Incentives

A multitude of cogitators, writing in JAMA Internal Medicine, have computed the annual cost of hospital-acquired infections in the U.S. They use the term "healthcare associated infections" but they actually limit the analysis to certain of the most important infections caused by hospital care. They come up with an annual cost of $9.8 billion per year, not counting the pain, suffering and death of the victims.

Okay, that's a bummer. But here's what is, to me, the interesting part. As the authors point out, we've been making some progress on reducing this problem, but it's been slow. Here's the rather dry money quote:

However, despite the availability of solutions, the strong ethical case for improvement, and the intuitive argument that saving lives ought to save money, large-scale progress against HAIs has been slow. Only recently have health care organizations begun to achieve successes and overcome doubts about the scalability of pilot studies and vanguard institutions. Along with leadership of patient safety professionals, an important driver of progress is the move by payers to deny reimbursement for health care related to preventable harm.^10- 11 By placing the costs of HAIs with hospitals, this shift has accentuated the fiscal case for prevention.

Let me translate this into lay language. Until very recently, hospitals made money  by making people sick. That average $45,814 cost of a central line bloodstream infection? That's what the hospitals were paid when one of them happened. The more central line infections, the more revenue. This is a particularly meaningful issue for me because a major teaching hospital of Harvard University (as my surgeon's card bragged) botched what should have been minor surgery on yours truly, and then tried sending me a bill for $25,000 back in 1991. That's on top of what my insurance had paid them. I refused to pay it, they sicked a collection agency on me, I told the collection agency what happened, and the collection agency guy actually called me up to apologize and said they would drop the matter. Most people, however, pay up, plus they probably had already made a profit off of the insurance.

If you think this is insane, you're sane. However, the new reimbursement policies are by no means universal. And they don't go far enough. If your auto mechanic screws up, he is responsible. So should your doctor.