Rewarded for doing more – another reason why things won’t change until reimbursement is reformed:

English hospitals are rewarded for keeping people healthy and having case management so patients will not need hospitals very often. American hospitals are rewarded for having a high proportion of commercially insured patients having many procedures, especially cardiac care.

We need incentives for American hospitals to develop home-based case management, to place the emphasis on positive long-term outcomes and health status improvement, reducing the need for hospitalization. Our hospitals are working to reduce the number of poor and poorly insured people using emergency rooms as substitutes for family physicians. But the poor still become sick and in need of care.

Unfortunately, advertising-driven consumer demand, consumer-directed health care, promotion of the latest technology and beautiful, comfortable facilities with gourmet meals and new drugs lure patients into our hospitals, including the uninsured or underinsured as well as those well endowed with insurance or Health Savings Accounts.