Thursday, May 24, 2007

US Hospitals Rewarded for Unsafe Care

The current method of financing health care not only fails to provide incentives for safe care, it rewards unsafe care.

Although much has been written about the rising costs of low-quality healthcare, less is mentioned about the rewards of unsafe care.

Several books have been published on the subject, most notably Critical Condition (2005) and Who Killed HealthCare? (2007). But no one describes the unnecessary and unindicated procedures as well as Stephen Klaidman does in his book, Coronary.

Coronary describes how and why a significant number of healthy individuals are victims of unnecessary and unindicated procedures each year:
Dr. Moon was soon putting up numbers in the cardiac catheterization lab that in their own worlds Michael Jordan and Barry Bonds could hardly dream of. He was doing four and five times as many catheterizations as his peers elsewhere… He never hesitated to tell anyone who would listen that he was one of the ten best Cardiologists in the country.

Dr. Realyvasquez came in, obviously excited, and said to her, “Can you believe it? We did a triple bypass on a twenty-eight year old.”

… The possibility that his case was not anomalous – that Moon and Realyvasquez were systematically doing angiograms and bypass operations on healthy people with no indications that they needed these procedures – never even entered his mind
Some even suggest that the uninsured are lucky because they are less likely to become victims of unnecessary or unindicated procedures. In the case of Tenet Health Systems, Melissa Davis wrote:
The "highly placed, highly esteemed" experts -- hailing from the Mayo Clinic, Stanford University and the University of Pennsylvania -- began reviewing past heart-bypass surgeries at two Tenet facilities after one of hospitals, Redding Medical Center, came under heavy fire last year. The physicians ultimately concluded that 83% of the procedures at Redding were unwarranted. But they also determined that 59% of the bypasses at neighboring Doctors Medical Center in Modesto -- a hospital overshadowed by Redding so far -- were unnecessary as well.
Although the United States spends twice as much per capita ($2 trillion) on health care than other industrialized nations, the World Health Organization ranks US health care quality 37th, between Costa Rica and Slovenia. If we reduce unnecessary and unindicated procedures by half (not 59% or 83%), Americans could save as much as $1 trillion in healthcare costs annually.

Until we identify and dismantle the conditions that promote the waste and dangers of unnecessary and unindicated procedures, legislators have no moral or ethical justification to force individuals or businesses to spend more. As long as we allow hospital administrators to put their dollar signs ahead of patient vital signs, healthcare quality will continue to deteriorate, and costs will continue to rise.