14 ms·

The human impact of having too few nurses

112 points by EndXA 7y ago

Proven 7y ago
There's never too few nurses, there's only not enough money to pay for "enough" nurses
EndXA 7y ago
You can find the original study here (open access): https://qualitysafety.bmj.com/node/156220.full https://qualitysafety.bmj.com/node/156220.full Abstract: Background- Existing evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered nurses (RNs). However, no previous studies have described the relationship between nurse staffing and staff–patient interactions. Setting- Six wards at two English National Health Service hospitals. Methods- We observed 238 hours of care (n=270 patients). Staff–patient interactions were rated using the Quality of Interactions Schedule. RN, healthcare assistant (HCA) and patient numbers were used to calculate patient-to-staff ratios. Multilevel regression models explored the association between staffing levels, skill mix and the chance of an interaction being rated as ‘negative’ quality, rate at which patients experienced interactions and total amount of time patients spent interacting with staff per observed hour. Results- 10% of the 3076 observed interactions were rated as negative. The odds of a negative interaction increased significantly as the number of patients per RN increased (p=0.035, OR of 2.82 for ≥8 patients/RN compared with >6 to <8 patients/RN). A similar pattern was observed for HCA staffing but the relationship was not significant (p=0.056). When RN staffing was low, the odds of a negative interaction increased with higher HCA staffing. Rate of interactions per patient hour, but not total amount of interaction time, was related to RN and HCA staffing levels. Conclusion- Low RN staffing levels are associated with changes in quality and quantity of staff–patient interactions. When RN staffing is low, increases in assistant staff levels are not associated with improved quality of staff–patient interactions. Beneficial effects from adding assistant staff are likely to be dependent on having sufficient RNs to supervise, limiting the scope for substitution.
dash2 7y ago
At least give me a diff-in-diff, guys. To be fair, they acknowledge their limitations and the fact that they can't make a causal interpretation. (Bad hospitals -> nurses leave?) But why the hell design the study this way?
- mft_ 7y ago
  How would you design it otherwise? An interventional study would presumably be ideal, but probably impossible to achieve.
mft_ 7y ago
Interesting; on the one hand, one could dismiss this as an 'in other news, water is wet'-type of study, but such evidence is probably very helpful in the overall debate around healthcare funding. Another factor not mentioned here but which might be relevant, is that as long as nursing is undervalued (particularly economically, but in less tangible ways too) to the extent that the system is short of nurses, it is unlikely that employers would able to choose pick and choose better nurses from those available, and/or remove bad ones. It seems obvious from an organisational perspective that nurse > no nurse, but there's a direct link (in my experience) between the quality of care patients receive, and the attitude/experience/quality of the individual nursing staff.
- tomatocracy 7y ago
  One lesson might well be that the relative pay gap between senior nurses and senior doctors is too big - i.e. senior doctors should be paid less / we should employ fewer doctors and more nurses. But that's probably a very very hard thing to actually do politically both in terms of internal hospital/NHS politics and national politics. There are strongly entrenched interests in the NHS which I suspect constrain relative pay between professions and grades much more tightly than they constrain absolute pay numbers.
  - mjevans 7y ago
    Probably a better approach would be less pay for better quality of life jobs* which would still require more doctors and slightly more overall pay. Also a lot more nurses; since with the baby boomer generation in and entering retirement the need isn't going to go down relative to historic levels. * Edit: By better quality of life I mean things like having a 4 x 8 hour shifts with each having about 2 hours of overlap for review of records, passing down, and filling out post shift paperwork. Yes nurses would need similar shifts, the overlap also gives time for the transfer of knowledge, in the process of getting it entered/updated in the health record systems.
    - tracker1 7y ago
      A lot of nurses already work 3x13 or 4x10-12 shifts, many also work secondary nurse staffing (temp/onsite) jobs beyond their regular work. The work is definitely under valued, and there is some range in pay, but the top caps out relatively low for the knowledge and experience. Some locations don't allow nurses to unionize or strike. In AZ, for example, there's an inverse-union all the hospitals joined that member providers for staffing have to comply with contracted rates, etc. Which I don't know why it doesn't go afoul of the right to work laws here, I don't know (probably lack of prosecution). In the end, it varies a lot and at some point there will definitely be more collective negotiation going on. Pay will have to go up in a lot of locations.
chvid 7y ago
The UK has free public health care but maybe introducing a price for a doctors or hospital visit would help lessen this problem? One could introduce a fee of say 20 pound pr. visit. Something that is low enough that anyone in UK could pay it but also high enough to remind people that what they are consuming is finite resource.
- pbhjpbhj 7y ago
