Hospitals and other health care institutions, whether voluntary or for-profit, need to be financially solvent to survive growing market pressures. In what ways has this “bottom line” focus changed the nature of the US health care system? The establishment of health services now depends almost entirely on its profitability. The predominant view of corporate-minded politicians at federal, state and municipal levels is that government does not belong in the health care business and should divest itself of its health care assets. To save themselves the hospitals must cut costs, merge in order to realize greater economies and capture markets and generally begin to function similar to other competitive business entities. The hospital, the final holdout in the total commodification of health care, must now drastically rewrite its traditional mission statement if it is to survive. If present tendencies continue, two developments are likely to occur.
First, the hospital will become a thoroughgoing creature of the marketplace. The financial bottom line will displace the clinical base line, wherever it not already done so. Hospital mergers “downsizing” and “shrinkages” are likely to accelerate. Hospital staff will continue to be replaced by machines wherever it is economically and technically feasible. The ideal patient will be one who’s got lots of insurance coverage, but isn’t particularly sick. Second, those without insurance coverage will receive less medical care. As private hospitals tighten admissions policies to maximize reimbursements, the poor and uninsured will be caught in a double bind. The cash-strapped public system will close its clinics or restrict access, cut back on services, and be generally less capable of providing quality care. Discussion Week Two
Although your textbook states that “ambulatory care is the predominant mode of health care delivery in the United States” (p. 121), the CDC’s National Center for Health Statistics’ National Health Care Survey revealed a 32% increase in the number of emergency room visits between 1996 and 2006. What factors do you believe contribute to the increase in emergency room visits and what is the impact on health care costs? Support your answer. What good is having health insurance if you can’t find a doctor to see you ? The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to 50 days, with almost half of internal medicine physicians closing their doors entirely too new patients. And when you consider that Massachusetts already has the highest concentration of doctors nationwide, wait times will likely be worse in other, less physician-abundant parts of the country, should universal coverage be enacted federally.
When patients are forced to wait weeks to obtain medical care, they inevitably find their way into the emergency department for treatment that ordinarily can be handled in a doctor’s office. According to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits, as newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician. David Morales, commissioner of the division, said several national and statewide studies have shown that expanding insurance coverage does not reduce emergency room visits. I’m on record with supporting health reform, and expanding coverage. I simply don’t think it’s acceptable to have tens of millions of Americans without health insurance. But we have to be cognizant of the unintended consequences if primary care continues its disastrous decline.
It will take significantly more than what’s included in the Patient Protection and Affordable Care Act to convince medical students to go into the field, and prevent current primary care doctors from leaving. And to those who say physician assistants and nurse practitioners are the answer, they’re not. First, there’s simply not enough of them to meet the demand, and second, the lucrative allure of specialty practice is also drawing mid-levels away from primary care. Unless drastic measures are taken soon, the emergency room will surely be the next domino to fall as more than 30 million newly insured patients are set to further strain our health system. Discussion Week Three
Given the increasing longevity of Americans and the costs of providing long-term care, anticipation of the costs should be a major element of every family’s financial planning. Current information suggests however, that very few families or individuals give this consideration. What factors might impede this advance planning? What measures might be effective in raising awareness among the Americans about this important matter?