Thursday, June 14, 2007

Expensive Care Does Not Mean Quality Care

It's increasingly difficult for me to stomach arguments against serious health care reform in this country. I couldn't be more for a single-payer system, whether the government be that payer or not. I was recently informed by a colleague that the measly raises we all got this year will be completely eaten up by health care costs; the college trustees voted to make us share 45% of our total health care costs. I am one of the lucky ones; I have health insurance in this country, even if I have a fairly large deductable. 47 million Americans do not have health insurance, and 80 percent of those uninsured are native or naturalized citizens.

Given how much health insurance costs in this country and how much health care costs, it is deeply disturbing (and not at all surprising) to know that higher cost for care does not mean higher quality care. The NYTimes today reports on a survey of 60 Pennsylvania hospitals:

In a Pennsylvania government survey of the state’s 60 hospitals that perform heart bypass surgery, the best-paid hospital received nearly $100,000, on average, for the operation while the least-paid got less than $20,000. At both, patients had comparable lengths of stay and death rates.

And among the 20 hospitals serving metropolitan Philadelphia, two of the highest paid actually had higher-than-expected death rates, the survey found.

And . . .

As eye-opening as the Pennsylvania report may be to the public, insurers have already been aware that their payment practices do not necessarily encourage hospitals to provide better care. Medicare, for example, pays essentially a flat fee, which varies depending on location and type of hospital, for the same surgery, regardless of outcome. Complications tend to simply mean additional payments. And many insurers follow the government’s lead.

And so hospitals are rewarded for providing more care, not better care.

“The Medicare program pays for services,” said Leslie Norwalk, the acting administrator for the federal program, who says hospitals are reimbursed even if the care they are providing is a result of a mistake or avoidable hospital infection.

Independence Blue Cross, which is Philadelphia’s largest private insurer, says the difficulty lies in finding the right measures to use to pay for quality care.

“Philosophically, you’re not going to get an argument from us,” said Dr. Richard Snyder, a senior executive at Independence. “We believe we should pay more for high quality than poor quality.”

While this survey is indeed "eye-opening" and in fact downright depressing, one can hope that this study will put the lie to the counterargument to health care reform from conservative quarters that claim a single payer system (or any sort of 'socialization' of medicine) will result in lower quality health care.

Geez, I am not sure we should be so proud of what we get now, considering this case: Edith Isabel Rodriguez at MLK Jr.-Harbor Hospital. Ms. Rodriguez died in the ER after writhing in pain on the floor for 45 minutes, while numerous hospital staff and 911 operators simply ignored her.