I was reading an article from last Sunday's Washington Post on physician-owned hospitals, and how they might get greater scrutiny soon regarding their operations. A POH is exactly what it says -- a hospital thats owned by doctors, rather than by an organization thats in the business of running hospitals, such as Humana. (Are they even still around?)
A POH tends to be focused on specific kinds of care, and therein lies the rub. Because, on one side, a hospital (or a doctor, or pretty much anyone providing any kind of skilled service, medical or not) that focuses on delivery of a specific service tends to get pretty good at it. Success rates go up, complications go down. Knowledgeable consumers look for these high-volume places because they know that the odds of getting a good result are better than if they go to a local hospital, no matter how generally good that local hospital might be. There's probably a crossover point, where they do too many, and volume matters more than quality (I'm thinking: McDonalds), but I have to admit I've never heard of this happening to a hospital. And its certainly true that general hospitals (well, anything, really) tend to get better when they have to -- because competition just showed up.
The flip side is -- well, if you go to a guy who does transmission repairs, and you ask him to evaluate a funny noise in your car, what's the odds that he'll think it might be something with the transmission, better take a look? And if he happens to own a company that does transmission repair, $349 complete, whats the odds he'll send you to his own company, rather than another, regardless of whether the other does a provably better job or not? Meanwhile, what happens to the transmission part of the workload at the general purpose mechanic's shop? And what if the transmission business was helping the general purpose mechanic offer some free services, like, oh, maps and washing the car when he's done, no matter what he worked on? So the transmission guy, he's getting rich, but the guy who provides the range of services, not so much. Is this a good thing?
Thats the dilemma. If you just care about results, you go to the place that does it the best. (Leaving aside: how do you judge a hospital's performance? What if one out of four patients die? Pretty bad, right? But what if the hospital in question only handles the really tough cases, where a one in two death rate is normal? Now it doesn't look so bad, does it? And all of that assumes you have statistics, and can interpret them -- both hard to come by.) But if you care about how the general purpose hospital, or mechanic, does, thinking that its a good thing for the community as a whole, then maybe you go to the general purpose hospital. (How many POHs have an emergency room? Not many. How many general purpose hospitals do? Lots. Think they make enough money from the service to offer it? Nope, not usually. So how do they pay for it? By offering other services, like cancer treatments, that they can make a profit on. Now, how do you think they feel when Cancer Docs R Us opens up across the street?)
My gut feeling is that I don't like POHs, but I know that its because I don't like rich doctors. Competence, success -- those I like, quite a lot. Relative to an earlier post -- its sort of like the difference between the decent public school and the provably better private school. If you thought the private one was better for your child, and you could afford it -- where would you send him or her?
Go ahead, I'll wait.
4 comments:
Good argument, I think it would be a tough call. But, surely done on a case by case basis.
At which point it becomes a form of the prisoner's dilemma....
As you pointed out, it might be difficult for a person on the outside to evaluate a hospital...do you have access to the statistics, are you in a position to judge?
In Canada, all hospitals are subject to federal government standards and oversight. In fact, it is actually illegal to open your own hospital, and even private clinics are really hard to get accreditation for. I remember a MRI clinic which opened up in the area because MRI waits exceeded one year, and it got told to shut down. Public outcry resulted in this case, but most clinics go to exist on the hospital grounds where they become physiotherapy departments and so forth.
There is a lot of trouble with the Canadian system, not the least of which is that specialists are annoyed they are not getting paid what they can get in a POH in Atlanta, so there is a serious brain drain. As well, there are too many people taking up space in wards when they should be in nursing homes (some say as much as 20%!) and emergency bays are always filled with non-emergency cases like sniffling kids because the moms work and can't get away to take their kids in during working hours.
Most people don't see the problem though....you get sick, you go to your doctor (if you have one!) and the doctor sends you to a local clinic for tests, and then to the General for repair.
In the US, we like private enterprise, until we don't. I don't think there is a good rule of thumb, but I'd offer this -- we like it until we think that someone's getting an unfair advantage, or making too much money. Its sort of our version of the tall poppy concept.
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