I've begun reading Maggie Mahar's treatise on the ills of America's Healthcare system, Money Driven Medicine (currently featured over in "What I'm reading"). It is truly a sobering read and I'm only 60 pages in. Her mission seems to be to chronicle how the increasing corporate influence in the practice of medicine is making it less efficient, not moreso. This is definitely the single most frustrating thing to me about the healthcare system. In fact, the original name for this blog was "Health Efficiency", but eh, there isn't enough material to have an entire blog devoted only to this subject, so I scrapped it. In any case, what frustrates me most about healthcare in America is that everybody touts "competition" as this great thing, but what it usually results in is turf wars, resource hogging, and ridiculous inefficiency, and the people who lose out are the patients and the people footing the bill, i.e. employers and the government. So, you can imagine how gratifying it was to see a book that devoted so much space to that idea.
Yesterday Calfornia Healthline highlighted an article in Health Affairs which is along these lines. The study by Robert A. Berenson, Thomas Bodenheimer, and Hoangmai H. Pham describes how highly competitive service areas often see their healthcare costs increase, even though capitalism theory tells us that competition reduces costs. Correcting for other factors, they found that a new clinic would increase the total amount of money spent on the services performed at that clinic in that area.
For example, if a new heart hospital were to enter Cleveland, Ohio, a capitalist would say "this area now has competition for heart patients. All Cleveland area hospitals that offer cardiology services will have to reduce costs and improve quality so they can get more of the patients to their facility instead of the others. This will result in better, cheaper care for the patients." The problem with that idea as it applies to healthcare is that healthcare supply and demand do not conform to normal economic theory. In normal economics, we are told that demand drives supply. If there is large demand for a product, supply will be created to meet that demand. Unfortunately in healthcare, the suppliers in many cases are also the ones creating the demand by convincing patients they need a service they may not need at all. If you're a frightened patient with symptoms you don't entirely understand, it's not hard to imagine a knowledgeably and experienced doctor convincing you that the invasive procedure (that happens to profit the doctor handily) is the way to alleviate your troubles.
Some would say it is unfair of me to target doctors in this way. They're trying to give patients a better experience and they are still bound to the Hippocratic oath, so we should assume that their actions are ethical. Unfortunately, the results speak for themselves. If you build a new clinic, you need money to make it worthwhile.
Of course, what upsets me most is this nugget tucked in the middle of the article: "Hospitals in several CTS markets have expanded profitable service lines while seeking to reduce or eliminate money-losing mental health services." Thank God for capitalism. A thousand specialty heart hospitals, but no mental health center because "it's not profitable". These are the kinds of things that make me glad and depressed that I'm working in healthcare. Glad because it's such an important field and there is so much that needs to be fixed. Depressed because it is such an important field and there is so much to be fixed.