Friday, October 18, 2013

How hospitals waste the patient's money


One of the ways private for-profit hospitals boost their profits is by insisting that patients have to repeat all their medical tests once again after they have been admitted. Thus, it's not uncommon to see patients who have had a MRI scan at a reputed imaging center being forced to repeat the scan once they have been hospitalized. " Hospital policy " dictates that before surgery can be performed, an MRI scan needs to be done in the hospital's own MRI department – and that the surgeon cannot do the operation without doing this.

This makes absolutely no sense for the patient who has already done all the tests his doctor advised him to do, before getting hospitalized for surgery. The surgeon says he is helpless because he is forced to follow hospital policy . This policy is mindless , and is designed not to enhance patient well-being , but to boost the hospital's bottom line . While it may have made sense in the past, to ensure that the quality of the imaging studies done was of high quality, it makes little sense today, when the doctor can review the images of the digital scan done elsewhere.

Sadly, there is very little the patient can do to protect himself. He is   worried, scared and completely dependent upon his doctor. When he is lying defenseless and undressed in a cold hospital bed , he is forced to toe the hospital line if he wants to get the surgery done.

This unnecessary repeated scanning is a wasteful expenditure which creates a lot of angst and anger.


The doctor pleads helplessness by saying that policy decisions are made by the hospital management, which remains faceless, nameless and impersonal.   Hospital management doesn't think they're in the business of maximizing the well-being of the patient – their first responsibility is to the hospital stakeholders and their priority is to maximize their revenue .

The situation will never improve by appealing to the better instincts of the doctors or hospital management. We will be able to prevent this ridiculous waste only when health insurance companies clamp down and refuse to pay for a second imaging study if it has already been done in the last few days, unless there's a very good clinical reason for repeating it.

This is the only way in which wasteful repeated expensive imaging studies can be curtailed. We need to learn from the experience of the US , and how they managed to prevent unnecessary  repeat cesarean sections . In the past, for someone who had already had a cesarean section ( CS)  , doctors in private practice would automatically schedule an elective repeat CS. They refused to allow vaginal birth after CS (VBAC) , claiming that this was risky for the patient , even though a number of studies done in academic medical centers had shown that it was safe for over 50% of women. It was only when health insurance companies refused to pay for repeat elective cesarean sections that the repeat cesarean section rate plummeted dramatically from 100% to 50%  ! Let's not forget that it's the one who pays the piper who plays the tune !

Even though health insurance companies continue to claim that they are not in the business of deciding what is appropriate medical care , if doctors and hospitals continue to abuse the privileges which they have been granted , health insurance companies will have no choice but to clamp down, in order  to ensure reasonable standards and policies are followed , to prevent frivolous and wasteful expenditure

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