I have unfortunately spent quite a bit of time in the hospital over the last 4 years.
In all the hospitals I found the same short comings. They are sterile and cold, the food is not only sub par but not ideal for promoting healing. Ill stop there for now but I have found from personal experience that the above concerns can have a great impact on health.
My question is, is this all about the money? I just feel like patient care could be taken to new heights by incorporating some pretty basic things.
I know, I know, I am idealistic and ignorant to the reality of health care as a business but I would love to understand the in's and out's of the business side (I have a finance degree and see myself heading that way eventually)
What would you recommend as a resource to help understand for profit health care in the United States? I would like to learn about old issues that have plagued the system for a long time and new ones as well. I would really love to get an understanding of how the national health care act has effected hospitals as well; good or bad.
I would love to know who would be ideal to talk to in a hospital that could guide me.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Perhaps it is a matter of interpretation. I didn't read subee's post and understand that she/he was advocating that health professionals make choices FOR the patient. Rather, I read it as advocating for the ongoing and honest education of patients relative to the real and reasonable options for care available to them along with the ramifications that may follow those choices.
There are some who believe that hospice type care ought to be accessible to those who have terminal illnesses and are not seeking curative treatment; even when that would result in more than a year in hospice care.
If you feel this way, you have the right to make the decision to forgo curative care for yourself. Other people have their own values.
The problem is that the care that the current system too often doesn't actually reflect these values, including extending life. There have been recent large scale studies on the terminal illness decision making. Patients with terminal conditions were randomized into a group that was offered palliative care consults. A much larger portion of patients in this group chose to have at least some aspects o their care be less aggressive when appropriate, and as a result they reported less distress due to their terminal condition. What was surprising about these studies was that not only were patients more comfortable and generally happy, but they actually lived 20% longer. I agree that wanting to try and extend life, as well as be happier are common patient values, but what we've found is that patients who aren't given palliative care counseling are far less likely to have their care reflect these values.
The fact that medical care is so expensive is not the fault of the patient.
Yes, actually it is. Our high costs are due to two main factors; the amount and types of services we use, and the cost of those services. It's not intentional on the part of patients, but there is good reason to believe that our documented failure to adequately inform patients causes them to make decisions that conflict with their values and cost more money.
As I posted earlier, the federal government cannot run out of money.
Technically it's always "out of money" since we generally operate on credit, but that in no way means the economy is not at risk of collapse due to the current trends in healthcare spending. Most likely it wouldn't get to that point, since we'd simply allow the healthcare economy by itself to collapse rather than taking the entire economy down with it. In other words, it wouldn't just be wasteful spending that would go away, it would be pretty much all costly treatments, even those that are clearly worth the cost.
We are all aware that there are providers and facilities which will engage in futile and unnecessary care because it will make them money, even if it will have absolutely no positive impact upon the life of the beneficiary. There are some who will not. The patient wanting futile care will have to seek out those medical providers who will accomodate that request. Health professionals have their own ethics and morals to deal with.
Patients get to self actualize their end of life care after they have received the information pertinent to their dx, prognosis, and options for care. They will choose what they will choose. They sometimes are not able to get what they really want, but they still get to choose.
The fact that medical care is so expensive is a concern of the healthcare professional and those trying to spread dollars across a huge range of health care needs. What percentage of the GDP do you think healthcare should occupy, it is close to 17% now, isn't it? How do we address this if not by having hard discussions about where the bulk of the $$ are spent and evaluating whether those $$ are doing what they are intended to do?
