Hospitals are where you go if you are really sick or seriously injured. You are fortunate if you live close to a major hospital with good staff and facilities. On the other hand, hospitals present significant problems for our individual health and for our health care delivery system.
Hospitals are not what they were a hundred years ago, or even fifty years ago. They have grown from individual hospitals that often gave free care to their neighbors into hospital chains that employ thousands and make millions of dollars, in spite of their non-profit status. Arizona has seen this trend at close hand. Good Samaritan Hospital in Phoenix opened other hospitals in neighboring communities to take advantage of some economies of scale. Then it merged with another hospital chain to form Banner Health. More hospitals were opened or purchased to operate under the Banner umbrella. It began to purchase the practices of individual doctors and to make them Banner employees. Today, it is the largest private employer in the State of Arizona with over 50,000 employees. Other hospitals took notice and followed suit. Dignity Health and Honor Health have joined Banner as the largest hospital chains in Arizona.
Economics 101 tells us what happens when consolidation like this occurs in an economic area. Competition goes down and prices go up. Study after study has shown that this is what has happened over the last few decades as hospital chains grew ever larger. Despite their large size and economic power, most of them retain their original status as non-profit corporations, which means they pay no taxes on the very large amounts of money they take in each year. We get very little back from the hospitals for our largesse in exempting them from paying their fair share of taxes.
Hospital chains enter into contracts with health insurance companies that set forth price schedules. These contracts are closely guarded secrets. The chains don’t want their competitors or the other health insurance companies to know what discounts they are offering. The negotiations often result in pricing with little economic justification. The hospital may agree to a discount in one area in return for preserving high prices in another. Poor you, if you happen to need the higher priced treatment. Even if you have good health insurance, you will pay more in co-pays and deductibles.
Charging us more is not the only problem hospitals cause us. Sick people go there and take their germs with them. Hospitals work diligently to eradicate these germs but it is a losing battle. Disinfectant will kill many of the germs and viruses people bring with them to hospitals, but not all. The ones that are tougher than the rest will survive and pass on their toughness and resistance to their descendants. The bugs that live in the hospitals today are difficult to shake, if you become infected by them.
Hospitals are also malpractice factories. Medical malpractice is the third leading cause of death in the United States and much of it occurs in hospitals. Of course, no one at the hospital is going to advertise that fact. Patients and their families are rarely informed of the reason there was a bad outcome. Better just to keep quiet about it.
Medicine is so complicated today and requires so many providers that easily a hundred people may be involved in the care of a single patient during a multi-day hospital stay. Each of those people must communicate their thoughts and plans to the others through the patient’s hospital chart or through private conversations. Many of you have played the children’s game of Telephone where a message is passed from one person to another and inevitably becomes increasingly changed along the way. This is very true of hospital communications as well. No matter how hard everyone tries, errors will inevitably occur.
I have read thousands of medical records and considered thousands of potential malpractice cases. In my experience, you cannot be in a hospital for three days without being the victim of an avoidable medical mistake. Fortunately, most of these mistakes will be minor and will cause no serious harm, but some will cause serious harm and perhaps even death. Even if minor, their mere presence is indicative of the complexities of modern medicine.
If you must go to the hospital, be careful. Have someone with you to act as your advocate and observer on those occasions when you cannot do for yourself. Make sure doctors and nurses wash their hands before touching you or the things around you. They have undoubtedly been with other patients whose germs you don’t want to receive. Make sure medications offered to you are indeed for you and, to the extent you can, make sure they are the ones you are supposed to be taking. If it looks or seems wrong, don’t just accept it. Ask questions and get answers that satisfy you. Be polite but firm in insisting that you receive the care to which you are entitled.
