Where is money wasted in healthcare?

mauxtav8r · Jul 11, 2009

there is a VERY big difference between living and existing. Lying in a bed isn't living IMHO.

Very well said.:yeahthat:

mauxtav8r · Jul 11, 2009

No one has mentioned this . . . but I see it all the time. There is a huge disconnect between the care given and cost information about that care. I see this from small items like a dressing "set up" that costs literally three times as much as the the individually purchased pieces assembled as needed to big ticket items like scans and chemo treatments.

The docs have no clue what stuff costs, the pt doesn't because they don't see the bill until way after. There is no comparison shopping, no market driving influence. We price shop for oil changes to mortgages, why not with cat scans?

The market will drive costs to a level that people can live with, and there will always be people who CHOOSE not to buy expensive items. They should be allowed to make that choice. Without COST DISCLOSURE patients and families cannot make informed decisions. I envision a "COST FACTS" label, similar to our food labels that are "NUTRITION FACTS" so that anyone can understanding how much their care will ultimately cost someone.

Mortgages have "Truth in Lending" junk that you have to sign when you get a loan so that everyone knows you have been told how much your loan will cost. I think medical costs are skyrocketing so much that many people spend more in the last six months of life on medical care than they did on all their homes and cars for a lifetime. Why shouldn't we disclose their costs in a similar way? Let the people choose. Some will always opt for "anything and everything", some will say, that $10K treatment with 5% success rate (can anybody say bone marrow transplant?) is not worth it.

Lastly, if we don't do this ourselves, you may rest assured that government sponsored health care will have a cost-based discrimination and quota. Optional services, the best (but most expensive care) will no longer be an option for anyone regardless of means. The standard of care will reach to the least common denominator, which means your baby might not get that needed treatment that you would be willing to pay for. No elective procedures for people over the average life expectancy. No choices. But, ironically, in the end it will cost you more.

Itzallgood · Jul 11, 2009

The people who profit and abuse the healthcare system the most: In random order:

Doctors

Insurance Companies

Drug Comapanies

Hospital

These make way too much money off the American Consumer

rph3664 · Jul 11, 2009

No one has mentioned this . . . but I see it all the time. There is a huge disconnect between the care given and cost information about that care. I see this from small items like a dressing "set up" that costs literally three times as much as the the individually purchased pieces assembled as needed to big ticket items like scans and chemo treatments.
The docs have no clue what stuff costs, the pt doesn't because they don't see the bill until way after. There is no comparison shopping, no market driving influence. We price shop for oil changes to mortgages, why not with cat scans?
The market will drive costs to a level that people can live with, and there will always be people who CHOOSE not to buy expensive items. They should be allowed to make that choice. Without COST DISCLOSURE patients and families cannot make informed decisions. I envision a "COST FACTS" label, similar to our food labels that are "NUTRITION FACTS" so that anyone can understanding how much their care will ultimately cost someone.
Mortgages have "Truth in Lending" junk that you have to sign when you get a loan so that everyone knows you have been told how much your loan will cost. I think medical costs are skyrocketing so much that many people spend more in the last six months of life on medical care than they did on all their homes and cars for a lifetime. Why shouldn't we disclose their costs in a similar way? Let the people choose. Some will always opt for "anything and everything", some will say, that $10K treatment with 5% success rate (can anybody say bone marrow transplant?) is not worth it.
Lastly, if we don't do this ourselves, you may rest assured that government sponsored health care will have a cost-based discrimination and quota. Optional services, the best (but most expensive care) will no longer be an option for anyone regardless of means. The standard of care will reach to the least common denominator, which means your baby might not get that needed treatment that you would be willing to pay for. No elective procedures for people over the average life expectancy. No choices. But, ironically, in the end it will cost you more.

Actually, a bone marrow transplant is more like $10,000 per day in the hospital, minimum. You don't hear much about those any more because they have been proven not to work as well as authorities initially thought they would, and the procedure itself kills 1/3 of the people who undergo it.

OTOH, I know of two people in recent months who had stem cell transplants, which aren't exactly fun either but are much less brutal. 10 years ago, they would have had a BMT. One of them is 23 years old.