Well you start by not giving pharmaceutical companies free reign to charge whatever they want. We are the only country where this is standard business. Also non profit shouldn't be allowed to pay no taxes and take credit for charity care and then pursue patients into judgements, liens on their home, sometimes foreclosure and bankruptcy while charging much higher than insurance companies and medicare. Medical inflation starts with the outrageous costs that hospitals charge in general especially to those without insurance who aren't able to get the true discounted price that insurance companies pay. There is no financial transparency. You have no idea what you will be charged before care and then are at the mercy of your insurance and the hospital in what you end up paying! Healthcare is the only industry where you have no idea what you will have to pay and there should be price controls in place for meds, for surgeries, treatments, etc. You should be able to know what the bill will be before you use medical services and there should be a limit of your maximum out of pockets that is reasonable and affordable! One positive of the affordable care act is your insurance out of pockets are capped, they can't charge you extra for copays on top of your maximum as has been the case in the past. Medicare patients do not have that luxury and are at the mercy of pharmaceutical companies for chemo and other expensive meds, there is no yearly cap!
As for Jahi I think that is a tragic situation that looks like a failure to rescue. If they had been more aggressive in stopping her bleeding she wouldn't be brain dead now! She obviously needed surgical intervention in a timely fashion to stop the uncontrolled bleeding. I don't know where the ball was dropped, whether nurses didn't take it seriously, or more likely the surgeon and Dr's didn't act quickly enough! But we need policies in place where if there is an unstable patient and the Dr isn't giving adequate treatment an override option to ensure the patient receives appropriate care in a timely fashion! I have seen a case where a surgeon refused to act and a person bled out and this didn't have to happen! The nurses called multiple times, but the Dr didn't come in and take the patient back to surgery. It shouldn't happen!
The real expense comes from all of the x-rays, scans, treatments, specialists, etc.... Do you know how much every bag of TPN costs? At my hospital 10 years ago they were $1400 per each bag. Some of my ICU patients had like 40 some bags of TPN during their stay while we put them through the meat grinder to keep them alive at all costs. Food is not as expensive as the futile surgeries and aggressive treatments that we do to people. Aggressive palliative care teams need to educate and form goals with the patient.
Slightly off-topic, but I was shocked when I read how much a patient in the US is charged for TPN. Fourteen hundred dollars? Is this a bag for one day?
This prompted me to check the price for TPN in my own country, Sweden. One 1.920 ml bag of TPN with added water soluble vitamins, fat soluble vitamins and trace elements costs a total of USD 58,54. That's 1/24th of the price. That's frightening!
(The patient doesn't pay for this directly, it's the cost for the hospital to buy the TPN, and it's the end cost since there's no markup/profit goal. Healthcare is financed through taxes and a patient is charged $10 per 24-hour period regardless of whatever medications or treatments/surgeries are provided during the hospital stay).
Slightly more on-topic. I do believe that a patient has a right to be informed and that healthcare professionals have an obligation to supply the information, when cure is no longer a viable goal.
High quality palliative care is a right and with it we can attempt to optimize quality of life for the for the patients for time they have left. If we aren't honest and realistic I think that we're being deceptive and might provide false hope, when there really is none to be had.
Treating aggressively when the the only thing these treatments will realistically achieve are painful and difficult side effects is in my opinion cruel and essentially means that we rob our patients of higher quality life and a dignified end of life care, for the sake of trying to add a short/small quantity of life.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Typically speaking, hospitals are doing pretty well on the financial front these days. More Americans than ever before now have insurance coverage for their health care needs in the acute care setting.
I believe that the USA made an enormous mistake when we opted to connect health care to employers and then put what is essentially a financial gambling industry into the middle of it. I believe that we ought to now move toward a single payer system which would be much more affordable for the tax payers. As well, private insurance ought to be moved out of the center of the vast majority of health care.
In many, many communities large health conglomerates operate the acute care, long term care, and ambulatory care facilities. Those health systems could self insure their patient base it would be less expensive and would take the middle man out of the equation. I would recommend taking a look at a book called "America's Bitter Pill".
toomuchbaloney
16,029 Posts
Perhaps it is a matter of interpretation. I didn't read subee's post and understand that she/he was advocating that health professionals make choices FOR the patient. Rather, I read it as advocating for the ongoing and honest education of patients relative to the real and reasonable options for care available to them along with the ramifications that may follow those choices.
There are some who believe that hospice type care ought to be accessible to those who have terminal illnesses and are not seeking curative treatment; even when that would result in more than a year in hospice care.