In health care, one is rarely like the other

  • Article by: FRED ZIMMERMAN
  • Updated: August 20, 2009 - 10:13 AM

Hospitals and clinics vary. Patients too. Costs, especially. This is an issue.

The debate over health care reform carries special significance for my family. A family member has battled a serious illness for more than 20 years, making us extended and extensive customers of several of the most prominent medical institutions in the United States.

As I look over the various medical bills and benefit statements we've received -- with charges ranging from a few dollars to several million dollars -- it is impossible to escape the conclusion that the American medical system is riddled with variance.

We have been fortunate to know many highly dedicated and competent caregivers -- physicians, surgeons, nurses and staff members. Our family member's life has been saved not once, but several times, by these dedicated people. We are grateful.

Differences exist, though. The Mayo Clinic, the Children's Hospital of Minneapolis and the Cleveland Clinic were all well-organized, exceedingly well-equipped and efficient, and the staff there exhibited exemplary caring, often well beyond what we might have expected.

Other major hospitals have caring personnel as well. But they are occasionally less clean, less efficient and far less organized.

What's more, costs vary widely, from the reasonable and affordable to the offensive and ridiculous.

Just a few weeks ago, our family member received a statement from a major hospital out east for services performed during 68 days of hospitalization more than two years ago. This bill, which had no backup detail at all, was for $1,996,881.52.

Our family member is no stranger to surgeries or hospitalizations, so many comparisons were possible.

The daily charges were nearly 10 times the charges for a highly critical multiweek stay at the Mayo Clinic just a few years earlier.

Geographic variances exist as well. Medicare reimbursement rates for the same procedures are not standardized. There is evidence that a radiologist in Florida makes a great deal more money than a pediatrician in the Midwest. Why?

There are also variations in patients. Some are trim and active physically. Others are obese and inactive, consume harmful substances, or engage in risky behavior. Should all of these people pay the same premium?

Variances within the insurance community also exist. Is obtaining heavy discounts from health care providers really progress if the money is paid in executive compensation and backdated stock options?

A couple of decades ago, I served on the board of directors of a health insurance firm. I noticed that one of the problems was that the customers -- the patients -- had very limited opportunity to comment either on the quality of service provided or the reasonableness of the charges. I proposed at one of the board meetings that a small box be provided so that patients submitting bills for payment could rate both quality and charges on a scale of one to 10. Then we could tabulate these results over time to see what we could learn. The idea was rejected, however. The insurance salespeople were afraid the firm would lose business.

Yet one of the problems today just may be that customers are too removed from being able to examine the costs they are incurring. With our modern, connected billing systems, everything seems to have become a little too automatic.

The United States does need reform in its health care system, and we should not dilly-dally. But we should also make sure that, in our haste, we do not initiate some unintended consequences that we will be very sorry about later.

In the final analysis, we may find that our principal shortcoming is not funding, but organization. Some health care facilities are cleaner, more professional and far better organized than others. My family's experience has been that these more impressive hospitals cost a lot less.

Perhaps if health care reform could remove some of the unwholesome variances within the system, there would be more enthusiasm for paying for it.

Fred Zimmerman is professor emeritus of engineering and management at the University of St. Thomas.

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