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scross
join:2002-09-13
Cordova, TN | reply to John K
Re: Best way to complain about a Hospital? said by John K :
Do you have a link with examples of those "real bargains" you refer to? I'm looking for some sort of cost-benefit analysis so I can see the numbers for myself. No links, but I can give you several first-hand examples:
1. Public education (everybody's favorite whipping boy) - It's costing me something well in excess of $8,000 annually to send my daughter to a local private school. If she were in the local public school (which is actually pretty good, from what I'm told), then some fraction of my property taxes would be paying for that - let's say $800, to keep it simple. So a 10x cost difference but definitely not a 10x quality difference, that I can tell.
2. Toll roads (my pet peeve) - There is a toll-road that I travel every once in a while where I pay something like 10 cents a mile. My fuel cost also happens to be 10 cents a mile, of which 2 cents is gas taxes for road construction. So there's a 5x difference there. To be fair, I'm not sure what the private/public relationship is for this toll road, but I do know that it's not taxpayer funded.
3. Local library - There is a small but fine public library not too far from where I live; it is part of a much larger system so I can get pretty much anything I want from there if I'm willing to wait a while for it. A little further out is another library of similar size which just so happens to maintain a much better selection of materials on the subjects that I'm usually interested in. Unfortunately it is also outside my municipality, so while I can still use it for free I'm not allowed to actually check anything out unless I pay $50 a year for the privilege, which so far I've declined to do. Both are taxpayer funded bargains, but given the choice of "free" for good quality vs. "pay" for slightly better quality, it still makes more financial sense for me to choose "free".
I could go on using examples for the police department and the fire department and the local health department and the local agricultural department and the animal shelter and so on and so on, but I have limited first-hand experience with these and I'm too lazy to do the leg work, since I think I've made my point.
And, my friend, there is an astounding amount of waste and fraud in the private sector, but they (we) are generally much better at concealing it. (If you want a chuckle, go read what Scott Adams (the "Dilbert" guy) has to say about all the years he spent at Pacific Bell and elsewhere.) Even then, we tend to give the private sector a break because, while our taxes are mandatory, we convince ourselves that our dealings with the private sector are strictly voluntarily and that we can always just take our business elsewhere, and that "free market" forces will ultimately rule the day - all the while ignoring the fact that things like collusion and price-fixing and market manipulation and political manipulation and huge conglomerates masquerading as individual "competitors" or even "private citizens" actually do exist, as is documented daily on the front page of this web site. | |
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| reply to dogtem
Re: Best way to complain about a Hospital? quote:
privileges - authority granted to a physician or dentist by a hospital governing board to provide patient care in the hospital. Clinical privileges are limited by the individual's professional license, experience, and competence. Emergency privileges may be granted by a hospital governing board or chief executive officer in an emergency and without regard to the physician's or dentist's regular service assignment or status. Temporary privileges may be granted a physician or dentist to provide health care to patients for a limited period or to a specific patient.
»medical-dictionary.thefreedictio···ivileges | | |
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| reply to billydunwood
Well, I emailed the Join commission yesterday, and today, someone emailed me saying they take the complaint seriously, that they opened an investigation, and they will email me later this week. | |
Mele20Premium
join:2001-06-05
Hilo, HI
kudos:4 | reply to scross
said by scross:Yes, the whole "hospitalist" concept is fairly new. At my wife's hospital this was all the rage a few years back, but now they've dropped it completely, as I recall. Not sure why, as it seemed like a pretty good idea to me. It probably revolves around money, as in the hospitalists wanted decent salaries, which the hospital couldn't or wouldn't provide. As to "privileges", if the doctor doesn't have said relationship with a given hospital then he can't admit there. Sometimes these privileges exist, but then the hospital suspends them for some reason - often due to malpractice concerns, but I'm sure there are other good reasons, too. Likewise, a doctor may suspend his own privileges at any given hospital for various reasons - maybe he no longer cares for how it's being run, or maybe it's now in a bad part of town and he doesn't feel safe going there, or maybe he just doesn't have the time or energy anymore to spend a full day at the office and another half or full day at the hospital. Here there is only the one hospital and most doctors don't want privileges there. That is why the hospitalists. My family doctor is 72 years old and doesn't have time to also do hospital visits. We have a SEVERE shortage of physicians throughout Hawaii but most severe on the neighbor islands and worst of all on the Big Island because it is so big (all other islands could be put inside it with space left over). Hawaii County and the State of Hawaii declared an emergency regarding access to physicians several years ago and it gets worse every year instead of better. All physicians here are terribly overworked again a reason for hospitalists. We have one orthopedic surgeon on the island ..the others left. I think there is another one recruited (maybe already here but not in Hilo). Statistics show we need six to properly serve the population of this island.
