Forbes: Patients Lose Thru Lack of Hospital Competition

Forbes Magazine this month includes an exhaustive and question-inducing series of articles about hospitals and their ability to best take care of the patients who trust them.

And the picture isn’t pretty. Even the titles make us pay attention:

Bad Medicine

Dirty Tricks

Hospitals’ Nightmare

And the subtitle under Bad Medicine is — The heart of the health care industry has failed the consumer.

I’ll try to condense it here. It’s complicated and frankly, much of it is over my head. When they start talking about government regulations, like Certificates of Need, my eyes glaze over.

But there are aspects of the discussion that directly affect us as patients and consumers that we need to be aware of:

1. Hospitals seem to be divided into two, maybe three types: community-based, private hospitals — or — community-based public hospitals (including academic medical centers) — or — small, specialty hospitals that focus on one body system, one type of surgery (ex: eye surgeries, knee surgeries, etc)

2. Studies have shown that medical errors, infection rates and even death rates are much higher in larger, community type hospitals than in the smaller, specialized hospitals. Even Medicare’s studies have shown that patients fare FAR better when they have surgery in the specialty hospitals.

3. But now those specialty hospitals pretty much can’t be built. There are a number of reasons, all of them focused on special interests, all of them stemming from stymied competition. Hospital-employed lobbyists have made sure it can’t happen by using words like “doctor profits” — oooo! b-a-a-d! They lobby legislators to make it sound like doctors would only perform knee replacements because they can profit from them. (Well? it would not be out of the question, would it?)

4. The point to the articles is that competition has been legislated away. Large community hospitals, in many ways, have a free pass to continue conducting business as if they aren’t losing and infecting patients, because marketplace balances have been stripped.

By removing competition, patients lose. Why shouldn’t we patients have the option to choose the place that is the safest for us to get the surgery we need?

But here we have to add a dash of this and a dash of that. A dash of — only the rich, or those with great health insurance can afford the luxury of specialty hospitals. A dash of — it’s the poor and indigent who are treated in the big public hospitals, and they will by nature be a sicker group, which may mean the numbers are skewed. A dash of — if we are saying competition is a good thing, then how does that fit into healthcare reform where the majority of the conversation centers around “universal” healthcare?

You know — usually I try to stay out of the “big issue” fray unless I can boil it down to make a difference for patients today. In this case, I think it’s something we patients need to be aware of because yes, we are making choices about where we will have surgeries. If we know the specialty hospitals — today — are cleaner and safer, then by all means, they become a better choice.

But there is a part of me that is nagging… a part of me that says there should be a way to find a level here… a part of me that says “hey! if the smaller hospitals are doing so well, despite the fact that they are making that big, bad profit, they why don’t we make a trade? How about giving them a bit of freedom to be built in trade for some sharing of their secrets for staying cleaner and safer?”

Wouldn’t it be better to find a win-win than just a whine-whine?

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Trisha Torrey
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