Fees & Insurance

It would be nice to see the fees/payments adjusted to be for individual procedures rather than a flat rate.

ie. Instead of $150 for "tennis elbow" it would be more accurate to charge for the basic doctor clinic visit (50-75), plus any x-rays or imagining done (50 - 350), plus any treatments or medication administered.

A flat rate for a hospital stay really doesn't make any sense, when this could be anywhere from a few 100 to a few 1000 per day.

The more efficient you are could determine how many insurance companies will send business your way, could affect government funding, patient satisfaction and the number of patients that will come to you seeking treatment.

This could also allow the game to better incorporate the concepts or private vs publicly funded hospitals/healthcare, or a combination of the two.

A menu to see what the "going rate" or recommend fee schedule is for a procedure and the ability for you to adjust your fees.

This could also create the option to have some services outsourced early on (Diagnostic imaging or lab services) rather than building your own x-ray or lab services. ie. Order the test, the patient leaves and comes back the next day (or a few days later) when the results are in.

It would be nice to see equipment degrade over time or even different levels of equipment. (A 4 slice vs 16 slice CAT scan). One is more expensive to buy but much faster.
And the option to buy new or used equipment.

I strongly agree. When visiting a hospital you pay for services done to you or have an insurance covering this and those list up any analysis, diagnosis, beds occupied etc. - the more things the doctors do, the more you pay. Well, unless the insurance dictates that some things are redundant like after having a clear diagnosis running some more tests to milk the cash cow a bit more or totally unreasonable like doing an X-Ray with diagnosis: flu. The greatest issue: Why on earth do the insurances send you patients? If I am ill I go for a doctor and not my insurance broker and ask for allowance. The insurances might pay differently for certain services or offer special treatment for your patients like having your own room in the ward and just pay for the things the docs prescribe - and check it for flaws in the invoice or fraudulent behavior like charging the same thing twice or more often. Or check with their own experts, whether the doc has done the right things and not billed extra stuff not needed. But they do not send you a certain quantity of patients.

The departments should pay for themselves, that means the more blood you analyze in a lab, the more revenue of the lab you will have and can determine whether this is economical or not. If all departments will bill their own stuff done to the patient you might get a better feeling for how economical a certain department is like I have 5 beds and 2 nurses in the ward but do my cases cover the upkeep? I have a specialist doctor but does his work cover his costs? I have an X-Ray department but do I get enough cases to cover the costs? Also, doing a full CT should net way more money than for example a hand X-ray. Currently, we only get cash for curing a disease, no matter how many departments and doctors work on it and with what equipment and how long - only an arbitrary value per case and modified by insurance. This is wrong.

Also, when having a lab - why not accept samples from GPs not located in your hospital lacking such equipment as a service? You might receive a biohazard delivery once a day and have your lab crew occupied while your docs might not need them. In this case, I find it rather strange, that the patient has to go to the lab. Usually, the GP collets the sample and sends it to the lab and also gets back the results from which he has to to the diagnosis.
Same services for patients asking for a X-Ray diagnosis for their own GP or chiropractitioner. I mean, there are doctors that offer those services without a hospital around. It is quite common that patients have their own GP somewhere in town in his own office and for special cases he sends you to a specialist who is not necesarily located in a hospital.

I remember in the Bullfrog game there was a rating system on how good you were at curing patients of a certain disease and to a certain degree the costs were part of it - so if you can effectively cure certain diseases with fewer or more efficient diagnostics done the more patients of a certain kind you get.

**yawn** DrDesastro, still complaining about the billing system in the game. Is your hospital perpetually broke or something? Otherwise, hey, I've had to come to grips with the reality that this is a game and certain true-to-life hospital dynamics simply won't make it in due to various reasons.

But we have true-to-life injuries and illnesses as well as quite realistic working docs and behavior with authentic equipment, and yet we are not to place a price tag on an action done as it is usually done. But hey - it is a game! Great, because 'reasons'.

You seem to miss the point that we miss a big chance here in putting transparency into the game on why patients come to our hospital and how much they pay and whether our departments are working economically.
The flat sum that is administered to a cured person should rather be the median to be kept in back and be compared with what we charge for it depending on the things our doctors do. If we are better than the median because we have good docs that can diagnose with less procedures or have more efficient equipment then we might get more patients for that case in the future. If we are above it because our docs are fishing in the murky waters and pile up things on the bill not needed, less patients will come as we are more expensive than others. This might be offset by people liking our hospital for nice interior, quick help instead of long waiting times or good cures or even by their insurance company. If e.g. you have none, you might want the treatment to be as cheap as possible as you ruin yourself by going to the hospital and do not care about time. If you have a premium insurance because you are rich enough to afford one, you might want to skip waiting, have the most experienced/senior treat you, might want a single ward-room for you and do not care whether the treatment costs more than the median.
By adjusting prices to processes done we can influence patient groups coming to our hospital or 'repel' them.

