Service Utilisation and Patient Satisfaction among Patients Availing Mediclaim Facility in a Multispecialty Hospital: A Descriptive Observational Study

Abstract

Background: Health insurance in India serves as a critical financial safety net that protects patients from catastrophic out-of-pocket expenditures. Third-party administrators (TPA) facilitate cashless hospitalization at network hospitals, yet evidence evaluating the efficiency of hospital-based insurance desks and patient satisfaction with cashless versus reimbursement modes remains limited. Objectives: This study aimed to assess the structure and operational workflow of the health insurance/corporate desk, measure turnaround times (TATs) at each stage of the cashless claim process, and evaluate patient satisfaction among insured inpatients at a multispecialty hospital in Delhi. Methods: A descriptive observational study was conducted at a multispecialty hospital accredited under ISO 9001:2000 certification and NABH, and registered with the Directorate of Health Services, Government of the National Capital Territory of Delhi. Ninety patients who availed of cashless hospitalization during the study duration were enrolled consecutively. Data were collected using a structured patient questionnaire and augmented by institutional records maintained at the health insurance/corporate desk. Descriptive statistics were used to report TATs and patient satisfaction ratings. Results: All 90 respondents (100%) considered cashless hospitalization superior to reimbursement. 11% favored reimbursement, 22% described it as tedious, and 67% rated it inferior to cashless. Regarding satisfaction with the insurance desk, 22% rated the interaction as very good, 44% as good, and 33% as satisfactory. The most common delay was in transmitting the initial pre-authorization form to the TPA (44.4% of cases took 2–4 h) and in forwarding the discharge summary and final bill (66.7% of cases took 2–4 h). Post-approval patient discharge was efficient, with 88.9% of patients released within 30 min. Conclusion: The health insurance/corporate desk operated efficiently relative to comparable facilities; however, specific bottlenecks in documentation turnaround were identified. Targeted operational interventions, including extending working hours, digitizing claim submission, and deploying medically trained personnel, could meaningfully improve efficiency and patient satisfaction.