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Friday, February 22, 2008

The skyrocketing healthcare cost debacle

Over at Respiratory Therapy Driven is posted an interesting post noting the high prices for various respiratory therapies, followed by an interesting discussion.

I no longer get to see the prices of therapies at our hospital because charges are automatically dropped when we chart, however I know that prices compare from hospital to hospital, and they all seem to charge way too much.

It seems ridiculous that each day in a hospital room would cost over $800, or almost $2,000 for an ICU bed per night. Or that one day on a vent would cost as much as $1,500, or that a BiPap charge per day $800.

However, after I think about it further, perhaps some of this cost can be justified because they do include services. And all you RTs and RNs know full well that one patient might require much more attention than just the usual Q2 or Q4 vent check. Some patients can be easy, but others can be down right challenging.

And then there is the liability involved. If the hospital gets sued there could be millions of dollars on the line, and the hospital would have to be able to cover this cost. Thus, the prices get jacked up a bit more.

And then there is the increase in supply of patients coming to the hospital since the inception of Medicaid in 1965. The general rule taught in economics 101 is that when people perceive something as free they tend to seek it.

Another basic economics 101 rule is that when demand for a product increases and supply stays the same the price goes up. This simple law of economics would explain why the cost of medicine has skyrocketed since 1965. Top that off with frivolous lawsuits and you can see why healthcare costs continue to rise.

I can buy a nebulizer for less than $100, a box of Ventolin for around $20, and give myself breathing treatment to myself for free. I can buy a ventolin inhaler for $20 and each puff is free.  When I can do this myself for this low of a cost, why then does it cost as much as $350 for QID Albuterol and Atrovent nebulizers?

Likewise, why would doctors continue to order Nebulizers when they aren't indicated?  Studies show that nebulizers work the same as MDIs, so why not order MDIs on stable patients? Most patients can do MDIs on their own for free, minus the initial education and cost of the inhaler.

And, if the cost of Nebulizers treatments is so high, why then do not more hospitals have more treatment protocols to cut down on useless breathing treatments? Would not this drive down the price?

Some of the cost of a hospital stay can be justified, as I mentioned the risk involved, but also for the simple reason of being able to pay competitive wages to doctors, nurses, ancillary staff, and all the other people needed for a hospital to function.

Likewise, hospitals have to be able to cover the cost of keeping up to date on all the expensive new technologies in order to stay ahead of the game and provide the best care possible for its patients. In this regard, the high cost might be understandable.

I read somewhere that the cost of medicine used to be trivial before the government got involved, mostly because once people realized they could get medical attention for free in emergency rooms, they flocked to emergency rooms.

At the same time, regardless of the indication for an emergency room visit, hospitals are not allowed by Federal law to turn any person down for treatment.

Even illegal aliens get free health care in the U.S., and they have no billing address of which to send a bill to either. All of this, as per economics 101, drives up the cost of medicine for all of us who pay, and makes it challenging for those without health insurance to pay for hospital services.
Some people contend that the U.S. needs to create a federalized health care program in the mould of Canada and Europe. I for one am not convinced that this would solve the problem, and you can check out posts I've written on my other blog regarding Federalized Health care and decide for yourself (and feel completely free to disagree with me, but be nice if you decide to leave a comment.)

A good discussion on this topic in the arena of ideas is something that is much needed, and with the coming presidential elections, all options should be on the table. The only way to solve a problem this big is via debate, regardless of how hard this might be.

Still, $40 for a sat check is quite ridiculous. At our hospital doctors get paid $40 for just reading an EKG. I calculated once that if one doctor read all the EKG in a year, he would make $40,000 a year. And that was ten years ago.

Yet, 40 years ago people could simply walk into a hospital and pay cash for services rendered.
(Here is a doctor's perspective on the high cost of medicine, and an RT from Canada.)


Beverly said...

Thanks for stopping by my blog. You have lots to talk about! I have MG as you read in that post. After I had a thymectomy in 1991, I went home and began to have symptoms that I had never had before. I ended back up in the hospital and the next morning crashed. (I was so glad I was back there.) The RT's were wonderful.

I was intubated for a week, and when I got back up to the floor from ICU, the young woman who had squeezed the bag while I was wheeled down to ICU told me that she had just graduated three weeks earlier and wondered what she would do in an emergency. I thanked her and told her she did just fine.

Do you work with patients with CF? My little granddaughter who is 18 months old has it. So far she is very well, thankfully, but I know the day will come...

Freadom said...

Occasionally we have a CF patient in our little hospital, but not very often.

Asthmagirl said...

I don't know the answer to the current healthcare insurance system but I'm not in a huge rush to join Canada. While the costs may be managed the care is less than optimal. My asthmatic friends indicate they must wait 3 months or more for a chest ct whereas I can get one the next day. Even though my meds would be cheaper, I cannot imagine those kinds of waits for additional tests are considered productive in treating any chronic (or not) disease.

icanseeclearlynow said...

freadom, you make some excellent points about the high cost of healthcare. i also think that wherever millions of dollars are at stake, things are not likely to change. especially if the change is to benefit the larger and less economically fortunate.



Djanvk said...

Thanks for citing my posting, I've enjoyed the discussion this has started. Keep up the good work

Amy said...

"Likewise, why would doctors continue to order Nebulizers when they aren't indicated, when studies show that a correctly used MDI with spacer works just as well as a nebulizer, and most patients can do the MDI on their own for free, minus the initial education and cost of the inhaler."

Yes, yes, YES. Do you know, when my kid was diagnosed and we were given an nebulizer, the drs. basically told me she *couldn't* use an inhaler because she was too young? (age 2) It took a Canadian parent--where, apparently, drs. do NOT prescribe nebulizers in lieu of inhalers for home use--on a messageboard to tell me about spacers and inhalers for little kids.

Only when I made an absolute nuisance of myself did anyone let her try it. Is it any wonder healthcare costs are so high when parents have to fight for the CHEAPER alternative? Grrrrrr. This is a huge pet peeve, if you can't tell.

Freadom said...

Since I've been doing my research on aerosol protocols in an attempt to get one enacted here at Shoreline, I've learned that many larger hospitals recommend RTs use an MDI before an aerosol, especially in the emergency room setting. Since cost is a major selling point with the admins here, perhaps we could use this as a selling point. Using MDIs, you'd think, would be a major cost savings for any hospital.