Medical costs are on the rise in the United States, and the cost of health insurance and health care are a burden for many American families. The cost of health care has outpaced inflation in this country every year since 2008. Hospitals, labs, doctors' offices and other medical providers need to be able to provide care while still turning a profit. With costs already going up rapidly, increasing fees isn't the answer. Instead, medical care providers are trying to cut their costs. But are some going too far, jeopardizing the well-being of patients in an effort to save money?
Cost-cutting is neither inherently bad nor inherently good; when expenses are reduced judiciously, hospitals can save millions of dollars a year without impacting patient care. When care isn't used in deciding when to scale back on diagnostics and treatments, however, the financial savings can be outweighed by the cost in human life and health.
Some people would argue that rather than being too focused on cost-cutting, hospitals and other medical facilities are more concerned about insulating themselves from potential liability than keeping patient costs down. Even if this does have the effect of reducing liability (which is unclear), it's not placing the focus where it belongs: on making sure patients get the best, most appropriate care. However, some trends do point to cost-cutting measures having a negative effect on patient outcomes.
In the past decade or so, many medical providers have consolidated in an effort to operate more efficiently and cut costs. There have also been concerns about the cost of "defensive medicine," whereby doctors who fear being sued may over-test or over-treat patients, generating unnecessary cost.
Perhaps as a result of both of these phenomena, the pendulum may be swinging toward a "leaner" practice of medicine. So long as reductions in testing and treatment are reasonable and evidence-based, this isn't a problem. But when doctors arbitrarily decline tests or treatments in order to cut costs, even when those interventions are medically appropriate, they may be committing medical malpractice.
It's not always obvious when a medical decision was made with cost taking priority over patient need. But if a decision is not one that a reasonable doctor would have made in a similar situation, and the patient suffers harm as a result, it is medical malpractice.
The irony of cost-cutting measures in health care is that not only might they not be effective, they may actually cause health care costs to keep rising. A primary cost-cutting measure is to address line-item expenses such as personnel and supplies. Immediate cost savings can be realized by reducing the number of support staff, for instance.
Unfortunately, reductions in support staff don't eliminate their functions. Who ends up picking up those functions? More highly-trained and specialized staff, such as nurses. Not only does the need to perform support functions take highly-trained staff away from their own tasks, but the tasks formerly performed by support staff are now being performed by those who are more highly paid.
Other short-sighted cost-cutting measures include failing to adequately invest in treatment and diagnostic equipment and space and rushing patients through the system in order to maximize the number of patients seen.
There are no easy answers, but a step in the right direction would be striving for an appropriate number of both nurses and support staff, so that tasks can be performed by the person best suited for them. Another would be ordering diagnostics and performing procedures based on a patient's actual health profile and needs, rather than simply a desire to avoid liability for any negative outcomes.
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