We have another small state run hospital in Kona but the Hilo hospital (also state run) is the larger one. There is a very small holistic private hospital up in Waimea. So, three hospitals on the island and none have proper staffing because of the severe physician shortage. Thus, the idea of hospitalists.
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 acid343211Hallo lisa Aus AmerikaPremium
join:2001-08-31
Byron, GA | reply to John K
said by John K : quote:
That's her right to tell you to sit down "immediately" If he was going to have a seizure like you were saying. they would have ran out.
You can examine a patient and determine with complete certainty whether or not they might have a seizure? That's a new one on me. I thought the -real- problem here is the widely-held expectation that nurses are supposed to respond promptly to calls for assistance? When my mom was in the hospital, there was only one button to press to ring for assistance. For all the person at the other end knew, my mom could have needed anything from a glass of water to a crash cart. Until they showed up to take a look, they had no way of knowing what was needed to put things to rights. All Patients go through a screening process when they are admitted to the Emergency room.The most serious of them go first like Accidents life threatening/Heart attack's, i don't and neither do you know if that day they were busy and waiting 12 hr's what if they had no beds because they were busy has anyone thought about that.
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acid343211Hallo lisa Aus AmerikaPremium
join:2001-08-31
Byron, GA | reply to billydunwood
Re: Best way to complain about a Hospital? There's a big issue in our Society when someone who lived a long life and the Family's want the Hospital to do everything in their power on the Family member for 2 Hr's. and spending $500,000 the person dies when will it come to a end people come on.
I mean people get real you wonder why health care is so Expensive,
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dogtem
join:2009-01-28
Simi Valley, CA | reply to Bobcat79
Re: Best way to complain about a Hospital? said by Bobcat79: quote:
privileges - authority granted to a physician or dentist by a hospital governing board to provide patient care in the hospital. Clinical privileges are limited by the individual's professional license, experience, and competence. Emergency privileges may be granted by a hospital governing board or chief executive officer in an emergency and without regard to the physician's or dentist's regular service assignment or status. Temporary privileges may be granted a physician or dentist to provide health care to patients for a limited period or to a specific patient.
» medical-dictionary.thefreedictio···ivileges Right, I understand that. I'm just saying here it's nothing I've had to deal with. Granted, I'm actually on disability and indeed do have someone else take care of it but they usually mention things like this to me.
And the hospital in question doesn't have anything like this.
Nevertheless, I can understand a hospital wanting this, due to frivolous law suits. And sad to say, this country is full of them.
There's definitely a problem when patients do not give information - due to not looking things up [in this day no excuse for that, but even in the past there was no excuse imo if you have an issue], or even plain not caring. There's too much of that, all because of taking their life for granted.
And then either way doctors are sometimes screwed over when it's not their fault. Of course there are times when the doctor should know better, but other times it's hard to know - if the patient has a life threatening issue but there is a complication with another [required] medication that would be worse - if the doctor isn't told a thing useful [medical history, medication list, etc] then what are they to do ?
So I definitely understand this. | |
| reply to scross
Re: Best way to complain about a Hospital? quote:
No links, but I can give you several first-hand examples:
1. Public education (everybody's favorite whipping boy) - It's costing me something well in excess of $8,000 annually to send my daughter to a local private school. If she were in the local public school (which is actually pretty good, from what I'm told), then some fraction of my property taxes would be paying for that - let's say $800, to keep it simple. So a 10x cost difference but definitely not a 10x quality difference, that I can tell.
2. Toll roads (my pet peeve) - There is a toll-road that I travel every once in a while where I pay something like 10 cents a mile. My fuel cost also happens to be 10 cents a mile, of which 2 cents is gas taxes for road construction. So there's a 5x difference there. To be fair, I'm not sure what the private/public relationship is for this toll road, but I do know that it's not taxpayer funded.
3. Local library - There is a small but fine public library not too far from where I live; it is part of a much larger system so I can get pretty much anything I want from there if I'm willing to wait a while for it. A little further out is another library of similar size which just so happens to maintain a much better selection of materials on the subjects that I'm usually interested in. Unfortunately it is also outside my municipality, so while I can still use it for free I'm not allowed to actually check anything out unless I pay $50 a year for the privilege, which so far I've declined to do. Both are taxpayer funded bargains, but given the choice of "free" for good quality vs. "pay" for slightly better quality, it still makes more financial sense for me to choose "free".
