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Health Care
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"Nurses and hospital administrators are,
in some ways, between a rock and a hard place because most Americans
refuse to rethink how we pay for health-care. |
The result is what nurses call "sicker and quicker," sicker patients, shorter stays but not more nurses, better trained to do care.
Insurance companies, safely hidden from public view, adopted reimbursement policies that also encouraged sicker patients and shortened stays. But private health insurers rarely appear in our discussions of financial problems facing hospitals and hospital workers --- and the healthcare of Americans. Most Americans might get angry when their health insurance companies refuse to cover treatments, or support more time in hospital for women after delivery.
But few Americans know the dollar cost of private health insurance. You may be surprised by the statistics from the US and Canadian governments, and the OECD, a quasi-non-governmental organization of wealthy industrialized nations.
Marketing, sales, profits and the administration of the private health insurance eat up about 1 percent of GDP, and about 14 percent of premiums. In Canada's single-payer system, it's about 1-2 percent, but overhead costs of their private supplementary insurance system is about the same as here. In 1995, the US spent about 4 times per capita what Canada did on health care administration ($995 to $248). Hospital billings and administration was $361 in the US compared to $119 in Canada.
Physicians' billings and office expenses in 1993 in the US were over twice that of Canadians. I don't know the percent of physicians who have been driven from solo and private practice into groups and HMOs --or new careers or retirement-- by the difficulties of continuing good medical practice while coping with the headaches of billing.
The reimbursement system also affects work life in the hospital. Nurses spend time documenting the care they give patients, not to improve it but to satisfy the insurance companies that they are not giving too much. So, the private insurance system drains time, money, and services from hands-on care itself.
Nurses and hospital administrators are, in some ways, between a rock and a hard place because most Americans refuse to rethink how we pay for health-care. For starters, we have to cease thinking about only the visible players--doctors, nurses, patients, hospital administrators, -- and recognize that our private insurance system drains big bucks from our health-care.
The Canadian single-payer system treats patients much better than the American one, contrary to the bad rap it gets in the U.S. press. Out-of-pocket expenses, getting care, seeing a specialist, receiving prompt treatment, and not having a problem paying are all and better for Canadians than Americans. Neither is it "over-using" by American patients, as some allege, that drives up the cost of health care. In the mid-1990s, Australians and Japanese outdid us two and three times respectively, in visiting physicians, and Canadian, Germans, and the French saw their doctors at least as often as we Americans.
Figures for 1995-97 contradict any fantasy that our costly health care system increases life expectancy. Longevity is better in all of those countries. Canadian women have a life expectancy of 81.3 years compared to 79.2 for us. Canadian men have a life expectancy of 75.3 years compared to 72.5 for us. Our infant mortality in the first year of life is twice that of Sweden's, and 20 percent higher than Canada (8/1000 live birth below the border compared to 6.3 above the border).
Perhaps most scary, the World Trade Organization threatens the health of Canadians. The WTO is suing a publicly owned Canadian utility, alleging that public ownership allows the sale of electricity at a price much lower than any privately held utility can offer electricity to Canadians. If the logic holds, there's no reason that American insurance companies can't destroy the Canadian single-payer system for private profit, regardless of the consequences for the health and pocketbooks of Canadians.
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Those interested in health care might also might want to know about The Center for National Health Program Studies,
Harvard Medical School/ The Cambridge Hospital, 1493 Cambridge Hospital, Cambridge, Massachusetts 02139, which analyzes statistics on health-care.
I drew from a publication by Steffie Woolhandler,M.D. and David Himmelstein, M.D. for the statistics in my article.
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Dr. Nona Glazer, a teacher and painter, is Professor Emerita, Sociology Department, Portland State University, Portland, Oregon. Her findings were published in Women's Paid and Unpaid Labor: the Work Transfer in Health Care and Retailing by Nona Y. Glazer, Temple University Press, 1993, Philadelphia 19122, and in various social science journals.