Hospitals Supply of Medical Services

Hospital survival rate: 34%. Casino survival rate: 50%.

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.


  1. What about the simple chance of your malady being noticed? In a casino people are mostly standing or sitting, actively involved in the gaming. If they fall or slump over, they are noticed immediately or nearly so. Contrast this with a hospital, in private or semi-private rooms, where the patients are mostly lying down, or at best sitting up in bed. Unless the patient is being monitored electronically in a way that would pick up the MI, or being attended to, there’s naturally less chance of being noticed in those critical first 2 minutes.

  2. Jason,

    I want to be clear about my thesis here. My thesis is NOT that hospital administrators are sitting around conspiring to let their patients die of cardiac arrests in order to save money. I do not believe in any way this to be the case.

    Rather, what I believe is that preventing sudden death is simply not a big priority in hospitals, as it is, for instance, in casinos. Inherently, preventing many of the 300,000 sudden deaths that occur each year in the United States, while entirely feasible with existing technology, would be very expensive for the healthcare system. The healthcare system, being founded on a paradigm of covert rationing (where the rationing is based not on what is most effective, equitable or efficient, but instead on what you can get away with) would rather ignore the problem. And since there is no constituency for sudden death (as there is for breast cancer and cerebral palsy, for instance), nobody is forcing the healthcare system to focus on it.

    So, what with all the well-known and sundry crises that hospital administrators and their medical staffs must face each day, the “problemâ€? of poor response times to cardiac arrests in hospitals simply does not appear above the radar. This is not a conspiracy. It’s simple human nature.

    I am trying to call attention to the irony. Owners of casinos have noticed a clear incentive for preventing sudden death among their customers, and this realization has led to their adoption of readily available technology (AEDs), which in turn, has led to casinos becoming possibly the “safestâ€? place for you to have your cardiac arrest. In contrast, people who run hospitals (institutions that exist for the express purpose of staving off death) have not availed themselves of this readily available technology. Instead, they seem content to rely on byzantine bureaucratic processes (that, once again, were not designed by evil cabals, but instead evolved, like all bureaucratic processes), so that first responders can often do little more than dial the phone and wait for the officially designated, properly credentialed individual to arrive and then operate the unnecessarily complex hospital defibrillator.

    So there’s no conspiracy – just a deep-seated disinterest in addressing the subject. It is a disinterest that will remain unless somebody forces the issue, or unless utter embarrassment requires a change.


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  4. The success ratio in medical treatments generally is dependent more on the degree of severity of illness in the patient under treatment. The greater success ratio of casino defibrillations is probably the result of the obvious fact that the average casino patron is less ill than the average hospital patron. Hospitals are also often required to attempt resuscitation on terminal or preterminal patients because of cultural beliefs in some American subcultures than a no-code order is a betrayal of one’s loved one.

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