  >Something that is low enough that anyone in UK could pay it // The problem is with such things that they're regressive taxes. Rich people can still afford to go to the doctors when they have a sniffle but poor people will re-consider even when they have a life-threatening illness because £20 is a months food bills for the poor person.
  - dragonwriter 7y ago
    You could have income-dependent copayments to mitigate the regressive nature of this, but you are still stuck with the fact that you are incentivizing delaying care without urgency, which is mostly routine and preventive care, which does save money (IIRC, in total as well as just on that care) but also has an adverse impact on health outcomes.
    - markdown 7y ago
      > copayments What's a copayment?
      - dragonwriter 7y ago
        A required payment by a recipient of insurance-covered service of part of the cost of service, like the fixed £20 per doctor visit suggested upthread.
        markdown 7y ago
        Thanks
esotericn 7y ago
It beggars belief that such a topic is even up for debate. We're at such a state of technological advancement now in a place like the UK that we're essentially post scarcity. We need very few people any more to provide the basic building blocks of life. In such a scenario, what we should be doing is taking advantage of that fact to distribute labour more appropriately - more hospital work, more social work, more housing, etcetera. Instead what we have is seemingly some sort of race to put half the population on retail/delivery/general grunt work to please the whims of the other half, who don't actually end up happy because they're working their arse off and generally stressed by the lack of 'life infrastructure' as well. How has this gone so wrong?
- squish78 7y ago
  "How has this gone so wrong?" Hindsight? Care to take a crack at the complex socioeconomic issues that will exist in 50 years arising from technology, infrastructure and social dynamics that haven't been invented yet?
  - jressey 7y ago
    I'm reading Middlemarch, a well-regarded novel about life in 1820s-30s England. What has stood out is how things are basically no different than they are now. This is not a technology or advancement issue, it is about our society's values. One of the characters, the rich banker, is described over and over as being able to justify in himself that he disagrees with. That is being a human, that is the source of these types of challenges. "I want it because... I want it, and if I have the means then why wouldn't I take it?"
    - squish78 7y ago
      I agree with you that greed is an intrinsic human trait and bankers are always a great literary punching bag, but it doesn't address the OP's comment on how to predict job market trends 50 years away
      - esotericn 7y ago
JJMcJ 7y ago
What happens with Brexit, with all the health care workers from the Continent? Do they have to go home? Special rules to allow them to stay?
scotty79 7y ago
In Poland by the end of 2020 half of the nurses will be eligible to retire. Not to mention that Poland already has low number of nurses for its population. If you want to study how bad it can be keep an eye on Poland.
purplezooey 7y ago
Too few nurses and too many share buybacks.
rayiner 7y ago
Nurses in the UK are relatively poorly paid: https://nursingnotes.co.uk/agenda-for-change-pay-scales-2019-2020 https://nursingnotes.co.uk/agenda-for-change-pay-scales-2019.... They start at Band 5, which is about 24,000 pounds annually. That’s about $30,000 per year for a job that requires a three-year university education. (Somewhere between an ADN and BSN in the US.) London gets a 20% or so bump, so let’s say $36,000. A VA nurse in NYC starts at more than double that, over $78,000: https://www.va.gov/OHRM/Pay/2019/LPS/NY.xls https://www.va.gov/OHRM/Pay/2019/LPS/NY.xls.
- eterm 7y ago
  It's too crude to compare salaries like that. That said, it's true that nursing is relatively under-paid in the UK. Part of that however is because the state is the largest employer of nurses which keeps wages down but that in turn keeps the cost of healthcare down. When your state only provides a minority of nursing then it has to pay higher wages to compete with the profit-driven sector. But it's crude to say "Nurses make less than half than in the US", because so do software developers, but no-one's saying "think of the devs!".
  - tptacek 7y ago
    Why is it too crude to compare those salaries? The gulf between 30k and 78k is enormous. The UK nurse certainly isn't making up all, or even most, of that difference in government benefits.
    - magduf 7y ago
      Are the costs of living comparable between those two locations? NYC is one of the highest-CoL places in the USA, if not the world.
      - rayiner 7y ago
        Isn't London one of the other most expensive cities in the world? Anyway, both scales have a locality bump. If you're in Baltimore, the VA scale goes down to $60,000 starting. But outside London, the NHS scale starts at $30,000.
jimbob45 7y ago
There is no shortage, my gf just finished nursing school and can't find a job and many of her peers are in the same boat. Hospitals don't want to hire nurses because it loses them money. They only care about staying at the federally-mandated minimum staffing ratio, which they can skirt by only staffing adequate numbers when the oversight agencies come around. Seems like this is happening in every industry - CS appears to not want to hire either unless they absolutely are forced to fill a void. They'd rather just have one person do the work of two people since that person won't be able to find a job elsewhere anyway.
- phpnode 7y ago
