CommonHealth

In case you missed it, read this post by Kristiina Sorenson on Healthcare Savvy about her husband’s new tattoo. The story begins like this:

One day my husband came home from work and announced that he wanted to get a tattoo.  Greg was a neuroradiologist at Massachusetts General Hospital — more of a science nerd than an ink lover — so this caught my attention.  He said he wanted to have a tattoo right across his forehead that said:

“IF FOUND DOWN, TAKE ME TO MGH.”

A volunteer tests out Greg’s tattoo design.

If he ever collapsed somewhere, he said, he wanted to be sure that he was taken to Mass General, and not to the nearest community hospital.

Greg had started working at a lab at MGH when he was in medical school, and he had done his radiology residency and fellowship there, so his ties to the hospital went back a long ways.  But this bit about the tattoo was more than just institutional loyalty.  He was convinced that the care at Mass General was better than at many of the smaller hospitals.

He proved his commitment to MGH one night when he became a patient himself.  One evening I came home and found Greg lying on the bathroom floor writhing in pain.   On the 1-to-10 scale of pain, he said he was at a 10.  He clearly needed to be seen by a doctor, so he managed to get himself out to the car, and I started heading to the nearest emergency room.  “No,” he said. “Take me to MGH.”  Every bump in the road caused him to moan in pain, and and every extra minute of the drive was excruciating, but even in unbearable pain, he was adamant that he wanted to go to Mass General.

The piece, however, is far broader than simply about one guy’s loyalty to his workplace. It raises issues about the validity of tiered health insurance and speculates about the potential for growing disparities in health care:

This raises some real questions about the tiered insurance plans that many insurance plans are now introducing in Massachusetts. In these plans, patients are free to choose which hospital they use, but they pay less for some hospitals and more — a lot more — for others.

The idea is to push patients toward the most cost-efficient hospitals — the places where they can get the best care for the least amount of money. It’s a great goal, but does it really work out that way?

In practice, it’s hard to put a value on all the different things that go into making a great hospital. How much is it worth to have a neurologist in the emergency room 24 hours a day? How much do you subtract for a wrong diagnosis? Is it valuable to have access to an MRI scanner anytime? Does a hospital need an acute cardiac care team? Are nurses with extra training better than recent graduates? Is it valuable to have a doctor who is involved in research? All those factors can make a difference for patients, but they are awfully hard to measure and score on a spreadsheet.

In the end, the tiers in the insurance plans seem to be mostly about price. The insurance companies are trying to push more patients out to the community hospitals because they are cheaper, not because they offer better care.

The result will be more inequality in our health care system. People who can afford to pay thousands of dollars in co-pays will be able to use the Boston teaching hospitals. People who can’t afford those huge co-pays will end up in the community hospitals.