Category: Cost Containment Services in Egypt Published on Wednesday, 20 April 2011 14:01
As Our Mission is to keep the cost level always to a minimum without affecting the quality of the services provided, it goes without saying that we are highly motivated to achieve the best possible result in this segment. Following example indicates how we approach this issue and also shows clearly that if we are involved in handling the case from the beginning of the process we have the necessary local knowledge & expertise in this field to achieve a maximum result on your behalf. Case study: We ran a comparative study between the actual cost of cases and the fair cost revised on both financial and clinical audit that are the bases of EIA cost containment protocols that we implement to assure both medical quality and cost control as well. We calculated a percentage of fair cost/actual cost.
This percentage reflects the calculated possible saved amount of money for the insurance company dealing with these files.
In our market study done we found that the main causes of the sharp increase of the medical expenses to be paid by the insurers is due to:
• Involvement of non-medical personnel e.g. tour leaders, hotel staff etc due to commission paid by medical personnel. • Some medical centers and clinics tend to treat their patient in public hospitals, pay in cash and issue their invoices as if they are a private hospitals (without license).
• False classification of surgeries.
• Over investigations and over hospitalization.
We classified the cases according the EXACT time request for assistance, into the following stages: o Stage 1: Prophylaxis. o Stage 2: Call for medical help. o Stage 3: Transfer to hospital. o Stage 4: Hospital Assessment. o Stage 5: Hospital Investigations. o Stage 6: Hospital Admission. o Stage 7: Over-Hospitalization. o Stage 8: Hospital-revised Decisions. o Stage 9: Bill Negotiation. o Stage 10: Provider Rating and assessment.
Last Updated on Wednesday, 20 April 2011 14:01