Hospital question
1. If a hospital has fewer surgeries, is it still necessary to purchase surgical accident insurance?
Although some hospitals perform fewer surgeries, each surgical procedure carries inherent risks, whether it is a low-frequency or high-frequency surgery. Patient safety during surgery is always the hospital's primary responsibility. Even low-risk surgeries still have the potential for accidents, and when such events occur, they can easily lead to disputes between doctors and patients. By promoting surgical accident insurance, it helps spread risks, avoid disputes, and enhances patient trust and satisfaction. For hospitals with lower surgical volumes, it is recommended to start with high-risk departments or specific surgeries, and gradually expand the coverage. Over the long term, surgical accident insurance contributes to improving the overall quality of hospital services and enhances its overall competitiveness.
2. How can we ensure the long-term and stable operation of the surgical accident insurance program?
To ensure the long-term stability of the surgical accident insurance program, hospitals should regularly evaluate the program’s performance, focusing on key metrics such as enrollment rates, claims data, and patient feedback. By continuously monitoring and assessing the program, hospitals can adjust coverage options and service content based on actual needs. In addition, raising awareness of risk among medical staff and patients and ensuring the widespread dissemination of insurance knowledge will help maintain the sustainability and stability of the program. Hospitals should maintain regular communication with insurance providers to address any issues that arise during implementation and make adjustments based on emerging risk trends.
3. If compensation has already been paid, can the patient still claim compensation from the hospital?
Surgical accident insurance compensates for incidents based on accidental circumstances without medical malpractice. However, this does not prevent the patient from pursuing legal action against the hospital if necessary. The compensation helps alleviate the patient’s emotions and reduces the risk of unreasonable claims. If a patient has already received compensation through insurance and the family has signed a Medical Accident Compensation Confirmation form, which confirms that this was not a medical accident, further claims against the hospital can be regarded as fraudulent. The hospital can use this document as strong evidence, which will significantly reduce the chances of future disputes.
4. If the hospital’s surgical volume is small, can we choose to insure only specific departments or surgeries?
Even if a hospital performs fewer surgeries, this does not mean selective coverage is acceptable. To effectively manage medical risks and reduce doctor-patient disputes, hospitals should ensure that high-risk departments and surgeries are covered 100% by insurance, rather than opting for selective coverage. Especially in departments such as surgery, cardiothoracic surgery, and neurosurgery, all patients should be given adequate protection. Full coverage helps standardize hospital management and avoid the concentration of risks due to selective selection, thus reducing the hospital's overall risk.
5. How can we ensure that patients fully understand the insurance coverage and avoid confusion?
To ensure that patients understand the insurance coverage, hospitals should establish a comprehensive patient education system, including pre-surgery instructional videos, written materials, and digital tools, to help patients and their families understand the details of the coverage. Patients must sign an informed consent form before the surgery, ensuring they make an informed decision. By combining risk education with patient communication, hospitals can ensure that patients have a clear understanding of the coverage, claims process, and insurance terms, reducing the chances of disputes caused by information asymmetry.
6. How can hospitals efficiently manage the claims process for surgical accident insurance?
Hospitals should establish a centralized claims management system and integrate it with the insurance company's electronic platform to ensure the efficient processing of claims. Hospitals can appoint a dedicated Claims Coordinator to handle data coordination and communication with departments such as medical records, insurance, and anesthesia. Hospitals should also regularly review claims data to ensure transparency in the claims process and avoid any omissions or delays. By establishing effective communication mechanisms with the insurance company, hospitals can set up a green channel for special claims cases, accelerating the processing time and reducing patient wait times, thus improving patient satisfaction.
7. How can hospitals increase the coverage of surgical accident insurance?
Hospitals can improve the recognition of surgical accident insurance by using multiple channels for publicity and patient education. This includes distributing promotional materials during hospitalization, face-to-face explanations before surgery, and updating information on the hospital’s website to raise patient awareness of risks. When communicating with patients, doctors should clearly inform them of the surgical risks and the protection that insurance can provide, helping patients make more informed decisions. Additionally, hospitals can gradually increase the departments and surgeries covered by insurance based on the specific needs of each department, ensuring the expansion of coverage over time.