  This article is about the UK where the NHS has been chronically underfunded for the last decade.
  - isostatic 7y ago
    The NHS has been chronically underfunded for 40 years. In 2007, before the crash, after 10 years of New Labour, the U.S. spent 15% of its GDP on healthcare. German 10%, the Netherlands 9%. The UK spent 7.4%. In fact it's over the last 10 years that the UK has begun to catch up with the rest of Europe. http://imgur.com/mUI9oWil.png http://imgur.com/mUI9oWil.png
    - barry-cotter 7y ago
      Life Expectancy at Birth Netherlands 81.6 U.K. 81.2 Germany 81.1 USA 78.6 https://data.oecd.org/healthstat/life-expectancy-at-birth.htm https://data.oecd.org/healthstat/life-expectancy-at-birth.ht...
      - isostatic 7y ago
        Which just goes to show how superior the NHS is. It’s still underfunded though.
- DanBC 7y ago
  Nurses are on the Shortage Occupation List so the UK government (the one with the hostile environment for immigration) wants immigrant nurses. https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-k-shortage-occupation-list https://www.gov.uk/guidance/immigration-rules/immigration-ru...
carapace 7y ago
So obviously this comes down to cost. > in the aftermath of austerity and with not enough staff to go round Pay more, get more nurses. Or you can trade-off nurses for less-good health care. - - - - Just to show an "existence proof" of an alternate universe, there are two totally free hospitals in India. They have no billing desk because they do not bill. So how is it funded? The people who work there and who support them financially believe that they are literally working for God. It is as if a Christian was volunteering to work at hospitals established by Jesus. https://en.wikipedia.org/wiki/Sri_Sathya_Sai_Super_Speciality_Hospital https://en.wikipedia.org/wiki/Sri_Sathya_Sai_Super_Specialit... > The Sri Sathya Sai Institutes of Higher Medical Sciences also popularly known as Super Specialty Hospitals are tertiary health care hospitals established by Sri Sathya Sai Baba to provide patient care facilities to all irrespective of caste, class, creed, gender, religion or nationality totally free of charge.
- markdown 7y ago
  > So how is it funded? Actually it's funded by the billions of dollars donated to his charitable trust. > Just to show an "existence proof" of an alternate universe, there are two totally free hospitals in India. They have no billing desk because they do not bill. That's not an alt universe, that's just free healthcare, just like in the UK, Fiji, New Zealand, and numerous other nations.
  - carapace 7y ago
    I'm not sure what point you're making, and I don't want to be disagreeable, but I would point out that those nations' healthcare systems are paid for by taxes, not charitable donations. To me it seems impressive and wonderful that people have been inspired to contribute billions of dollars to support health care and clean drinking water and other charitable good works.
anbop 7y ago
Obviously? It’s like saying “reducing the number of hole diggers on your staff reduces the number of holes they dug.” Almost all care in hospitals is provided by nurses, doctors function like high level executives who drop in for a few minutes every day to look at the dashboards.
stupidcar 7y ago
Better pay and recruitment might help move the needle on the number of nurses in the short to medium term, but long term, the demographic time-bomb in western countries means they will never have enough nurses to care for their entire aged population in the manner they do now. So either a lot of people are going to get sick and die without anybody to care for them, or, one way or another, nursing and healthcare is going to have to change to become more efficient. That will mean it becomes a lot more impersonal, with much greater use of mechanisation, automation and robotics. I don't see this as being entirely a bad thing. While nurses and other caregivers can be an important source of human contact for the sick and elderly, caring and being cared for by another person can be an emotionally and physically fraught and draining process. If we can build automated systems that allow baseline physical and hygienic needs to be met, even for the frailest and sickest people, I think that had to be good for the mental health of both those needing care, as it will reduce their sense of being a burden, and on the caregivers themselves, as they will be able to focus on the most important quality-of-life issues instead of being stuck on a treadmill of providing basic care.
- tracker1 7y ago
  I would assume pay rates are relatively locked in and restricted under the government health care program in the UK. Not sure if there's a general Nurses union, but much like police, they may be legally unable to unionize or strike.
tomohawk 7y ago
You can look at healthcare as a cost or as a benefit. If you look at it as a cost, you will attempt to minimize it. If you look at it as a benefit, you will attempt to maximize it. The State looks at healthcare as a cost to be minimized. The State does not get sick or need healthcare. Likewise, employers also look at healthcare as a cost to be minimized, but they do have some motivation to provide better quality insurance if they wish to attract employees. Only you, the potential patient, really care about the benefits side of healthcare, and the quality of healthcare. Health insurance has been screwed up by having the State and/or employers provide it for decades. What is required is for people to be able to purchase health insurance themselves just like they do any other kind of insurance. That would be a start anyway.

