Map of life expectancy at birth from Global Education Project.

Friday, October 21, 2005

In More Business News . . .

As I have noted before, the place to find the health care policy news is in the business section -- not that there's anything wrong with that. For example, today the Boston Globe has four stories on the front page of its business section, three of which are about health care, plus teases to two more health care stories inside. So now we know what constitutes the largest industry in the United States, and what really drives our economy.

The stories are about blood clotting associated with coronary artery stents; a Massachusetts Medicaid HMO that is adding dental coverage for its members (Hooray! Worth a story when I get back from the boondocks this weekend); the Cleveland Clinic Foundation stepping up to try to kill what otherwise appeared to be imminent FDA approval of a new drug for Type II diabetes, called Pargluva, which its sponsors Bristol-Myers-Squibb and Merck apparently didn't bother to point out doubles the risk of heart attacks and strokes (Some people are just so hypercritical, aren't they?); Pfizer's earnings get whacked on the Celebrex and Neurontin debacles (which, by the way, is not the fault of the stockholders but they're the ones who pay, not the executives who were responsible. Just sayin'); and finally, the one I'm going to say something about here, which is that community hospitals in Massachusetts are hurting big time.

The reason? Almost half the patients in the state are going to the big name, famous teaching hospitals. The community hospitals aren't filling their beds, are losing money, and are having trouble finding capital to modernize and keep up their capacity. Of course, the teaching hospitals are much higher cost providers, which hurts payers and ultimately, consumers and taxpayers as well.

Okay, you are probably saying, but it's only natural that the people want the best for themselves and their families, and of course they go to the academic medical centers where all the Top Docs (as the tabloids will have it) are to be found. Well I've got news for you -- unless you're going for the latest experimental procedure, such as a face transplant, or high risk surgery where your local hospital is not a high volume provider (surgical teams get better with practice), you're much better off going to your friendly, neighborhood community hospital.

If you go to A Major Teaching Hospital of The World's Greatest University, the Top Docs will be around someplace in the building, but the doctors who actually do things to you will be inexperienced residents who haven't slept for 36 hours. Half the people who draw your blood and set your IVs will be doing it for the first time, and you're likely to end up with an arm like a 12 bag a day junky. Not only will the sleepless resident want to stick his finger up your ass, but so will 12 medical students. Every morning, a gang of 8 people will come in at 6:00 am, wake you up, and stand at the foot of your bed discussing you as if you are some non-sentient entity in another state.

Surveys consistently show that patients are much more satisfied with their experience at community hospitals than at teaching hospitals. And for most of the reasons why people go to the hospital, they get equally good or better care. Plus it's a lot easier to park. So take my advice on this one.

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