For-Profit Hospitals vs. Patient Care...
This is the term paper I put together for an Expository Writing class last semester...
FOR-PROFIT HOSPITALS VS. PATIENT CARE:
HOW THE BOTTOM LINE AFFECTS PATIENT CARE
ABSTRACT
This paper examines For-Profit hospitals and how having a profit margin can, and often does, adversely affect patient care. I will begin by discussing the role of For-Profit health care providers, including hospitals, clinics and labs, and their place in the health care field. From there, I will touch on the larger for-profit health care providers in the United States, with a brief run-down on how they came into existence. Finally, I will explore how for-profit health care affects patient care, along with possible long-term ramifications and solutions.
INTRODUCTION
Aunt Sarah is the epitome of health; at seventy-something, she hasn’t been sick a day in her lively life. Meanwhile, Grandma June, Sarah’s older sister, has been in and out of the hospital all her life: pneumonia, TB, heart attacks, the flu…Not a year goes by without a trip or two to the emergency room. Thank goodness for Medicare; that helps with a good portion of the bills. Not all of them, mind you, but between that, her Medicare supplement, and her drug plan, she’s getting along. Too bad she lives near that For-Profit hospital, since that’s where the ambulance takes her. The last time she went in with a heart attack, she nearly died after waiting an hour to be seen in the emergency room. If only she lived closer to that city-owned non-profit hospital…
Most of us give little thought about the medical facilities in our area, figuring that most hospitals, clinics or labs are the same, that one is as good as the next. True, we may realize that there are facilities that cater to one group of people: a Children’s Hospital is better suited for treating children than geriatric patients; a hospital set up for OB/GYN problems is not set up to deal with general trauma. However, many people are unaware that there are differences in care between for-profit and not-for-profit hospitals. I plan to explore why the average non-profit may very well be a safer place than the average for-profit facility.
DISCUSSION
The main topic for discussion is how for-profit medical facilities’ quest for the best profit margin has the ability to cost patients and their families, in higher medical bills, in poor-quality care, and in lives lost. While there is be a place for for-profits, everything else being equal, the non-profits are a better choice.
Is There a Place for For-Profit Hospitals?
It is simplistic to state that medical care in the United States would be better if all for-profit facilities closed, for while not-for-profit hospitals tend to be safer than for-profit ones (everything else being comparable), there are times when for-profit facilities provide a much needed service.
In many instances, for-profit chains have either brought hospitals to communities that didn’t have medical facilities or bought out facilities which were about to close, up-grading them and turning them around, thereby keeping valuable medical care in places that would otherwise have little more than one or two overworked doctors (Inlander 225).
Given the choice between no medical care or for-profit facilities, there is no contest.
Small community hospitals in rural areas tend to have fewer resources; fewer people mean less revenue for the facility, making it necessary to ration resources: Do we spend money on one piece of equipment that may be used possibly once or twice a year, or spend the same money on what will be utilized on a daily basis? In this case, having a for-profit group take over the hospital can be a blessing; with their additional resources, they can obtain equipment and care that might otherwise not be available.
The Rise of the For-Profits
During the 1960s, Dr. Thomas Frist, Sr. of Nashville, Tennessee, along with a group of doctors, created Park View Hospital. By the end of the decade, along with Dr. Thomas Frist, Jr., and Jack C. Massey, formed Hospital Corporation of America (now HCA) and began building a chain of for-profit hospitals.
The 1970s saw a rapid industry growth, spawning numerous for-profit hospital chains. As HCA grew, it began buying up smaller for-profit chains, until it finally merged with Columbia in 1994. (Prior to the merger, Columbia had bought out the Humana chain.) HCA is now the largest for-profit chain in the United States, though Tenet Healthcare is also growing with 63 hospitals (http://www.tenethealth.com/Tenet-Health/OurCompany), as well as Universal Health Services (UHS) and Iasis, among others.
Realistically, one can expect the growth of for-profit hospital chains to continue, fulfilling a need in underserved areas, buying out not-for-profits where they can.
