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2008 June - Note 6

Precautions in giving package / estimate / quotation

Under Section 2 (a) of the Indian Contract Act, 1872, any package/estimate/quotation given by a doctor/hospital to a patient would be a ‘proposal’. In case this ‘proposal’ is accepted by the patient before its revocation by the doctor/hospital, it becomes a ‘promise’, an ‘agreement’, a ‘contract’ under Sections 2 (b), 2 (e), and 10 of the Contract Act.

Hence, every doctor/hospital must be extra cautious in giving package/estimate/quotation to any patient because if the patient indicates his/her acceptance, it will become a ‘contract’ legally binding the doctor/hospital.

While giving a package / estimate / quotation, the following aspects must be taken into consideration and the inclusions and exclusion must be clearly spelt out:

  • Type of room/bed – how many days in ICU/ordinary room. Extra charges on transfer from lower class to higher class and rebate on transfer from higher class to lower class.
  • Fees for initial pre-operative consultations with specialists and investigations.
  • OT charges, equipments, OT medications, anesthetic agents, anesthetic drugs.
  • Fees of surgery/procedure team including anesthetist – both for surgery and inpatient visits.
  • Post-operative investigations.
  • Inpatient medications
  • Fees of dietician, physiotherapist, etc.
  • Physiotherapy/rehabilitation services – during/after hospitalization.
  • Nursing care.
  • Meals/laundry for patient/attendant.
  • Items of personal nature such as in-room soft drinks, telephone charges, guest meals, etc.
  • Take home medications and supplies.
  • Fees for post-discharge consultations with specialists and investigations.
  • Add-on charges, if any.
  • Ambulance charges.
  • Medical insurance.
  • Cashless hospitalization/managed care.
  • Amount required to be deposited and how many days/h before admission. On non-deposit of the specified amount what would be the fate of the scheduled surgery/procedure.
  • Modalities for canceling a scheduled surgery/procedure. Refund – amount and time frame.
  • In case of foreign patients, express conditions must be incorporated to take care of international
  • currency fluctuations and translators (where requisitioned).

In case of packages, it would also be advisable to include the following clauses in the publicity material, brochures, website, etc:

  • Specify the list of diseases/disorders whose patients would be considered high risk and hence ineligible for the particular package or would be charged more.
  • It is advisable to specify that – ‘final estimate will be given only after the patient has been thoroughly examined by the concerned doctor’.
  • It is advisable to specify that – ‘prices subject to change without any prior intimation. Patients are advised to take individual estimates’.


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