A doctor at a private hospital who requested anonymity told FMT that doctors have been asked to put a cap on the number of admissions in favour of treating as many cases as possible as outpatients.
The directive to raise the quota of outpatients over inpatients forces doctors to make judgement calls, raising the risk of them making calls that may have a long-term adverse health impact on patients, the doctor added.
The “directive” came on the heels of a new initiative that allows policyholders to go directly to private hospitals for outpatient treatment for the select list of ailments.
Prior to the introduction of the initiative, patients had to come with letters from their insurers guaranteeing payment in the event that they had to be admitted.
The doctor who spoke with FMT said one insurance company has told its panel of hospitals to treat those with illnesses such as dengue fever, influenza, bronchitis, peptic ulcer and gastroenteritis just as outpatients where possible, rather than prescribe hospital admissions.
However, he said, some of these ailments, while common, require patients to be admitted for observation and further tests after the initial findings.
“With the pressure of the quotas, there is a likelihood that some doctors end up making the wrong call,” he said.
The doctor said hospitals are putting pressure on their doctors to meet the insurers’ quotas. Failure to toe the line could result in the hospital being removed from the insurer’s panel.
“Doctors have been told to keep this commercial interest in mind when handling patients,” he added.
Rather than officially written documents, these directives come in text messages and verbal reminders from the hospital management, adding pressure on doctors especially when they are in the middle of a decision-making process.
“This can impair professional judgement,” the doctor said.
“We understand outpatient care helps patients recover faster at home, avoids unnecessary hospital costs and maintains continuity in managing chronic conditions.
“We also agree the cost difference between inpatient and outpatient care is significant since they exclude hospital room and monitoring charges, which include doctors’ visits.
“However, it’s the unwritten quotas that insurers set for hospitals that is highly questionable,” he added.
FMT has reached out to an insurance company involved for comment.