Even the Healthcare Till is Feeling the Financial Squeeze

In keeping with my concern about patients getting the shaft for physicians’ bottom lines, here’s an article that erases any doubts that the healthcare industry will weather the current economic crisis unscathed. According to the article, older physicians may delay retirement due to major losses in their retirement plans, which may alleviate immediate physician shortages in some areas, but may also result in those physicians being less likely to treat uninsured or underinsured patients, including Medicare and Medicaid, because the profit margin is so low or even nil. Also, aspiring physicians may find they cannot secure the loans necessary to enter or complete medical school with the credit squeeze, which could worsen the physician shortage in the long-term. Of particular concern is the abandonment of primary care for more lucrative specialties when primary care is where the most disease prevention and health promotion measures take place, essentially where the most bang for the healthcare buck is generated. And, of course, many hospitals are halting massive expansion projects for lack of credit, which is bad for their bottom lines because the more ill people they can admit, the more reimbursement they get.

The central problem here is that all these healthcare players’ financial destinies are linked to treating illness, and they need a steady supply of sick bodies to ensure their livelihoods. Insurance companies don’t pay well, if at all, for preventative care, and they certainly don’t pay hospitals for patients who never use their services. For all the grandiose talk about disease prevention that spews from hospital’s marketing departments and physicians mouths when they talk to wayward patients, there’s no financial incentive for physicians or hospitals to keep their patients well. It’s a delicate paradox because both patients who are too sick and too well are financial losers for physicians and hospitals. If they’re too sick, the costs of their care will outstrip the reimbursement rates, and if they’re too well, they show up maybe for an annual physical that is time intensive and poorly remunerated. The best financial scenario for the players is to maintain patients in a holding pattern of manageable sickness where they need care on a predictable basis. Am I saying that physicians and hospitals actually try to keep patients sick? No, but by complacently participating in a for-profit healthcare system that rewards treatment rather than prevention, they’re serving their bottom lines first and foremost, not patients and long-term public health.

The aforementioned article focuses on the economy’s impact on physicians and hospitals and totally ignores nurses and ancillary personnel that perform the majority of actual care within the industry. We certainly aren’t immune to the economy’s effects. Like older physicians, older nurses may have to stay on the job longer to recoup 401K losses, which might temper the ever-growing nursing shortage in the short-term. But, if nursing students can’t secure funding for their educations, there will be fewer nurses in the workforce in the long-term, which translates into harder, more stressful work at the bedside that ultimately increases the likelihood of injury, burnout, and job attrition for both new and seasoned nurses. And, even though the financial status of our patients doesn’t immediately determine our bottom line, like the bigger players, we’re caught in the same nonsensical illness paradigm that ensures we’ll have jobs, particularly in hospitals, for years to come if only our bodies can withstand the increased workload and of course, we don’t become ill ourselves. With the time-is-money dragon breathing down our necks, the endless paperwork, and the pressing needs of an even sicker patient down the hall, we have little time to spend on educating and empowering patients to make informed decisions about their health and positive behavioral changes.

What our adherence to this illness paradigm ensures is the continuation of a healthcare system with runaway costs, unjust delivery of care, and poor quality outcomes. A select few will find ways to get wealthier while the masses grow unhealthier. Envisioning a different system is difficult, I realize. But, it’s time we face the situation and swallow the bitter pill of change. We definitely need a new drug, one that we collectively create and market ourselves because given the zero profit factor, I’m certain Big Pharma isn’t up to the challenge. Are you?