[SUGGESTION]Change payment mechanics for patients.

This could be moot for many reasons, but here in the US fees for healthcare are pretty flat for a basic visit to the doc. The variation comes in with the tests that are done such as X-Rays or MRI's and such. It appears right now that for the game that this is abstracted and just folded into the fee charged for a given diagnosis. My suggestion is to implement a system where a visit to the doctor is a flat fee and then diagnostic tests generate a separate fee for the patient. And for hospitalization there should be a flat per day fee to the patient(Perhaps variable depending upon the ward and if they are receiving an ongoing treatment like intravenous medication.).

Hi, thanks for the suggestion! We tried different variations in the early stages of development and unfortunately this is not a good choice for an ingame system - as soon as you let players schedule paid procedures, there will be a strong incentive to plan as many of the most expensive ones for as many patients as possible, strongly shifting the goal from "reaching a diagnosis as efficiently as possible" which the current system encourages. There might be a solution with some penalties for sending patients to unnecessary tests, but I don't think that sounds very fun.

Then perhaps implement a system that creates the risk of a doctor quitting/resigning if you interfere too much with their work. Or create a mode that more accurately represents the role you as the player are supposed to be envisioning yourself in, that of hospital administrator and not doctor. Since realistically this game is more a hospital administrator sim than a doctor sim.

@ jan.oxymoron: agree.

catloverjerrygarcia wrote:Then perhaps implement a system that creates the risk of a doctor quitting/resigning if you interfere too much with their work.  Or create a mode that more accurately represents the role you as the player are supposed to be envisioning yourself in, that of hospital administrator and not doctor.  Since realistically this game is more a hospital administrator sim than a doctor sim.

I like the idea. Currently the game is really a matter of volume, more patients = more revenue; and equipment, testing and procedures are not free.

This is the problem healthcare is facing and can be incorporated into the game.

If you run lots of tests this can result in longer wait times for a test or procedure. This is already seen in the game.
If you higher more staff and purchase more equipment to reduce wait times then your costs go up.
Insurance companies don’t want to spend more than they need to.
If you are too expensive then an insurance company may not cover patients who visit your hospital (a real word problem) or they may not cover certain procedures (another real word problem).
If your patients cannot get a procedure covered or cannot pay for it themselves they may refuse to have the test or procedure completed... or the hospital may be out of pocket for the cost.
Plus having good, experienced doctors who can diagnose with fewer tests and reduce expenses can justify the higher fees they demand.

I think adding this dynamic allows the player to weigh the options. Buy equipment and use it sparingly, or use it freely. Be too greedy and you risk losing insurance companies and therefore patients. If you’re too stingy then you may misdiagnose more patients and having poor patient scores and more malpractice penalties as a result.

I would rethink the point of view concerning abuse by the players. I guess we can already do wacky stuff to milk patients for money. If I were to 'abuse' current mechanisms for profit, then I would probably stick to an orthopedy clinic, because in terms of risk/payment this type of clinic is the most favorable. The game does not encourage me to use other departments - in fact it forces my hand as insurance companies will only unlock after a certain number of departments opened. And this is kind of railroading me - in a sandbox style game a poor design choice.

Sending a patient from department to department to fully diagnose the disease and get all treatments possible might at first glance be a way to milk patients for cash. In reality, the following two points are valid: Patients do not like to spend too much time at the doctor or in a clinic. Reputation will drop. Second: the extra personal and facilities needed to do extra diagnoses cost money in their own way - we have wages and initial costs for the extra equipment. I cannot say where the break-even point is and after which number of tests a lab is profitable but the current system basically fails at this very point: extra labs and diagnosis rooms are just money-eaters, which must be offset with more patients treated. They have no own revenue so we might get a hint, whether a department bolsters our concept or not. And of course a doctor running multiple tests on me cannot treat other patients the same time.

Additionally: while insurance companies certainly do not want to spend too much money on a single case, let us not forget the bigger picture. As they are paying for curing a disease, they know the median of the costs for treating such a disease. While not deviating much from this median, the company will pay. They will, however, not turn a blind eye anywhere. Where something is odd, they will check and confront like doing redundant tests but at first, they trust the docs to do their jobs right. And of course, the docs know these values themselves. They won't ask too much to get unwelcome inquiries from the insurances paying for them or want to build up a reputation of robbing their patients blind. You usually train to be a doctor to heal persons unless you see your training (and its costs) purely as an "investment", which justifies you milking the diseased for money later. (In that case I deem those persons morally unfit for a vocation like being a medic).

Games like Theme Hospital and to some point obscure game "BIIING!" (a hospital parody) depicted this quite nicely. If you are too expensive, people will go elsewhere. Period. Counterweight to this: The better the patient feels i.e. the more symptoms are treated, the better for your hospital because you will get the reputation of "caring and helping" instead of just "processing" patients, which will in turn have patients go to your hospital, if they can choose. In my country you can choose the doctor you want to go to - same for hospital (unless the ambulance brings you in). You won't go to a doc with bad reputation if you are not forced.
What drops reputation? Going home still in pain (unless you have anesthetics from the pharmacy). Having the feeling the doc did not help you or the feeling something odd was done not related to the disease i.e. feeling ripped-off. With payments the patient has to do...well, in my country the insurance company does not cover certain treatments, which are deemed optional, but not essential and you are asked, whether you want them and pay for them yourself. What is covered differs from insurance company to insurance company. The basic stuff is always the same and covers almost everything needed. What is not covered are usually stuff like your own ward room (usually you are placed with 3 persons in the same ward) and more privacy costs more money, certain rehab stuff like gymnastics after injury or optional diagnostics or higher grade optical glasses or tooth fillings. But if you have cancer, then the company will cover you for nearly all stuff done to you and yes, this can easily sum up to half a million euro for a complete life-saving therapy.

We might need to have a system of patient happiness, median cost of treatment and relate this to the patient intake. The better your docs and the better your patients feel, the more will come. The more expensive you are or the more unhappy your patients are (for whatever reason like dirty floors, unfriendly personal, long waiting times), the less will come. I remember Theme Hospital being able to adjust the costs for treatment to compete against other hospitals for patients.