Opinion: The Peril Of Cost-cutting Health Care Programs

<b></b>Copyright 2009 San Jose Mercury NewsAll Rights Reserved <span id="x_hitDiv1"> <b>San</b> <span id="x_hitDiv1"><b>Jose</b> <span id="x_hitDiv1"><b>Mercury</b> News (California) <br> <br> <b></b><span id="x_hitDiv2"><b>August</b> 6, 2009 Thursday <br> <br> <b>SECTION: </b>NEWS; Opinion <br> <br> <b>LENGTH: </b>658 words <br> <br> <br> <b>HEADLINE: </b>Opinion: The peril of cost-cutting health care programs<br> <br> <b>BYLINE: </b>By Dr. Sidney Marchasin Special to the Mercury News <br> <br> <p></p> In the not too distant past, doctors viewed patients from the perspective of scientists and humanists. The issue of quality health care eclipsed that of cost. <p></p> Those of us who began their medical careers in the halcyon days of the 1960s confronted environments that are almost unrecognizable today. Financial pressures were largely unknown. But the buzz words today are "cost containment.'' <p></p> As early as 1983, Congress deplored the precipitous increase in Medicare expenditures and enacted a "prospective payment system.'' That legislation changed the way Medicare reimbursed hospitals for the care of senior citizens. Before 1983, a hospital submitted an itemized bill to the government for services rendered to a senior citizen; the government in turn issued a check to the hospital covering a substantial portion of those expenditures no questions asked. <p></p> But under the prospective payment system, the government pays a hospital an amount it deems is appropriate for the care of a Medicare recipient. Payment size is determined by a patient's discharge diagnosis, not the services rendered during the hospitalization nor the patient's length of stay. An institution that spends more than the government allots eats the loss. <p></p> The system that once rewarded hospitals for doing too much now rewards them for doing too little. And since hospitals now get paid by the job, the patients are being pushed out in fewer days. It is a sad irony that reimbursement schemes designed to protect elderly patients from soaring medical costs may deprive some patients of the potential benefits of longer hospital stays and more medical care. <p></p> In considering plans for further cost containment, the government assumes that health care services are being wastefully deployed. Is there evidence to support the notion? <p></p> Dr. John Bunker of Stanford University did a study in which he compared the hysterectomy rate in a matched non-physician group. <p></p> Since many hysterectomies were deemed unnecessary, it was anticipated that the hysterectomy rate in doctors' wives would be significantly less than in the general population. But surprise! The surgical rate actually exceeded that of the non-physician group. <p></p> Some years ago Blue Cross of Northern California, at my request, studied the utilization patterns of their insured doctor groups. The study found that doctors' consumption of health care services was of the same order of magnitude as that of the general population. <p></p> Since the implementation of the prospective pricing system, many hospitals are exerting pressures on doctors to consider the broader financial interests of the institution in deciding what type and amount of medical care to deliver to hospitalized patients. <p></p> When hospitals are faced with reduced revenue because of diminishing government payments, they cut costs through reductions in staff, elimination of selected services and postponement of capital improvements. Some of these initiatives seem to have a negative impact on patient care, which in turn seems to lead to poorer outcomes for patients. <p></p> Few today would argue against an effort to control soaring medical costs. But cost is not the only issue. Access to care and the quality of care are equally important. <p></p> The superb health care system built up by years of public investment is beginning to erode. All of us have to start recognizing that we can't maintain the same level of sophistication and quality with inadequate funding. It is hoped that Congress and President Barack Obama will take the time to examine these concepts more carefully than they have to date, and that they will enact legislation that serves not only cost containment objectives but also makes sense for the consumer. DR. SIDNEY MARCHASIN of San Carlos has practiced medicine for 40 years and is serving as a physician consultant for the National Republican Congressional Committee"s Council for Responsible Reform from California. He wrote this article for the Mercury News. <br> <br> <b>GRAPHIC: </b><br> <br> <b>LOAD-DATE: </b>August 7, 2009 <br> <br> <div> <div class="x_nshr"> <center></center> <center><a href="http://www.lexis-nexis.com/lncc/about/copyrt.html" target="_new" class="x_pagelinks">Copyright © 2009 LexisNexis, a division of Reed Elsevier Inc. All Rights Reserved. </a><br> <a href="http://www.lexis-nexis.com/terms/general" target="_new" class="x_pagelinks">Terms and Conditions</a> <a href="http://www.lexis-nexis.com/terms/privacy" target="_new" class="x_pagelinks"> Privacy Policy</a> <br> </center> </div> </div> </span></span></span></span>