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>patient preference As a patient, I'm always suspicious when I see this. When I'm in a bad enough shape to go to the hospital, going home is not my priority, g

by xaldir 9y ago

>patient preference As a patient, I'm always suspicious when I see this. When I'm in a bad enough shape to go to the hospital, going home is not my priority, getting better is. As someone who also work in an hospital, pushing patients out as quickly as possible has more to do with financial objectives than anything else. (e.g. we were told that our hospital should have 25% less beds by 2020)

kingkongjaffa 9y ago
how and why would you plan to have less beds in the future? Is that backed by population growth and average hospital utilisation per person or some other metric?
- frobozz 9y ago
  If you can do more outpatient work, you can reduce the bed count, the cost of having a patient taking up a bed in a hospital is very high, even if they are as close to perfect health as possible and are just waiting to be discharged. This is money that could employ another doctor or buy another piece of health-giving equipment. The sooner you can kick a patient out of hospital, the sooner they become someone else's problem, coming out of someone else's budget. In a publicly-funded system, the local authority may pay for in-home care visits and the patient's GP may be responsible for post-hospital outcomes. Stupid PFI deals can mean that the cost-per-bed is ludicrous, and that money that could be going towards patient care is being funnelled to failing companies like Carillion. In an insurance-funded system, the relationship between costs and fees comes down to negotiation between the hospitals and the insurance companies, rather than from the hospital simply coming up with the fees and the insurance companies paying them. This may mean that the income per-bed-per-night is less than it costs, whilst the income per procedure is higher than it costs. Even if the hospital is still responsible for post-discharge care, they may be able to make more profit out of expensive home visits by low-paid carers than in-ward rounds by higher-paid nurses.
fifteenforty 9y ago
>> patient preference > As a patient, I'm always suspicious when I see this. There are many practices in medicine that exist only because of patient perference and despite their harm. I think this is because of ongoing poor health education amongst the general public, physicians who are worn out and choose their battles and that private health care systems (at least in Aus) reward practitioners who get good feedback from patients better than those who have the best health outcomes.
- Bartweiss 9y ago
  In general this is true, but I would guess it's least true in hospitals? They have a lot of throughput and are generally over-burdened, so 'driving away' patients isn't much of a risk. Beyond that, a lot of their patients are there because it's the nearest hospital and aren't actually choosing where to go. At least anecdotally, my impression is that PCPs and clinics worry about satisfying patient demands (e.g. antibiotics for colds) to maintain revenue, while hospitals mostly worry about how to get more patients who can pay and fewer who can't.
apatters 9y ago
In Thailand, where medical care is both cheap and good, most of it takes place in hospitals. You can still find clinics, but people usually go to a full-blown hospital when they have health-related issues. Inpatient treatment is much more common here than in the US, in fact from my American perspective it sometimes feels like they overtreat (lots of tests, prescriptions, IVs, and overnight stays for minor ailments). I would have thought that treatment at a hospital would generally be better--they're larger than clinics, they have more equipment and more specialists. Though I wouldn't be surprised if clinics had certain advantages like a more personal relationship with your doctor. All this is to say that in a market where health care is both cheap and good, hospitals aren't going away and people are spending more time in them. I wouldn't be surprised if the decline of hospitals in the US was about costs like you say.
- xamuel 9y ago
  Most simple things can be dealt with at a clinic in less time (in-the-door to out-the-door) than you'd spend merely filling out the initial hospital paperwork.
  - deleted 9y ago
    [deleted]
- OhDagny 9y ago
  Yes, why would centralization not be good for efficient delivery of healthcare services, particularly where multidisciplinary treatment is involved? It's basically why the cancer centers were set up.
cperciva 9y ago
When I'm in a bad enough shape to go to the hospital, going home is not my priority, getting better is. I'm not saying that patients want to go home before they're ready to be discharged. But for non-emergency procedures, patients will almost always opt for a minimally-invasive surgery which allows them to go home sooner rather than a more invasive surgery even if the minimally-invasive surgery is less effective.

by xaldir 9y ago

kingkongjaffa 9y ago

how and why would you plan to have less beds in the future? Is that backed by population growth and average hospital utilisation per person or some other metric?

frobozz 9y ago
If you can do more outpatient work, you can reduce the bed count, the cost of having a patient taking up a bed in a hospital is very high, even if they are as close to perfect health as possible and are just waiting to be discharged. This is money that could employ another doctor or buy another piece of health-giving equipment. The sooner you can kick a patient out of hospital, the sooner they become someone else's problem, coming out of someone else's budget. In a publicly-funded system, the local authority may pay for in-home care visits and the patient's GP may be responsible for post-hospital outcomes. Stupid PFI deals can mean that the cost-per-bed is ludicrous, and that money that could be going towards patient care is being funnelled to failing companies like Carillion. In an insurance-funded system, the relationship between costs and fees comes down to negotiation between the hospitals and the insurance companies, rather than from the hospital simply coming up with the fees and the insurance companies paying them. This may mean that the income per-bed-per-night is less than it costs, whilst the income per procedure is higher than it costs. Even if the hospital is still responsible for post-discharge care, they may be able to make more profit out of expensive home visits by low-paid carers than in-ward rounds by higher-paid nurses.

fifteenforty 9y ago

>> patient preference > As a patient, I'm always suspicious when I see this. There are many practices in medicine that exist only because of patient perference and despite their harm. I think this is because of ongoing poor health education amongst the general public, physicians who are worn out and choose their battles and that private health care systems (at least in Aus) reward practitioners who get good feedback from patients better than those who have the best health outcomes.

Bartweiss 9y ago
In general this is true, but I would guess it's least true in hospitals? They have a lot of throughput and are generally over-burdened, so 'driving away' patients isn't much of a risk. Beyond that, a lot of their patients are there because it's the nearest hospital and aren't actually choosing where to go. At least anecdotally, my impression is that PCPs and clinics worry about satisfying patient demands (e.g. antibiotics for colds) to maintain revenue, while hospitals mostly worry about how to get more patients who can pay and fewer who can't.

apatters 9y ago

In Thailand, where medical care is both cheap and good, most of it takes place in hospitals. You can still find clinics, but people usually go to a full-blown hospital when they have health-related issues. Inpatient treatment is much more common here than in the US, in fact from my American perspective it sometimes feels like they overtreat (lots of tests, prescriptions, IVs, and overnight stays for minor ailments). I would have thought that treatment at a hospital would generally be better--they're larger than clinics, they have more equipment and more specialists. Though I wouldn't be surprised if clinics had certain advantages like a more personal relationship with your doctor. All this is to say that in a market where health care is both cheap and good, hospitals aren't going away and people are spending more time in them. I wouldn't be surprised if the decline of hospitals in the US was about costs like you say.

xamuel 9y ago
Most simple things can be dealt with at a clinic in less time (in-the-door to out-the-door) than you'd spend merely filling out the initial hospital paperwork.
- deleted 9y ago
  [deleted]
OhDagny 9y ago
Yes, why would centralization not be good for efficient delivery of healthcare services, particularly where multidisciplinary treatment is involved? It's basically why the cancer centers were set up.

cperciva 9y ago

When I'm in a bad enough shape to go to the hospital, going home is not my priority, getting better is. I'm not saying that patients want to go home before they're ready to be discharged. But for non-emergency procedures, patients will almost always opt for a minimally-invasive surgery which allows them to go home sooner rather than a more invasive surgery even if the minimally-invasive surgery is less effective.