Cutting the Cost of Medical Care by Ted Bacharach MD (retired)

One of the ways it was thought medical care costs could be decreased was by cutting the cost of hospitalization. The simplest way this could be accomplished was felt to be by limiting hospitalization. If less people were hospitalized it should cost less. This it was felt could be accomplished by getting patients out of the hospital sooner, thus lessening the cost of hospitalization. To accomplish this hospitals began to employ “discharge coordinators”. The “discharge coordinator” was charged with making rounds daily on all hospitalized patients and if they did not require monitoring or i.v.’s they should be discharged. Another way to limit hospitalization was to set a predetermined number of days for certain diagnoses. If the hospital could get the patient discharged even sooner than the allowed number of days they could reap better financial benefits.

The result of these measures has not shown to be significant judging by the rapidly increased costs of hospitalization nor the increased overall cost of medical care. The simple solution that when you buy less of something it should cost less has not been true in this instance. Why??

Medicare has allowed a certain number of days for patients having a hip replacement, regardless of age, other medical problems or complications. On a trip to India I was surprised to learn that for a hip replacement a 10 day stay was mandatory to observe for possible post operative infections and to be sure that starting physical therapy is started promptly.

Less days of hospitalization should result in less cost. This has not occurred as the cost of hospitalization has risen as the cost per day of hospitalization has increased rapidly. If the severity of the illness and the requirements for increased care increase the cost of hospitalization will rise rapidly. More nurses, more care all cost more. The savings expected have not occurred and may well have resulted in unexpected results. Patients discharged early may well have unanticipated infections as well as other complications. Re-hospitalizations increase and occasionally outcomes are less favorable.

The cost for hospitalizations depends on the medical and nursing facilities required by the patients being taken care of, and the number of individuals being needed to provide for their care.

Reasonable care should be determined by the physician. Hospitals and Insurance companies should not determine length of hospitalization.

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