I recall one of our Thursday lunches, to which the physician organizer invited representatives of a local hospice to talk about hospices and specifically about their hospice's services to patients and their families. It was an informative interesting talk, enlivened by a lot of questions from doctors. But the really interesting conversation came after the hospice people left.
Several cancer specialists angrily complained about a local hospital. These physicians found that immediately upon a patient's diagnosis of cancer, someone in the hospital (perhaps social services?) arranged for a prompt hospice consult before a cancer specialist could review the case with the patient, his or her family, the patient's primary physician, pathologists, radiologists, and other experts. Patients and their families were having "the crepe" hung for them, with the gloomiest possible prognosis. The cancer specialists said that patients were being whisked out of the hospital, consigned to hospice care, when they could have been treated palliatively (even during hospice care), to relieve pain and suffering and perhaps to prolong life, or could have explored the possibility of an effort at curative treatment.
Now, this wasn't the government convening a "let's shorten your life" committee. The physicians felt this was an apparent hospital policy.
Before we again shake our fingers at Senators and Representatives, and accuse our government of rushing people off to die to save money, let's think about other actors: insurers, hospitals and institutions which - if there are no ethical safeguards - could be advantaged by hastening the process of dying.
Showing posts with label Hospitals. Show all posts
Showing posts with label Hospitals. Show all posts
Tuesday, August 11, 2009
Thursday, April 24, 2008
Health Spending Causes Disinvestment in Our Kids
In "The 2008-09 Career Guide to Industries", the U.S. Department of Labor, Bureau of Labor Statistics, makes several significant points: in 2006, health care was the largest U.S. industry; and in 2006 it provided "13.6 million jobs for wage and salary workers and about 438,000 jobs for the self-employed". During the decade ending 2016, health care is predicted to add 21.7% more jobs (3 million new wage and salary jobs) than any other industry(www.bls.gov/oco/cg/print/cgs035.htm). In our recessionary economy, health care has become the engine for employment growth among both highly and lesser educated individuals, income generation (average earnings for nonsupervisory health care industry employees are more than average), and economic stability.
The Guide identifies nine segments of the health care industry: hospitals, nursing and residential care facilities, physicians' offices, dentists' offices, home health services, offices of other health practitioners,m outpatient care centers, other ambulatory health care services and medical and diagnostic laboratories.
About 30% of hospital workers are registered nurses though "Hospitals also employ large numbers of office and administrative support workers". Approximately 65% of the jobs in nursing and residential care facilities are in service occupations (nursing, psychiatric and home health aides). Physicians' offices employ 40% of their work staff ij office and administrative support occupations such as receptionists and information clerks.
A table in the Guide shows that management, business and financial occupations employ 4.2% of the health care work force, service occupations employ 31.8% and office and administrative support occupations account for about 18%.
In my opinion, America's older citizens are the group most likely to benefit from surging health care employment and resources. In an article in Scientific American a number of years ago, Bok wrote about America's increasing investment in the elderly and its disinvestment in its children. Wouldn't it be better to provide a health care system which provides efficient appropriate diagnosis, treatment plans, and quality of care for all Americans and focus the predicted 21.7% employment and resource "surge" on improvement of schools and services for our children? After all, those children will grow up to be the young adults who pay for the elder generations' health care.
The Guide identifies nine segments of the health care industry: hospitals, nursing and residential care facilities, physicians' offices, dentists' offices, home health services, offices of other health practitioners,m outpatient care centers, other ambulatory health care services and medical and diagnostic laboratories.
About 30% of hospital workers are registered nurses though "Hospitals also employ large numbers of office and administrative support workers". Approximately 65% of the jobs in nursing and residential care facilities are in service occupations (nursing, psychiatric and home health aides). Physicians' offices employ 40% of their work staff ij office and administrative support occupations such as receptionists and information clerks.
A table in the Guide shows that management, business and financial occupations employ 4.2% of the health care work force, service occupations employ 31.8% and office and administrative support occupations account for about 18%.
In my opinion, America's older citizens are the group most likely to benefit from surging health care employment and resources. In an article in Scientific American a number of years ago, Bok wrote about America's increasing investment in the elderly and its disinvestment in its children. Wouldn't it be better to provide a health care system which provides efficient appropriate diagnosis, treatment plans, and quality of care for all Americans and focus the predicted 21.7% employment and resource "surge" on improvement of schools and services for our children? After all, those children will grow up to be the young adults who pay for the elder generations' health care.
Wednesday, April 9, 2008
Parallels: Big Steel and the Hospital Industry
Years ago I attended a program which drew parallels between the 1950s steel industry and the hospital industry. After World War II, the U.S. steel industry enjoyed a privileged position. It did not modernize, it did not introduce technology which was being developed in other nations to lower costs and improve quality, and it continued to pay dividends unabated. The failure of steel to recognize that devastating competition usually comes from an unexpected direction coupled with its failure to protect its equity base led to its near demise. Today, the US exports scrap metal which comes back to us from Asia as steel girders and finished goods. We are steel's third world country.
