What so you think is the biggest problem in Health Care?

[madwife2002, BSN, RN]

I have been in health care for 21 years and the problems have always been the same no matter where I have worked nor in what town, country etc.

My biggest gripe is the lack of staff I can probably count on 2 hands the time that we were fully staffed.

Now I am a manager and I know from behind the scene how difficult it is to staff my unit, it is my biggest headache. The way that the upper management calculate staffing requirements is almost 'alien' to me!

I think it should be a simple math ie we have x amount of pts, x amount of days so we need this many nurses and PCT's! But where I work it is not done that way, it done by division of hours etc. So this means staffing is worked to the exate number but does not allow for vacations, call offs, higher acuity in fact it is rigid.

[Esme12, ASN, BSN, RN]

Welcome to one of the greatest kept secrets of healthcare.....It really is about the almighty dollar!!!!!! That what is percieved by staff as an uncaring lazy manager have no idea that you beg, plead, and bribe anyone to try to get your staff the help they need. Watch your battles...too much attention that you don't agree completely with what is going on and you are not a team player......that's why I went to supervision.....

[tobesmartt]

Upper Management.. They walk around thinking they are all that. They very seldom acknowledge "lower skilled" workers. Not to mention when help is needed for patient care, transportation, cleaning butt,feeding. Where are they? oh yeah......in their office, door close.

[GreyGull]

It probably isn't that they don't recognize you, they are caught up in dozens of issues that go along with the day to day activities of running a business. Healthcare is a business, like it or not. Occasionally the CEO, CFO or President of the hospital or corporate with come in for a little gathering in the conference room with cookies and coffee with a "state of healthcare" address. While it may make some feel warm and fuzzy, I would just prefer the hard facts in a black and white memo which I can file for comparison.

The allied health professions realize this even more so since if they fall out of favor with reimbursement by CMS, they must scramble to reinvent themselves, raise their education standards to petition for more opportunities or find themselves out of a job. In their meetings, they are constantly planning and trying to find ways to cut costs themselves before the administrators decide what needs to be cut. Many of the allied health professions include a business course where they set up a department as a project. It is an eye opener but it gives them a reality check for the profession they are entering.

I do know of some nursing units that also started committees themselves with their managers to find a better way to curb expenses for the entire budget. Even the waste of a free for all system of grabbing incentive spirometry devices can cost up to $250.000 per year in lost charges and supplies that aren't accounted for. Oxygen equipment is another enormous expenditure. This is why RT departments have requested NC and masks to be placed in the charge as you grab machines. Even O2 tanks are being switched over to the units for their own charge rather than RT trying to recoup all the misused tanks which are left on, broken regulators (now many are Grab and Gos) and tanks being "loaned" to EMTs. But, RT may also pick up phlebotomy and EKG which are not big on revenue. Lab gets the paper charge for the tests and the reimbursement on an EKG is peanuts or less.

I personally offer my sympathy to the managers and administrators of all levels. Just trying to make sense out of all the ever changing healthcare regulations is frustrating. Sometimes I wonder how we'll ever get patients discharged with all the supplies and meds they need for homecare. Back and forth with the insurances. Then the ambulance service doesn't want to take the patient for whatever reason (lack of skilled providers or issues with insurance) and our hospital CCT must be used for a home transport. Case Managers are a blessing. But, to deal with that on a grand scale for reimbursement and to recoup charges has got to be overwhelming. The U.S. also has a very fragmented healthcare system with the haves and the have nots with too many variables in each category.

Yes, I know this thread was probably started just to vent one's frustrations, but there are many sides to every coin.

[eriksoln, BSN, RN]

I believe the same thing I thought when I was a student, new nurse, travel nurse and staff nurse. I've carried this idea (of what is wrong with healthcare) with me through many different hospitals, both as an aid and as an RN. Never once saw anything that would make me change my mind.

Biggest problem: Too many people skimming off the top. They come from many different angles and carry many different titles. Some contribute a little (as with mid level management) and some none at all (most administration, the consultants and hundreds of others). If someone pays a $500 dollar bill, eh.........maybe $150 of that is for anything that actually went to their care. The rest goes to the benefits of a very corrupt system designed to steal away as many public funds and resources as possible.