112 points by EndXA 7y ago

There's never too few nurses, there's only not enough money to pay for "enough" nurses

You can find the original study here (open access): https://qualitysafety.bmj.com/node/156220.full https://qualitysafety.bmj.com/node/156220.full Abstract: Background- Existing evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered nurses (RNs). However, no previous studies have described the relationship between nurse staffing and staff–patient interactions. Setting- Six wards at two English National Health Service hospitals. Methods- We observed 238 hours of care (n=270 patients). Staff–patient interactions were rated using the Quality of Interactions Schedule. RN, healthcare assistant (HCA) and patient numbers were used to calculate patient-to-staff ratios. Multilevel regression models explored the association between staffing levels, skill mix and the chance of an interaction being rated as ‘negative’ quality, rate at which patients experienced interactions and total amount of time patients spent interacting with staff per observed hour. Results- 10% of the 3076 observed interactions were rated as negative. The odds of a negative interaction increased significantly as the number of patients per RN increased (p=0.035, OR of 2.82 for ≥8 patients/RN compared with >6 to <8 patients/RN). A similar pattern was observed for HCA staffing but the relationship was not significant (p=0.056). When RN staffing was low, the odds of a negative interaction increased with higher HCA staffing. Rate of interactions per patient hour, but not total amount of interaction time, was related to RN and HCA staffing levels. Conclusion- Low RN staffing levels are associated with changes in quality and quantity of staff–patient interactions. When RN staffing is low, increases in assistant staff levels are not associated with improved quality of staff–patient interactions. Beneficial effects from adding assistant staff are likely to be dependent on having sufficient RNs to supervise, limiting the scope for substitution.

dash2 7y ago

At least give me a diff-in-diff, guys. To be fair, they acknowledge their limitations and the fact that they can't make a causal interpretation. (Bad hospitals -> nurses leave?) But why the hell design the study this way?

mft_ 7y ago
How would you design it otherwise? An interventional study would presumably be ideal, but probably impossible to achieve.

