Dr. Tom Roberts - July 08, 2005
Two hospitals, one town
It didn’t make the front page, but the latest news on the local health care front should make all of us shiver, not with anticipation, but with dread. If any of you out there are still clinging to the belief that we have a rational health care system, and that everything will work out OK, then I’m sorry to tarnish those thoughts. But really, I’m sorry because the system is not rational, and it looks like everything is not going to be OK.
The latest news is that our two hospitals here in Missoula, after a long process, have agreed that they will not cooperate with each other. They’ve done this in a rather friendly way. Handshakes, first names, smiles, straightforward. We’ll try to eat your lunch, and you can try and eat ours. No hard feelings, just business. After all, it’s the way we do things in medicine, and in business in general these days. No big deal I suppose, which is why it never made it to the front page. Except that it is a big deal and the effects of this agreement, or disagreement, whatever we want to call it, are going to be felt by everyone living in Western Montana.
What this means is that unless one of the two hospitals fail, we’re going to see the development of two completely independent medical systems in our little town. Before long you’ll be able to have your baby at either hospital, not to mention an independent birthing center. You’ll be able to have your heart problems not only diagnosed, but also your heart surgery, at either hospital. You can have a helicopter ride to either hospital, in their very own helicopter. I suspect that pretty soon you’ll be able to take your children for whatever care they need and get inpatient rehab on either side of town. If it’s fancy and can generate dollars to the bottom line I predict there will be two of them, at least, in town.
This should make you shiver for at least two reasons. Medical care will cost more, and it will be worse. Having two or three birthing centers means that you, the health care consumers, have to pay to build, staff, and operate each of these. Although the care may well be adequate in all of the centers, the actual experience of the people who work in them, not to mention the doctors traveling back and forth, will be diluted and less expert. This is clearly true in the case of open heart surgery where having an adequate number of cases is closely related to patient outcomes. Splitting the existing caseload of heart surgeries between two centers is practically guaranteed to lower overall quality, not to mention doubling the expense by running two similar programs. I believe the same can be said for many other health care components, including for example helicopter and newborn care. Two of these cost nearly twice as much, while at the same time diluting the experience and expertise of the care providers.
It’s of course too early to know the outcome of this agreement to compete rather than to cooperate. It could very well turn out that each hospital system is able to generate more business and put more profit to the bottom line. This profit could then be used to expand services to less profitable areas or to expand into new areas that might also generate profit. In fact, this kind of competition does make sense in the business world where our health care system operates. That’s why it’s happening.
This process should serve as a good example of why competition does not work in health care. The system is not designed to provide the best care at the lowest price. In fact, we can see that it does just the opposite. In fairness to our hospitals, I should emphasize that this type of competition is the norm in all aspects of health care, not just here, and not just with hospitals.
The implications are profound and unsettling. Health care costs will continue to rise. As this happens of course, less of us will be able to afford the price. The number of people without health insurance and adequate access to health care will continue to rise. Having more people providing the same expensive services will result in more expensive services being provided. This does not improve overall health care outcomes and probably does the opposite. Quality of care is not and will not be a significant factor in health care organization or delivery. The bottom line will continue to be what matters. Important and even basic health care services that don’t turn a profit will continue to decline in availability.
Despite the best efforts of many people locally these changes could not be avoided. Until there is a fundamental shift in national policy on health care, we can expect more of the same.
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