Monday, December 03, 2012
The Storm of Reform
The consolidation of the professional and institutional
components of health care (notably physicians and hospitals) is an essential
but very difficult part of health care reform.
There is not much hope for significant improvement in both quality and
efficiency so long as the system lacks accountability due to their separation.
But bringing them together raises new issues.
Throughout history, the medical profession has been the
dominant force in the provision of health care.
Hospitals were often referred to colloquially as doctors’ workshops. In later years, that relationship has begun
to change, with more and more doctors selling their practices to hospitals and
becoming hospital employees. According
to the news article referenced below, only about 39 per cent of U.S. doctors
are currently in independent practice, down from 57 per cent in 2000. The executive head of the American Hospital
Association has been heard to say that the number of doctors employed by the
hospitals he represents is greater than the membership of the American Medical
Association.
A front page article in the December 1 issue of the New York
Times deals with the matter. Titled “A
Hospital War Reflects a Bind for U.S.
Doctors,” the story is about the competitive situation in Boise ,
Idaho where together, the two largest
hospitals now employ about half the doctors in southwest Idaho .
According to the story, the doctors now complain that the hospitals
“have too much power over every aspect of the medical pipeline, dictating which
tests and procedures to perform, how much to charge and what patients to
admit.”
In addition, the government anti-trust people are getting
interested in the situation. The
authority granted to doctors to order tests and treatments has economic
consequences for the providers of those services and for the cost of health care. Historically, doctors and hospitals were
separate business entities, presumably operating at arm’s length. Now that they are together, the question is
whether they are colluding to increase the amount of service provided, thereby
driving up the cost of care.
So unifying the system is not such a simple thing after all
and some stormy times can be expected along the way.