Baylor College of Medicine’s struggle to define its future in the choppy waters of America’s health care finance system has been a frequent topic on this blog. But Baylor is far from the only medical school that is struggling with such problems. This Kevin Moran/Houston Chronicle article reports on the recent troubles at Texas’ oldest medical school, the University of Texas Medical Branch at Galveston. Those troubles were alluded to in this earlier post.
In a year when this island city has avoided even the threat of a major natural storm, its largest and oldest employer ó the University of Texas Medical Branch ó is experiencing an unprecedented financial, employment and political tempest.
Facing a $20 million deficit and aiming to cut $130 million in spending in 2007, the 13,000-employee medical center started the year by hiring a consulting firm to heavily reduce expenses.
Faculty and staff feared that any solution involved a massive layoff. Morale dropped precipitously when UTMB announced in June it would cut 1,000 jobs. Next came a storm of dissatisfaction when administrators unveiled plans to cut salaries of tenured faculty, physicians, researchers and others.
The article goes on to report on how UTMB’s initiatives to generate more income is being opposed by competing physicians and how little of UTMB’s professional services are compensated through proceeds of health insurance. Although somewhat different from Baylor’s problems because UTMB operates its own hospital in Galveston, UTMB’s difficulties are another reflection of the cascading problems that are resulting from the federal and state governments’ failure to address America’s broken health care finance system. The risks of that broken system are a decline in the quality of physician training and medical care, which is something that should concern us all.
It is a bizarre time for health care. And nothing makes sense.
In a week when the CEO of one of the largest health insurers was fired, and will be investigated (http://money.cnn.com/2006/10/16/news/united_health.reut/index.htm), and a former head of the FDA (Lester Crawford) is going to be penalized for continuing to own stock in companies he was appointed to regulate (although he did divest himself of major bigpharma stocks), there are stories of yet another medical center in financial trouble.
Possibly the entire US health care system could, like the fine US Congressman from Florida, admit itself for alcohol rehab then blame it’s problems on abuse by a priest.
I have no hope that the US mess will be cleaned up. On one hand medical centers are suffering from social/public health issues:
– poverty, and a class of people unable to pay for their health care;
– social trends like the prolifigation of lard serving fast food outlets; and the decline of physical activity
– very toxic environmental hazzards causing morbidty and mortality.
Yet on the other hand, Bigpharma, and fellows like United Health’s CEO are collecting record money.
No one has the answers right now, and especially not the medical leadership. Unlike medical leadership several decades ago, who appeared to be alturistic and concerned with the overall health of people, the current leadership appears to be in bed with Bigpharma, Big Industry, and Big Money.
I would suggest that people who are interested in health care take a look at conflicts of interest in the leadership and financing of the huge medical centers. There is a great deal of money in health care, and much of it is not going for patient care, or medical training.
First, when medical centers like UTMG, or other medical centers in economically impoverished areas go broke, a huge vacuum of providers to these high intensity areas of health problems will occur. That will generate even more public health crisies.
And second, because of social trends, if the US health care system does not solve issues such as UTMG is encountering, the system will get worse.
For instance there is an impending crisis in Type-2 diabetes. This is a serious disorder with incredibly complex manifestations, that appears to be epidemic in the population that UTMG serves (http://clinical.diabetesjournals.org/cgi/content/full/20/4/217). As these patients age, an increasing burder will be shifted to the large public health care centers that serve at the countries training centers.
Thus far, many academic centers have answered the crisis with cutbacks in services, in employess, and in students. The short supply of doctors and nurses (some of which is generated by short sighted policies of the academic centers themselves) has thus far been made up by recruitment of foreign medical professionals, some with questionable training.
To conclude, the signs and symptoms of major problems have been visible in the US health care for decades now. I see no major corrections, nor coherent corrective plans or coherent solutions. Some day, soon, the health care chickens will come home to roost.
I add add one aspect, which you, Tom, are sensitive. A clear issue to those interested is the explosion of paperwork in this field is the explosion of burdensome regulation. How much of these financial problems are caused by the addition of paperwork burden?
I think of this because, I was completing several medical evaluations authored by myself and psychiatric residents. Dozens of these complete evaluations are sent back to us because of bureaucratic concerns. A 3-4 page report is sent back because ‘the pain section isn’t completed’ (these are psychiatric reports).
That may seem inconsequential, however, each paperwork burden adds to the financial burden suffered by the medical centers.
Take a look at the number of support personnel major medical centers employ these days. Many of these costs go to the perusing of documents for minutiae that meet government, insurance, and regulatory tasks. There is a significant amount of time talking on the phone to insurance second guessers, filling out redundant paperwork, and dealing with nonsensical regulations. I would suspect not all over these regulations really add importance to the quality of health care. Each implementation of this bureaucratic pyromania takes away a dollars that could be spent on direct health care.
The US could end up with a system that is highly regulated, expensive, very detailed in obsessive minutiae, yet wholly inadequate to meet the actual health care needs of the population.