Many hospitals have incurred enormous debts (i.e., through bond issuance), engaged in a multitude of expensive marketing ventures, hired streams of expensive consultants (who generally tell them what they already know), paid extravagant salaries to their top executive staffs and, like the steel industry, failed to protect their capital bases. Whether an individual hospital or a hospital system is not-for-profit or for-profit, the financial pressures are the same: insurers, HMOs, government and employers are driving prices down below the level at which capital impairment occurs. The result is hospitals with fancy lobbies and executive suites and crowded emergency departments which make patients wait for hours before receiving service. The result is hospitals providing substandard services because they lack the volume or local expertise to improve the quality of these services, but are afraid to give them up because of marketing competition (or sometimes, physicians threats). The result is hospitals which disseminate messages that they are interested in caring for those who are basically healthy and that those who have serious expensive diseases should go somewhere else.
Hospitals are not going to be saved by grants, donations, government largesse or union busting. Hospitals will be saved by responsible stewardship and management, by responsible questioning boards of trustees and directors, and by active communities which demand - not grandiose facilities - but competent management of one of their most important assets.
What do you know about your community hospital? What has been the response to your inquiries about its financial health?
Many hospitals have incurred enormous debts (i.e., through bond issuance), engaged in a multitude of expensive marketing ventures, hired streams of expensive consultants (who generally tell them what they already know), paid extravagant salaries to their top executive staffs and, like the steel industry, failed to protect their capital bases. Whether an individual hospital or a hospital system is not-for-profit or for-profit, the financial pressures are the same: insurers, HMOs, government and employers are driving prices down below the level at which capital impairment occurs. The result is hospitals with fancy lobbies and executive suites and crowded emergency departments which make patients wait for hours before receiving service. The result is hospitals providing substandard services because they lack the volume or local expertise to improve the quality of these services, but are afraid to give them up because of marketing competition (or sometimes, physicians threats). The result is hospitals which disseminate messages that they are interested in caring for those who are basically healthy and that those who have serious expensive diseases should go somewhere else.
Hospitals are not going to be saved by grants, donations, government largesse or union busting. Hospitals will be saved by responsible stewardship and management, by responsible questioning boards of trustees and directors, and by active communities which demand - not grandiose facilities - but competent management of one of their most important assets.
What do you know about your community hospital? What has been the response to your inquiries about its financial health?
Monday, March 3, 2008
Health Care - Who Works Where?
Health care-related articles appeared in the New York Times on March 2 and March 3, 2008. The Times focused on the Presidential candidates' positions (for a useful summary of these positions see: Kaiser's "health08.org" ) and looked at the causes of high cost health care and the tools available for cutting health care costs. The articles quoted an authority as saying that "spending on unneeded procedures, medical errors and hospital infections is a more dire problem than the cost of calling for the uninsured, and that waste accounts for a much larger share of the country's $2.1 trillion health care bill."
In 2006, the U.S. civilian workforce was about 144 million, of which about 14 million were employed in health care. In 2000, the figures were about 137 million and 12 million, respectively. In the last eight years, health care has absorbed and increasing proportion of the workforce. Physicians and dentists have shown an approximately 8% increase in the percentage of employment, hospitals have decreased from 42.6% in 2000 to 39.8% in 2006. Health care is a major U.S. employer and most of the employment occurs in hospitals. Perhaps the first place to look for efficiency in the expensive world of health care is in hospitals, or in the insurers who control the gateway to hospitals and shift costs from their insured, to other payors such as government, the self-insured, employers, and taxpayers. The largest portion of "waste" may not be unneeded procedures, medical errors or hospital infections, but in the enormous administrative overhead of commercial insurers who provide no true health services in exchange for the expensive administrative overhead wrung out of billions in premium dollars.
In 2006, the U.S. civilian workforce was about 144 million, of which about 14 million were employed in health care. In 2000, the figures were about 137 million and 12 million, respectively. In the last eight years, health care has absorbed and increasing proportion of the workforce. Physicians and dentists have shown an approximately 8% increase in the percentage of employment, hospitals have decreased from 42.6% in 2000 to 39.8% in 2006. Health care is a major U.S. employer and most of the employment occurs in hospitals. Perhaps the first place to look for efficiency in the expensive world of health care is in hospitals, or in the insurers who control the gateway to hospitals and shift costs from their insured, to other payors such as government, the self-insured, employers, and taxpayers. The largest portion of "waste" may not be unneeded procedures, medical errors or hospital infections, but in the enormous administrative overhead of commercial insurers who provide no true health services in exchange for the expensive administrative overhead wrung out of billions in premium dollars.
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