Viewpoint
FROM THE CHIEF MEDICAL EDITOR

Hidden Costs of Healthcare

Larry E. Patterson, MD

In the ongoing healthcare reform debate, it often is pointed out that other countries provide healthcare comparable to the United States, but at lower cost. While you and I might argue about their quality of care, we in the medical field can point out many reasons why Americans have to foot a much bigger bill. Our prescription drugs cost much more than in other countries, as we seem to subsidize drug development for the rest of the world. Our malpractice exposure (and big-ticket insurance premium) doesn't come close to existing at the same level in other countries. I've talked with doctors who practice in our neighbor to the north, and these Canadian physicians rarely ever hear about medical malpractice. Do they have better doctors than us — or better laws?

But there is another, often overlooked, cause of our increased costs of providing care, which is in turn passed on to our patients and their insurance companies: regulation. Let me cite just a few examples in my personal experience.

When I built my office/ASC facility in 2002, I budgeted for a battery backup system for the surgery center. These are commonly used because of low cost, low maintenance, and they are actually quite green. The state refused, requiring we spend nearly $250,000 dollars more for a major generator system that could power my center for at least 24 hours in case of a power disruption. Nearly a quarter of a million dollars that someone has to pay for something that is completely unnecessary.

We also had to build into our center at least 1000 square feet of unnecessary space. We have several required rooms that are never used, because they have no utility in an ophthalmic ASC. My OR is sized for the finest open heart surgery.

I could go on and on.

But regulatory's finest hour was the outdoor sprinkler system. Yes, you heard that right. We submitted the construction documents to the state for their approval as part of the Certificate of Need process. All was approved. Then, deep into the construction, one of the state inspectors informed us that we had to install a sprinkler system outside, under the drive-through. My very experienced builder had never, ever heard of such a thing. We informed the inspector that his own department had approved the plans, and they had mentioned no such unneeded system. I mean, if the building is on fire and you're already outside, wouldn't you just walk away from the building?

The inspector's response was that if we wanted his approval, we'd have to install it. Now, if you've ever done one of these projects, you realize that while you could fight this sort of abuse, it would cost so much money in delays that you'd financially go under. The power of these unelected people is staggering.

Today I'm the proud owner of one of the very few outdoor fire sprinkler systems in the nation. Oh, and by the way, having an outdoor sprinkler system in a part of the country that freezes in the winter is a rather expensive add-on.

I don't know if there's any correlation or not, but less than a year later God took that inspector from this earth.