Health Reform Mail Call

The two pieces of health care-related mail that arrived in my mailbox this weekend were sent by providers taking very different approaches to a common health care dilemma - that of constrained resources.

I noticed the first mailer because it boasted a shiny, wood-paneled station wagon with an "Ambulance" decal on the window and a surfboard in the trunk. This image associated the sender (a local hospital) with the relaxed but not inexpensive vibe found at many Southern California beaches. The pamphlet opened to a full page describing the health care amenities found at the hospital. Alongside glossy photos of surgeons and high-tech imaging technology were descriptions of special procedures offered at "Centers of Excellence" and bedside perks like Wi-Fi and flat screen TVs.

The second mailer escaped my attention initially because it arrived in nondescript packing. Only the hospital's logo in the corner of the envelope revealed the sender. Inside was a patient survey from the hospital I recently spent a night at for treatment of an infection. The survey consisted of a simple Scan-Tron sheet and left no room for written comments.

These different mailers demonstrate the hospitals' divergent approaches to dilemmas caused by constrained resources. These issues are common for American health care providers as costs of care rise, uninsured Americans continue to seek care, and public (Medicare and Medicaid) and private (The Blues, Aetna, etc.) insurers demand quality for health care expenditures.

The first hospital is responding to resource pressures by emphasizing revenue generation. Advertising procedures, technology, and specialty care reveals their push toward high margin services. They aim to attract insured patients able to afford elective care. Noticeably absent are mentions of services that typically cut into hospital profits such as obstetrics or pediatrics, and the mailer only lists a 24/7 emergency department - a service frequently utilized by uninsured patients - in one line at the bottom of the page.

The second mailer reveals another approach to constrained resources. This is an emphasis on cutting costs. A patient survey without a space for comments demonstrates that the customer service department is reducing expenses by automating the response-reading process and my own experience at the hospital confirmed that other cost center departments are likewise relying on minimal staffing. The only luxury provided by this hospital was a prepaid envelope to return the survey.

Although both of these hospitals' response presents rational decision-making in the face of constrained resources, both leave much to be desired. If all hospitals were to ignore obstetrics America's maternal mortality numbers would likely rise above already embarrassingly high rates. And if all hospitals cut costs and forced patients to constrain their feedback to 20 prepackaged questions American patients' frustration with the health care system would similarly continue to climb. There must be some U.S. hospitals making decisions that increase profits and cut costs without compromising services - they just don't seem to be in Southern California.

Photo credit: salimfadhley (flickr)