More insurance woes. We received a bill from Emerson Hospital, the hospital where I was initially admitted, for an obscene amount. The bill does not detail what the charges are for or whether an insurance claim was submitted. Naturally we are asking for more detail. Hospitals would do well, I would have thought, to submit bills that are understandable by the patient, but there seems little incentive for them to do so. The market forces at play in the industry do not work to reduce health care costs or increase health care quality. Problems with the crude, and often misdirected market forces, in the current health care arena are pointed out in the book “To Err is Human” and the follow-up book “Crossing the Quality Chasm.” If health-care were aviation, we would be living in the pre-deregulation era, where air travel was accident-ridden, available only to the rich or sponsored business traveler, there was only one airline to choose from for any particular journey, and there was only one flight a day.
Health-care has a lot to learn from aviation system-safety in becoming more transparent in its incident reporting, reducing costs by improvement in quality, and becoming more customer (patient) centric. Robbie, on his KickingCancer site talks a lot about mouth sores. Now I don’t know if this particular infection was preventable, but I know that one of the things that my nurses drilled into me repeatedly was about the need for rigorous mouth care, to prevent just this type of secondary infection. Just suppose how much better Robbie would have felt, and, from a purely economic front, how much cost the hospital would have saved if this particular infection could have been avoided. I would be curious to know how many incidences of secondary infection are reported for cancer patients, by type of infection, by hospital, and what the economic cost is of treating these infections. There appears to be little *economic* incentive on the hospitals to reduce secondary infection, since the cost just gets passed on to the insurance company.
I offer no pat solutions to the type of problem I detail above, but from the patient’s point of view, there is obviously an incentive to reduce the incidence of secondary infection. Not all secondary infection can be avoided, but we know, for example, that hospitals are not good places to be if you want to avoid getting sick, because that’s where all the other sick people are! The precautions with masks and gowns and Purel that I’ve seen doctors and nurses take were generally laughable, and even when I was neutropenic, and it said so on a big purple sign on the door, folks would still leave the door to my room open. Staying home seems like a good idea, but you need to know how to monitor your health and stay healthy.
Another suggestion I would offer is for those organizations operating to improve quality and cost and, and to oversee adherence to procedures, whether at the hospital, city, state, or national level, to include a central role for patients and patient coordinators in their decision making. This role should be along the lines of the customer in agile development in the software industry, recognizing that all the doctors and nurses and specialists and administrators exist only to serve the need of the customer (the patient), not the other way around.
With my new found interest in the issues, I will be following discussions on health care during the 2008 (please come soon!) elections with great interest. Leaving health care cost and quality to the market forces of the insurance companies is not going to cut it! I’m happy to be at DFBWCC; especially following the Betsy Lehman accident, I think they remain very cognizant of the need to constantly improve quality; I’ve talked about the accident with several of the folks that were there at the time. But, in the end, I can’t help thinking that in a better world, having good information about the multiple providers available to treat my condition would drive better quality and lower costs.
p.s. As you’ll see from the featured photo 1– it’s girl scout cookie time again! Support your local girl scouts.
- Photo no longer available ↩︎