Sunday, January 23, 2005

Poverty Amidst Plenty

In my local paper, the Providence Journal, was this story about the now annual winter event, the hospital capacity crunch. With even a small and routine uptick in influenza and respiratory illnesses, local hospital emergency departments overflow, and patients wind up in every corner. Everyone seems bewildered by this, although the article notes that the new leaner hospitals run an 90% capacity, so any increase in demand overwhelms them. Furthermore, it seems impossible for hospitals to get enough nurses, although no one seems to care to think about why.
Similarly, in Houston, a story from the Chronicle about how the new Texas law designed to make mental health care more efficient has resulted in long waiting lists for anyone not overtly psychotic, and an apparent dearth of chronic care.
At the same time, the Chronicle reported how the latest trend in Houston general hospitals is patient amenities. It described, for example, the University of Texas M.D. Anderson's new Ambulatory Clinical Building, "with its commissioned artwork, hotel-like lobby, waiting rooms with wireless internet access and garden terraces."
So we have poverty amidst plenty. In the US, where health care costs increase annually much more than the inflation rate, where we spend more than $1.5 trillion on health care, we cannot provide enough emergency room and hospital capacity for the predictable acute respiratory illness surge in winter. In one city, the wait for an out-patient mental health care appointment for the poor is 3 1/2 months, but a state-supported hospital now displays commissioned artwork and provides wireless internet access? What does this say about the values of our health care leaders?


APeticola said...

In my opinion health care has gone too far in selling the sizzle not the steak -- but that's what sells! I realize! and got to stay solvent or fail. The biggest "sizzle" is technology so we are horrified if someone can't get an MRI or a heart transplant but indifferent when nursing home patients have to wait an hour for pain meds or assistance to the bathroom, then often getting them from grudging (because overworked and rushed) aides, or that they cannot count on adequate assistance transferring from bed to chair and live in fear of being dropped during an inept transfer. Or trays are left beside hospital patients unable to sit up without any offer to feed them when they can't feed themselves. I'll trade off my right to mega-expensive intervention anytime for a guarantee that I'll never have to suffer from that type of privation in a hospital or nursing home. But most Americans are quite the opposite and have made what I consider a devil's bargain, they can have all the things that cost a fortune they want -- covered by insurance -- but no guarantee of good basic care.
We are also indifferent to providing good work conditions not only for CNAs but for doctors, and bad work conditions make disgruntled and worse workers (how many doctors envisioned spending all the time they do learning bureaucratic coding tricks?).
Don't get me wrong, there is much good care given in nursing homes; but at least at the nursing home I'm an ombudsman at, you absolutely cannot rely on it.

Roy M. Poses MD said...

But do people, i.e., the general population, realize they have made this bargain, and if so, do they understand the bargain they have made? My guess is the answer is that many people don't realize they have made any bargain, and the few that have consciously thought about high-tech vs. basic care don't understand how over-priced much high-tech is, nor how badly basic care has suffered. Re my first assertion, most people have little choice about what sort of health plan they get, and so couldn't choose between lots of high-tech but poor basic care vs the opposite. And most public discussion of health care seems to avoid this trade-off.

Unknown said...

Two Thoughts:
First: See also the fact that hospitals feel the need to advertise in terms of weirdness to the average patient.
Second: I think the cost of financing the installation wireless internet into a hospital would probably make a negligable change in the quality of care if invested elsewhere.

Both of the above are connected in that amenities are just another way of drawing consumers, and I share your disdain of the fact that amenities, as opposed to the quality of service, are what the industry uses to bring in patients.