I wish I could stop talking about money but that is what drives the health care business in the United States and it affects every aspect of your health care. Annual spending on health care ($3.2 trillion) constitutes almost 20% of our nation’s Gross Domestic Product. That is a lot of money and where there is a lot of money, there are people determined to get what they consider to be their fair share.
As spending on health care has increased, hospitals have become more profit-driven. Fewer and fewer hospitals are led by doctors. The business people and accountants have taken over and these changes are having a big effect on the way health care is delivered to patients. Historically, doctors have had great independence in making treatment decisions. If a patient needed to stay in the hospital longer, the doctor could order it, even if it made more financial sense for the hospital if the patient were discharged. Today, hospitals subtlely or blatantly insist that doctors discharge the patient when Medicare, for example, won’t pay for a longer stay. Hospitals are also encouraging doctors to perform the most lucrative procedures at their facilities because they make more money when that happens.
A recent opinion piece in the New York Times by a concerned doctor discusses the problem in the context of a small community hospital in California. The business people running the hospital fired the medical staff and replaced the members with new members more likely to do things the way the business people wanted. The fired staff members sued and the case in pending in the courts but it points out the degree to which business people are now controlling or attempting to control what happens in their hospitals to maximize their bottom line.
Another way in which hospitals are remaking the health care delivery system is by purchasing medical practice groups and making the doctors in the group employees of the hospital. This is certainly what I am seeing on a large scale here in Phoenix where Banner Health has been buying up practices left and right. While theoretically, the employee doctors are still required to exercise independent judgment and to act in the best interests of the patient, the hospital now has a far greater input into the physician’s decision making process. Just by controlling the manner in which the physician’s compensation is computed, the hospital can influence the physician to act in a way that puts the most money into the hospital’s pocket.
There is not much the individual patient can do except to be aware of the problem, to continue to ask questions of his or her doctor and to continue to use the internet to monitor the quality of the health care being delivered by the hospital’s in the area. As always, being an informed consumer gives you the best chance to receive quality health care and to avoid being the victim of malpractice.