The Pain of Dealing With For-Profits
On the surface, it can be incomprehensible why anyone would object to for-profit
hospitals, especially in the United States. Since its founding, the United States has thrived as a capitalistic country, with all its strengths and weaknesses; profits are part of this system.
As for hospitals, most of us acknowledge the fact that we will most likely need their services at one time or another during our lives. Add the two together—for-profit and hospitals—and theoretically, you have a win-win situation.
However, there is the problem of the profit margin. According to the University of Buffalo (NY) Reporter (Thursday, June 27, 2002), “A study…from more than 26,000 hospitals…has shown that people treated in private for-profit hospitals in the U.S. have a greater risk of dying than those cared for in private not-for-profit hospitals (Baker).” The report goes on to state that this study appeared in the Canadian Medical Association Journal (CMAJ).
According to the Canadian Health Coalition press release titled, “Higher death rates in for-profit hospitals: Study,” two thousand (2000) more Canadians would die each year if Canada switched over to for-profit hospitals (CHC Press release, May 27, 2002).
In addition, a commentary in the May 28, 2002 issue of the Canadian Medical Association Journal (CMAJ), titled “Your money and/or your life?” states that “the authors have…reviewed…the results of 14 US studies that compared short-term mortality outcomes for elderly patients admitted to private, for-profit hospitals with those for elderly patients admitted to private, not-for-profit hospitals.” After careful study, the authors concluded that there was a “statistically significant increase in 30-90-day mortality among patients admitted to private, for-profit hospitals (Naylor).”
Dr. Naylor, who was the Dean of Medicine and is now the President of the University of Toronto, ends his commentary by asking, “Does anyone still want to contract out large segments of our publicly financed health care system to for-profit US hospital chains after reading this article (commentary)? I hope not (Naylor).”
In addition, according to the American Hospital Association (AHA), when looking into hospitals, a person is strongly advised to find out if a hospital is nonprofit of for-profit. While the AHA admits that “the quality of care varies widely within each of these categories (for-profit or nonprofit),” they report that “a study in the Journal of General In-ternal Medical found that patients at for-profit hospitals are two to four times more likely than patients at not-for-profit hospitals to suffer complications from surgery or delays in diagnosing and treating illness. Previous research found death rates 25 percent higher at for-profit hospitals than at teaching hospitals and six to seven percent higher than at non-profit, non-teaching hospitals (“All Hospitals Are Not Created Equal”).”
Why the problems? Simple bottom-line: it’s cheaper—on the surface, anyway—to pay for two RNs per shift per floor than four. When Medicare and other insurance companies pay a flat rate for a procedure, it makes sense from a financial standpoint to get the patient out of the hospital as quickly as possible to reduce cost.
On a personal note, I experienced this first-hand with my husband. He had been hospitalized on several occasions since we’d been together: twice at a city-owned not-for-profit hospital, once at a for-profit, chain-owned hospital. While at the not-for-profit facility, he received consistently good care. Even when moved to a non-critical floor, his care remained good: the nurse-to-patient ratio remained low, giving the staff the ability to care for their assigned patients; call lights were acknowledged and answered in a timely manor; patients were cared for as though their lives depended on it!
However, during his last hospital stay, the ambulance was forced to bring him to the closest hospital, a for-profit facility. While the care he received in the CCU was extraordinarily—good, caring staff, a 1-to-1 nurse-to-patient ratio—once on the floor, the profit-margin took over: on a wing where 4-6 nurses may have comfortably handled the work load, there were never more than half that number to be found on the ward. These over-worked souls were then put on 12-hour shifts as opposed to 8-hour shifts. Simple math shows us that this gives us 4-6 nurses on a ward for every 24-hour period, as opposed to 12-18 for the same period. Multiply that number through the non-critical wards and you see not just a smaller staff but a much higher profit-level.
