Fortis chief calls for Mediclaim overhaul

Health insurance products need to be realigned to the changing market situation, feels Shivinder Singh, managing director of Fortis Healthcare.

“Our insurance products belong to 1980s and 1990s when the insurance products were much more regimented. Therefore, they were protected in that regime. Now, it is an open market regime and the products need to get realigned to the market. There needs to be system where the patient or the hospital does not misuse the system. This needs a proper network including the quality providers,” he said.

The call for an overhaul of the system gains significance as the Insurance Regulatory and Development Authority tries to iron out differences between insurers and healthcare providers on the issue of cash-less treatment.

“We don’t have any framework for creation of a network to ensure that all the stakeholders in the cash-less process are on the same page. The consumer is looking at the best possible treatment, since he knows that billing is not his problem. The insurance companies are concerned about the claim ratio and that is their only concern. The hospital is not really concerned about the payment and they look only at providing the treatment,” Shivinder Singh, managing director of Fortis Healthcare, said.

Singh conceded that there were cases of high levels of billing, but said the billing issues were genuine since the hospitals were looking at providing the best possible treatment.

“Unfortunately, today, the bills are higher by larger players. They are seen as the people misusing the system. There is no malpractice happening and no misuse of billing. But, there is no doubt that these players are offering quality care and it is expensive. We have to look at it more comprehensively. Unless all the stakeholders get onto a platform and support each other, there is no solution to these grouses,” he said.

In fact, going by Singh, cash-less treatment sometimes prevents hospitals from providing better use of the facilities.

“We have patients from the CGHS coming in. they are entitled to stay in the hospitals for 12 days. But in our hospitals, the patient turnaround is 8-9 days. If I treat the patient within that time and discharge him on the ninth day, you will see what happens there. Though they don’t need it, they want the treatment for the full entitlement. Though we explain them that there are chances of infections if you stay in a hospital without need, the patient wants to make use of his entitlement. It is eventually the doctor who decides when to discharge, but the patients under these schemes do not listen to this. There has to be a system to manage this,” he said.

Singh also has an issue with the behaviour of patients in some cases. “If you check into a hotel where you would pay the bill and if there is a mini bar in the room with a price list on it, you would think twice before using the mini bar. But if the mini bar is for free, you would definitely use it even if the need is not great. Somebody is paying for that.

“Similarly, in the case of a cash-less patient, even for a smaller problem he wants to do a CT scan and find out the exact reason. It is not wrong, but if he is paying the bill there are less chances of him insisting on it. As long as there is no liability of payment, the patient would like to leverage the advantage whether it is a better room or better treatment,” he explained.

After exiting the Parkway deal, Fortis is now working on a strategy to take its growth plans forward. While Parkway was seen as a vehicle for taking Fortis to the international market, the company is now planning a different vehicle for tapping the global healthcare market.

“Even after the Parkway experience, our vision has not changed. The vehicle will now change. Parkway was a very good vehicle for achieving that objective of growing in the Asian market. In the current context, we have to find another vehicle for doing that,” he said.

Fortis is planning to make use of a mix of Greenfield, inorganic growth and management contracts for growing in the domestic and the international markets.

“Asia is a big enough market for us to explore. Going international is definitely the way forward. We don’t have any timeframe for doing this. We are not going to do this under pressure or because people expect us to do that. We will wait for the right opportunity,” Singh said.

Fortis has 10 Greenfield projects at various stages of development. About four of them are expected to become available during the current year and in the next two to three years all the ten projects would become operational. It would then have a total capacity of 8,000 beds.

In fact, Fortis is mulling an option of seeking a listing in Singapore. While this would provide a vehicle for the company’s growth in the international market, it would also help the company raise the funds for strengthening its growth plans.