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DocDesastro
DocDesastro
specialist
Posts : 138
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Join date : 2019-09-07
Location : Germany

Calculating revenues is a bit odd Empty Calculating revenues is a bit odd

Sun Sep 08, 2019 12:10 am
Getting the doctor's bills myself and knowing what is written on it, I can tell you that the current system of payment after successful diagnosis is somewhat wrong.
The current system does not take into account that hospitalization or advanced diagnosis methods are both expensive and will be charged.
It is true that treating the common cold does not earn much money and that things like body examination, interview and laryngoscopy fall into the category 'analyzing an organic system' and will be accounted en bulk by the insurance company and this will be not much.

I suggest a system, where some diagnosis methods will always be paid because it is mandatory for a proper examination. Interview and body examination fall into this. Also, costs for ambulance transfer to hospital fall into this category. Every diagnosis method leading to revealing a hidden symptom should be charged as well. A justified sonography for example could easily cost 100-200€ in reality. Blood analysis, X-Rays and microbiologic sampling cost as well and should generate revenues for their departments if justified. As far as I see ICU does not cost anything in the game...it would be a serious chunk of money to be charged in reality.
Again: if a method or treatment leads to reveal or suppressing a symptom it should generate money. Also, there are methods being reasonable to exclude certain diagnoses. Even if they do not lead to reveal a symptom, they could be charged because they were important to identify the disease. I remember the case of deciding whether a patient suffers from either Morbus Crohn or a bacterial infection of the intestines. A microbiological sample or stool analysis could exclude the latter so even if the patient has Morbus Crohn the lab can be charged on the bill as it was important to exclude other diseases.

So...basically, payment should depend on revealing symptoms, basic medical counseling and excluding certain factors as well on reasonable hospitalization costs.
Ordering a hospitalization and an X-Ray when the patient has only an Athlete's foot should generate no extra revenues as those examinations and measures are not medically reasonable. Doing a mycotic analysis however, is totally reasonable to identify the disease.

How to implement this into the game could prove tricky and I am no medic by profession. BUT: let me show you how it could be done:

Patient comes into hospital and has influenza - which we do not know yet.
The doctor does an interview which is always reasonable and we charge - let us say 10€ for it - this is reasonable and in reality the sum on my bills for this.
The patient reveals a clogged nose, tiredness and coughing. A clogged nose will justify to nasal cavity examination which could be charged as well when done. An MRI is not justified at this point and will not be chargeable even if ordered. Tiredness could reason a blood test to check for anemia or iron deficit. Even if it is not found, this is reasonable. Coughing might justify a thorax X-ray to exclude tuberculosis so basically spoken:
Each symptom revealed will justify the action done to find it and allow certain diagnoses to be charged. Based on that, the bill for the patient should be done. Also - at least in my country - some insurances will not pay for some examinations unless really necessary. So insurance company A would not pay for a sinus sonography for common cold while insurance company B would do this. Finding out how much money is charged might be another difficult task. I can tell you that kidney stones easily can cost 5000€ for 3 days of hospitalization and not a flat 800 or what the game does. And each department will write its own bill based on what they have done to cure you - even if the measurement - like an extracorporeal shock-wave lithotripsy that fails will still be charged even if surgery is needed nevertheless. It could have worked and can be justified.

Working on that system could lead to have more reasonable income for your hospital and not being dependent on grants for curing a certain number of patients. The number of patients sent to your hospital should also not be calculated on accepted insurance companies but on a random factor and prestige of your hospital. Number of content and cured patients should lead to an increased patient number - not the signing of insurance company A over B.

The current system leads to having Radiology, Labs and ICU destroy your income - mainly because your patient intake is capped by insurance companies and their tasks - this should never be the case as investments should pay off in some time. Imagine: They demand an ICU or full department including hospitalization - which in turn costs about 1500€ per shift easily and initialisation costs of what? 40k to 50k or more? And we do not even get more patients in return to cope with those costs nor charge for lab, X-Ray or ICU usage? Change this please.
Blue_Bug
Blue_Bug
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Calculating revenues is a bit odd Empty Re: Calculating revenues is a bit odd

Mon Sep 09, 2019 12:21 pm
I don't agree. In this game you have to create an efficient hospital. The current reward systems is perfect for that. The current system is clear and simple and its abuse proof. I wouldn't like it if the developers spend resources to change something that already works well. I rather see some (more) DLC's. Balancing income and expenditure is always a very time consuming task within building games. In my opinion that time can be spend better on other things.

