Waves of suffering: the flip side

Today’s Boston Globe features Waves of suffering; Patients struggle on without surgery; hospitals feel pinch about the impact of the depression on health care. The story features a number of individuals who seem to need surgery, but can’t afford it:

Judi Campbell inches along at work with the help of a walker. Degenerative arthritis has ruined her hip and ravaged much of her body, so she takes prescription painkillers every four hours to cope.

“I cannot walk. I cannot live,” she said. “I am in such pain. And I feel guilty about what I’m putting my husband through. If I have to get out of bed, I need his help.”

Hip replacement surgery, however, will have to wait. Campbell, 62, already owes a Northampton hospital $1,000 for medical expenses not covered by her insurance – two $500 copayments for arthritis-related surgeries in 2007. She doesn’t want to add to her debt, especially since the status of her secretarial job at a nonprofit organization is uncertain.

The story provides other, similar examples, and discusses the impact on health care providers.

And as more people forgo treatment, hospitals are suffering financially, industry specialists say. Their profits depend heavily on lucrative surgical procedures paid for by private insurers…

To compensate, hospitals are cutting jobs, and canceling or postponing expansion projects. Nursing jobs, once abundant, for the first time in a decade are in short supply.

The author has a point and clearly a number of patients and hospitals are suffering. However, there is another side of the coin.

Overtreatment is one of the major reasons why health care costs are so out of control in the US. A lot of surgeries aren’t needed and one reason people sign up for them is that their out of pocket cost is relatively low. Also, with fewer people seeking surgery, waiting lists are shorter so people who do have surgery can have it done sooner. And finally lower revenues to hospitals equate to lowers costs for payers, which may help blunt the rise of premiums.

Of course the depression is a blunt instrument for reducing waste in health care spending and I feel for those who need care and can’t afford it. But in aggregate it’s not necessarily a bad thing that fewer surgeries are taking place.

May 4, 2009

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