Deliberate, explicit rationing of hospital beds - in the U.S.!
Doctors Fight Plan to Limit Beds in ER
By Thomas M. Burton
The Wall Street Journal
February 28, 2009
A plan to curb the number of beds available to emergency-room patients at one of the nation’s most prestigious hospitals has spurred a divisive internal debate that is being closely watched by hospital physicians across the country.
At issue at the University of Chicago Medical Center, located in the South Side’s Hyde Park neighborhood, is a proposal that could limit the number of beds available to emergency-room patients. In February, two high-ranking doctors quit their administrative posts to protest the plan, saying it could lengthen already long waiting times for patients who visit the ER.
The dispute touches on one of the most critical questions facing hospitals that serve low-income populations: How many patients on Medicaid insurance, and older patients on Medicare, can a hospital afford to serve?
Many emergency physicians across the country say limiting beds for ER patients could become a means of economizing that might spread to other hospitals.
One 2007 internal report on the emergency department said, “On many afternoons/evenings, 30 or more patients are waiting with longest wait-to-be-seen times often exceeding 8-9 hours.” The same document showed that by 2007 the sickest ER patients who need intensive care waited, on average, 14 hours before being transferred to the ICU. In recent interviews, hospital doctors said those waits have been increasing.
Peer-reviewed studies suggest lengthy waits can be dangerous. “Critically ill emergency department patients with a greater than six-hour delay in intensive-care-unit transfer had increased hospital length of stay and higher intensive-care-unit and hospital mortality,” according to a 2007 study in Critical Care Medicine.
James L. Madara, the University of Chicago’s chief executive and dean of medicine, declined to comment on specific wait times at his hospital, but said the administration’s intent is to set aside more beds for specialties like oncology, gastroenterology and neurosurgery that attract patients from around the U.S.
Among other moves, the hospital is considering cutting the number of beds available to ER patients who are so acutely ill that they must be transferred to general-medicine or intensive-care wards. It plans to close, for economy reasons, a 24-bed general medicine unit and an intensive care unit of just under half that size. These units at present serve many emergency patients, hospital doctors say.
In his Feb. 1 letter to the administration, Dr. Vanden Hoek suggested that several of the changes could favor patients with private insurance. “Some patients will have rapid access to an ICU or private bed,” he wrote, but lower-income emergency patients who require admission to the hospital “will not be so lucky.”
http://online.wsj.com/article/SB123577975486997825.html
Comment:
By Don McCanne, MD
This article points out that a final decision has not been made, but it is nevertheless shocking that a non-profit university hospital has had under consideration a proposal to reduce the number of beds in an emergency room that already has a strained capacity.
The reason given for even considering rationing of emergency room beds demonstrates just how sick our health care financing system is. They would increase the overload of the emergency room to a level that would drive away low income populations so that they would not have to admit those who are “so acutely ill that they must be transferred to general-medicine or intensive-care wards” within their hospital. Just to be sure, they would reduce those acute in-patient beds as well. At the same time that they would create deliberate rationing for acutely ill, low-income individuals, they would expand their bed capacity for lucrative services for insured patients.
Sick, sick, sick!
This isn’t about a lack of money, because we already spend more than enough to pay for these services. This is about the way we finance health care. The uninsured and those in the under-funded Medicaid program are a drain on resources, and it is understandable that the administrators would want to reduce that drain. But our sick system of financing care leads them to the consideration of truly perverse methods of reducing that burden.
The current leading proposal to expand our fragmented, dysfunctional system of financing health care will not correct the perversities of a multi-tiered system. But imagine if we re-directed the $2.5 trillion that we are already spending into a single payer national health program, these perversities would be sharply curtailed. Health delivery system design would be based on patient needs rather than on the nature and distribution of the financing sources. Can’t those in Washington working on reform understand this? It’s not that complicated of a concept.