because of constraints of resources, patients are often asked to buy certain
items required for their treatment procedure. There is an inadvertent delay in bill reimbursement process due to the
cumbersome procedure, which causes dissatisfaction among patients. Thus, it was highly imperative to reduce the
reimbursement time and improve the level of patient satisfaction by improving quality of services. The present study
depicts modifications initiated to reduce causes of delay and improve patient satisfaction.
Methods: Process mapping was done for different procedures which are carried out under package system at Cardio
Neuroscience Centre. All the available documents were analysed from Operation theatre, Wards, ICU, Billing section,
Account office, OPD area etc. and Interviews were taken from consultants, nursing staff, staff working at Billing
section, Account office etc. to identify causes of delay.
Results: The study helped in improvement in efficiency by 60% percent and reduces the number of resources by 10
percent.
Conclusions: The study helped to increase productivity gains and improve accuracy.
Keywords: Account section, Billing, Delay, Process mapping, Patient satisfaction, Reimbursement
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181767