Map of life expectancy at birth from Global Education Project.

Thursday, December 09, 2010

Reap This Righteous Rant

Michael Millenson, on the Health Affairs blog, opens a can of whoop ass on the medical industry for apathy about patient safety. Since the much ballyhooed Institute of Medicine Study To Err is Human, issued in 1999, we have made essentially no progress on reducing the estimated million preventable patient injuries, and close to 100,000 deaths, in hospitals every year. (People don't even seem to think about outpatient iatrogenic injuries and deaths. I'll get to that in due course.)

Millenson's basic point is, we know how to enormously improve safety and reduce errors that harm patients, but people just don't bother to do it. Hospitals eschew opportunities to join programs to enhance safety, because their administrators think they're already just so fabulous, or they are worried that by trying to do better it will look like they are admitting they have a problem, or . ..

They actually make money by harming patients. That's right: when people suffer avoidable complications, such as catheter associated infections, the hospital gets paid more to take care of them. Of course if the patient dies they might earn less due to the shortened stay, but that's usually a risk worth taking. Millenson doesn't mention that Medicare is trying to change reimbursement policy to eliminate this perverse incentive in certain readily definable and obvious cases, but in general, it's still true. (It was true in my own case, BTW, when surgeons erroneously removed my ascending colon and then fed me while my bowels were still paralyzed, and oh yeah I got nosocomial C. difficile. Then they sent me a bill for $25,000. I told them to fold it until it had as many corners as humanly achievable entonces metelo donde el sol no brilla. But they tried. But I digress.)

The way to fix this, of course, is the way civilized countries fix it: put hospitals on a global budget to take care of the population of their catchment area. Everybody gets a salary, and nobody makes a profit, but people can get bonuses for doing good stuff. That way, the incentives are to deliver care as efficiently and effectively as possible. And oh yeah, they have to meet the standards of the single payer, whether they like it or not.

But no, that would be socialism. So don't even think about it. Just shut up and die.

1 comment:

roger said...

this seems connected with your immediately previous post. i think maybe it's the money angle.