I am continuing my series on the costs of cancer I wanted to write about medical waste. But let's back up a minute, why am I pretending I am scholarly and writing about these 'big' topics in my little tiny blog? Because I think they are important. The medical costs a cancer patient incurs are amazingly high compared to other ailments - particularly in the first year after diagnosis and the last year of their life.
Cancer is becoming more treatable but is also becoming more expensive at alarming rates. The idea that a single chemotherapy infusion can cost over $10,000 is crazy. And unfortunately it is common place. Then if you take the infusion style chemo out of the hospital it becomes a pill that is covered by the pharmacy benefit which means it can costs hundreds of dollars per daily pill. So it may be physically easier on the patient to take a pill instead of receiving an infusion but is much more damaging on their wallet.
But I digress. Today I am writing about the broader spectrum of all medical costs. When I think of medical waste, I think of these big sterilized packages which are used to protect an IV kit and what isn't used is dumped in the trash. All those individually sterilized and sealed items where wrappers larger than the tool are thrown in the trash. By health standards, if a package is unsealed, anything that is not used is no longer sterile and goes in the trash. There are lots of single use items which make their way to the incinerators and landfills.
Unfortunately medical waste is also defined as a much larger problem. Medical waste often happens when there is a patchwork of care.
"Manhattan in New York City is a good example. Because healthcare
utilization there is among the nation’s highest, Manhattan is seen as
wasteful and inefficient. But it is a patch-quilt of wealth and poverty.
Utilization in the low-income Bowery is double the rate of the affluent
Upper East Side and Upper West Side, and utilization in Harlem, the
poorest area, is more than triple (unpublished data). Without either,
Manhattan’s utilization is among the lowest in the nation, lower even
than Grand Junction, Colorado, whose healthcare system was held out by
President Obama as a model for the nation. But like Grand Junction, the
Upper East Side and Upper West Side of Manhattan have few African
Americans and no poverty ghettos.
How much does the extra
care in poor neighborhoods add to overall utilization costs within a
region? The best estimate is 20% to 25%. Yet, tragically, this fact
is ignored—indeed, denied. For example, Dartmouth researchers mock the
fact that “some physicians believe their hospitals or regions spend more
because their patients are sicker and poorer” and declare, “regional
differences in poverty explain almost none of the variation.” In a
similar manner, Nicholas Kristof, a columnist for The New York Times and
an advocate for the poor globally, labeled as “opponents of health care
reform” those who attributed poor outcomes to “America’s large
underclass.” In fact, poverty explains virtually all of the regional
differences in utilization, and “America’s large underclass” accounts
for virtually all of the differences in outcomes between the US and
Real healthcare reform would address these
socioeconomic realities. Instead, the US is waging a regulatory “war” on
exaggerated measures of waste, one that shows little promise of
reducing costs or increasing quality but will assuredly crush “needed
innovation by practicing physicians, who best understand the delivery of
care.” Moreover, because there are no risk adjusters for poverty,
physicians whose low-income patients fail to meet federal utilization
and quality norms will suffer financially, and hospitals whose poor
patients have high readmission rates will be penalized. All the while,
the “war on waste” will distract policymakers from building the social
infrastructure that could lower the high healthcare costs of poverty.
These are no ordinary times. For the first time, physicians and their
patients are caught in the crosshairs of the “war on waste.”'
So where does this all leave us? The Republicans believe that market forces will help reduce costs and waste while the Democrats look for answers in the Affordable Care Act. What this tells me is that the system is flawed and needs changes which is nothing new. We can't look to politicians for reform as our sole solution. We need to look at the health care system to resolve this.
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