Also, I suggested that we can use our departments as services for docs in the outside world to generate extra revenue as well as the OP suggested that we might 'outsource' procedures we cannot do currently. Nothing on that either?

In that case we might have the need to get paid because while we did not cure the patient, we sent him to the correct doc after examination to get his cure and this is a service worth payment as well, so if even only a fraction of the sum. And this is another point why pay-per-procedure is the correct way. Sending away patients is always bad currently. You make him angry, you lost the time the doc worked on him and get nothing.
It isn't a bad thing. No patient will blame the doctor if he tells you that here they do not have the correct equipment to treat you but sends you to the correct place. And no one would object him writing a bill for his services as still he did some examinations and lent medical counsel. It is bad when you turn quack and keep the patients in the hospital although you exactly know you cannot help them. The game should recognize that mechanism-wise.

In terms of insurances, I guess we are in no position to influence the kind of insurance our patients has. But I could see at least 3 kinds of patients:
- no insurance: will wait long, does not care for interior or stuffed wards. Just wants to get cured for the least amount of money
- basic insurance: will accept reasonable but not long waiting time, likes a tidy place and friendly docs, will accept normal fees but complains about higher fees than that
- premium insurance: will not accept waiting times but short ones, demands privacy and friendly docs, wants hospital to look good, cares less for money. V.I.P. attitude

Imagine a county with a hospital system where the insurance companies are in control (mostly). No matter how many tests are run the only thing that matters to the insurance company is the disease. This is also a game design where you can't just cheat the system by ordering every single test just to get more money from a patient.

Interesting read from numerous people: https://ask.metafilter.com/312806/Do-doctors-really-order-unnecessary-tests-to-make-more-money

DocDesastro wrote:But we have true-to-life injuries and illnesses as well as quite realistic working docs and behavior with authentic equipment, and yet we are not to place a price tag on an action done as it is usually done. But hey - it is a game! Great, because 'reasons'.

You seem to miss the point that we miss a big chance here in putting transparency into the game on why patients come to our hospital and how much they pay and whether our departments are working economically.
The flat sum that is administered to a cured person should rather be the median to be kept in back and be compared with what we charge for it depending on the things our doctors do. If we are better than the median because we have good docs that can diagnose with less procedures or have more efficient equipment then we might get more patients for that case in the future. If we are above it because our docs are fishing in the murky waters and pile up things on the bill not needed, less patients will come as we are more expensive than others. This might be offset by people liking our hospital for nice interior, quick help instead of long waiting times or good cures or even by their insurance company. If e.g. you have none, you might want the treatment to be as cheap as possible as you ruin yourself by going to the hospital and do not care about time. If you have a premium insurance because you are rich enough to afford one, you might want to skip waiting, have the most experienced/senior treat you, might want a single ward-room for you and do not care whether the treatment costs more than the median.
By adjusting prices to processes done we can influence patient groups coming to our hospital or 'repel' them.

Also, I suggested that we can use our departments as services for docs in the outside world to generate extra revenue as well as the OP suggested that we might 'outsource' procedures we cannot do currently. Nothing on that either?

In that case we might have the need to get paid because while we did not cure the patient, we sent him to the correct doc after examination to get his cure and this is a service worth payment as well, so if even only a fraction of the sum. And this is another point why pay-per-procedure is the correct way. Sending away patients is always bad currently. You make him angry, you lost the time the doc worked on him and get nothing.
It isn't a bad thing. No patient will blame the doctor if he tells you that here they do not have the correct equipment to treat you but sends you to the correct place. And no one would object him writing a bill for his services as still he did some examinations and lent medical counsel. It is bad when you turn quack and keep the patients in the hospital although you exactly know you cannot help them. The game should recognize that mechanism-wise.

In terms of insurances, I guess we are in no position to influence the kind of insurance our patients has. But I could see at least 3 kinds of patients:
- no insurance: will wait long, does not care for interior or stuffed wards. Just wants to get cured for the least amount of money
- basic insurance: will accept reasonable but not long waiting time, likes a tidy place and friendly docs, will accept normal fees but complains about higher fees than that
- premium insurance: will not accept waiting times but short ones, demands privacy and friendly docs, wants hospital to look good, cares less for money. V.I.P. attitude

No, I get your point. I worked in a hospital, understand how it works. Sure it would be nice to have a procedure-based fee system (which would also include other misc fees as well tacked onto the final bill) this is a coding/engine constraint though. At this point seeing them fix the majority of the bugs so that DLC s can progress and the game can function well. are vastly more important and likely.

