Surge Pricing on Weekends in Hospitals

Is a hospital asking for more charges for procedures on weekends, any different than surge pricing?

How different is holiday pricing of hospitals from surge pricing of cab aggregators like Ola/Uber? Today many companies charge a premium for weekend services when there is more demand. However, is it fair for the healthcare sector and emergency services?

According to the CEO of a prominent tertiary care hospital in Mumbai, many managements don't have much choice in this matter, because doctors are not willing to work on weekends.

Many senior executives didn't want to be identified when HE contacted them because of the sensitivity of the matter. "Sometimes it's due to higher footfall and other times it's because there aren't as many staff available. It differs across set-up," says one doctor from Bangalore.

So, if surge pricing kicks into action when the demand is higher than the availability of human healthcare resources, does the increased procedure cost ensure that there are more doctors on the supply on weekends at hospitals. Well, there is no clear answer to that.

Explaining Surge pricing in healthcare

"For procedures done by on-call physicians for weekends— this is like overtime in a normal company," says a global operations head of a healthcare company.

"Physicians don't get a day off for working the weekend - so to compensate them - hospitals will charge higher. Now I'm using the word physician, but that is true for most non-essential non-routine clinical staff. So if you go to the ER and have suturing done - it would be the same price. However, if you get a plastic surgeon to do the same, the cost would be higher than on an average day. Hospitals that do this versus not would be 60-40 or at least are in that divide by my experience," he explains.

Limited Resources takes a toll on Doctors

There is another concern too, connected with this holiday pricing. Patient Safety. Most of the doctors in India are overworked, unlike countries like the UK, where they have to work only fixed number of hours. "An average Indian doctor works for several hours more than other professionals. If doctors are made to work like this in the UK, hospitals will have to pay fine. Further, Indian hospitals don't have emergency shift system, where if the doctor works on weekends, then they don't have to work on Saturday and Monday. If they work on weekends too, errors can creep in," says Dr. Bhooshan Shukla, a physician entrepreneur.

There is a more esoteric concern too if a patient falls sick on the weekend, what will he do? "Because, unlike other services, healthcare is not something where you have a choice to go to a provider when you want. It is more of urgent assistance," adds Shukla.

Shukla also adds that the bigger worry for a provider is the demands of the Indian patients. "They often paint a different picture after surgeries. That's the reason why today, for complicated procedures like an organ transplant, hospitals take video consent. Many are not even aware that in India when you get a discount on your hospital bill for any reason, it comes out of the doctors' charges. Doctors charges are 10-13% of your total bill in a corporate hospital. If you negotiate a 20% concession, your treating doctor gets Rs 0 as fees," explains Bhooshan.

The Challenges of Transparency in Pricing

One of the biggest questions facing Indian has been the issue of transparency of pricing. In a highly diverse, yet unequal society with a multitude of regional variations, ensuring a uniform code for pricing has proven to be an insurmountable challenge.

Sujay Santra, Founder and CEO of Ikure Techsoft, points out that a plausible reason for high pricing could be that "there are many minor operations or procedures for which most of the patients choose weekend interventions so that their office attendance does not suffer, and they can recover over the weekend as also their family can give them company on similar grounds to make good use of the weekend off. Since there are many such requests to hospitals, they take good advantage of this demand and supply issue." He adds that all hospitals though don't take advantage in this manner. "It is similar to non-availability of seats on weekend journeys/movie shows and different rates of buffet meals on weekends and weekdays," he says.

Too many details to share?

One of the popular arguments about sharing data about healthcare pricing is that it is data-intense. If there are complications, the bill amount can go from 5000 to a couple of lakhs. So, the document could go up to even 300 pages. "If hospitals transparently charge more for services provided overnight or over the weekends, that would be fine, but it should be clearly stated.

 Also, patients should be provided with a full itemised bill to enhance trust and transparency," says Kamal Mahawar, author of The Ethical Doctor.

Joy Chakraborty, COO of Hinduja Hospital, seconds his views. "At Hinduja, we are transparent about our pricing policies. At the reception of the hospital, itself, a patient can easily access the pricing details of all procedures," he says.

Patient Woes

"My 90-year-old grandfather was experiencing increasing loss of functions on the right side of his body for the last five months. Our Jaipur family physician advised an MRI which revealed that his brain tumour had regrown. We opted to show the reports to his neurosurgeon in Mumbai who had successfully operated on him seven years ago. So we got him to Mumbai in February, last year for his appointment. Surgery was advised, provided he got clearance from the hospital cardiologist. After two weeks of tests, on 27th February last year, he was cleared for the high-risk surgery," says *Varsha, a Mumbai resident.

"The neurosurgeon and the hospital OT could only accommodate my grandfather's surgery on 1st March or 2nd March, which meant my grandfather would either have to be admitted on the very next day as admission two days before the surgery date is the norm. Also, the next available date was after a month. We intimated the doctor of the decision through his PA in an email. This is the reply we received: Please note you can get admitted today, but surgery will be done tomorrow, i.e. 1st March 2018. 2nd March is a holiday, and if you want to get the surgery done on 2nd March, then charges will increase by 50% more. If you are OK for tom surgery then only get admitted today otherwise don't get admitted today.

"I was shocked by this policy of Sunday charges in hospitals. Luckily for us, this was not an emergency. However, what if it was? We would never be able to afford it. Moreover, it is grossly unfair. I do understand that even doctors need a holiday, but this is blackmail," the Mumbaikar concludes.

The takeaway: there is no shortcut to fix Indian healthcare's pricing woes.

Vedanthdesikan Ranganathan, a former consultant of the Public Health Foundation of India, argues that the world over including the US, there is no transparency in pricing. "Possibly, the service providers themselves are unsure of the value they offer in return. Also, one should understand that healthcare services are priced based on what the competitor charges. Thanks to Arvind Eyecare, many people might know, a cataract procedure does not have to be expensive. Therefore certain private clinics/hospitals might have problem overcharging in the areas where Arvind operates. Similarly, Narayana Hrudyalaya might have brought pricing transparency to heart surgery," he concludes.