My town's outpatient cancer center isn't taking Medicaid right now, which is interesting because we are at the confluence of three states. It's because one of the states is notoriously slow in reimbursement (as much as a year behind) and they just can't keep losing that much money. So, these patients have to come into the hospital and all the red tape accompanying that, in addition yet another perceived assault on their dignity for being on Medicaid.

One of my cats died in March, and when I took her to the emergency vet, the vet was very upfront with me about how much this or that procedure cost. Once the x-rays and blood work came back, and she deteriorated visibly during that time, I told her (the vet) that all I wanted to do was take her home. It had nothing to do with the money; it was that no amount of money was going to save my 18-year-old cat who had pancreatitis and multiple organ failure. Among other things, her SGOT was so high, they couldn't measure it with their equipment, and she died a few hours later at home. It was actually worth the $250 I did pay that vet to know why she died, that her big kitty heart didn't just stop beating due to old age.

Wish people could die so peacefully.

JustMe · Jul 11, 2009

When I was an agency nurse, I worked in the NICU of a large children's hospital. Half the electrical outlets were broken and most of the charger cords were frayed just to name a few problems. This hospital benefitted from the Children's Miracle Network, but the staff nurses told me that any money they received went for cosmetic improvements to the building, like new statues for the outside. It's disgusting.

Maybe the Children's Miracle Network needs to know how their funds are being spent. I went to their website and this quote is from their Mission Statement:

"Children's Miracle Network is a non-profit organization that raises funds for more than 170 children's hospitals. Countless individuals, organizations and media partners unite with Children's Miracle Network hospitals to help sick and injured kids in local communities. Donations to Children's Miracle Network create miracles by funding medical care, research and education that saves and improves the lives of 17 million children each year."

The waste in health care does not only involve government waste, insurance waste, etc. It also involves the charities we send our hard-earned dollars to. I learned a long time ago that there are only a handful of worthwhile charities whose overhead and spending are closely monitored. Children's Miracle Network was NOT one of those charities.

http://www.childrensmiraclenetwork.org/Index.aspx

irisorchid · Jul 11, 2009

End of life. When medicine was less technological, many people died because there was little to do to change the outcome. With medical advances like ventilators, suddenly we had the capabilities to keep a brain dead body alive for years. ICUs have led to many miraculous recoveries. It is not always easy to determine what will happen, even when a person looks like a lost cause (I refer you to a film I saw on PBS recently "Life.Support.Music." about a 34yo musician who had a stroke and was initially in vegetative state.) Then there is the phenomena of human attachment, that invisible bond that we have with people that we love. The power of that attachment may seem weak in regards to family members that we have difficulties with in day to day interactions only to surge with great power when we lose them or are about to lose them. Most of us are so unprepared to deal with death, especially when it is an untimely one. So, my thought is that there is much more that could be done to educate the population about death and how to deal with it and how to understand the critically ill body and what is realistic. Also, Medicare's parameters for receiving Hospice state that a person must have a diagnosis of only 6 months to live and that no further inventions can be done. There is a movement to create a type of care that is transitional, that is, some interventions can be done while receiving care that helps the family and patient to get the care that is similar to Hospice. I just heard about it so I don't have all the info. Often families don't get the support they need to face EOL if they aren't in Hospice because the focus is still fully on making the pt "get well" and the patient doesn't get the care they need physically and emotionally to transition. If the intervention works, then the pt can be taken off transition, but if the pt is truly dying the support is there to help the family unit to come to terms with it. Hospice is usually called in at the last minute which doesn't allow time to really help the pt and family. So, it seems that money could be saved by changing the Medicare rules to allow for some transition so as to not totally close the door to the family's need to do everything they can, while they are learning more about what is really going on with the patient, and the patient is getting the comfort care along with some treatment. Most families that experience Hospice care are very grateful for it.

