You are 80 years old and have two years to live. Which hospital would you prefer, Bellvue (large NYC public hospital) or Columbia-Presbyterian (NYC academic private hospital)?
I assume that most who know these hospitals would jump at Columbia-Presbyterian. I think that is a safe assumption, but…(you knew it was coming)
I was listening to the Brian Lehrer show on WNYC (NPR) and was fortunate enough to listen to an interview discussing Consumer Reports findings (based on Dartmouth Atlas of Health Care 2008) in which consumer reports says that, especially at end of life (data comes from Medicare), more aggressive health care leads to worse outcomes. Too many pricks, tests, procedures, hospital acquired infections, extensive recoveries, pharmaceutical mix-ups, etc. Exposure to more health care can be bad for you. Sometimes conservative health care is better. Sometimes the primary care physician is better than the specialist. Sometimes the neighborhood hospital is better than the state-of-the-art hospital. Bigger is not always better – a lesson Americans are slow to grasp. SUV’s are not necessarily better than compact cars. The 6,000 square foot mansion is not necessarily better than the 1,000 square foot apartment. The truth is that the private hospitals have perverse incentives to do more – to the point of harm. The public hospitals might have incentives to do less. Both extremes can be to the detriment of the patient.
Most health economics and policy makers grant that health care resources have diminishing returns the more you receive. Meaning the first few interventions will have dramatic effects, but each additional resource used will have less and less impact until the care actually becomes harmful. Some patients reach that point in some of our hospitals.
Overuse reaches the point where some states, hospitals, cities use 3x more health care resources than others with unmeasurable effects. Why? Because more is not always better, just richer. Health care needs to be smarter. Cars need to be smarter. We need to be smarter. However, getting back to the quiz…
With all that said I would still choose Columbia-Presbyterian, however, I would ask the questions to determine if the care proposed is really going to be good for me.