Modern medicine has done some pretty amazing things to improve the survival chances of babies born prematurely. This article in Business Week discusses the fact that babies born at 28 weeks gestation, once thought doomed to die, are now surviving in greater and greater numbers; babies born at 22 weeks gestation may even survive, and in the future the survivability of babies born as early as 20 weeks gestation may be a strong possibility.
Though I find that an amazing and wonderful thing, the article is discussing the costs involved:
Preemies are a quickly expanding class of patients in the U.S., Britain, and other advanced nations. And the costs and technical challenges of caring for them are a growing source of controversy. Nearly 13% of all babies in the U.S. are preemies, a 20% increase since 1990. A 2006 report by the National Academy of Sciences found that the 550,000 preemies born each year in the U.S. run up about $26 billion in annual costs, mostly related to care in NICUs. That represents about half of all the money hospitals spend on newborns. But the number, large as it is, may understate the bill. Norman J. Waitzman, a professor of economics at the University of Utah who worked on the National Academy report, says the study considered just the first five years of the preemies' lives. Factor in the cost of treating all of the possible lifelong disabilities and the years of lost productivity for the caregivers, and the real tab may top $50 billion, Waitzman says. [...]In the U.S., corporations handle most of the financial burden. Employers generally cover some or all of the hospital charges in their health plans, and they also must deal with lost work hours of staff who spend weeks, sometimes months, attending to their premature infants. Corporations pay out nearly 15 times as much for babies born prematurely in their first year of life as for full-term babies, at an average cost of about $41,000 per child. For the earliest of the preemies, who are born in fewer than 28 weeks and spend up to three months in the hospital, the tab is higher. Says Waitzman: "The million-dollar babies are there."
The article is reasonably balanced between the real-world costs of NICUs and the strong love and determination parents have for their tiny infants, and their willingness to do whatever it takes to help them survive and thrive. Still, it's always unsettling, I think, to hear human lives discussed in terms of cost/benefit ratios.
But whatever else we know about the crisis in health care, we know that these kinds of conversations are going to be heard more and more often. Who is going to decide at what point a baby is too young for us to try heroic measures to save him or her? Who is going to decide that great-grandfather is too old for a blood transfusion that might save his life? Who is going to deny care based on a too-low percentage of success, or approve it on the grounds that the patient is a good risk for a particular procedure?
When I was reading through some summaries of both Obama's and McCain's health care proposals, I noticed that details like that aren't spelled out all that clearly. The assumption is that we'll continue the "care" side of the ratio just as we have done all along, while the "insurance" side will be the only thing that has to change--though how it changes varies, of course. But can we ever get health care costs under control without some rationing of care, without some removal of these agonizing questions from those biased in favor of the patient, and to those capable of seeing someone like Ryan Cole as numbers on a balance sheet?
I hope not, though I know there's something irrational and contradictory about that hope. But what are the options? How can we achieve the kind of parity that will allow the most premature infants to survive without cutting costs somewhere else, somewhere just as vital, perhaps, for someone else? How do we decide?
Add to Del.icio.us
Add to Technorati
Add to Digg
Add to Newsvine
Add to Facebook
Add to StumbleUpon
Subscribe
Actually, I read another analysis recently that said most of the increase in premature babies in this country involved babies born close to term.
http://www.msnbc.msn.com/id/24863702/
The study found that scheduled c-sections were one of the main factors driving the increase. A number of these c-sections were being done to protect doctors from liability or lawsuit rather than for actual need. And the babies were paying the price because even a late preemie runs higher odds of needing time in the NICU or having lung complications.
So, it seems one way to get a handle on the preemie increase would be to reduce the number of c-sections. I also think induced labor has something to do with it. Other studies have indicated doctors are inducing labor for convenience (theirs or the parents). If the woman's body isn't ready and labor fails to progress in a timely manner, voila it's c-section time.
Just some other thoughts on the matter.
Andrea makes a good point about the common practice of unnecessary (and in the case of obstetrics "convenient") procedures. When medicine became all about profit instead of helping, the ethics went out the window. I've worked in medical billing and I have seen physical therapists and nurses alternately harassed and highly rewarded for doing "more" procedures. They are encouraged to skirt the line between what the insurance company will accept as "medically necessary" and what is truly necessary just to increase profits. And not only are C-sections more convenient for the doctor but they are also more profitable. Don't forget the machine that goes "ping".
