Guest Blogger: Thomas Steffen, M.D., PhD, MBA
The outpatient service at the Neurosurgery Department of the Tribhuvan University Teaching Hospital is the most efficient one I have ever seen – and on top it is the cheapest one too I have ever seen!
The weekdays for the outpatient walk-ins (Sunday, Tuesday, Friday) are posted. All patients, first time visits as well as follow-up visits, upon arrival, report to the coordinating nurse and are then added to the list, to be seen in order they arrived by the resident or the staff neurosurgeon in a single room. No patients are refused, all are seen and if required examined the same day. No reservations, no waiting lists – that simple!
All outpatients between visits hold on personally to their handwritten patient’s file, as well as to any radiographic films, laboratory results, special examination reports, etc. Doctor’s visits are always serious family matter, with the patient being accompanied by at least one member of his close family (husband, mother, brother). Radiographs are neatly sorted, the patient promptly hands over to the surgeon the most recent reports. At the end of the consultation the surgeon updates the patient’s file by hand. Prescriptions or any other paper-based forms requesting special exams are equally prepared and signed in front of the patient.
All consultations are paid in cash the same day; the patient’s file is being stamped confirming that full payment was indeed received. A first time consultation costs 50 Nepalese Rupee (NPR) or approx half dollar US, a follow-up consultation is even cheaper at 25 NPR. If the patient wants to be seen exclusively by the chief surgeon of the department (i.e., “private patient”), the consultation costs 250 NPR regardless if it is a first visit or follow-up visit. Of these 250 NPR the chief surgeon receives 100 NPR, the hospital the balance. This is a one US dollar fee paid to the chief surgeon for an utmost competent and effective consultation. For the same amount buying you in a “One Dollar Shop” paper pads, plastic spoons, colorful ribbons or other typically useless junk, in Nepal one dollar buys you a possibly life saving professional advise from a passionate and utmost knowledgeable, skilled surgeon with a 30 years professional experience.
To put this all in perspective: In most of North America or Europe waiting times to schedule an appointment in an outpatient clinic can be weeks or even months. Typically appointments need be confirmed, as the date gets closer. Sometimes patients still don’t show up.
The North American or European hospital must archive all medical information. Despite, patient records still once so often do get “lost.” Billing services rendered is a tedious, costly and possibly lengthy administrative procedure – now and then bills are not even honored.