mft_ 7y ago

Interesting; on the one hand, one could dismiss this as an 'in other news, water is wet'-type of study, but such evidence is probably very helpful in the overall debate around healthcare funding. Another factor not mentioned here but which might be relevant, is that as long as nursing is undervalued (particularly economically, but in less tangible ways too) to the extent that the system is short of nurses, it is unlikely that employers would able to choose pick and choose better nurses from those available, and/or remove bad ones. It seems obvious from an organisational perspective that nurse > no nurse, but there's a direct link (in my experience) between the quality of care patients receive, and the attitude/experience/quality of the individual nursing staff.

tomatocracy 7y ago
One lesson might well be that the relative pay gap between senior nurses and senior doctors is too big - i.e. senior doctors should be paid less / we should employ fewer doctors and more nurses. But that's probably a very very hard thing to actually do politically both in terms of internal hospital/NHS politics and national politics. There are strongly entrenched interests in the NHS which I suspect constrain relative pay between professions and grades much more tightly than they constrain absolute pay numbers.
- mjevans 7y ago
  Probably a better approach would be less pay for better quality of life jobs* which would still require more doctors and slightly more overall pay. Also a lot more nurses; since with the baby boomer generation in and entering retirement the need isn't going to go down relative to historic levels. * Edit: By better quality of life I mean things like having a 4 x 8 hour shifts with each having about 2 hours of overlap for review of records, passing down, and filling out post shift paperwork. Yes nurses would need similar shifts, the overlap also gives time for the transfer of knowledge, in the process of getting it entered/updated in the health record systems.
  - tracker1 7y ago
    A lot of nurses already work 3x13 or 4x10-12 shifts, many also work secondary nurse staffing (temp/onsite) jobs beyond their regular work. The work is definitely under valued, and there is some range in pay, but the top caps out relatively low for the knowledge and experience. Some locations don't allow nurses to unionize or strike. In AZ, for example, there's an inverse-union all the hospitals joined that member providers for staffing have to comply with contracted rates, etc. Which I don't know why it doesn't go afoul of the right to work laws here, I don't know (probably lack of prosecution). In the end, it varies a lot and at some point there will definitely be more collective negotiation going on. Pay will have to go up in a lot of locations.

chvid 7y ago

The UK has free public health care but maybe introducing a price for a doctors or hospital visit would help lessen this problem? One could introduce a fee of say 20 pound pr. visit. Something that is low enough that anyone in UK could pay it but also high enough to remind people that what they are consuming is finite resource.

pbhjpbhj 7y ago
>Something that is low enough that anyone in UK could pay it // The problem is with such things that they're regressive taxes. Rich people can still afford to go to the doctors when they have a sniffle but poor people will re-consider even when they have a life-threatening illness because £20 is a months food bills for the poor person.
- dragonwriter 7y ago
  You could have income-dependent copayments to mitigate the regressive nature of this, but you are still stuck with the fact that you are incentivizing delaying care without urgency, which is mostly routine and preventive care, which does save money (IIRC, in total as well as just on that care) but also has an adverse impact on health outcomes.
  - markdown 7y ago
    > copayments What's a copayment?
    - dragonwriter 7y ago
      A required payment by a recipient of insurance-covered service of part of the cost of service, like the fixed £20 per doctor visit suggested upthread.
      - markdown 7y ago
        Thanks

esotericn 7y ago

It beggars belief that such a topic is even up for debate. We're at such a state of technological advancement now in a place like the UK that we're essentially post scarcity. We need very few people any more to provide the basic building blocks of life. In such a scenario, what we should be doing is taking advantage of that fact to distribute labour more appropriately - more hospital work, more social work, more housing, etcetera. Instead what we have is seemingly some sort of race to put half the population on retail/delivery/general grunt work to please the whims of the other half, who don't actually end up happy because they're working their arse off and generally stressed by the lack of 'life infrastructure' as well. How has this gone so wrong?

