Three random topics. Or so I thought.
Maryland sets an annual global budget
for each of its hospitals. The federal
government also participates in the regulations, by requiring that the
hospitals comply with the state-set budgets.
I suppose the feds’ interest is that they finance Medicare and share in
the financing of Medicaid. But the global
budgets apply only to residents of Maryland.
Hospital revenues from out-of-state patients – “medical migrants” - are
outside the global budgets and thus produce unregulated additional revenues for
the hospitals.
Hopkins’ former employee alleges
Hospital management pressured staff to migrate out-of-state patients into Hopkins
Hospital, taking beds that might otherwise have been available to Maryland residents, and
generating revenues that Maryland residents would not have generated. Hopkins has responded that “Our census shows
that the majority of our patients are from Maryland and that the number has
steadily increased over the past several years” - which is fine as far as it
goes, but does not directly or fully answer the issue. A judge will have to sort all this out.
2. Medical Tourism? This term describes a growing international trend among patients
seeking medical care outside their own country. It has been a recurring topic
at InsureBlog over the past few years - here is an old post from 2007; there
are many others.
Medical migration is similar to medical
tourism because both have similar motivations and similar ends: the unbreakable linkage between money and
medical care, and access to medical care that may not be locally available. The
Johns Hopkins situation is not exactly medical tourism because it involves
movement between states in the same country, not between two different
countries. Yet it may be evidence that U.S. patients are
becoming more willing to travel for their medical care. And, of course, it’s also evidence of
hospitals’ continuing creative efforts to improve their revenues.
What’s that? Scotland is “exiling” certain patients to
other countries in the U.K. for medical treatment?
It’s complicated. It seems Scotland has allowed
at least 460 NHS specialist positions (plus an additional unspecified number of
nurse positions) to go unstaffed. As a
result, a growing number of Scottish patients face unexpected travel for
specialist or routine nursing care. NHS
Scotland is sending these patients to England, Wales, or Northern Ireland. NHS actually anticipated this as an infrequent
contingency, so there are funding and administrative means in place to handle referrals. But the recent, sharply increasing volume of
such referrals was not anticipated.
Scotland has apparently been managing – or mismanaging - its understaffing
problem by “exiling” patients to obtain care outside their own country, rather
than filling the vacant specialist positions inside Scotland.
The available information is hard to interpret. For example, how does Scotland reimburse other
U.K. specialists? How does the sum of
those reimbursements compare to the sum of the salaries and other employment
costs for the 460 specialists the Scots would otherwise employ? I can’t help but suspect one of those numbers
is a fair bit larger than the other.
So why tie these three phenomena
together? Movement.
Specifically, the movement of a growing
number of patients willing - or obliged - to travel far from where they live,
in order to access medical care. Movement
of patients within the U.S. to access medical care has been a slow-growing thing for some years. But in other parts of the world, such patient
movement seems to be growing faster, and is more common across national
borders. And the worldwide phenomenon is
not exclusively physician- or patient-driven. Governments are facilitating and,
in some cases (i.e. Scotland), are requiring such travel.
Is patient movement likely to improve
care? Will it improve access? Balance patient loads? Result in better match of patient
needs with services across local, national, and international medical care
delivery systems? Or will it be not so
beneficial? Will these trends instead
end up exposing a world delivery system largely unprepared to meet the rising demand
for medical care? Is this the start of some classic B-movie, in which a flooding
river causes the dam to spring small leaks, as rising waters spill around and
over the dam, and no one is listening to the few townspeople who notice what is
happening?
Time will tell. Meanwhile these phenomena are related, and do
bear watching.
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