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outLOUD is St. Luke’s Health Initiatives’
initial foray into online communications. Our
intent is put together bits and pieces of information
and perspectives on health issues on a monthly
basis that Arizonans might find useful in thinking
outLOUD together
about how to move forward on community
health issues, how to connect with other
people and organizations who have similar interests,
and how to work together more effectively
for a healthier Arizona. |
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Is Good Health
Care Profitable?
A hospital CEO was telling
us recently about the difference the increased
use of beta blockers and stents made in his facility
in terms of reduced open heart surgeries.
He said, “the good news
is that patients have better outcomes, and the
health care is delivered more efficiently. The
bad news is that open heart surgery is a money
maker, and our bottom line is down.”
We’re seeing a spurt in
hospital growth now in the Phoenix metro area,
especially in high growth areas, and an increased
demand for services. But are the new beds going
to be filled with high-profit, high tech opportunities,
or low tech, run of the mill medical services?
In the health care world, “inefficient”
care is often someone else’ bread and butter.
We say we want efficiency and quality, but do
we really? |
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Mandates and
Regulations: Links in the Chain
Many of
the high-tech surgical procedures mentioned above
are going to specialty hospitals and outpatient
surgical facilities. One of the advantages of
docs practicing there is that they can “do
their thing” on a set schedule without having
to take emergency call and deal with the “riff
raff” of the world.
This creates an unfair situation
for general hospitals, which are required to have
emergency services and treat everybody who walks
through the door, whether they can pay for it
or not. Why should they be required to serve these
people, when specialty hospitals and fancy surgical
suite operations don’t have to?
Ergo, the push in Arizona to
require specialty hospitals to provide emergency
services and level the playing field.
It makes sense. But it’s
also ironic. Hospitals aren’t shy about expressing
their displeasure with mandates and regulations
that weigh down their operations (like EMTALA),
and here they are calling for more mandates and
regulations – for others, of course.
Just so. Every link in the chains
that bind us is forged from the logic of political
and social necessity. This is how government grows,
no matter who’s in charge. Mothers, teach
your children to be lawyers. They have a secure
future. |
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Trauma Drama
A recent column in the Arizona Republic calls
for creating a Level 1 trauma center in Mesa,
and notes that the reason Desert Samaritan Medical
Center hasn’t gone ahead with plans to build
one is “money.”
Déjà vu already.
Last Fall we did an Arizona Health Futures issue
brief on Arizona’s trauma centers (http://www.slhi.org/ahf/ahf/ahf-01fall.pdf)
and held a policy forum on the same subject, which
was attended by all the players in the unfolding
trauma drama.
Bottom line: everyone sees the
need for a statewide, coordinated trauma system,
but the water isn’t high enough yet to get
everybody into the boat.
The Arizona legislature, in
its infinite wisdom, is willing to put money into
trauma centers, but only if it comes from something
easy, like tobacco taxes. Barring that, it’s
clear to us that the problems facing trauma centers
– and emergency departments generally –
are going to require more “links” in
the chain of public oversight and regulation because
they represent issues of public safety and welfare,
no different than fire and police services.
Ladies and gentlemen, start
your engines. We need to develop a stable public
funding base for trauma and health emergency services.
We need to put a public system in place to ensure
the safe, fair, efficient and effective discharge
of these services. If we can’t get this done,
it’s not clear what we can get done in this
state.
Do you have a different view? Let’s hear
it. |
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Free Drugs
Psssst. Want free drugs? Your local physician
has a drawer full of them, courtesy of pharmaceutical
reps, whose industry spent almost $16 billion
dollars on promotion in 2000, up over 70 percent
from 1996.
Pharmaceutical companies say
they’re doing us all a favor by lowering
overall health care costs. For a different take
on the issue, get The Drift, an occasional column
on our web site: http://www.slhi.org/ahf/thedrift/thedrift.htm. |
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Arizona: Below
Average—and That’s Good
We recently ran across some numbers from the Institute
for Healthcare Improvement (IHI) that use both
hospital discharge and Medicare data to compare
hospitals on mortality rates and costs. Bottom
line: Arizona is well below the national average
for both. Arizona is even below other western
states There are several possible explanations
and the usual litany of qualifiers, but it confirms
that we have some excellent hospitals here that
deliver quality care for a reasonable cost –
comparatively speaking. Of course, hospital mortality
rates are declining overall as length of stay
gets shorter and shorter. The deeper issue is
how this affects hospitals’ financial bottom
line. |
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Exercise is
Bad for Your Health
AARP’s State Profiles 2001 (you’ll be
able to order it soon at www.aarp.org)
is chock full of interesting statistics on health
status, access, quality and the like. The sharp
data sluths at SLHI immediately noticed that (a)
the prevalence of high blood pressure in Arizona
in 1999 was 14.2%, compared to 23.9% nationally;
and (b)the percentage of adults having no physical
activity within one month in 2000 was 34.2% in
Arizona, compared to 26.9% nationally.
Our inescapable conclusion:
Exercise is bad for your health.
Hmmm… |
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Mastectomies
in Mesa
The Dartmouth Health Atlas of Health Care (www.dartmouthatlas.org)
is a national project that uses large health databases
(Medicare, Blue Cross organizations, etc.) to
answer some fundamental questions about America’s
health care system – including whether we
have anything like a “system” at all
in the U.S. It’s worth visiting and using
to pursue all sorts of interesting opportunities
for change.
We recently downloaded profile
reports for the Arizona hospital referral regions
of Mesa, Sun City, Phoenix and Tucson. A number
of things jumped out at us, but perhaps the most
interesting was the extremely low number of mastectomy/lumpectomy
procedures performed in Mesa per 1,000 Medicare
enrollees (<10% nationally) compared to the
rest (Tucson-60%, Phoenix-40%, Sun City->70%).
Assuming the data are correct,
what are some reasons for this? Lower rates of
mammograms and self examination? Better health
in Mesa generally?
Population/demographic characteristics,
social/cultural factors?
Is this a health issue in Mesa,
or merely a statistical anomaly and blip on the
local health care screen?
Have an issue you’d like
to kick around? Let us hear from you! |
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