HEALTH CARE #2

My first post was a brief explanation of the physician’s portion of the health care cost pie. Today we shall explore albeit perhaps incomplete and too simple some other slices of the pie.

Much has been said about the excessive use of diagnostic studies such as X-rays, Ultrasounds, Cat scans (CT), MRIs, Bio-chemical laboratory studies, pulmonary function test etc: Almost all are relatively late comers to the physician’s armory. As an example; for studies of abdominal organs the best techniques were the use of contrast media, barium for all portions of the intestinal system and iodine based solutions for the Kidneys and Gall Bladder. Those injected intravenously carried a risk of a fatal allergic reaction. The radiologist made his diagnosis by noting defects in outlines.

Without risk and free from invasive procedures, first the CT scanner then the ultrasound and in the 80s the MRI gave a detail picture of these organs and all other portions of the body . All have undergone marked improvement since first appearing on the scene.

New and sometimes exotic biochemical laboratory exams had widened our ability to diagnose body malfunctions and often prevent body damage or make an early diagnosis such as an early stage of a heart attack enabling us to reduce fatalities. There are test to detect early curable stages of cancers.

Not only have we taken all the above for granted, but many a physician has been sued for malpractice for not requesting a test or examination which would have detected a serious condition even if there were no indications. Thus the practice of medicine has become defensive for the doctor. All of the above add up in the cost of medical care.

Hospitals have to be able to do all these examinations and some of the equipment costs up to more than a million dollars. They need skilled highly trained personnel to operate and staff the units. Specialized floors for different disorders make treatments more successful, staffed 24/7 surgical units are essential. Whether in a hospital or free standing facility there are daily thousands of patients who would have been dead if not treated in dialysis units.

These are only a few of the expensive modalities that have caused costs to rise, but have saved useful lives. To cover their debit even the non-profit hospitals must recoup all their expenses plus enough to be able to maintain and upgrade as needed. They are not hotels, and even without any special units or care the daily costs are high.

Unfortunately they are also multitier in their billing. Most have been forced to sign low ball contracts with the HMO and other insurance carriers as well as the Medicare agents. The hospitals have never received even their cost from Medicaid and must treat patients who cannot pay. They try to counter balance these low payments by inflating the stated charges to the uninsured individual.

Finally, the insurance companies and the HMO providers including the Blues are not in business for your benefit, but to make money. They do so by (a) premiums based on risk, (b) restricting use of facilities and modalities. In fact in many cases they are dictating how an individual receives care. Most often it is the least expensive and of poorer quality. This includes payments for medications where a most effective drug is not reimbursed but a cheaper an often not as efficacious medication must be substituted.

Returning to premiums it is obvious that the risk is highest in the very young and in the oldest. Therefore at both ends of the curve the premium reaches its peak especially in the elderly who can least afford the annually increasing costs.

This “Table Setting” just scratches the surface of the costs of medical care. We will next begin to study the pros and sons of the various solutions that have been offered or proposed to date.