Did this figure into my husband’s death, as well as in the other horror stories I’ve discovered about this and other for-profits, due to under-staffing and higher profits? True, a for-profit hospital is better than no hospital, as mentioned earlier in this article. But when a profit-margin is more important than caring for the patient, we need to ask ourselves the hard question of, “What is more important? A life or a dollar?”
Finally, as Jeffrey Kaye states, “The for-profit industry adamantly maintains its
goal is to combine efficiency with high standards of patient care. But as an increasing number of hospitals have been converted nationally, critics have repeatedly questioned whether profits come before quality care.”
CONCLUSION
While for-profit hospitals may be a positive approach in areas where no other medical facilities would otherwise be available, if given a choice between a for-profit or not-for-profit hospital, with everything else being equal, the not-for-profit would be a healthier choice.
Works Cited
_____, “All Hospitals Are Not Created Equal,” Health Pages: The voice of the Health
Care Consumer, http://www.thehealthpages.com/artricles/ar-hosps.html.
Baker, Lois, Hospital Mortality Rates Analyzed, University of Buffalo Reporter, Vol. 33,
Number 29, June 27, 2002.
_____, “Higher Death Rates in For-Profit Hospitals: Study,” Canadian Health Coalition
(CHC) Press Release, May 27, 2002, http://healthcoalition.ca/for-profit-death.
html.
Inlander, Charles B. et al, The People’s Medical Society Health Desk Reference,
Hyperion, 1995
Kaye, Jeffrey, Community Care-Part 2, The NewsHour with Jim Lehrer Transcript,
KCET
McCabe, Justine and John Battisa, “Warning: For-Profit Hospitals Can Endanger Your
Health And Finances,” The Litchfield (CT) County Times, January 26, 2001.
Naylor, C. David, “Your Money And/or Your Life?” Canadian Medical Association Jour-
nal (CMAJ), May 27, 2002.
Schiff, Gordon, MD, “Fatal Distraction: Finance vs. Vigilance in Our Nation’s Hospi-
tals,” Journal of General Internal Medicine, April, 2000.
FOR-PROFIT HOSPITALS VS. PATIENT CARE:
HOW THE BOTTOM LINE AFFECTS PATIENT CARE
ABSTRACT
This paper examines For-Profit hospitals and how having a profit margin can, and often does, adversely affect patient care. I will begin by discussing the role of For-Profit health care providers, including hospitals, clinics and labs, and their place in the health care field. From there, I will touch on the larger for-profit health care providers in the United States, with a brief run-down on how they came into existence. Finally, I will explore how for-profit health care affects patient care, along with possible long-term ramifications and solutions.
INTRODUCTION
Aunt Sarah is the epitome of health; at seventy-something, she hasn’t been sick a day in her lively life. Meanwhile, Grandma June, Sarah’s older sister, has been in and out of the hospital all her life: pneumonia, TB, heart attacks, the flu…Not a year goes by without a trip or two to the emergency room. Thank goodness for Medicare; that helps with a good portion of the bills. Not all of them, mind you, but between that, her Medicare supplement, and her drug plan, she’s getting along. Too bad she lives near that For-Profit hospital, since that’s where the ambulance takes her. The last time she went in with a heart attack, she nearly died after waiting an hour to be seen in the emergency room. If only she lived closer to that city-owned non-profit hospital…
Most of us give little thought about the medical facilities in our area, figuring that most hospitals, clinics or labs are the same, that one is as good as the next. True, we may realize that there are facilities that cater to one group of people: a Children’s Hospital is better suited for treating children than geriatric patients; a hospital set up for OB/GYN problems is not set up to deal with general trauma. However, many people are unaware that there are differences in care between for-profit and not-for-profit hospitals. I plan to explore why the average non-profit may very well be a safer place than the average for-profit facility.
DISCUSSION
The main topic for discussion is how for-profit medical facilities’ quest for the best profit margin has the ability to cost patients and their families, in higher medical bills, in poor-quality care, and in lives lost. While there is be a place for for-profits, everything else being equal, the non-profits are a better choice.