squish78 7y ago
"How has this gone so wrong?" Hindsight? Care to take a crack at the complex socioeconomic issues that will exist in 50 years arising from technology, infrastructure and social dynamics that haven't been invented yet?
- jressey 7y ago
  I'm reading Middlemarch, a well-regarded novel about life in 1820s-30s England. What has stood out is how things are basically no different than they are now. This is not a technology or advancement issue, it is about our society's values. One of the characters, the rich banker, is described over and over as being able to justify in himself that he disagrees with. That is being a human, that is the source of these types of challenges. "I want it because... I want it, and if I have the means then why wouldn't I take it?"
  - squish78 7y ago
    I agree with you that greed is an intrinsic human trait and bankers are always a great literary punching bag, but it doesn't address the OP's comment on how to predict job market trends 50 years away
    - esotericn 7y ago

JJMcJ 7y ago

What happens with Brexit, with all the health care workers from the Continent? Do they have to go home? Special rules to allow them to stay?

scotty79 7y ago

In Poland by the end of 2020 half of the nurses will be eligible to retire. Not to mention that Poland already has low number of nurses for its population. If you want to study how bad it can be keep an eye on Poland.

purplezooey 7y ago

Too few nurses and too many share buybacks.

rayiner 7y ago

Nurses in the UK are relatively poorly paid: https://nursingnotes.co.uk/agenda-for-change-pay-scales-2019-2020 https://nursingnotes.co.uk/agenda-for-change-pay-scales-2019.... They start at Band 5, which is about 24,000 pounds annually. That’s about $30,000 per year for a job that requires a three-year university education. (Somewhere between an ADN and BSN in the US.) London gets a 20% or so bump, so let’s say $36,000. A VA nurse in NYC starts at more than double that, over $78,000: https://www.va.gov/OHRM/Pay/2019/LPS/NY.xls https://www.va.gov/OHRM/Pay/2019/LPS/NY.xls.

eterm 7y ago
It's too crude to compare salaries like that. That said, it's true that nursing is relatively under-paid in the UK. Part of that however is because the state is the largest employer of nurses which keeps wages down but that in turn keeps the cost of healthcare down. When your state only provides a minority of nursing then it has to pay higher wages to compete with the profit-driven sector. But it's crude to say "Nurses make less than half than in the US", because so do software developers, but no-one's saying "think of the devs!".
- tptacek 7y ago
  Why is it too crude to compare those salaries? The gulf between 30k and 78k is enormous. The UK nurse certainly isn't making up all, or even most, of that difference in government benefits.
  - magduf 7y ago
    Are the costs of living comparable between those two locations? NYC is one of the highest-CoL places in the USA, if not the world.
    - rayiner 7y ago
      Isn't London one of the other most expensive cities in the world? Anyway, both scales have a locality bump. If you're in Baltimore, the VA scale goes down to $60,000 starting. But outside London, the NHS scale starts at $30,000.

jimbob45 7y ago

There is no shortage, my gf just finished nursing school and can't find a job and many of her peers are in the same boat. Hospitals don't want to hire nurses because it loses them money. They only care about staying at the federally-mandated minimum staffing ratio, which they can skirt by only staffing adequate numbers when the oversight agencies come around. Seems like this is happening in every industry - CS appears to not want to hire either unless they absolutely are forced to fill a void. They'd rather just have one person do the work of two people since that person won't be able to find a job elsewhere anyway.

phpnode 7y ago
This article is about the UK where the NHS has been chronically underfunded for the last decade.
- isostatic 7y ago
  The NHS has been chronically underfunded for 40 years. In 2007, before the crash, after 10 years of New Labour, the U.S. spent 15% of its GDP on healthcare. German 10%, the Netherlands 9%. The UK spent 7.4%. In fact it's over the last 10 years that the UK has begun to catch up with the rest of Europe. http://imgur.com/mUI9oWil.png http://imgur.com/mUI9oWil.png
  - barry-cotter 7y ago
    Life Expectancy at Birth Netherlands 81.6 U.K. 81.2 Germany 81.1 USA 78.6 https://data.oecd.org/healthstat/life-expectancy-at-birth.htm https://data.oecd.org/healthstat/life-expectancy-at-birth.ht...
    - isostatic 7y ago
      Which just goes to show how superior the NHS is. It’s still underfunded though.
DanBC 7y ago
Nurses are on the Shortage Occupation List so the UK government (the one with the hostile environment for immigration) wants immigrant nurses. https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-k-shortage-occupation-list https://www.gov.uk/guidance/immigration-rules/immigration-ru...

