Thursday, December 20, 2007

The Economics of Hospital Infections

A few days ago, amidst my operation recovery, I found myself a victim of a common post-operative infection known as UTI (infection of the bladder). What I didn't know at the time was that this is almost as common to occur to anyone with a bladder catheter from an operation as raining in Belgium. Initially I panicked as the infection was accompanied with pain and blood urination. Eventually, my home doctor came to the rescue with strong antibiotics that delivered the goods within hours...

I would have forgotten the incident and have cataloged it as another acquired experience if it wasn't for this NYT article that my eyes fell upon earlier today. Read an excerpt here and follow the link if you are interested in the remaining of the article. Unbelievable!

"... In most businesses, customers don’t pay for a vendor’s mistakes. But when hospitals make errors, they charge patients additional money to fix the problem. The perverse economics of hospital charges were outlined yesterday in a fascinating article in the Journal of the American Medical Association. The story focused on one common but largely preventable medical error: urinary tract infections associated with the use of a catheter. It showed how in some ways, the medical system has built-in financial incentives for bad care. Hospitals use urinary catheters more than almost any other medical device, and they account for 40 percent of all hospital-acquired infections — about one million annually. A urinary tract infection can add a day to a hospital stay; sometimes it can lead to a more serious infection, even death. At one Colorado hospital, the article noted, Medicare would pay $5,436.66 for the care of a heart attack patient who recovered without complications. But if the patient developed a urinary tract infection related to use of a catheter, the hospital would receive $6,721.44. If the patient developed a more serious infection after a catheter was used, the hospital collected $8,905.43. That means the hospital would earn 63 percent more by providing inferior care. Hospital-acquired urinary tract infections cost the health care system more than $400 million every year. But they are largely preventable, occurring most often because a catheter is left in too long. The risk of infection rises dramatically 48 hours after insertion. Most patients don’t need a catheter for nearly that long, but when nurses and other hospital staff are overstretched, or when record-keeping is lax, catheters may not be removed quickly enough. The reimbursement system “tolerates and even financially rewards poor performance by hospitals that fail to prevent hospital-acquired complications,'’ write the report’s authors, Dr. Heidi Wald and Dr. Andrew Kramer, health care policy researchers at the University of Colorado at Denver...."


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