- 03 Aug 2018 13:27
Hi. Healthcare cost is a very complex topic and definitley something that cannot be condensed down to a single, or even a few problems. I cannot speak for the whole world's problem but I can speak for the US's problems and how our current system is rigged to fail. It might fail 1 year for now, 10 years from now but it is unsustainable. Unless some drastic changes happen, it will fail, possibly catastrophically.
First, the system is designed idiotically. We do not have any sort of "universal coverage" however it is illegal to turn down uninsured patients that show up to the ER/hospital. So who ends up paying for these patients? Everyone does. Hospitals that are "For profit" usually either apply for emergency medicaid (taxpayer) or writes it off in the taxes (again, indirectly affecting taxpayers in similar way) or simply charges extra for procedures/medications/services to insured people. The end result is that the money is not coming out of the CEO making 7-8 figures salary but actually from tax-payers and other patients that do have insurance. Furthermore, insurance executives that also make 7-8 figure salaries do not take the cut either, they pass it along to their customers. That is how you end up paying $800 insurance premium rather than what would truly cost. This in turn means less people can afford insurance (and more people end up in social support such as medicaid or "freloader").
The problem is even worse, chronic conditions which can be easily kept controlled with cheap medications and regular doctor's visits end up costing thousands, hundred of thousands and sometimes even millions of dollars per year per patient when a few hundred dollars would have sufficed to keep the condition controlled.
Medical professionals get the stink eye, in my opinion unfairly but then again im biased.
I'll give you a typical example to prove my point. A 40 year old woman comes to the ED and says she has chest pain, this woman is known to the ED staff very well, she has presented 10 times in the last year, everytime with the same complain, chest pain. Everytime she is admitted for a "chest pain rule out" (basically trend cardiac proteins to make sure you did not have a heart attack), and discharged home and told that she did not have an heart attack and that she should see her primary care doctor upon discharge. She never sees any doctor outside of the hospital as she does not have insurance. Three weeks later she comes back again. Everyone knows this is a psychological problem, there is no cardiovascular or "physically" wrong ( don't get me wrong, psychological conditions are also medical conditions) and definitely nothing "urgent" that requires immediate hospitalization. The ED physician will try to admit 99.99% of chest pain patients because ED physicians are scared of being sued, they know that it is unlikely thats this lady has a heart problem, but nobody is willing to miss that 0.00000001% and put their license/money on the line even when it is the appropriate thing to do. When you see 20 patients per day, 20 days per month you end up having a high chance that you will either miss a minor detail or simply find that 1 young patient with no risk factors for cardiac disease in a million that happened to have a cardiac problem. As a result the ED physician will put the patient for admission. The internal medicine physician will surely fall in line after the ED physician. For one, profesional courtesy. And secondly because they are also scared of being sued. Now, this lady gets admitted for 24h and has a bunch of tests done (blood tests, xray, possibly ultrasound). The whole hospitalization for a mere 24h + ED evaluation probably cost about $5k if not more.
Now, nothing that is being done for this lady is addressing the underlying problem. She probably has some anxiety that will not be relieved permanently because she is not being evaluated by a pyschiatrist. So 5 weeks later she shows up again with same complaints and the cycle repeats. After 5-6 visits, one of the tests come back as positive (this can happen, our tests are not 100% accurate, false positive occur, lab errors occur, etc. If you try many many, many times, a male can have a positive pregnancy test). Now with a positive test, and an extensive documented history of "chest pain" on this lady, the IM physician feels obligated to get a cardiology consult to evaluate for cardiac problem. The cardiologist also thinks this lady does NOT have a cardiac problem, but again he is scared to miss that 1/100000000th chance, on top of that, he gets paid very well to do procedures and frankly, it is faster/easier for him to do a stress test or a cardiac catheterization than to spend 1h with the patient trying to pinpoint all of her symptoms, family history and risks factors, so instead he will schedule this lady for next morning cardiac cath. Cardiac cath which by the way, is worth 30-50k. When this lady goes to the cardiac cath, the cardiologist will find "non-obstructive CAD" basically meaning your heart vessels are open but you have some plaque (WE ALL DO, even fetuses and newborns have it) and after 3 day hospitalization (upwards of $50k) the patient gets discharged with a paper that says she has some kind of heart condition (a condition btw that we all have and that is normal). But this will only make her more anxious and more likely to want to be evaluated. This time she will go to another hospital, and when the ED physician asks if she has any medical condition she will say "I have CAD and I had a heart cath in the past", the ED physician will freak out because now this patient is a "high risk patient" and will admit again. The cycle repeats again and again and again.
This is the "simple" chest pain. We have patients that by age 40 have had dozens of surgeries and procedures and half of them completely unnecessary or to fix a problem created by a complication of a previously non-indicated procedure.
The root of this problem is because we live in a very litigious society. The mall manager cares more about putting a big yellow cone warning not to step on top of the water than to have somebody come with a napkin and dry it down in 3 seconds. They just dont want to get sue. The same applies to hospital.
Homeless patients know all the tricks to get admitted. Cold winter night outside? Go to the nearest hospital and say that you have chest pain or that you are suicidal and you get yourself a nice warm bed and a meal.
We have drug seekers patients that literally get discharged from the ED and return 20mins later and end up with dozens of visit per month.