BigBallinStalin wrote:Licensing is allowable on a free market. There would be more than one license agency per state, so it would be much more competitive, thus more open to customer preferences, innovation, higher quality, lower prices, etc.
See, this I wouldn't have an issue with, but TGD made it sound that he wanted to go to some schmuck with a camera and butterknife to do a knee replacement...
Are there any examples of how the licensing process today inhibits these things?
Actually, yes.... and we have posted them previously, but we have to be very careful.
As you say, medicine is one of those things where people do not always want the cheapest option. Quality really does matter. However, there is a lot of push about whehter, say PA's (Physician assistants) and Nurse practitioners should do more or are doing too much of basic exams. Midwivery is another area where this happens. In the case of midwives they have a very different approach, so its not just a matter of not having the same skills, its also a different way of doing things. Many modern hospitals are embracing midwives, trying to form relationships so that moms can use a midwive, but still have the full medical staff if something goes wrong. (just as an example).
So, there are cases where things can be simplified and costs reduced.
HOWEVER, there are 2 other issues. Medicine, ironically enough, is one of those things that responds negatively to competition. I posted a couple of articles on this before, specifically a stuffy of back care in Texas, but could not find that link again. Here is a journal article on the topic. Its orientation is how to prevent this from happening.http://www.ncbi.nlm.nih.gov/pubmed/9952205
The United States has experienced dramatic growth in both the technical capabilities and share of resources devoted to medical care. While the benefits of more medical care are widely recognized, the possibility that harm may result from growth has received little attention. Because harm from more medical care is unexpected, findings of harm are discounted or ignored. We suggest that such findings may indicate a more general problem and deserve serious consideration. First, we delineate 2 levels of decision making where more medical care may be introduced: (1) decisions about whether or not to use a discrete diagnostic or therapeutic intervention and (2) decisions about whether to add system capacity, eg, the decision to purchase another scanner or employ another physician. Second, we explore how more medical care at either level may lead to harm. More diagnosis creates the potential for labeling and detection of pseudodisease--disease that would never become apparent to patients during their lifetime without testing. More treatment may lead to tampering, interventions to correct random rather than systematic variation, and lower treatment thresholds, where the risks outweigh the potential benefits. Because there are more diagnoses to treat and more treatments to provide, physicians may be more likely to make mistakes and to be distracted from the issues of greatest concern to their patients. Finally, we turn to the fundamental challenge--reducing the risk of harm from more medical care. We identify 4 ways in which inadequate information and improper reasoning may allow harmful practices to be adopted-a constrained model of disease, excessive extrapolation, a missing level of analysis, and the assumption that more is better.
I won’t reiterate the abstract, it explains the points well.
The other issue you eluded to above and is very controversial. In most hospitals you have maybe 1-2 RNs who will supervise several Nursing Assistants. The nurse, either RN or LPN have degrees. The practitioners have certificates. They do a lot of the day-to day, labor-intensive care, such as bathing and feeding, moving patients, etc. Depending on the location and training they may do other things. The tendency of administrators is to cut back on Nurses and use more aids. On the one had, it makes sense to not have an RN or LPN just bathing a patient, but it also means that the nurses and doctors don’t see the patients as much as they used to… that means they are more likely to miss things, particularly in elderly patients, some other situations where things can change very rapidly. Further, the aids are often way overworked. One aid having to take care of 15 patients is not uncommon. Just think about trying to hand feed 6-7, never mind 10-12 patients in an hour and a half! Regulations mandating patient coverage ratios are being suggested and, I would say, are warranted, but they mean higher costs.
One factor making hospital costs particularly hard to manage are widely varying patient counts. Most hospitals have part-time people who work more when required and less when not required. That works, to a point, for them, but wreaks havoc on families. It is hard enough to get childcare on a nursing schedule (our area, for example, has no certified night care and very, very limited care after ), but when you don’t know when or if you will work from one day to the next, it can be impossible. Basically, you need to have a family member or friend willing to take your child or you are out of luck. The local hospitals and care homes each are understaffed, but they just laid off 3 Nurse Aids because they kept calling off, mostly for childcare issues. This is less of a problem in the bigger cities, but it is still a problem there.