Today there is a variety of surgical and nonsurgical programs and packages available for providing medical treatment. Packages are in fashion today for most surgical procedures in various corporate hospitals. A package system allows the hospitals to get cost settlements performed with more ease. Also, it is also more convenient for the patients who have information upfront of the charges.

The major disadvantage seems to be for the surgeon, who may have to cope with displeasure of the patient, hospital or insurance agencies. This is apart from forfeiting his personal charges if (a) he is a novice in conducting the particular surgery and takes extra time to get through a procedure, (b) unforeseen hiccups happen during surgery, or (c) new pathologies are found on exploration.

A majority of private and corporate hospitals have designed various surgical and nonsurgical programs and packages for various surgeries performed in the hospital. According to the central government health scheme (CGHS), a package is defined as a lump sum cost of inpatient treatment for which a patient has been referred by a competent authority to the hospital or diagnostic center.

Surgical and nonsurgical programs and packages comprise all the charges relating to a particular treatment/procedure including registration charges, admission charges, accommodation charges, injection/transfusion charges, dressing charges, operation charges, anesthetic charges, operation theatre charges, procedural charges/surgeon fee, doctor/consultant visit charges, ICU/ICCU charges, monitoring charges, cost of disposable surgical charges.

A package also consists of expense of all sundries utilized during hospitalization-related routine investigation, and physiotherapy charges, etc. from the time when the patient is admitted to the time of discharge of the patient. The only charges that are not included in the surgical and nonsurgical programs and packages are telephone charges and toiletries charges.

The insurance companies and government organizations, like the CGHS referring these patients for various surgeries to such private/corporate hospitals, strongly demand firm adherence to the packages and routinely block any charges if they go beyond the schedule package, irrespective of any valid reason put forward by the hospital or as a result of any unforeseen complication. Time has come to seriously consider this issue and debate whether such packages are really supporting the patient "enough". It is definitely not providing a "feel good" factor to the minimally invasive surgeons.

The surgical and nonsurgical package system was forced upon the hospitals by various government establishments and insurance companies when it was understood that there is a great difference in the cost of various surgeries performed in different hospitals in various corners of the country. The surgical and nonsurgical package system ensures uniformity of surgical costs, less difficulty for the patient and the company's approval for the surgery.

It is time to question the way these packages are fixed. A few bureaucrats and doctors, considering the basic salary of the patient or his dependent, make a decision as to what package he is entitled to in the general/special ward. In most of the cases, the packages are faxed to the concerned employee and the expense of the surgical procedures is sanctioned even before the surgeon has moved the patient to the operation theatre.

During surgery, one has to be doubly careful during clipping the cystic artery and cystic duct as the "quota" is one clip pack only during laparoscopic cholecystectomy. If laparoscopic surgery is converted to an open procedure, the company sanctions for one package only. Thus, the surgeon may be forced into proceeding with laparoscopy in an effort to avoid a conversion - a dangerous situation indeed!

There are lots of disadvantages associated with the surgical and nonsurgical package system. If the surgeon does anything that is against a thorough surgical procedure, it is seen as a deterrent as it may lead to a "non-package" pathology, which may require intervention. Further, it is anticipated that surgeons should have no learning curve, have a nil complication rate and there should be no patient-related morbidity during surgeries.

The duration or dosage of antibiotics may not be increased as it may elevate the charges above what the sanctioned package allows. The patient is anticipated to be discharged within 72 hours irrespective what medical condition he is in. The surgical and nonsurgical programs and packages present quite a precarious situation indeed which needs to be addressed upon as quickly as possible.