things should be "off limits to commerce" Healthcare in my view can be
compared to Education which, so far, has not been totally privatized. If
shareholders must be satisfied, then patients’ interests will be compromised.
The way managed care works is by rewarding investors, HMO CEO’s, and even
doctors, while simultaneously holding down services to patients.
months ago Healthcare was not a hot topic, today it is. Hardly a week goes by
without a major story, either on TV or in print. Recently 60 minutes did a story
on Seniors going to Montreal with Mike Wallace to purchase prescriptions. I was
truly surprised as the Industry Standard on 7/10/99 reported "CBS acquired
35% of Internet health company Medscape in exchange for $157 million in
advertising and promotion – a potentially profitable investment if Meds cape’s
pending IPO soars". So is everything up for grabs? I guess so.
New England Journal of Medicine in their August editorial concluded that
"some aspects of life are off-limits to commerce. We prohibit the selling
of children and the buying of wives, juries and kidneys." Parenthetically
we do allow the sale of female eggs on the web and body parts for
transplantation are routinely sold. "Tainted blood is an inevitable
consequence of paying blood donors; even sophisticated laboratory tests can’t
supplant the gift-giving relationship as a safeguard of the purity of blood.
Like blood healthcare is too precious, intimate, and corruptible to entrust to
Steven Katz President of the Conn. State Medical Society wrote on 10/13/99 that
"HMO’s have not been paying doctors at all in many cases (latest estimate
that docs in Fairfield County Ct. are owed 40 million dollars by 7 managed care
Huber, CEO of Aetna still owns $60 million of Aetna stock after having the value
fall $61 million.
consider the case of Joe Plocica who signed up with an HMO in Texas that
advertised " as many hospital days as your doctor will authorize." The
patient later was hospitalized following a suicide attempt but was discharged
too early. That very night he proceeded to drink antifreeze and lapsed into a
coma and died. Mr.Plocica’s family sued the managed care company. The lawyer in
his brief states (1) that Mr. Plocica was "encouraged to enroll via
deceptive TV advertising" (2) The HMO failed to use ordinary care in
influencing, controlling, participating in or providing health care treatment.
(3) The managed care companies involved in Mr.Plocica’s care used
"aggressive cost controls and incentive compensation arrangements"
thereby influencing the practice of medicine. (4) The HMO’s involved created
unreasonable risk by increasing the likelihood there would be a failure to
properly diagnose, test and refer patients for specialty medical care. (5) The
administrators of the managed care companies were also paid incentive
compensation as were the physicians, based on holding down costs. There was no
reward for quality care. Joe Plocica was the "victim of a knowing,
calculated scheme whereby the Defendants (The HMO’s in question) increased their
profit by adversely affecting medically necessary, but costly, psychiatric
medical care. There will be many more suits in the future, class action and
trend can hardly bode well for a system that is supposed to represent healing,
caring and pain control.
HAPPENED TO COMPASSION AND HEALING?
US Congress can’t seem to understand the difference between palliative care
(pain control, not killing the patient) and physician assisted suicide. This
week (October 24) the infamous Henry Hyde and his fellow Senator from Oklahoma
Don Rickles intend to overturn Oregon’s law on physician assisted suicide
BECAUSE they want to give the DEA (Drug Enforcement Administration) the power to
determine whether a controlled substance has been prescribed for a
"legitimate medical purpose". Now we have another administrative
bureaucratic tier to go through before the doctor can prescribe appropriate
treatment. Eleven states have said that the bill would do"significant
harm" to doctor’s ability to manage their patients’ pain. It doesn’t take a
genius to understand this:
cancer patients do not become drug addicts and, if by some remote chance they
were to develop some tolerance, so what? They are getting pain relief. I hope
Henry Hyde is never caught screaming out in pain in a hospital just to be told
that the DEA did not approve the request for morphine.
We are too paranoid about drugs and can’t see their legitimate use in medicine
Doctors are poorly trained in Palliative Care although there are several new
programs starting up in Medical Schools.
doctors took the Hippocratic oath on completion of Medical School but few really
live by its words. There was a time in this country when patients trusted their
doctors completely…trusted them with their very lives and listened to them.
