Map of life expectancy at birth from Global Education Project.

Tuesday, November 13, 2012

I can tell you from personal experience . . .

. . . hospitals make money by screwing up.

I've written about this before, so first let me emphasize, no personal condolences or sympathy required, this happened many years ago and I'm fine now. Not to worry.

Without going into great detail, back when George Bush the First was bombing Iraq, I entered a Major Teaching Hospital of Harvard University through the emergency department. I had pain localized between my navel and right hip, with rebound tenderness and a fever. They told me I had acute appendicitis and they were going to take my appendix out. Eight hours after entering the operating room, I awoke severely dehydrated, in agony despite enough morphine to float William S. Burroughs for a week, and lacking my ascending colon. After opening me up they had seen, not appendicitis but rather a lesion that they decided was cancer but was actually diverticulitis. Eleven days and many travails and grievous errors and misjudgments later, I finally left the hospital.

I had insurance. However, they weren't happy with the amount the insurance company paid them. A couple of weeks later I received bills totaling more than $25,000 -- it would easily be twice as much in nominal dollars today. I told them to go pound sand and eventually they did but . . .

Hospitals get paid for doing stuff. The more stuff they do, the more money they make. Suppose you hired a roofer, who set up scaffolding incorrectly which caused a staging plank to crash through your living room window and smash thousands of dollars worth of antique glass. Would the roofer then bill you to repair the window and replace the artifacts? I think not. However, that's what hospitals do when the doctors make mistakes.

The linked article in Health Affairs reveals a major problem in efforts to control health care spending. If hospitals undertake quality improvement programs to reduce the rate of surgical errors and complications, they lose money. Not only do they have no incentive to do it, some small community hospitals might actually go broke if they didn't screw up so much.

In civilized countries such as the totalitarian dungeon to our north, hospitals are given a global budget to care for the needs of a community. It's in their interest to be competent, and efficient. So here's what we need:

We need universal, comprehensive, single payer national health care. Shout it from the rooftops.


robin andrea said...

It is a rather astonishing thing to see that they billed you for their outrageous error. The profit motive in health care boggles the mind.

I shout that mantra from my rooftop everyday! (No one seems to ever be listening.)

kathy a. said...

friends -- i hope things are moving forward on that front. aca didn't get killed; that's a step.

it seems to me that the longer-term incentives are more in the direction of "measure twice; cut once," to steal a carpentry phrase. also, doctors and hospitals need to get out of the mind-frame of thinking about profits.

you have probably the worst captcha i've ever seen. just fyi. i'm on try 3, and it's not looking promising...

Cervantes said...

Sorry about that captcha, the spambots are everywhere.