In the summer of 2010, a troubling letter reached the chief ethics officer of the hospital giant HCA, written by a former nurse at one of the company's hospitals in Florida...[T]he Lawnwood Regional Medical Center, in the small coastal city of Fort Pierce, had been performing heart procedures on patients who did not need them, putting their lives at risk.
HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing.
Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.
At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages...
On Monday morning, in a conference call with investors, company executives disclosed that in July the civil division of the United States attorney's office in Miami requested information on reviews assessing the medical necessity of interventional cardiology services provided at 10 of its hospitals, located largely in Florida, but also two or three hospitals in other states. In the conference call and in a statement on its Web site, the company also referred to inquiries by The Times. HCA's stock ended nearly 4 percent lower Monday, at $25.55.
In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law...HCA also declined to show that it had ever notified patients, who might have been entitled to compensation from the hospital for any harm.
---"Hospital Chain Inquiry Cited Unnecessary Cardiac Work," by Reed Abelson and Julie Creswell, The New York Times (8.6.2012)
Because medical insurance, generally, pays doctors and hospitals primarily for office visits and procedures (rather than patient wellness), we can't be surprised that doctors might stress more office visits and procedures--but this is especially true at for-profit hospital chains like HCA. That's just the way the financial incentives work. And too often the result can be patients put at risk rather than protected in their wellness. And it implies tacit approval, or more, by the medical profession and government. Of course, overt approval and public advocacy marks the beneficiaries at every profit point for medical equipment, medications, tests, and skilled medical services--and for medical insurers, too. When it is about income and profit first, you know that whatever the product or service, it will not be treated and delivered as a public good, and in the case of health care services, when there is a conflict of interests, patient wellness will too often come second.
As I use the term, broadly and socially speaking, "public goods" are goods and services necessary or appropriate for the protection, including social protection, and economic strengthening of a state or country. And they are meant to be available equally to all its people. Think national defense and national security, public safety, transportation and travel infrastructure, but also social goods like social welfare programs, education, and, yes, health care. They are deemed important to the welfare and advancement--including economic advancement--of the country as a whole as well as to the individual.
(And yes, health care should be approached as a public good, too. That's what experience makes evident and what most people intuitively understand: better, more affordable, preventative and basic healthcare more broadly strengthens individual health and, in turn, economic productivity and civic contribution. That's also the conclusion of most other industrialized countries.)
So, when the delivery of "public goods" are undertaken with a for-profit model, we cannot be surprised that things go awry. This report about the for-profit hospital chain HCA is just the latest example of how the profit motive distorts public services values and undermines the process of delivering competent, trustworthy, and affordable healthcare to the public (which is delivered as a public good in many other industrialized countries at half our cost).
I've also recently posted about how for-profit higher education is most often delivering a subpar product (or service) at an unaffordable price, a price beyond the means of it's mostly nontraditional students, a price that can only be financed through US government educational loans (i.e., by taxpayers). And the result in most cases is debt without benefit, because it must be borne by the students, most of whom soon drop out of the programs. There's a lot wrong with that picture.
But too many people just don't appreciate this key distinction, this difference, that inheres in public goods--or they don't want to. Markets, by definition, discriminate between customers based on quality and abilty to pay for the product or service. That means some get a product of inferior quality, and some get less of it or none at all. For delivery of public goods, profit motive and market mechanisms simply undermine success in meeting the public need and national goal.
Link to NYT article:
As I use the term, broadly and socially speaking, "public goods" are goods and services necessary or appropriate for the protection, including social protection, and economic strengthening of a state or country. And they are meant to be available equally to all its people. Think national defense and national security, public safety, transportation and travel infrastructure, but also social goods like social welfare programs, education, and, yes, health care. They are deemed important to the welfare and advancement--including economic advancement--of the country as a whole as well as to the individual.
(And yes, health care should be approached as a public good, too. That's what experience makes evident and what most people intuitively understand: better, more affordable, preventative and basic healthcare more broadly strengthens individual health and, in turn, economic productivity and civic contribution. That's also the conclusion of most other industrialized countries.)
So, when the delivery of "public goods" are undertaken with a for-profit model, we cannot be surprised that things go awry. This report about the for-profit hospital chain HCA is just the latest example of how the profit motive distorts public services values and undermines the process of delivering competent, trustworthy, and affordable healthcare to the public (which is delivered as a public good in many other industrialized countries at half our cost).
I've also recently posted about how for-profit higher education is most often delivering a subpar product (or service) at an unaffordable price, a price beyond the means of it's mostly nontraditional students, a price that can only be financed through US government educational loans (i.e., by taxpayers). And the result in most cases is debt without benefit, because it must be borne by the students, most of whom soon drop out of the programs. There's a lot wrong with that picture.
But too many people just don't appreciate this key distinction, this difference, that inheres in public goods--or they don't want to. Markets, by definition, discriminate between customers based on quality and abilty to pay for the product or service. That means some get a product of inferior quality, and some get less of it or none at all. For delivery of public goods, profit motive and market mechanisms simply undermine success in meeting the public need and national goal.
Link to NYT article:
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