carapace 7y ago

So obviously this comes down to cost. > in the aftermath of austerity and with not enough staff to go round Pay more, get more nurses. Or you can trade-off nurses for less-good health care. - - - - Just to show an "existence proof" of an alternate universe, there are two totally free hospitals in India. They have no billing desk because they do not bill. So how is it funded? The people who work there and who support them financially believe that they are literally working for God. It is as if a Christian was volunteering to work at hospitals established by Jesus. https://en.wikipedia.org/wiki/Sri_Sathya_Sai_Super_Speciality_Hospital https://en.wikipedia.org/wiki/Sri_Sathya_Sai_Super_Specialit... > The Sri Sathya Sai Institutes of Higher Medical Sciences also popularly known as Super Specialty Hospitals are tertiary health care hospitals established by Sri Sathya Sai Baba to provide patient care facilities to all irrespective of caste, class, creed, gender, religion or nationality totally free of charge.

markdown 7y ago
> So how is it funded? Actually it's funded by the billions of dollars donated to his charitable trust. > Just to show an "existence proof" of an alternate universe, there are two totally free hospitals in India. They have no billing desk because they do not bill. That's not an alt universe, that's just free healthcare, just like in the UK, Fiji, New Zealand, and numerous other nations.
- carapace 7y ago
  I'm not sure what point you're making, and I don't want to be disagreeable, but I would point out that those nations' healthcare systems are paid for by taxes, not charitable donations. To me it seems impressive and wonderful that people have been inspired to contribute billions of dollars to support health care and clean drinking water and other charitable good works.

anbop 7y ago

Obviously? It’s like saying “reducing the number of hole diggers on your staff reduces the number of holes they dug.” Almost all care in hospitals is provided by nurses, doctors function like high level executives who drop in for a few minutes every day to look at the dashboards.

stupidcar 7y ago

Better pay and recruitment might help move the needle on the number of nurses in the short to medium term, but long term, the demographic time-bomb in western countries means they will never have enough nurses to care for their entire aged population in the manner they do now. So either a lot of people are going to get sick and die without anybody to care for them, or, one way or another, nursing and healthcare is going to have to change to become more efficient. That will mean it becomes a lot more impersonal, with much greater use of mechanisation, automation and robotics. I don't see this as being entirely a bad thing. While nurses and other caregivers can be an important source of human contact for the sick and elderly, caring and being cared for by another person can be an emotionally and physically fraught and draining process. If we can build automated systems that allow baseline physical and hygienic needs to be met, even for the frailest and sickest people, I think that had to be good for the mental health of both those needing care, as it will reduce their sense of being a burden, and on the caregivers themselves, as they will be able to focus on the most important quality-of-life issues instead of being stuck on a treadmill of providing basic care.

tracker1 7y ago
I would assume pay rates are relatively locked in and restricted under the government health care program in the UK. Not sure if there's a general Nurses union, but much like police, they may be legally unable to unionize or strike.

tomohawk 7y ago

You can look at healthcare as a cost or as a benefit. If you look at it as a cost, you will attempt to minimize it. If you look at it as a benefit, you will attempt to maximize it. The State looks at healthcare as a cost to be minimized. The State does not get sick or need healthcare. Likewise, employers also look at healthcare as a cost to be minimized, but they do have some motivation to provide better quality insurance if they wish to attract employees. Only you, the potential patient, really care about the benefits side of healthcare, and the quality of healthcare. Health insurance has been screwed up by having the State and/or employers provide it for decades. What is required is for people to be able to purchase health insurance themselves just like they do any other kind of insurance. That would be a start anyway.