Category Archives: Hospitals

Race and Health Coverage: Medical Apartheid?

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I’ve invited Niko Karvounis, a colleague at The Century Foundation, to guest-blog. Niko is currently a Program Assistant at the Foundation and an Alumnus Senior Fellow with the Roosevelt Institution. His post follows below.

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Recently I was handed a report from Bronx Health Reach (BHR) entitled “Separate and Unequal: Medical Apartheid in New York City” that reveals some startling inequities right here in the so-called capital of the world.

Bronx Health Reach is a coalition formed by the Institute for Urban Family Health, with the mission of examining and addressing racial and ethnic health disparities in the southwest Bronx portion of NYC.

At the local level in the Big Apple, these disparities play out through discriminatory care tied to health coverage. Since “health insurance is a major determinant of access to medical care,” poor insurance increases the probability of “delayed care and poorer health outcomes.” And in NYC, health insurance status is closely linked to race: “52 percent of blacks, 63 percent of Latinos” and only “24 percent of whites are uninsured or publicly insured.”  This skewed distribution of health coverage ultimately “creates a de facto sorting of patients by race.”

The most compelling evidence of apartheid can be found in the records of medical institutions which reveal the characteristics of patients that they admit and discharge.

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When Women and African-Americans Receive Better Care Than White Men

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Last week a new study in the Journal of the American Medical Association documented yet another case of discrimination in American medicine. It turns out that blacks and women suffering from heart disease are much less likely than white men suffering from a comparable level of disease to have a defibrillator (a cutting-edge device that uses a jolt of electricity to shock an erratically beating heart back to a normal rhythm) implanted in their hearts.

But as Merrill Goozner points out at GoozNews:  "Guess what? They may be the lucky ones, at least when it comes to implantable cardioverter-defibrillators (ICDS) . . ."

The study showed no benefit for the white men who received the implant. Below, Merrill’s analysis, plus his comment (from a separate post) on the need for more and better research into the effectiveness of new drugs and devices:

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More Thoughts On the Hospital Building Boom

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A Startling Insider’s Look at What Happens to Patients Who Stay in the Luxury Suites of a Prestigious Hospital 
             
         

Last week, thehealthcareblog.com (THCB) asked if they could put up my post about the hospital building boom below where I ask “Can we Afford the Waterfalls”– and all of  the other hotel-like amenities that new hospitals are beginning to offer. Do we really need grand pianos, valet parking and all-private rooms—especially in hospitals that don’t yet have electronic medical records? (See my original post here)
         

Quite a few readers at THCB commented, with a number voting “yes” for the
amenities.  But one young doctor said “no”—and then offered this startling insider’s  view of  the care patients do and don’t receive on the luxury floor of one prestigious hospital:

“Maggie’s right-on regarding the disconnect between hospital frills and quality of care…

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Are We Willing to Accept a Two-Tier Hospital System?

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Yesterday, I wrote about the hospital-building boom and suggested that we may not need it—and more to the point, we may not be able to afford it.

In my description of how hospitals are adding costly amenities like waterfalls and all-private-rooms in order to woo well-heeled, well-insured patients, I suggested that the money might be better invested in computerized medical records or Level I trauma units. (In some parts of the country, trauma units are spaced so far apart that if you are in a car accident, there is a real danger that the unit will be too far away to be of any help.)

Barry Carol responded, agreeing that safety should come first, but also arguing that the private rooms help prevent infections. As for the waterfalls, he noted that “while they may make good journalistic copy as illustrative of frills,” given the high cost of hospital construction “they probably get lost in the rounding as a cost factor.” See his comment here.

Because Barry had raised a number of good points, and because the hospital boom is such a large and crucial subject, I decided to return to it today while responding to his comment.

Barry—

I’m afraid the waterfalls are more than good copy for journalists.. Similar amenities are being included in hospital construction across the country–and it adds up.

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The Hospital Building Boom: Can We Afford the Waterfalls?

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In Money-Driven Medicine: The Real Reason Health Care Costs So Much I talk about the nationwide hospital building boom—and ask two questions: Can we afford it? Do we need it?