You used to be able to talk to your doctor in privacy behind closed doors and
you felt entirely confident that what he or she recommended was 100% in your
best interest. Because of the complicated nature of managed care your physician
may be preoccupied with many different issues that do not have to do with health
care. The Managed Care and Emergency Medical Ethics Policy Statement of the
American College of Emergency Physicians is inherently contradictory. The
American College endorses the following:
ethical obligations of emergency physicians do not change when practicing in
a managed care or any other environment. The physician’s primary
responsibility remains with the patient.
the economic interests of physicians, hospitals, purchasers of health
services or managed care organizations are in conflict with patient welfare,
the highest priority is patient welfare.
the financial resources of our society are finite, emergency physicians have
a responsibility to practice medicine in a cost-conscious manner. Regardless
of the payment structure, the emergency physician should not provide care
without reasonable expectation of patient benefit.
is a conflict in the above because "patient benefit" really means
Care Theory" allows doctors and health-insurance executives to deny not
merely high-tech interventions but treatments as CPR and antibiotics to the
disabled and people at the end of life. These caretakers and healers can, and
do, routinely override the patient and family’s wishes by assessing the quality
of life. Little noticed by the mainstream Futile Care Theory is already being
implemented in hospitals, nursing homes, hospices and clinics. Again money is
speaking, and even in the pristine halls of Palliative Care this message crossed
my desk. "You ask how to get physician buy-in to your palliative program?
The best way to accomplish this goal is to make it a service that looks
any other consult service. For example, your consults should be staffed by a
physician with recognized expertise in palliative medicine. The actual consult
note needs to look like other consultant notes, like the cardiologist or
oncologist, or any other medical sub-specialty. If you want credibility avoid
alternative therapies initially. Focus on the medical problems and how they are
affected by the patients’ social situation that will be the bread and butter for
your service. Help a few docs out of a jam, without coming across as too
"touchy-feely" or as co-dependent crusaders, and you will get
referrals. Once you have established your legitimacy, you can begin to change
the standard of practice at your institution. It is important to have visibility
in the hospital, the specialized units, and have a doc that is active in medical
OUR METHODS ABROAD
to the Bangkok Post 7/8/99 Hospitals were left with massive stocks (up to 19
years) of overpriced goods. Many community hospitals bought drugs and medical
kits at exorbitant prices on the orders of officials found involved in this
medical supplies scam. The medicine had 3-year expiration dates. In Nakhon
Pathom, officials testified before the Counter Corruption Commission that a
surgical mask, usually priced at 15 baht, was bought at 120 baht. A surgical cap
was priced at 150 baht instead of the usual 15 baht.
Health Institute has become India’s first hospital to tie up with a health
insurance company, US-based Blue Cross and Blue Shield Ass’n. The alliance will
be of special help to the frequent US business travelers in India, non-resident
Indians who travel to India on holidays and people covered under the plan while
in the US and who have now returned to India. However, Indians staying in India
will be able to access the facility only after a clear policy emerges on the
participation of foreign companies in the insurance sector.
excerpt on a website follows: "How about corporatising hospitals to attract
foreign patients? We can make a ‘killing’ with cheaper rates in India. We could
allow world’s best doctors in India so that patients from all over the world are
attracted to India for treatment. We should also ask the WTO to have a clause
that Western governments should not subsidize healthcare, as it would affect out
business interests. For starters, we could have tax concessions for hospitals
getting their money from abroad. To protect our citizens, we could have a clause
that no more than x% of patients can be foreigners. Or else, Indians will be
neglected". All humor aside The Hindu reported on December 28,1998 that
"The Centre has recommended to the World Bank a proposal for implementing a
Rs.850-crore ‘health scheme’ in Tamil Nadu, aimed at upgrading the health care
system in the State.
it just a coincidence then that on March 20,1999 the Calcutta Stock Exchange set
up the first Indian Stock Exchange for derivatives? The new exchange will also
be used for futures trading in commodities. The system will include adequate
risk management measures and be on a par with other international systems. You
may draw your own conclusions.
little over a year ago in Mumbai, India Sheela D’Souza’s 62 year old father was
admitted late at night with severe breathing problems to a neighborhood nursing
home. He was wheeled into the Intensive Care Unit and hooked up to an oxygen
he continued gasping. I asked the nurse to check the tubes, check the cylinder.
She shrugged me off," recalls Ms. D’Souza (name changed), a Kurla resident.
"Finally, my persistent questioning forced her to take another look. The
cylinder was empty."
many of the city’s mushrooming private ICUs such specialized critical care is
more a myth than a reality. These ICUs are often housed in cramped nursing homes
which are understaffed and inadequately equipped.
bottom line is profit not patients. Stay tuned.