The Perfect Storm
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E very professional meeting, including the most recent Symposium on Advanced Wound Care, has two types of dialogue: The scheduled formal program and the informal hallway discussions. The former is carefully planned; the latter is always a surprise. This year, the hallway buzzword was busy. Overflowing practices are the norm, patient acuity is at an all time high, and demand for healthcare professionals who have the knowledge, skills, and credentials to care for persons with wounds, ostomies, and continence-related concerns continues to grow.
This, of course, is just the beginning. Every industrialized country is starting to witness the effects of a "graying population" and its attendant healthcare costs while feeling the pressure of a growing, global nursing shortage. While concerns about a financially sustainable healthcare system are also global, the situation in the US is already close to emergency status. Health insurance premium increases of more than 10% per year are the norm. The number of small businesses offering any healthcare benefits has dropped almost 10% to about 66% in the past 4 years.1 On a per capita basis, US spending on healthcare is 50% higher than the second-highest spending country (Switzerland). Yet between 1993 and 2003, the number of uninsured has grown from 37 million to 43 million people and obtaining coverage (even when you are relatively healthy and able to pay hefty premiums) is exceedingly difficult.2 Prescription drug costs, as well as procedure, hospital, and provider charges, have increased substantially.
Ironically, only those who are uninsured or underinsured pay the full healthcare bill. While individuals make payment arrangements (with interest) for the entire amount billed, insurance companies only pay a pre-negotiated fraction. To navigate the healthcare finance maze, hospitals now spend one out of every four healthcare dollars on administration costs, not on patient care. This is not an American phenomenon, but rather, the result of adopting a market-driven healthcare system. For example, after managed competition was introduced to overhaul the National Health System (NHS) in Britain, healthcare costs actually increased because the new system required more regulation and government monitoring (at tax payer cost) and the number of managers in the NHS tripled.3 In the US, the actual amount spent on patching existing system flaws tends to be overlooked. For example, tax dollars are used to legislate healthcare (eg, drive-through deliveries), to provide emergency and non-emergency care for the under- and uninsured (eg, clinic grants), and to provide health insurance grants for children. The collective costs of debating, issuing, and adopting ever-changing rules and regulations (just to name a few) are staggering and translate into millions of dollars not spent on patient care.
1. Andrews M. Affordable health care. Fortune, Small Business. 2004;May:44-53.
2. Miller J, Miller M. Singled out. New York Times Magazine. 2004;April 18:48-51.
3. Light DW. Universal health care: lessons from the British experience. Am J Publ Health. 2003;93(1):25-30.
4. Johnson SJ, Rohrbaugh RL. Reserve and surplus levels of hospital plan and professional health services plan corporations: Application Notice 2004-01. Available at: http://www.pabulletin.com/secure/data/vol34/34-3/122.html. Accessed May 10, 2004.
5. Rhode Island Department of State Press Release. Secretary of State Matt Brown says "absurd" blue cross executive pay points to need for insurance commissioner. Providence, RI. March 17, 2004.
6. Families USA. Top dollar: CEO compensation in Medicare's private insurance plans. Available at: http://www.familiesusa.org. Accessed May 11, 2004.
7. Aetna. Aetna Reports First Quarter Results. Available at: http://www.aetna.com/news. Accessed May 9, 2004.
8. Foundation for Taxpayer and Consumer Rights. CA Health Insurers spend $1 million lobbying in 90 days. Available at: http://www.consumerwatchdog.org. Accessed May 11, 2004.