In many regions, suburban hospitals have been reaching for big-city business. “What we have to do to maintain our position in the markets is to keep adding services,” explained Westchester Medical Center CEO Ed Stolzenberg. “That’s the whole reason we went into liver transplants.”

Did the resident of Westchester Country (just outside of New York City) need a local hospital doing liver transplants? Just how many transplants would a Westchester hospital do? Would such patients be better off at a high-volume medical center in Manhattan where “practice makes perfect”?

Those questions didn’t seem to come up.  The CEO knew that transplants would raise the hospital’s image.

Across the nation, as not-for-profit hospitals set out to invest in new construction and equipment, decisions seemed to be market-driven—but  not necessarily driven by the local population’s medical needs.  Instead, they were powered by the hospital’s need for market-share.

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Employers and Healthcare: “Which Frogs A-Leaping?”

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At “Healthcare Renewal” (hcrenewal.blogspot.com) Brown University’s Dr. Roy Poses recently posted a thought-provoking piece about the Leapfrog Group, an employer group that has made its reputation pushing for higher quality care.  Poses points out that nearly 30% of the members of Leapfrog are healthcare corporations, and notes that this might skew their view of healthcare’s goals:
 

“One would expect that companies who make money by providing health care goods and services may have different ideas about health care costs and quality than companies who do not do any health care related business” said Poses in his post.

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Preventing Hospital Errors by Howard C. Berkowitz

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I have asked Howard Berkowitz to guest-blog on hospital errors.

Howard is in an unique position to write on this topic because he consults on
medical information systems for hospitals and also has been a long-time
patient. Over the years, he has taken an unusually detailed decision-making role
in his own care for heart diseases and diabetes which, he says, “has kept me
going, with bad heart genetics, at least 17 years more than my father.”

Howard also reports that “when no one else would coordinate my mother’s complex
cancer care, I did so…and I know what it is to preserve the semblance of
life, when only pain remains. Complex pain management is also one of my
interests; too few doctors know that pain should always be controllable.”

As a result of his own health problems and his parents’ illnesses, he has spent
more time in hospitals than anyone would ever want to endure. But unlike
most of us, he understood what was going on. Originally trained in microbiology
and biochemistry, Howard was doing independent research in antibiotic
resistance and working in a clinical laboratory while in high school. He
confesses that, for his 10th birthday, he asked his mother for a copy of the
Merck Index of Chemicals and Drugs. Subsequently, he built the first clinical
computer system for Georgetown University Hospital,
developed virological systems for Electronucleonics’ “hot lab” and developed
cardiac care simulators and for the George Washington University School of Medicine,
Office of Computer-Assisted Instruction. He also developed the first automated blood
bank laboratory tools for the Red Cross.


Full disclosure—he has two patents in process for hospital communications and staff management dedicated to keeping them informed, in real time, of patient needs.
His post follows below.

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Preventing Hospital Errors Part II by Howard C. Berkowitz

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Given the medical community’s reluctance to step up and admit to mistakes, Medicare has decided to get tough, saying that it will stop reimbursing  hospitals for the thirteen adverse advents listed below. Before discussing the list, let me suggest that not all of these events are within a hospital’s control. I’ve rated the mishaps on the list from 1 to 4, with “1” indicating something that, I agree, should never happen, and “4” referring to something that, in my experience, a hospital may not be able to prevent.

    The 13 Things That Should Never Happen in a Hospital
   1. Catheter-associated urinary tract infection [2]
   2. Bed sores [1]
   3. Objects left in [THE PATIENT”S BODY] after surgery [1]
   4. Air embolism, or bubbles, in bloodstream from injection [1]
   5. Patients given incompatible blood type [1]
   6. Bloodstream Staphylococcus (staph) infection [2]
   7. Ventilator-associated pneumonia [2]
   8. Vascular-catheter-associated infection [2]
   9. Clostridium difficile-associated disease (gastrointestinal infections) [3]
  10. Drug-resistant staph infection [3]
  11. Surgical site infections [3]
  12. Wrong surgery [1]
  13. Falls [4]

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