Reimbursement of medical bills is a facility given by the government to its employees. However, over the past few months, I started noticing that people are misusing this facility. People are claiming hundreds of thousands of Rupees every month for the medical bills. Most of these bills contain branded medicines, multivitamins, and costly placebo medicines. To claim these medical bills, a signature of a consultant is required. Most of these costly branded medicines are prescribed by the senior doctors including all the placebos. Attendants of these patients visit the OPDs every month or three-monthly just to rewrite the same prescription.

Don't need to see my patient, Just rewrite my prescription.

To repeat the prescription, the junior doctors are asked to fill in all the medicines written by the consultant without even seeing the patient.

These medical reimbursement bills directly affect our economy as there is no limit to the amount a person receives from the government each month (multiplied by 12 – each year).

Before discussing how to reduce these medical expenses, below are a few examples of medical bills I came across which stunned me and compelled me to write and share this article with you.

Example of a medical bill for reimbursement 

This patient came to sign his medical bills for reimbursement purpose. His prescription indicated that he is a diabetic and hypertensive patient and he has been getting these medicines for so many years.

This is a list of his medications:

This is a relatively benign prescription. The bills I saw and refused to sign were a little heavier than this. Probably I missed mentioning some of the medicines in it.

Now another benign looking prescription

These two prescriptions are the so-called benign prescriptions. Most of the medical bills are double or triple the amount I just mentioned. The prescription above came to my OPD today so I remembered them. I will write about other prescriptions as I see them.

Now, how to reduce the bills and the cost of the bills?

Let's rewrite the first prescription. I will write the same medicines but less costly brands.

This is the same prescription as in the first example. This prescription also contains good quality medicines but you can see the difference in the price.

Just replacing the generics resulted in 63.85% reduction in the medical bill.

Now let's rewrite the second prescription

You can see in the above example as well, how writing a simple prescription resulted in reducing the cost of the bill by almost 60%.

These bills can be further minimized to half without even affecting the quality of the prescription if all the multivitamins are subtracted and the proton pump inhibitors are changed to H2 blockers.

How these thieves steal our money?

Medical reimbursement bills directly affect our economy. There is no limit to the amount a person receives from the government.

While writing this article, one of my patients who is running a pharmacy, told me that people buy medicines from one shop and ask them to make the bill for reimbursements. These people then go to another pharmacy and sell all those medicines. Thus, they take the money from the government via the reimbursement process and simultaneously, they sell those medicines and get their cash back as well.

Another person who is a medical distributor told me that medicines worth millions of Rupees from the government hospitals are sold on a daily basis in the market.

Role of the doctors in reducing the cost of Medical Bills ...

These are just a few simple examples from the medical department I shared with you just for the sake of awareness. I am sure that other departments have similar issues and their medical bills are probably much more than this.

Everybody has to play his role to build Pakistan.

My advice for the doctors is:

• • To write only the necessary and required medicines.
  • Do not fill your prescriptions with multivitamins.
  • Do not prescribe costly branded medicines.
  • Always review the prescription before rewriting it and reduce the medicines as the patient gets better.
  • Cross check the bills before signing them.

The government should also limit the total amount per person per year. Patients who are hospitalized and treatment bills of only chronic diseases should be approved.

What is your opinion? 

Write your opinion in the comments or mail me @ emedz.net@gmail.com if you want me to post it below the main article.

Together, we build Pakistan - by starting with ourselves rather than blaming the governments and the institutions.

Thought-provoking comments by Dr. Aneza Jalil (Assistant Professor of Medicine, Pakistan Institute of Medical Sciences Islamabad):

" Very nicely written. Agony is when we do this with Zakat fund. In Zakat forms we can prescribe simple ones and which are not available from hospital formulary. While doing an audit I came to know that people are providing it from hospital formulary and showing it in Bill’s of Zakat. Secondly, optimized use of zakat fund ll let it be used more economically and the number of dialysis patients and other costly treatments can be manageable. Another item which bothers me is glucose strips in prescription as if we are giving a grocery list to patients. We should be writing glycemic record and the patient can claim strips in Bill’s."