SubscribeBy preferring the support of domestic to that of foreign industry, he intends only his own security; and by directing that industry in such a manner as its produce may be of the greatest value, he intends only his own gain, and he is in this, as in many other cases, led by an invisible hand to promote an end which was no part of his intention.Now here's some hand action:
The mortality rankings - adjusted for the relative sickness of patients at different facilities - graded hospitals as either average, above average, or below average for ailments and procedures from pneumonia to coronary bypass surgery.Now try and get the laws inforced VS government officials by another government official.
The law calls for the [Health Care Quality and Cost] council to post insurance claim information on the web so that the public can see the disparities. But a year and a half after the law was passed, the council has still not published its findings because of disputes with medical groups about how the numbers should be presented and whether they are accurate in every detail.That failure to disclose is what makes the hand I referred to in the OP an invisible one. As a practical matter, it is impossible for a patient to shop for either the best hospital or for the cheapest hospital. This is true both generally and for particular health problems.
"Apparently, this subject is the equivalent of the third rail," said Gregory W. Sullivan, the state's inspector general and a member of the Quality and Cost Council.
At a Federal Trade Commission workshop on healthcare in April, the moderator asked a panel of healthcare leaders, "Is price a signal of quality in healthcare markets?"Later in the article, they make a good point that you may not want to be at a teaching hospital for a difficult procedure - because you are going to have residents and interns involved, rather than all experienced doctors. It's like going to a prestigious university, only to find that you aren't taught by the famous professors but overworked grad students who don't necessarily specialize in what they are teaching and may not know much more than you do. (Yes, medievalists and early modernists have to teach Vichy France - and the most I know about Vichy France is what I learned from Casablanca.)
A professor quickly offered a one-word answer: "No."
There was a pause. Then someone else chimed in, "There's a universal no on that."
The moderator concluded, "That was pretty easy," and moved on to the next question.
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As not-for-profit medical centers, Brigham and Women's and Mass. General don't earn "profits," but do, as responsible stewards, use their considerable smarts to produce a margin. This article doesn't differentiate between community hospitals and academic medical centers like Brigham and Women's and Mass. General, which have entirely different missions to the community. A not-for-profit academic medical center is expected not only to generate community benefit in the form of charity care and medicaid shortfall, it has to fund teaching programs, residencies and fellowships, not to mention the research we are all counting on to cure cancer and heart disease. The kind of cheap populism that demands that academic medical centers, who care for the highest acuity cases, have the largest expenses, and produce the most economic benefit for their communities, put on sackcloth and ashes and pretend to be shabby free clinics, is going to tear down these complex, fragile insitutions, which are the envy of the world.
posted by Faze at 4:48 AM on November 19, 2008 [2 favorites]