Giving an amount for each examination that reveals a symptom will only lead to abuse of the earning system and less efficiency of the hospital. I don't see any problem that various departments don't have their own income. Without these departments you couldn't diagnose all your patients, Without the diagnoses you will have to send those patients away and you earn nothing . So these departments don't destroy your income, they help other departments to earn income.

DocDesastro
DocDesastro
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Calculating revenues is a bit odd Empty Re: Calculating revenues is a bit odd

Mon Sep 09, 2019 3:49 pm
Since you have to send patients away who you cannot treat you will have even less for for coping with your expenditures. You cannot even charge the work invested for the diagnosis just because you lack the correct room to treat the disease. What hospital in the world works like this? This will happen once you open up your first specialized department. You even need to waste your money on an unprofitable department capable of hospitalization to get emergency trucks to feed your almost useless trauma centers. Once you have made this transition past 50 patients successfully you might make money. If you do not, your hospital will fail. From status quo I never would like to have an emergency ward or ICU. Every ward eats up loads of money to keep it active. For what? That 5 out of 50 patients I get a day are slightly more profitable? And dish out services like X-rays and laboratory time for free? Things done to the patient are always charged. I cannot fathom why to create a more realistic hospital simulation than Two Point but then be so unrealistic in basic financial terms. In that case I could stick to a clinic and send away everyone needing more than basic services just because this is most profitable which basically kills the game for me. I am forced by the insurance company mechanism to expand my hospital to non-profitable departments to get more patients and am prodded by the reward system to build another unprofitable department to unlock further aspects of the game. I opened my 4th hospital since I got the game but once I come to the point of needing to expand to non-profit departments like ICU (which in reality is most expensive for the patient) I am stuck or go bankrupt as I have neither money for expansion nor can compensate for the extra staff those departments need or the bank loan interest. I would rather put all DLCs on hold and do the mechanisms right to evade spoiling the game upon reaching mid-game. Correcting balancing even after more features have been added seems a lot more tedious than correcting the status quo. The devs have been consulted on the topic of diseases by experts and it is great to see a game going into those details so why should they fail in balancing out expenditures/revenues just for the sake to 'keep it simple' or for sake of 'never change a working system'. It is refreshing to be able to treat real diseases in a real environment instead of curing patients thinking they are clowns in a room containing a tiny circus tent or have peoples ballon-heads popped with a needle and replaced by another inflatable head. I could have stuck to Theme Hospital if I wanted that. The game evolves and while the status quo might have been good for a game status where you only could do a clinic it definitively fails on a later stage once you need to open up wards or are not able to progress the game. Again: each department and any room should be able to make revenue with the exception of infrastructure like elevators, janitors (mandatory for health standards) or receptions (optional but might save lifes). Each treatment and examination is a service done to the patient. This is just a necessity business-wise. You have people working there and being paid. You have to put those cost on the patient. Everything else is part of a medical treatment process of an illness and usually will be charged. Expanding the hospital to offer more or new services should be profitable and not vice versa. Your investments should be returned in the long run and not get a flat arbitrary reward for building X or curing the n-th patient. As stated above: to make this abuse-proof you 'just' have to make the program recognize which symptom will justify an examination and for which ones plausible. A crumbly toe does not justify a thorax X-Ray. Bruises and respiratory problems however, will do. You won't get money for something not necessary to reveal the sickness or to exclude other sicknesses. And you won''t get flat money for the disease anymore - just for stuff you have done correctly to treat it and nothing for having done useless stuff.

You write "Giving an amount for each examination that reveals a symptom will only lead to abuse of the earning system and less efficiency of the hospital." Pray tell me, how? I do not see what you see. Can you be a bit more concrete, please?


Last edited by DocDesastro on Mon Sep 09, 2019 6:40 pm; edited 1 time in total (Reason for editing : clarification)
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MedJet
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Calculating revenues is a bit odd Empty Re: Calculating revenues is a bit odd

Mon Sep 09, 2019 8:52 pm
Hmm, I seem to make enough dough consistently with the payment system as it is. Course it might be more realistic to bill per exam/procedure I see where for the developers it would be very tedious and as it is the doctors in game aren't very adept and honing in on the ideal STAT lab test to perform for a respective disorder.
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Calculating revenues is a bit odd Empty Re: Calculating revenues is a bit odd

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