Cost containment in Egypt
Global Excel shares a case study of acute gastroenteritis in Egypt, and how they helped reduce excess costs charged by the healthcare provider
A 56-year-old woman with no known premedical history was admitted to a private Egyptian hospital with acute gastroenteritis (diarrhoea) as well as trauma to the left side of her body.
Once we were notified of this claim, we sent the GOP to the provider for Customary & Reasonable charges, with the client made aware of all final costs. Full medical notes were not included with the invoice.
Our client knew this bill had been over-charged, they expected us to pay a reasonable amount for the treatment of their patient, anticipated no follow up from the provider for further funds, and wished for
no patient involvement after payment had been made.
In Egypt, charges in private clinics are not regulated by the government, most patients stay in large, all-inclusive holiday resorts with an outpatient clinic on site, and receptionists will often guide patients to local healthcare facilities when requested. Rules about day care versus inpatient treatment at medical centres can be unclear.
We successfully reduced our client’s initial bill by 55%, basing our arguments on verifiable facts, and demonstrating our knowledge of their local laws and practices.
Clinical summary
The provider stated that the patient’s condition started the day before admission, when she had abdominal pain followed by frequent diarrhoea and persistent vomiting, leading to generalised weakness and loss of appetite. She experienced disequilibrium, which caused her to fall to the ground, resulting in trauma to her left side, and pain at her left hip and left lower limb. The next day, she was referred to a local hospital, with a request for medical assistance due to the severity of her case.
Patient examination by the provider
The healthcare provider noted several conditions during the general examination:
• The patient was conscious, alert, and oriented, but dizzy and weak
• She showed signs of pallor, a dry mouth, tongue and lips, and dehydrated skin
• She had tachycardia and elevated
blood pressure
• There was trauma to the left side of her body
• No signs of respiratory distress were present, and her lungs sounded clear
• She displayed diffuse distension in her abdomen, with hyper audible bowel
sounds and experienced epigastric, hypogastric tenderness.
The orthopaedic examination found post-traumatic tenderness over the left hip and left lower limb.
The provider administered treatment and discharged the patient within the average length of stay of two days.
Financial summary
To persuade the treating facility to reduce the excess costs of the bill, in line with the patient’s condition, we showed the provider that our deductions were valid by offering proof of the following:
• Over-charging
• Over-treating
• Discrepancies
• Knowledge of local laws regarding treatment protocols, VAT, service and medical charges.
We acquired these proofs by employing a variety of tools, such as:
• Agreements, including prices and discounts
• Medical reviews
• The patient’s account of the treatment and the severity of her condition
• Knowledge about the medical
centre, including demographics and licensed services
• Payments made by the patient.
To cost-contain this bill, we highlighted the following points:
• The patient was admitted at 10:30am
and was discharged at 14:30pm the following day
• The hospital charged for two full days, but the medical report did not justify the total length of stay
• Charges were not in line with our agreed price list, or were added with no
reasonable cause
• Charges were added that did not correspond to a service, or should have been included in other charges.
The provider agreed to make deductions on the additional service charges and to adjust the charges not in line with our agreed price list. The final allowed amount was 55% below the initial charges (see table above).
Conclusion
By showing the provider that our review
was backed up with factual knowledge,
and that the deductions had grounds
for being removed, they respected our decision. They did not follow up for funds, and the patient was not pursued for any balance billing.
May 2025
Issue
In this issue of ITIJ we consider cultural considerations and understanding in the Middle East and Africa; look at IPMI in the MEA region and the customisation of policies; and gain insights from woman in leadership positions who share the obstacles and opportunities they have encountered.
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