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One problem (of many) with our system of health care August 21, 2007

Posted by The Armchair Economist in Commentary, Health, Health Care, Politics, Technology.
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Its 1am. I have to be at the hospital in 5 hrs. These mid afternoon naps are killin me I tell ya.

What better way to spend my time than to write about the new developments going on at our favorite health care buyer – Medicare. Medicare announced over the weekend that they will stop paying for procedures that stem from medical errors, ranging from instruments left in surgical patients to patient falls to infections acquired while in the hospital (specifically UTIs from cathed patients). Basically they are only going to pay for treatment relating to what the patient originally presented with… (makes sense right?).. however the reality is that being in a hospital brings a whole host of risks that arent always preventable (not really ‘medical errors’) which brings up another issue.. in order to accurately diagnose a patient, lots of tests need to be run (no, it isnt supposed to be this way..).. but medicare only reimburses a flat rate for each case… (btw. i’m not going to talk about the inexcusable cases where the wrong leg is amputated or where a scalpel is left in the body.. these things happen.. but its so rare that the news media actually decide to write about it.. more of the financial impact to health institutions will come through ‘errors’ such as patient falls and nosocomial infections)

Unfortunately, whatever Medicare does, the private insurance industry will adapt and pervert to their will. It will be interesting to see how things shake out.. for example, how exactly do you minimize the number of times that a 75 year old patient needs to go to the bathroom (ie:to prevent falls)? You can give them a bed pan (very dignified eh?).. or maybe make them ring the nurse everytime they need to go (uh.. good luck with that.. might as well keep a bed pan handy)… or maybe you can just put them on a catheter… wait.. that increases the chance of infection.. for which treatment is no longer covered. Also, regarding preventable infections.. unfortunately until we know how to eliminate bacteria there is no such thing as ‘preventable infections’.. no matter where you are, even in the sterile surgical field, there are bound to be bacteria.. the question is whether the antibiotics and your immune system are up to snuff in dealing with it. The main point is that there are always complications (almost ‘expected’ if you will).. and it is alittle rediculous to say that no complications will ever happen. (it kind of provides indirect validation to people who sue due to bad outcomes rather than bad decision making or medical errors).

What we need is to close the liability gap between the payer and the care provider. The problem stands in that the liability for error falls in the health care providers hands.. while the purse strings are being controlled by another party who has no liability whatsoever. For example, if a 10y/o kid presents with recurrent headache with nausea and vomiting, the diagnostician has to consider brain tumor (no matter how remote the idea). The physician will order an MRI, the insurance company will come back with ‘we won’t reimburse for an MRI in this case (basically the chances of an brain tumor is very low, while the number of people who have recurrent headaches with nausea and vomiting are very high.. so it is a business decision not to do reimburse for the MRI.. otherwise they would go bankrupt)… but note: they didnt say don’t get it, they just say they won’t reimburse for it, so now, they’ve thrown te ball back into the doctors court. its up to the doctor to decide what to do.. either make the hospital foot the bill or make the patient foot the bill (btw: its very expensive).. If the doctor thinks that its REALLY low on the differential, perhaps they will tell the patient its most likely nothing (or they could be a real bastard and leave it up to the patient to decide if they want it or not ie: not give them any guidance)… but 5 years down the line, if it really happened to be a brain tumor, guess who gets sued? (by the way, doctors have been sued (and lost) by telling patients time and again to get specific tests.. (ie: writing prescriptions time and again).. but the patients never got it.. and when their disease progressed to an advanced stage, they sued the doctor because the doctor never stressed how important it was for them to get the test!! Its actually progressed to the point in which doctors can call CPS (ie: child protective services.. the same people who come if you are caught abusing your children) if parents don’t get necessary tests for their kids (ie: lead screenings)… now if that isn’t an adversarial/defensive relationship, I’m not sure what is. To be fair, I don’t really know how often this is invoked or how accurate it is.. the anecdote was just passed on to me by another doc)

If the insurance companies want to make decisions on what to reimburse for (ie: they think they know enough to make the decision of what is important and what isnt), they need to share some of the liability.

(btw: regardless of how good you think a hospital is or how good the doctors are, you never want to be in a hospital any longer than you need to be.. consider it a risk benefit decision.. )

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