Don’t Get Sick in St. Louis (part 1)
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This is part 1 in a multi-part article on the US Healthcare system.
An article in the local paper says that at any given moment, there is a 48% chance that at least one hospital in the region is diverting ambulances to other hospitals. It doesn’t really matter why you are coming in, either. Patients with everything from injuries from car accidents to pregnancy complications to chest pains are being turned away diverted.
Of course, they’re not being turned away because hospitals legally have to stabilize every patient that comes in the door. But, hospitals have figured out that as long as the patient doesn’t get to the door that means that they have no responsibility. So, an ambulance calls in to say they are coming and the hospital tells them to go somewhere else.
Why is this happening? The rise of for-profit hospitals is one reason. In the past, hospitals have run at about 40% capacity. However, 40% capacity really cuts into the profit potential of HCA and other for-profit hospital chains. Hospitals have responded by increasing their capacity utilization to 80%, which means that if a bed is expected to be opened but there is a complication, a backup happens in the ER.
Another factor is insurance companies. They play the hospitals against one another to cut costs. That has also lead to the increased capacity utilization as hospitals have to compete with one another for patients based on cost rather than quality of care. This has worked out well for insurance companies and their stockholders, but not so well for patients and doctors, many of whom go into specializations where they do not have to deal with insurance companies as often.
A lack of doctors has pushed more of the work on nurses, who are in short supply. Nurses often get retention and signing bonuses in order to keep them on the job. This is more money that is flowing out rather than into patient care and makes the hospitals cut corners on care even more. All this work also puts more pressure on nurses, which makes them leave the profession and puts them in an even shorter supply.
Hospitals have also turned away from ER care and towards specialities that pay more. Part of it is to increase profits for shareholders and part of it is to cover increasing costs to keep doctors and nurses.
So what can we do about it?