Is There a Place for For-Profit Hospitals?
It is simplistic to state that medical care in the United States would be better if all for-profit facilities closed, for while not-for-profit hospitals tend to be safer than for-profit ones (everything else being comparable), there are times when for-profit facilities provide a much needed service.
In many instances, for-profit chains have either brought hospitals to communities that didn’t have medical facilities or bought out facilities which were about to close, up-grading them and turning them around, thereby keeping valuable medical care in places that would otherwise have little more than one or two overworked doctors (Inlander 225).
Given the choice between no medical care or for-profit facilities, there is no contest.
Small community hospitals in rural areas tend to have fewer resources; fewer people mean less revenue for the facility, making it necessary to ration resources: Do we spend money on one piece of equipment that may be used possibly once or twice a year, or spend the same money on what will be utilized on a daily basis? In this case, having a for-profit group take over the hospital can be a blessing; with their additional resources, they can obtain equipment and care that might otherwise not be available.
The Rise of the For-Profits
During the 1960s, Dr. Thomas Frist, Sr. of Nashville, Tennessee, along with a group of doctors, created Park View Hospital. By the end of the decade, along with Dr. Thomas Frist, Jr., and Jack C. Massey, formed Hospital Corporation of America (now HCA) and began building a chain of for-profit hospitals.
The 1970s saw a rapid industry growth, spawning numerous for-profit hospital chains. As HCA grew, it began buying up smaller for-profit chains, until it finally merged with Columbia in 1994. (Prior to the merger, Columbia had bought out the Humana chain.) HCA is now the largest for-profit chain in the United States, though Tenet Healthcare is also growing with 63 hospitals (http://www.tenethealth.com/Tenet-Health/OurCompany), as well as Universal Health Services (UHS) and Iasis, among others.
Realistically, one can expect the growth of for-profit hospital chains to continue, fulfilling a need in underserved areas, buying out not-for-profits where they can.
The Pain of Dealing With For-Profits
On the surface, it can be incomprehensible why anyone would object to for-profit
hospitals, especially in the United States. Since its founding, the United States has thrived as a capitalistic country, with all its strengths and weaknesses; profits are part of this system.
As for hospitals, most of us acknowledge the fact that we will most likely need their services at one time or another during our lives. Add the two together—for-profit and hospitals—and theoretically, you have a win-win situation.
However, there is the problem of the profit margin. According to the University of Buffalo (NY) Reporter (Thursday, June 27, 2002), “A study…from more than 26,000 hospitals…has shown that people treated in private for-profit hospitals in the U.S. have a greater risk of dying than those cared for in private not-for-profit hospitals (Baker).” The report goes on to state that this study appeared in the Canadian Medical Association Journal (CMAJ).
According to the Canadian Health Coalition press release titled, “Higher death rates in for-profit hospitals: Study,” two thousand (2000) more Canadians would die each year if Canada switched over to for-profit hospitals (CHC Press release, May 27, 2002).
In addition, a commentary in the May 28, 2002 issue of the Canadian Medical Association Journal (CMAJ), titled “Your money and/or your life?” states that “the authors have…reviewed…the results of 14 US studies that compared short-term mortality outcomes for elderly patients admitted to private, for-profit hospitals with those for elderly patients admitted to private, not-for-profit hospitals.” After careful study, the authors concluded that there was a “statistically significant increase in 30-90-day mortality among patients admitted to private, for-profit hospitals (Naylor).”
Dr. Naylor, who was the Dean of Medicine and is now the President of the University of Toronto, ends his commentary by asking, “Does anyone still want to contract out large segments of our publicly financed health care system to for-profit US hospital chains after reading this article (commentary)? I hope not (Naylor).”