I could go on using examples for the police department and the fire department and the local health department and the local agricultural department and the animal shelter and so on and so on, but I have limited first-hand experience with these and I'm too lazy to do the leg work, since I think I've made my point.
Well, not really, sir.
I asked in my post:
quote:
I'm wondering if you're confusing relatively low front-end costs that the consumer -does- see (like Amtrak train fare) with massive economic costs that the consumer does -not- see (the bill the taxpayers are handed to keep Amtrak going). "Economic cost" being the -full- cost it takes to do something, or keep a going concern, as opposed to the front-end cost that the individual consumer sees.
In all the examples you've given, you tell us about your out of pocket cost, not the full economic cost of providing the service. Your immediate out of pocket cost is only part of the story.
The example you gave of spending $8,000 a year to send your daughter to private school versus paying $800 a year in property taxes to send her to a public school is the sort of thing I mean. In order to judge whether or not that's -really- a good deal, you need to know (among other things) how much money in total is being spent on a kid attending a public school. I understand that you, yourself, are only contributing $800, but what are all the rest of the taxpayers contributing altogether? You see what I'm getting at?
I would also be interested in test scores between your daughter's private school and a local public school. This tells you just what it is you're getting for your 8K a year. I'm not aware (though examples may exist that I'm -not- aware of) of a public school that has ever been shut down due to low test scores (they tend to get more money, not less, as a result of failing to do their job). Private schools, however, have to be careful about losing too many pupils due to poor test results, since bad test scores make it obvious that they are producing an inferior product (education).
Same deal with the toll roads. I understand that you prefer to pay 2 cents a mile rather than 10 cents a mile, but that raises the question, "How -many- people are driving over the same stretch of publicly-funded road and paying 2 cents for the privilege?" That kind of money adds up very quickly, but because your individual out of pocket cost is so small, it's harder to think about the problem in broader economic terms. If you'll excuse my cynicism, I think the cheif allure of paying for roads via gas taxes (versus tolls) is that it's easier to conceal where all the money is going, and when it is being misspent.
I can't say I blame you for examining this purely from an out of pocket perspective. What the other guy pays (and how often they pay) usually isn't of much concern to taxpayers (or consumers, for that matter). But what I'm trying to get at is that out of pocket costs are frequently the tip of the economic iceberg: the part that you see. In order to understand whether your tax dollars are hard at work, it's a good idea to take a look at the -other- two-thirds of the iceberg, the part that you -don't- see (and the part that those in the public sector are usually not in a hurry to talk about).
Anyhow, just as you say, examining this stuff in depth -does- take a lot of leg work. I, too, used to think that things like public schools were a good deal, until I started looking under the surface of things. In my own neck of the woods, they're always bragging about how much the public schools are spending per pupil. This would be fine, except the test scores seem to be declining. The problem doesn't seem to be a lack of money, but rather, a lack of wise -application- of money.
It's not hard to keep throwing money at a problem, particularly when the money is "for the children." Unfortunately, it's also not at all difficult to spend a lot of money and have very little to show for it. I guess that's why I've taken an interest, these last few years, in full economic costs as opposed to the out of pocket cost I am asked to bear as an individual. I'm interested in seeing the full picture, even if the picture presented turns out to be unpleasant one.
In any case, times being as difficult and miserable as they are, I honestly wish I had kept my mouth shut about all this. Fella always wants to be a wise guy, wants to tell folks stuff. If someone thinks they're getting a good deal, the smart thing to do is to remain silent and let them keep right on thinking so. That is one thing I've yet to learn.
quote:
Even then, we tend to give the private sector a break because, while our taxes are mandatory, we convince ourselves that our dealings with the private sector are strictly voluntarily and that we can always just take our business elsewhere, and that "free market" forces will ultimately rule the day - all the while ignoring the fact that things like collusion and price-fixing and market manipulation and political manipulation and huge conglomerates masquerading as individual "competitors" or even "private citizens" actually do exist, as is documented daily on the front page of this web site.
I agree with much of what you say here. If it's any consolation, I am just as cynical about the private sector as I am about the public one.
The key difference between the two, for me, is that I at least have -something- of a chance to direct my dollars where I want them to go in the private sector. The public sector seems to be largely concerned with gathering huge sums of money together, throwing it into a big pot, then quibbling over where it ought to go and who ought to spend it. As frustrating as being a consumer is sometimes, it's not hard to see why it might be considered preferable: the chances of my having my needs met are at least marginally better, depending on my knowledge (the InterTubes help there) and determination. Money in the public sector, OTOH, is largely doled out as a matter of political influence and, having none myself, I cannot rely on such a system to consider my own wants and needs.
