Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, December 12, 1994 TAG: 9412140014
SECTION: EDITORIAL PAGE: A10 EDITION: METRO
SOURCE: ROBERT F. ROTH
DATELINE: LENGTH: Medium
In the name of cost containment, an admirable concept, the health-insurance industry - in lock step with managed care - has unleashed the tyranny of the bottom line. To deliver this concept, to "cut the fat,'' slashing is getting down to the muscles, converting the finest medical services the world has ever known into a declining colony of hobbled dinosaurs.
Hospitals, spawned in communities across America by the Hill-Burton Act a half-century ago, are an endangered species moving rapidly toward limbo, if not extinction. A decade ago, there were 7,000 certified hospitals. Now the number is just under 5,000, and they're half-empty! By the year 2000, we hope the shrinkage will cease at 2,500 full-service institutions and, again, they may be half-empty.
What will replace them? You got it: a place called "home.'' Home care is now, and will become more so, the place for more than 90 percent of medical services. If ill, be prepared to do your own nursing for 23 hours out of 24 hours in your day. If a catastrophic need arises, requiring immediate professional intervention such as was available in the hospitals of 1990, forget it! That's how your fate-cookie crumbles.
You cannot be hospitalized under the premise of what might happen, until it happens; what might ensue, until it ensues. As for a lab test, X-ray, MRI, EKG, etc., if the result is "normal" . . . it should not have been ordered and done because it obviously was unnecessary. Failure-to-diagnose malpractice suits will abound. Pity the poor doctor caught between patient and payment source, strangled by purse strings.
Let's get used to it. When ill, you (we) will hear (no matter what the home situation), "You're not sick enough to be in the hospital;'' and after you've moved over that razor's edge called "admittable,'' you'll be greeted with a stonewall statement: "Admission will accomplish little or nothing; you're a do-not-resuscitate patient."
Where to point the finger? Point it at you and me, John and Mary Q. Public. We're all part of the din to control cost. We demand it, we want it, we need it. The question is: how to cut high administrative costs, including health-insurance executive salaries in the $200,000 to $750,000 range; control malpractice tort costs in the billions; curb health-maintenance-organization profits that are soaring 20 percent to 50 percent per year by sharply limiting medical services; reduce government regulations that send costs spiraling - yet not cut the muscle, i.e. quality.
Even if cost-cutting is limited to these areas of obvious fat, hospital care, as intensive as it is, will be expensive. There's no free lunch. Be prepared for more consequences as the next few years roll by, including rationing of services by quotas, as well as time limits on consultations, treatments, operations, hospital stays and follow-up care.
A cynic could boast: We can all take comfort in knowing that we have nothing to fear as long as we're not the ox (patient) being gored by bottom-line incentives in health-care delivery.
Robert F. Roth is a physician at Lewis-Gale Clinic in Salem.
by CNB