Ruby Vee, BSN · Jul 11, 2009

seems like a lot of families want eol pts to remain in the hospital rather than move into hospice because they don't/can't take turns taking care of their loved ones who took care of them for years. throw away society? no use for the elderly? no respect, i think. there comes a time when we all must change our schedules and work together as family and friends of a pt to care for them in this special end time.

i always shudder when i see these kinds of gross generalizations. there are a lot of reasons folks in this day and age cannot "change our schedules and work together as famiy and friends of a patient to care for them in this special end time." for one thing, famiies are scattered across countries, across continents, and across oceans these days. even a loving daughter with a family of her own to care for in seattle may find it impossible to move to massachusetts to care for dad while he's dying . . . and dying . . . and dying. there's a limit, after all, to how much time we can take away from work without losing our jobs and from our children.

but the other point you're overlooking, i think, is that some children of dying parents don't choose to take care of a "loved one" who abandoned them when they were a child or forbade them to marry their partner on pain of "never talking to you again." my own parents told me that if i ever married a catholic, they wouldn't even come to the wedding and they'd never want to speak to me again. i married a catholic, became a catholic and they relented. but if they had not, i'm not sure i'd be taking time away from my life to go back "home" where i hadn't been welcome for 30 years to take care of them in their "special end time." maybe that makes me a horrible person. but there are lots and lots of horrible people out there just like me . . . .

i did take three weeks out of my life and away from my job to take care of my mother, who has alzheimer's, after my father died. it quickly became obvious that she needed 24 hour/day supervision so she wouldn't burn down the house overfilling the wood heating stove, blow up the house with the gas cook stove or run outside (in -35 degree temperatures) in the middle of the night without coat or shoes. i couldn't even go to the bathroom in peace, much less close my eyes and actually sleep. i'm very grateful for the wonderful folks at the old times assisted living facility who are caring for her now. mom loves those people, and she's happier there in the county where she's always lived and knows everyone than she would be here among strangers.

Vito Andolini · Jul 12, 2009

You want to save money in health care? Make it a rule that unless a person has a real immediately life threatening medical condition (trauma, GI bleed, something demonstrable), if they come into the ER positive for illegal drugs, they are NOT admitted. Send them to a rehab, but DON'T ADMIT ADDICTS. If they want to get clean, that's great, and we'll move heaven and earth to help. But if they just want to get narcotics because they've run out of money before they've run out of month, or because they're hiding from the pusher they can't pay (and that's a fun night, cops all over the unit), they do NOT belong in a hospital.
If the facility can do it, have a 24/7 outpatient clinic -- the folks that come in with a cold at 2 am go to the clinic, not the ER. Keep the ER for what it's designed for, which is not primary care, but for emergencies.

Coming down from opiate dependence is hell - muscle cramps, belly pain, serious suffering. These people absolutely do belong where they can get immediate relief. To offer less, to consign them to literally sweat it out, to not alleviate their agony with a course of ta;pering off of narcotics is truly cruel.

I suggest we save money by not emptying a huge trash or linen liner that has far, far less than a full load of trash or linen.

1TachyRN, RN · Jul 12, 2009

Where is money wasted in healthcare?

Marketing budgets.

Vito Andolini · Jul 12, 2009

Seems like a lot of families want EOL pts to remain in the hospital rather than move into Hospice because they don't/can't take turns taking care of their loved ones who took care of them for years. Throw away society? No use for the elderly? No respect, I think. There comes a time when we all must change our schedules and work together as family and friends of a pt to care for them in this special end time.

What if an EOL person has no or few children or other relatives to care for them? Or the parent was abusive, neglectful, or otherwise evil?

Also, just as not everyone is cut out to be a parent, not everyone is cut out to be a caregiver. Some patients are far safer being cared for by decent "strangers" than by their well-meaning, loving, yet not able family.

Vito Andolini · Jul 12, 2009

When I was an agency nurse, I worked in the NICU of a large children's hospital. Half the electrical outlets were broken and most of the charger cords were frayed just to name a few problems. This hospital benefitted from the Children's Miracle Network, but the staff nurses told me that any money they received went for cosmetic improvements to the building, like new statues for the outside. It's disgusting.

Please inform the CMN immediately. This is outrageous. Of course, you might wonder how the staff nurses knew how much was received and how it was actually spent. Not saying they're wrong but just wondering how they knew the whole story. But let CMN know and see what they wish to do about it.

dunwanna · Jul 12, 2009

Wasted Money? Get rid of junk food and we'd probably eliminate most diseases, doctor visits and hospital visits.

Try to do things at home when you can and save health insurance fees. For instance, you can use the itworkspaste at home for skin tags and warts and it works like a charm!