In addition, according to the American Hospital Association (AHA), when looking into hospitals, a person is strongly advised to find out if a hospital is nonprofit of for-profit. While the AHA admits that “the quality of care varies widely within each of these categories (for-profit or nonprofit),” they report that “a study in the Journal of General In-ternal Medical found that patients at for-profit hospitals are two to four times more likely than patients at not-for-profit hospitals to suffer complications from surgery or delays in diagnosing and treating illness. Previous research found death rates 25 percent higher at for-profit hospitals than at teaching hospitals and six to seven percent higher than at non-profit, non-teaching hospitals (“All Hospitals Are Not Created Equal”).”
Why the problems? Simple bottom-line: it’s cheaper—on the surface, anyway—to pay for two RNs per shift per floor than four. When Medicare and other insurance companies pay a flat rate for a procedure, it makes sense from a financial standpoint to get the patient out of the hospital as quickly as possible to reduce cost.
On a personal note, I experienced this first-hand with my husband. He had been hospitalized on several occasions since we’d been together: twice at a city-owned not-for-profit hospital, once at a for-profit, chain-owned hospital. While at the not-for-profit facility, he received consistently good care. Even when moved to a non-critical floor, his care remained good: the nurse-to-patient ratio remained low, giving the staff the ability to care for their assigned patients; call lights were acknowledged and answered in a timely manor; patients were cared for as though their lives depended on it!
However, during his last hospital stay, the ambulance was forced to bring him to the closest hospital, a for-profit facility. While the care he received in the CCU was extraordinarily—good, caring staff, a 1-to-1 nurse-to-patient ratio—once on the floor, the profit-margin took over: on a wing where 4-6 nurses may have comfortably handled the work load, there were never more than half that number to be found on the ward. These over-worked souls were then put on 12-hour shifts as opposed to 8-hour shifts. Simple math shows us that this gives us 4-6 nurses on a ward for every 24-hour period, as opposed to 12-18 for the same period. Multiply that number through the non-critical wards and you see not just a smaller staff but a much higher profit-level.
Did this figure into my husband’s death, as well as in the other horror stories I’ve discovered about this and other for-profits, due to under-staffing and higher profits? True, a for-profit hospital is better than no hospital, as mentioned earlier in this article. But when a profit-margin is more important than caring for the patient, we need to ask ourselves the hard question of, “What is more important? A life or a dollar?”
Finally, as Jeffrey Kaye states, “The for-profit industry adamantly maintains its
goal is to combine efficiency with high standards of patient care. But as an increasing number of hospitals have been converted nationally, critics have repeatedly questioned whether profits come before quality care.”
CONCLUSION
While for-profit hospitals may be a positive approach in areas where no other medical facilities would otherwise be available, if given a choice between a for-profit or not-for-profit hospital, with everything else being equal, the not-for-profit would be a healthier choice.
Works Cited
_____, “All Hospitals Are Not Created Equal,” Health Pages: The voice of the Health
Care Consumer, http://www.thehealthpages.com/artricles/ar-hosps.html.
Baker, Lois, Hospital Mortality Rates Analyzed, University of Buffalo Reporter, Vol. 33,
Number 29, June 27, 2002.
_____, “Higher Death Rates in For-Profit Hospitals: Study,” Canadian Health Coalition
(CHC) Press Release, May 27, 2002, http://healthcoalition.ca/for-profit-death.
html.
Inlander, Charles B. et al, The People’s Medical Society Health Desk Reference,
Hyperion, 1995
Kaye, Jeffrey, Community Care-Part 2, The NewsHour with Jim Lehrer Transcript,
KCET
McCabe, Justine and John Battisa, “Warning: For-Profit Hospitals Can Endanger Your
Health And Finances,” The Litchfield (CT) County Times, January 26, 2001.
Naylor, C. David, “Your Money And/or Your Life?” Canadian Medical Association Jour-
nal (CMAJ), May 27, 2002.
Schiff, Gordon, MD, “Fatal Distraction: Finance vs. Vigilance in Our Nation’s Hospi-
tals,” Journal of General Internal Medicine, April, 2000.
Labels: avoid this Florida hospital, For-Profit hospitals vs. patient care, Northside Hospital (Tampa Bay)
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