NY Times Op-Ed Agrees that Hospital Care is in Decline

NY Times Op-Ed Agrees that Hospital Care is in Decline

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Oncologist, bioethicist, Senior Fellow at the Center for American Progress—and a key figure in the development of the Affordable Care Act—Ezekiel Emanuel recently wrote an op-ed in the New York Times that describes how the hospital has been in decline for decades and how this is more of a sign of medical progress than a lack of access to care. For those who are unfamiliar with our site, this is pretty much our raison d’etre, and it’s good to know that some of the most experienced professionals in the healthcare field agree with your central tenet.

 

Among the facts cited in the NY Times article:

 

At its peak, in 1981, there were “over 39 million hospitalizations — 171 admissions per 1,000 Americans. Thirty-five years later, the population has increased by 40 percent, but hospitalizations have decreased by more than 10 percent….the number of hospitals has declined to 5,534 this year from 6,933 in 1981.”

In 2002, researchers from the Centers for Disease Control and Prevention estimated that there were 1.7 million cases of hospital-acquired infections that caused nearly 100,000 deaths….Studies have shown that patients with heart failure, pneumonia and some serious infections can be given intravenous antibiotics and other hospital-level treatments at home by visiting nurses. These ‘hospital at home’ programs usually lead to more rapid recoveries, at a lower cost.

 

Just to say it, neither we nor Emanuel are zealots or absolutists when it comes to hospitals. There is still an important place for hospital-based care including major surgeries, trauma care, and other types of acute and specialized medical care. But hospital settings also carry their own unique healthcare risks—namely healthcare-associated infections—that may outweigh the potential benefits. Likewise, you may be that infectious agent. Otherwise healthy adults should avoid the hospital when they have the flu lest they infect more vulnerable populations.

 

Barriers to Empowerment in Modern Health Care

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One of the big ways in which the traditional hospital and healthcare system fails is when it disempowers individuals to understand the cost of their healthcare services. Health provider networks frequently claim to offer greater overall efficiency, but it’s hard to know and hard to measure when costs and services so frequently seem made up on the fly. Perhaps, just as bad, it creates an environment in which patients are unable to clearly understand the cost of their healthcare and, thus, are less empowered to plan for their future health needs.

 

Even Dental Coverage is Anything but Transparent

I’ve recently had a couple different circumstances to experience these frustrations, if not outright failings. I had a crown put in last November and December. During the initial visit, I sat down with the dentist’s billing coordinator to go over how much it would cost. I was told one price, split over two different bills that I paid during the initial visit as well as the follow-up visit. Putting in the crown was a two-step process.

In between the two visits, our health insurance was cancelled by my wife’s employer. So, then, in January, I got a bill for $133 itemized over some two dozen different largely indecipherable service descriptions. Now, this wasn’t my first rodeo when it comes to billing codes, service authorization, coverage policies, and the murky ways in which health insurance doesn’t works. But this bill seemed entirely unintelligible. I ended up calling the dentist and, after telling my whole story to a new billing coordinator and the regional manager, they decided to simply write the bill off. I still don’t know how much what service cost. I mean, it’s one thing to not consider costs for emergency health services, but the dentist office? Can’t I at least take a proactive approach to my dental care and service costs?

 

Trying to Get a Quote at the Dermatologist Office

Right around the same time, my wife went to the dermatologist and was deciding whether to get ultimately harmless but not very pleasant-looking age spots removed from her face. How much was the necessary liquid nitrogen treatment going to cost? The dermatologist’s office wasn’t sure. The Internet said the treatment might cost anywhere from $150 to $1,600. We eventually had to contact the health insurer with the correct billing codes from the dermatologist office to know what the bill was going to be.

 

Partisan Conflict Increases Dysfunction in the Health Care System

The health care system suffers from the haphazard way that competing philosophies have been implemented. It’s like we keep telling people and families to take greater personal responsibility for their health care and health outcomes, while simultaneously subjecting them to an over-managed and largely opaque health care system that tells them to shut up, wait to see what the bill will be, and then pay it—or don’t.

It starts with our state and national politics and then slowly, perpetually infects local health providers and individual health consumers. It degrades the trust that patients have in any number of hospital and healthcare settings. And it creates invisible inefficiencies that make it difficult for even health care industry experts to understand how to improve the system itself.

 

Food Choices More Effective than Nutritional Metrics?

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Sure, there are dozens of headline-grabbing studies that have us tweaking our diets and lifestyle for optimal health, but the fundamentals of good nutrition never change. Or do they? A new study published in JAMA suggests some fundamentals are, shall we say, more fundamental than others. For years, we were told if you want to lose or manage your weight, above all else, you need to watch and limit your calorie intake and increase your calorie consumption.

Here’s the key takeaway in this NYTimes feature story:

It found that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

 

Consistent Results Across Subgroups

The study also suggests that these weight loss benefits applied to whether the individual was following a low-fat or low-carb diet, as well as different genetics and insulin responses. Indeed, it’s easy to think that this type of approach might work for other people, but you think the meticulous details involved with counting calories in (diet) and calories out (exercise). It’s not as though you can’t lose weight, especially in the short-term, with this method. But it seems like the best long-term results must also take into account the composition and food choices of one’s diet—and the physiological effects that may be caused by the psychological act of counting calories.

It’s also easy to think that using added sugar and refined grains as a carrot for the rest of your diet and exercise is a solid strategy. And cutting these types of foods out of your diet altogether is hard in today’s culture and time demands. Still, incremental progress can be substantial progress over time. By picking out and eliminating even one food that you regularly eat that’s high in added sugar or refined grains and replacing it with a wholesome grain or vegetable, you’re likely doing yourself more good than all the calorie counts and exercise charts in the world.

 

The Human Body is a Complex Organism

In many ways, it makes us think of physics and the ways in which the observer and the observation itself can change the outcome of an experiment. Worrying about and counting calories really do seem to make the consumption of these calories less satisfying. Stress changes the composition of hormones and enzymes swirling around in our bodily system. If you combine counting calories with tracking your weight on a scale—or even just pant size, and who doesn’t do this?—but as you track more and more nutritional metrics, there becomes the very real possibility that you’re so removed from the holistic process of choosing what foods you eat and how you perceive these foods satisfying your appetite.

 

WATCH THIS VIDEO TO LEARN MORE

Modern Health Care and the “New Hospital”

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Compared to the health services of yesterday, healthcare today is a lot more sophisticated and responsive. Part of this improvement has been technological advancements, but these contributions are often over-hyped. By comparison, the contributions of taking an integrated and holistic approach aren’t given their proper due. It’s not so much that people are unfamiliar with integrated health or holistic medicine, but rather it’s the way they’re portrayed and received by patients and health-conscious audiences. More than new-age buzzwords, these terms speak to wide-ranging improvements to treatment protocols that seek to integrate different approaches and therapies to the benefit of the patient and health outcomes.

 

At Modern Health Care, we like to say that the new hospital has no walls. Instead, it’s a community of services, providers, and information resources. Sure, you still need a suitable building to house various types of medical equipment and health supplies. Yes, you still need a highly trained and highly skilled staff of health professionals. But the thing is that, more and more, health providers are doing a better job of understanding how to design treatment programs that take into account an individual’s environment and behavior outside of the clinical arena. It’s this kind of integration and innovation that we seek to highlight at Modern Health Care.

 

And yet, even as we recognize how interconnected our health and health services truly are, we can’t talk about the stories and influences and connections all at once. So, we created a few different landscapes and organizing themes to help you explore these various connections and what they mean to your personal health.