Furthermore, why is the cost of healthcare so expensive? Everyone knows that for what you pay for 10 Motrin capsules in the hosptial you could buy two full packages of your own at Walgreens. It's like fast food places charging $1 for a bottle of tap water, an outrageous price for something you can get at home much cheaper. Once you're in the hospital you are at their mercy. We hear about the ethics of inflated gas prices, but what about the ethics of inflated medical prices? And where does the money go? Just like with gas it goes in the pockets of CEO's, that elite 1%. You don't see very much trickle down from there.
And I just had a natural vaginal delivery in a hospital. My midwife charges ran about $3000 before insurance, but at least that included all the pre-natal visits. Off hand I can't remember what my hospital bill was, but it was at least a couple thousand. But what I love is that my daughter's Nursery Room charge is $1300. Do you know how much time she spent in the nursery? In the forty-eight hours we were there she spent four hours at most in the nursery. $1300. Thank goodness, we have good insurance.
The problem isn't profit motive, it's a broken system. Consumers don't pay $10 for a Tylenol in Wal-Mart because they're handing over the cash. If Wal-Mart charged $10 for one pill, they'd have zero sales. In the hospital, the patient doesn't look at prices, they let the insurance handle it. Do you think the nursery could get away with charging you $1300 for four hours if it came out of your pocket? They'd be sued out of existence. Or how about $10 eye glasses. If you just have a $10 co-pay, will you dicker over the price? Or do you get whatever you want, regardless of cost?
Hospitals also don't have rational pricing, if they even have pricing. In some cases they just make numbers up. Others use Medicare as a guideline, which is decided by bureaucrats, not the market. About 50% of spending is by Medicare, but many insurance companies use it. Our healthcare system is not far removed from Soviet style central planning. Now you can understand how they collapsed.
Don't forget that everyone's cost is someone's revenue. And it's not the hospital CEOs who collect most of the $700,000,000,000 spent on hospitals--there are fewer than 5,000 hospital CEOs in America. And it's not health plan CEOs either--fewer than 1,000 of those. It's the men and women who work in the hospitals who account for the majority of the money--and, in the state of Pennsylvania, nerly 25% of hospitals lost money in 2007.
And of course the >$450,000,000,000 spend on physician and clinical services goes to the ~900,000 physicians (and their nurses and assistants and overhead) in America. While the average physician earns much more than the average American, the median physician salary (all types) with about 10 years of experience is less than $160,000.
Finally I do agree, to some extent, with Other Jim that "pricing" is not rational in the way it is in the retail market. Frankly, a hospital doesn't care where it gets its money from as long as at the end of the year they aren't broke. That is, the amount received for any one service (preemies, heart attacks, etc) may be more or less than it really costs them--but if it's more, then it's subsidizing some other service for which they're receiving less than it costs them. You can't look at a unit price ($10 Motrin) and expect it to mean a lot all by itself.
I would disagree that "our system is not far removed from Soviet-style central planning". In the first place, at least we have potatotes. In the second place, if only someone were trying to plan. Rather, it's a service which is pretending to exist in a market economny without any of the characteristics of a market. As I intimated above (i'm the anonymous poster from 7:03 last night), we could get rid of 30-40% of cost which is wasted because no good outcome results due to services rendered and paid for. Which includes those antibiotics you take when you have a viral cold.
"we could get rid of 30-40% of cost which is wasted because no good outcome results due to services rendered and paid for. Which includes those antibiotics you take when you have a viral cold."
Right. My godson, age 3 at the time, was once scheduled for an ear operation. The day he was supposed to be brought into the hospital, his mother called the doctor and told him the baby had a cold and was running a fever, and should the surgery maybe be rescheduled? The doctor said no, bring him in anyway. To make a very long story somewhat shorter, after spending an entire night in the hospital having his upper respiratory tract further irritated by the very dry air there, the kid was sent home because they couldn't operate because he had a cold. His mother wrote the insurance company asking them not to pay the cost of the night at the hospital, since it could perfectly well have been avoided if the doctor had paid attention to her in the first place, and furthermore it left the kid WORSE off than before. The insurance company wrote back that this was a legitimate expense and they had to pay it.
Some years later, I had my law students research the issue, and they ascertained that, yes indeed, in the State of Illinois, the insurance company really does have to pay a bill incurred under those circumstances. However, apparently, Medicare is now cracking down on some of these cases, which is moderately encouraging.
Post a Comment
By submitting these comments, I agree to the beliefnet.com terms of service, rules of conduct and privacy policy (the "agreements"). I understand and agree that any content I post is licensed to beliefnet.com and may be used by beliefnet.com in accordance with the agreements.