My hospital is a good example. Its a smaller/mid sized hospital. You could call it a small hospital teetering on mid sized........or a mid sized one that is on the small end of mid sized hospitals. WE EMPLOY TEN VPs. Yes, here, I'll say it again so you know I'm not joking............10 VPs. As with all businesses/hospitals, they do need someone running the show, but there is really no justification for two VPs. If there were three, I'd say they were bold/reckless and wasteful. At four..........I'd label them as criminals. Not even going to waste my time coming up with the words for what I think about TEN. TBH, I don't think I have them. Now thats some serious skimming off the top going on right there.

The Healthcare Industry business types have done a wonderful job in convincing the general public too that they need this money because the medical workforce is so expensive (lol, cough, gag.........as if they staff themselves or something). So, the focus with cutting costs remains on cutting........us, the workforce. The general public falls for the "We can't afford to run with such expensive overhead" song and dance, gets angry with the workers............and the skimming of the top is allowed to continue without interruption. Not a single administrator at my hospital took a paycut or had to take unwanted time off during the recession. Many workers had hours cancelled though, raises were frozen and benefits were changed for the worse.

[Flo., BSN, RN]

For profit healthcare is the basis for alot of what I see wrong with health care.

[Fribblet]

People abusing the system. They're sucking medicaid dry for a bunch of nonsense.

[TakeOne]

People abusing the system. They're sucking medicaid dry for a bunch of nonsense.

Maybe, but I'm with the others who feel that it's the people at the top of each corporate heap who have been sucking the system dry for the last few decades. That's what I've been seeing for more than twenty years, without variation. Wherever (and however) there was a profit to be made they made it, without regard to who had to contend with the negative consequences. They passed the negatives down the line, to be suffered by someone else.

[dudette10, MSN, RN]

Whenever costs go higher and higher, look at the policies, paperwork, human resources required to implement those "cost-saving" measures and business process improvements.

Everyone looks at the people employed in order to say "Hey, there's where we can cut costs!" but look a little further back. Why are they there? Paperwork!

There is a shitload of expense associated with killing a few million trees to get people through our disjointed healthcare system.

[Altra, BSN, RN]

Quote from my PCP, speaking about what is unfortunately currently the best case patient payor scenario - patients who have "good" insurance:

"Healthcare is the only business where for every $100 you (the provider) spend caring for the patient, you spend another $20 trying to recoup $67 of the original $100 billed."

[Argo]

I personally think it boils down to insurance companies lobbyists lining the pockets of the politicians to pass crap policies that consistantly cut what medicaid/medicare/tricare will reimburse for patient care. The bottom line is what the bottom line is..... if that makes sense. These insurance companies now will only reimburse about 15% of billed services. So if my hospital sends a pill for $1000, we will get paid $150 back. This has gotten worse and worse over the past 15-20 years with the last 5 years being the biggest cuts in reimbursement.

The pencil pushers in the hospital have to watch the total income of the hospital and keep people employeed and keep the doors open, its business. When they are getting less and less reimbursement from all insurance providers because of the federal cutbacks on reimbursment the total amount of money available to spend is decreased, therefore staffing is decreased and the little people are worked harder and harder.

I also work in a smaller facility, we have a buttload of VPs also. I totally disagree with it. I am fortunately in the position that people respect my word and I have not had to cut anyone in my years tenure. I will voice my opinion on the top heavy business structure when the time comes and I have to make a stand, that time has yet to come though. Hopefully it wont in the next 9 months that I plan to be at my hospital....

[citylights89, BSN, RN]

Like some of the others have said in so many words, I think it would be the financial aspect of it. The people at the top of any business seem to get all the perks while the "little men" get near zilch. When expectations get really low from the workers, anything above what is there seems like a blessing.

Mostly, I think it is bad for the patients. Insurance robbing people of their premiums and not keeping their promises seems like a bad business practice but is the way of the market. Medical costs are so exorbitantly high that its surreal. I know medical technology can be a major cause of that, but sometimes it just makes you wonder if someone else is pocketing the cash.

Yes, money does in a fact make the world go 'round!