MikeTheNose wrote:Imagine a county with a hospital system where the insurance companies are in control (mostly).  No matter how many tests are run the only thing that matters to the insurance company is the disease.  This is also a game design where you can't just cheat the system by ordering every single test just to get more money from a patient.

Interesting read from numerous people:  https://ask.metafilter.com/312806/Do-doctors-really-order-unnecessary-tests-to-make-more-money

Not to argue with you. We just should keep in mind that the more stuff is added, the less easy it will be to change a mechanic. The main reason I am writing this is that I would like to see a way to get paid for services already done even if we send away the patient because we lack e.g. an operating theater to cure the disease, do not have a histology to decide between 2 diagnoses or we are out of ICU beds. We have done work on the patient before and even if we do not get the full payment, we should get a fraction of it. And the most easy way would indeed be - like getting XP after doing something, a small payment for each thing done after it is done. The patient would sum up everything and then the number is compared internally with the median for the case and this will affect patient ratings. The mechanism is already there as the docs gain XP after each treatment and after each payment in the Pharmacy. The part that consumes coding time would be the one writing the prices for the procedures and implement the code line that pays after treatment and create a new one that compares the money paid for treatment with the median database value.

But as told, primary, we should earn money for partial treatment like stabilizing at TC but no free beds, so the patient is transferred after that. As it stands, sending away the patient is always negative as it hits both reputation and wallet. You still saved a life or at least helped to cure a patient and get penalized!
As I told you - it isn't a bad thing and you will agree, if you ever worked at a hospital. If you cannot help them, then do what you can and quickly send them to one who can.

As a bonus, we get a better feeling of where the revenue is generated and what departments help to keep us afloat and which ones have to be subsidized by the others and to which extent. This affects the way of planning a hospital.

DocDesastro wrote:Not to argue with you. We just should keep in mind that the more stuff is added, the less easy it will be to change a mechanic. The main reason I am writing this is that I would like to see a way to get paid for services already done even if we send away the patient because we lack e.g. an operating theater to cure the disease, do not have a histology to decide between 2 diagnoses or we are out of ICU beds. We have done work on the patient before and even if we do not get the full payment, we should get a fraction of it. And the most easy way would indeed be - like getting XP after doing something, a small payment for each thing done after it is done. The patient would sum up everything and then the number is compared internally with the median for the case and this will affect patient ratings. The mechanism is already there as the docs gain XP after each treatment and after each payment in the Pharmacy. The part that consumes coding time would be the one writing the prices for the procedures and implement the code line that pays after treatment and create a new one that compares the money paid for treatment with the median database value.

But as told, primary, we should earn money for partial treatment like stabilizing at TC but no free beds, so the patient is transferred after that. As it stands, sending away the patient is always negative as it hits both reputation and wallet. You still saved a life or at least helped to cure a patient and get penalized!
As I told you - it isn't a bad thing and you will agree, if you ever worked at a hospital. If you cannot help them, then do what you can and quickly send them to one who can.

As a bonus, we get a better feeling of where the revenue is generated and what departments help to keep us afloat and which ones have to be subsidized by the others and to which extent. This affects the way of planning a hospital.

I don't know that anyone is stopping you from making a mod (at least for your own game) that takes a stab at implementing fee-for-services. Heck, I've been exploring some minor self-modding as well. My guess is very quickly, you'd realize that 1. It indeed might not be possible 2. It is and takes a heck of a lot of work 3. It takes a heck of a lot of work and you don't have the expertise to do it. I respect the reality of preferring facets of this game be different. My desire to see more expenses added with the last DLC was rejected by a developer directly.

DocDesastro wrote:In terms of insurances, I guess we are in no position to influence the kind of insurance our patients has. But I could see at least 3 kinds of patients:
- no insurance: will wait long, does not care for interior or stuffed wards. Just wants to get cured for the least amount of money
- basic insurance: will accept reasonable but not long waiting time, likes a tidy place and friendly docs, will accept normal fees but complains about higher fees than that
- premium insurance: will not accept waiting times but short ones, demands privacy and friendly docs, wants hospital to look good, cares less for money. V.I.P. attitude

That makes all sense. That's why employees can't take a dump in a patient's room. Maybe unless it's a no insurance