Bioethics Blogs

The Readmission Problem

No one seems to know what the answer is to keeping costs
down in healthcare but grand efforts have been undertaken to find someone to
blame. Some of the targets are patients, others are providers, and sometimes
the insurers are dragged into the fray as well. The rhetoric is tired and worn
on both ends.  Is it the folks with
chronic diseases like diabetes? Is it the folks who need dialysis? The smokers?
The patients who do not follow the doctors’ advice and stay sick and expensive?
The people who want ‘everything done’ at the end of life? Is it the doctors who
acquiesce to patient demands or the laws that obligate them to do so? Do
doctors order too many expensive tests, bleeding insurance system? Is it the
liability insurance that must cover them if they fail to order a test? Maybe it
is the insurance companies paying high salaries to executives while handing
down ever-shrinking reimbursements pressing institutions to find new ways to
eek out enough income to sustain an operating budget. Newer to this menu are
penalties for staying in the hospital too long and coming back too soon. This
latest addition to the list is perhaps among the most absurd.

I will agree that there are instances where patients remain
in the hospital too long, and poor discharge planning or malingering behavior should
not be paid out endlessly. However, to both restrict length of stay AND
penalize facilities for patients who then return still sick is never going to
achieve better health outcomes.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.