I agree that it's getting harder and harder to direct your money to just where you want it to go as a result of that market manipulation you refer to. It's just that I don't hold much faith with rules and regulations, as they always seem to be written with the "assistance" of the folks who are already in the business.
I don't mind being lambasted for being a proponent of free markets, so long as free markets were actually in existence. America seems to have become some sort of weird amalgam of both the public and private sector whereby an ever-increasing portion of the the private sector learns how to manipulate the public sector, and so no longer has to work for a living in order to make money.
I guess the difference between the two of us is that I see government as the mechanism responsible for allowing this to happen, while you see free markets as being the culprit. It doesn't appear as though we're going to change each other's minds on that salient point. | |
scross
join:2002-09-13
Cordova, TN | reply to billydunwood
Well, keep in mind that in addition to that $8,000 I'm still paying the $800, and in addition to that 10 cents a mile I'm still paying the 2 cents, too, even though I'm getting no direct and immediate benefit from it and have no way to reclaim it. Unlike some other people out there I do this without complaint, because I understand the importance of tax revenue for the general welfare of society, and I still think that what those taxes buy is generally a bargain, all things considered. (You'd be surprised how many childless homeowners I've heard complain about how "unfair" it is that a portion of their property tax dollars go to the schools. At which point I ask "So what happens to your property's value if the local schools go to pot?", at which point they usually STFU.)
If anything, I ought to be pounding on that private school to make them explain why they're so expensive (and they are actually on the lower end of the scale for comparable schools around here). They have nice facilities and labs and all, but not 10x nicer -and the money certainly isn't going into teacher salaries, as those folks will be the first to tell you that public school teachers make a lot more than they do. Same for the toll roads, as a lot of that expense goes into the toll-taking infrastructure itself, plus the people who man and manage it, not to mention the costs of the chase cars and such (don't see those as much these days, though). And don't forget the inconveniences of limited access, especially when someone is desperate to make a pit stop.
As far as testing goes, the private school probably gets to pick and choose the test(s) they want to take, unlike the public schools. I have no doubt that the private school students genuinely do at least a bit better on these tests, but the public schools around here lately have been making good progress with their test scores - at least up until this year, when they've been informed that all the rules have changed, so they've been warned to expect much lower scores now. And don't forget that while they government gets to keep my tax dollars, the public school loses out on a big chunk of that because they've lost a student (they're funded on a per capita basis), not the mention the benefit of my child's 95th percentile test scores. | |
| reply to John_W
My wife is a CNO, Chief Nursing Officer at a hospital. It is HER job to ensure adequate skilled and professional nursing in the hospital. JCAHO IS A VERY BIG DEAL to hospitals. Losing JCAHO accreditation effectively means the hospital loses the ability to bill insurance companies for services at the hospital, and hospital administration does (or should!) care very much about JCAHO. If the physician misdiagnosed the patient, and that physician is a hospital employee then it falls back on the hospital. If the physician is an independent practitioner then I believe JCAHO won't be much help. See if you can get in touch with the CNO at the hospital about the nurses behavior. Discussing patient medical data is a very serious offense, and my wife's hospital has terminated/FIRED nurses for HIPPA violations. The CNO (if they're good) WILL want to know about potential HIPPA violations by nursing staff so they can retrain/address the issue. said by John_W:A lot of the larger hospitals have patient advocates who will help with patient complaints. You can complain to the hospital administration who usually forwards it to their risk management dept. You can complain to JCAHO. That's the Joint Commission. Hospitals live and die by these guys. The do annual inspections of all hospitals. And these inspections are the corporate version of a prostate exam. Nothing means more to a hospital than to get a decent inspection from these guys and nothing stings more than to have major violations. St Johns has a NICU, so I am assuming they value this inspection very highly. » www.jointcommission.org/generalp···mplaint/ | |
 NYR 56Premium
join:2000-12-05
Smithtown, NY | reply to John K
That is one of the best posts I've read here in a while, John K.
Scross, you seem to have ignored his main point. You keep saying it's a bargain, while the reality is many people who don't directly use the service are paying. That isn't inherently bad, but that doesn't make it a bargain either. Over here, public schools spend over $10,000 per pupil. I can't comment how much the private schools cost, but you keep throwing around the "10x better" comment. It is very likely that the public schools spend just as much as the private schools, but use 10x more people's money. That's no bargain in my book, unless you are extremely short-sighted. | |
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