Doctor’s Tip: Health care reform requires understanding hospitals
In order to have optimal health, it’s important to understand our health care system, particularly when changes are being proposed. There is an excellent new book called “Mistreated: Why We Think we’re Getting Good Health Care — And Why We’re Usually Wrong.” The author, Robert Pearl, M.D., is recognized nationally and internationally as an expert on the business of health care.
In his book, Pearl writes about four “legacy players”: the insurance industry, hospitals, specialty medical societies and the pharmaceutical and medical device industries. These are all entities that benefit financially from the status quo and therefore don’t see our current health care system as broken. But it is broken because it is fragmented, inefficient, unsustainably expensive, is responsible for more 250,000 deaths a year, and compared to other developed countries results in poor patient outcomes. Last week’s column discussed the medical insurance industry. Today’s column will discuss hospitals, and next week’s will discuss physician specialty societies.
According to “Mistreated,” community hospitals are the second-largest source of private-sector jobs in the U.S., with 6 million employees (Valley View Hospital has 1,200). They account for “more than 30 percent of all health care costs in the United States, driven in no small part by inefficiencies in the way they deliver care.” Hospital administrators earn large salaries, “often in proportion to the number of beds they fill and the profits they generate.”
Pearl makes the case that good health care is a team sport, with all members of the team following standard protocols for diagnosing and treating problems patients present with. However, the American medical culture “elevates and celebrates the contributions of individuals” and “doctors in hospitals perceive variation in practice as a positive, not a problem.”
Pearl spent time in Sweden, which ranks third in the world in patient outcomes. He visited the hospital in Jonkoping, regarded around the world as the “crown jewel of clinical outcomes.” He notes that in Sweden “physicians and hospital administrators view health care as a public service,” not a private business, and they “work together on behalf of the entire population.” The hospital building in Jonkoping is old by our standards, but is “medically outstanding, with world-class clinical outcomes for every problem the doctors treat.” Pearl notes that as a result “the esprit de corps and level of fulfillment I observed among the doctors and nurses in this hospital were nothing short of inspiring.”
Perhaps competition in some areas of our economy is good, but it’s counter-productive in health care. I wouldn’t trade my 42 years of family practice at Glenwood Medical for anything. But based on that experience and talking to physicians from other parts of the country, the practice of medicine in the U.S. is definitely not a team sport. In our region, Valley View Hospital in Glenwood, Grand River Hospital in Rifle, Aspen Valley Hospital, St. Mary’s in Grand Junction and Vail Valley Hospital all compete against each other. When one hospital buys an expensive piece of medical equipment, the other hospitals feel they have to follow suit in order to compete, which drives up the cost of medical care. Doctors in each of these towns compete against each other and against doctors of the same specialty in the other towns. Primary care doctors sometimes hesitate to refer to certain specialists for fear the specialists will steal their patients. Medical groups come and go as doctors fight about money.
Other hospital-related issues in the U.S. are:
We’ve all experienced or know someone who has hospital bills with outrageous charges, such as $10 for an aspirin, $50 for an enema, hundreds if not thousands of dollars for a brief ER visit. A Time magazine article about high hospital charges a few years ago noted hospitals charge a lot “because they can,” and there’s nothing individuals can do about it.
It’s virtually impossible to figure out what a hospital service is going to cost beforehand.
If you are admitted to a hospital in the U.S. on a Friday or Saturday, on average you will spend an extra day in the hospital because hospitals are short-staffed on weekends. This increases your hospital bill and increases your exposure to hospital errors and hospital-acquired infections (700,000 patients are affected by them annually, and 10 percent of those die).
Unhealthy food is available in most hospitals. Such food caused the diseases that many people are hospitalized for, such as diabetes, heart disease, strokes and cancer. Many hospitals serve patients recovering from a heart attack bacon and eggs for breakfast. Most hospitals offer soda and pizza in their cafeterias and candy bars in hallway dispensers. If patients see this kind of food in hospitals, they assume it must be OK. The AMA recently came out with advice for hospitals to serve only healthy, plant-based foods, or at least offer them as options. It’s not unusual for big hospitals to have chain fast food outlets, although finally many children’s hospitals are getting rid of McDonald’s.
Valley View Hospital should be applauded for instituting “patient-centered care.” However, when it comes to money, they are like other legacy-player hospitals. Here’s an example: Periodic colonoscopies are important in screening for and preventing cancer of the colon, but they cost several times more in Glenwood, where they’re done at VVH, than they do in Grand Junction, where they’re done in an outpatient facility.
Granted, Sweden is a more homogeneous country than ours is, but if we want to fix our broken health care system we need to be more like them.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years of family practice, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. Call 379-5718 for an appointment for a free consultation. He also does a free PowerPoint presentation at 7 p.m. the first Monday of every month at the Third Street Center in Carbondale, and is involved with a plant-based potluck at 6:30 p.m. at the TSC every fourth Monday.
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