Ethics committees are an important part of hospitals and should have important decision-making capabilities. They should include house officers, clergy, physicians and surgeons, and all other types of health care workers in the high-tech health scene. Medical malpractice must be controlled to allow decreases in the cost of health care and to allow rational thought about and care for patients with hopeless prognoses. In the elderly age group we must strive for short hospital stays, with emphasis on posthospitalization home care, prevention of symptomatology, and the individualization of high-tech health care, including surgical procedures. Finally, we must collect more long-term data on the elderly to define the effects of high-tech health care on the survivors of operations and intensive care. All prospective randomized studies to date, particularly in cardiology and cardiac surgery, have excluded patients over 70. We need new studies to include elderly patients to begin to make rational decisions for the future. alta white teeth whitening
Cost of High-Tech Care Experts at the Health Care Finance Administration project that health care spending in the United States will hit 15 percent of the gross national product by the year 2000. Many experts have questioned whether we can actually become competitive in worldwide trade while allocating such a large proportion of our scarce supply of capital on skilled labor for health care consumption. Not so facetiously, it has been estimated that approximately $750 of the price of every Chevrolet pays for the health care costs of the workers at the Chevrolet division of General Motors. Industry is intensely interested in health care costs. Figure 1, from the Wall Street Journal of Sep 29, 1987, shows the escalating cost of health care in the United States despite all attempts by the government, insurance companies, and industrial health planners to keep medical costs down. Howard Hiatt, M.D., of the Harvard School of Public Health, has estimated that this country spends about $450 billion, or $2,000 per citizen, on medical care per year, but the country still ranks 16th in life expectancy. Up to now, the greater the amount of resources consumed for sick patients in the intensive care area, the greater the charge generated and the level of reimbursement. Now many third-party payers, including the US government, are finding themselves in a financial situation that is causing pressure for economic changes and restrictions in cost reimbursement to both physicians and hospitals despite increased technology. In Table 4, taken from a project proposal for cost containment in critical care, we see that high-tech health care is about four times greater than that for general care and, documented by many authors, the vast majority of dollars spent in intensive care is spent on nonsurvivors.
Table 4—Cost Containment Projections
|Cullen||1984||31||$22,000||$141,226||TISS Cat IV|
|Detsky||1984||44||12,300||27,954||Ventil > 48 hr|
|Schmidt||1983||36||16,930||177,660||Ventil > 48 hr|