The Business of Caring

St. Vincent’s Is the Lehman Brothers of Hospitals
Its demise was only the beginning. An alarming number of New York’s major medical institutions are teetering on the financial edge.
By Mark Levine from "New York" Magazine

An astute blow-by-blow description of St. Vincent’s demise. I don’t think of HHC hospitals as safety nets, because all hospitals are safety nets. Once you walk into an E.R., whether you can pay or not, you will receive care.

“They often come into the hospital through emergency rooms, which are required by law to treat anyone regardless of ability to pay and where the cost of care is much higher than it is in other settings. New York hospital patients tend to stay in the hospital longer than others; the city’s average of 6.6 days per hospital stay is more than a day longer than the national average (older people can’t be sent home to walk-ups until they’re capable, non-English speakers require translators to provide discharge instructions, and so on.”

Spurred on by Joint Commission, there’s a new focus on length of stay. An anecdotal example: Families who reside in the U.S. bring their family member from their native countries to the hospital straight from the airport because he or she is sick. The patient stays in the hospital for the work-up and cannot be discharged because diagnostic tests cannot be done outpatient due to lack of insurance. What happens to length of stay?

There’s a comment about salaries in the article, but no one seems to say outright that the taxes from the salaries pay for the uninsured. To put it differently, I’m paying for you to be cared by me – I’m paying myself to work. And I get your attitude on top of that? Sorry, but I did not get myself to a nunnery.

New York City expects all of its hospitals to be charity wards and not in the business of flipping beds. I’m all for benevolence and indiscriminate caring. However, the business of caring as we know now does not make room for charity. As the article puts it, “In New York hospitals, it helps to be smart, but it helps, above all, not to cater to the poor.”