Hospital Bed Shortage
Daily Observer
S.Q. Lapius was impatient,
“Come on Harry. I have to phone. You have been on it for an hour.” I waved him to silence, and finally hung up.
“Sorry, Simon, but I’m trying to find a hospital bed
for a patient of mine who is quite sick.”
“No beds again?”
“That’s right.
They have them in the halls. One
place said they even have one bed in an elevator.”
“Surely an exaggeration,” said Lapius
smugly.
“Surely not.
How come you don’t have this trouble?”
“My patients, by and large, own the hospitals.”
“Well, for us poor plebes the situation is
different. Honestly Simon I don’t know
what’s going to happen. It’s getting
worse all the time. Now that the
government wants to terminate the Hill-Burton program which provided matching
funds for the construction of hospitals, beds will become less available than
ever.”
“It’s hard to achieve a proper balance, Harry. If too many beds are available then hospitals
with poor occupancy rates go broke.
One reason for the high occupancy is that not all
insurance plans cover outpatient work-ups, and physicians and patients alike
find it convenient to hospitalize for work that could just as easily be done in
the physician’s office.”
“That’s not as prevalent as it used to be. I’m inclined to think that the prime cause of
hospital bed utilization now is for terminal cases, and for the elderly and
infirm who simply can’t be expected to run back and forth to doctor’s offices
daily for a work-up.”
For instance, a patient has to have a barium enema,
he’s ninety years old, crippled, living with an eighty-five year old wife.
How can you give him a laxative the night before, and
expect his wife to give him enemas the following morning so he can then call a
taxi or a rescue squad ambulance to cart him to and from the hospital for the
procedure? That patient should really be
hospitalized for a day or two.”
“I know what you are going to say, Harry. You hospitalize the patient, but no bed is
available until Friday. This patient
doesn’t have the X-ray work scheduled till Monday.
While he is in the hospital why not take advantage of
the situation and do a complete work-up.
By the time the patient leaves a week has passed.”
“Absolutely, providing you haven’t discovered some
other condition in the meantime, or asked for consultation. By the time a consultation request is written
and the consultant actually sees the patient and his report is on the chart, at
least three more days have passed.”
“You know, Harry, considering those days, plus the 75
or so days a year that are holidays or weekends, at an average rate (and I know
this is low) of $100 per day, considering a hospital of a hundred beds, the
community, including the insurance carriers lose about one million dollars a
year. Multiply this by the number of
hospital beds in the country and I bet the bill runs to a billion dollars or
more.”
“You’re right.
You know what they ought to have, Simon?
They ought to have ‘work-up’ hospitals, where a patient can go to a
hotel type of domicile, be transported to the hospital for tests, and be taken
back again.”
“Would this new facility have nurses?”
“Yes.”
“Would it be a nursing home or hospital, or what?”
“I haven’t figured that out yet.”
“You better if you expect the Blues or other
insurance carriers to pay for the stay.
And if they do pay for it the costs would just as high as in hospitals
because standards would have to be met---.”
“How about a private place, $30 dollars a day, meals,
and nurse on premises as well as transportation? The hell with the Blues.”
“No community would go for it. People no longer expect to pay for any part
of their illness or incapacity.”
“Then of course there’s the other side of the coin.”
“What’s that, Harry?”
“There ought to be more extended care units, you
know, sophisticated nursing homes, that convalescing patients can go to.”
“They have them.”
“I know, but somehow they haven’t got sufficient
round-the-clock services to make a doctor feel confident about sending sick
patients there. So we keep them in the
hospital longer than we might if these facilities were available.”
“What I think you are saying, Harry, is that not
every hospital has to have an X-ray department, an emergency room, or a suite
of operating rooms.”
I mulled that over for a while and agreed. “Yes, that’s what I’m saying.”
“Well, then for goodness sakes, why don’t you say
it? You could have said it half an hour
ago.”
“Sure, but then you wouldn’t have had a column.”