The US is facing a major crisis in the cost of health care. Corrected for inflation, health expenditures in the public sector are nearly doubling each decade, and those in the private sector are increasing even more rapidly. According to virtually all economists, this financial burden, which is now consuming about 17 percent of our entire economic output (far more than in any other country), cannot be sustained much longer. There is no current prospect of raising taxes. If the federal long-term debt is to be reduced, government health expenditures on Medicare and Medicaid must be controlled. However, there is no agreement in Washington on how that can or should be done. Both parties claim to have the answer but, as I will make clear, no initiatives proposed by either party have much chance of significantly slowing the rise in federal health costs without reducing access to needed services.
Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided. The draft recommendation, by the United States Preventive Services Task Force and due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a P.S.A. test, sometimes without their knowledge, during routine physicals. The task force's recommendations are followed by most medical groups. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the P.S.A. test is even more forceful and applies to healthy men of all ages.
At Village Health Partners, a comprehensive medical practice in this Dallas suburb, patients receive a year's worth of wellness exams in a single visit, get their e-mails answered 24 hours a day, seven days a week, and have their mammogram or MRI results logged into their electronic medical record by the time they pull out of the parking lot. Kelsey-Seybold in Houston is like the Galleria of health clinics: It has storefronts for every imaginable specialty, online, same-day, no-referral-necessary appointment scheduling, an on-site pharmacy, even complimentary valet parking. As the United States grapples with spiraling health care costs and a system that rewards doctors and hospitals for how sick their patients get, not how healthy they become, Texas health care providers are increasingly experimenting with new payment and care delivery models, joining forces to emphasize efficiency and outcomes. These new models present a culture shift for the state's physicians, who haven't been as quick to shed a kind of "lone ranger" status as some doctors elsewhere in the nation. But it has provided an intriguing benefit for patients, drawn to the convenience and comfort of a system financially motivated to keep them as well as possible.
The union representing registered nurses who went on strike Sept. 22 filed a complaint with the National Labor Relations Board that accuses Sutter Health of unlawfully locking out the nurses for four days after the walkout. California Nurses Association-National Nurses United, in charges filed this week, accused the hospital network of retaliating against the nurses and violating their right to strike. Kaiser nurses struck in sympathy that same day with optical and mental health workers, but Kaiser's administration allowed the nurses back the next day. Sutter officials have said they signed a five-day contract with the agency that supplied replacement nurses to fill in for striking employees. The strike took a tragic turn when a cancer patient at Alta Bates Summit Medical Center died because of a medical error by a replacement nurse. The incident remains under investigation.
A year after forcing all 11,000 of its employees into the Jackson Health System insurance plan, Jackson executives reversed course Thursday, announcing that the system's employees will be moved next year into the same AvMed plans offered to other county employees. "The majority of employees really don't like the Jackson health plan," CEO Carlos Migoya told the system's governing board Thursday. He said that when he told employees in recent town hall meetings about the possible change to AvMed, he received "almost a standing ovation." Still, the main motivation for the change, approved unanimously by the board Thursday, was about cutting losses. The JMH Health Plan has lost about $30 million so far this fiscal year. For several years, Jackson's previous executive team, led by Eneida Roldan, had been trying to build up the health plan as a way to make money for the financially troubled public hospital system.
Bamberg County Hospital is positioning itself to pull the plug on inpatient services and place its primary focus on emergency and outpatient services. The hospital's board of trustees in a special called meeting Tuesday voted to end inpatient care at the facility and shift its focus to ER and outpatient services, including radiology, rehab, X-ray, laboratory and physical and respiratory therapy services. John Hales, hospital administrator, said inpatient services will be phased out within the next two to three months. "For a long time, the inpatient census at the hospital has been slowing down and ... deteriorating," he said. Most of the hospital's business is being generated through its emergency room and other departments, Hales said.