An interesting article (“Sudden Death…“) at the Covert Rationing blog addresses the poor care given to cardiac patients in hospitals. Dr. Rich states that:
“…hospitalized patients who have cardiac arrest (sudden loss of cardiac function due to the onset of a heart arrhythmia known as ventricular fibrillation) are often not receiving defibrillation (an electrical shock delivered to the chest) within the recommended 2-minute window of opportunity. Further, patients whose defibrillation is delayed beyond the 2-minute window have a substantially reduced chance of surviving the cardiac arrest….An accompanying editorial (written by Dr. Leslie Saxon, an old friend of DrRich) points out that in public areas where Automatic External Defibrillators (AEDs) are available, such as casinos, the odds of surviving a cardiac arrest is over 50%. In contrast, the odds of surviving cardiac arrest in a hospital, according to this new study, is only 34%“
Why would this be the case? Casino’s may have a business interest in saving people’s lives in order to get some good publicity and more consumer loyalty by survivors. On the other hand, hospitals may actually save money by not treating cardiac patients appropriately since patients experiencing cardiac arrest are likely to be “individuals with chronic and expensive medical problems – most often they have coronary artery disease, diabetes, or heart failure – and (as DrRich has pointed out before) their sudden death today will save the system countless dollars tomorrow.”
Insurance companies do have a financial incentive not to treat cardiac arrest patients optimally. The question is whether or not these financial incentive impact the manner in which physicians practice medicine in the hospital. Dr. Rich gives some evidence that financial incentives may be playing a significant role in the quality of hospital care in the U.S. today.