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Health Care Reform Must Target Hospitals, Physicians Who Push Expensive Treatments Over Prevention

September 10, 2009

By Diana Mason, AJN editor-in-chief emeritus

Knowing all too well the failings of our health care system, I’ve become increasingly concerned about the vocal opposition to health care reform. It’s déjà vu all over again. Fear, lies, and irrationality killed Clinton’s Health Security Act—and they’re all at work again now.

Health care reform is not just a matter of covering the uninsured. It’s also about developing a less chaotic, unfair, unsafe, misdirected health care system. Let me give you an example, one that has everything to do with the skyrocketing costs of health care.

by colros, via flickr

by colros, via flickr

Over the past two months, I’ve noticed radio and TV announcements and billboards telling the public about a local hospital’s bariatric surgery center. Two recent studies (here and here) reported that these surgeries are getting safer and the cost is coming down as complications decrease.

But the cost of the hospitalization alone for an uncomplicated bariatric surgery is now about $28,000. That goes up to over $38,000 if complications arise—and almost $70,000 if the patient has to be readmitted. Now, what if a patient decides he’d like to go to a nutritionist every week for several years to gradually lose the weight and change his eating habits permanently? Let’s say that the cost of seeing a nutritionist is $100 per visit—that’s just over $15,000, but who’s paying to put up signs advertising a hospital’s nutritional service for weight loss ?

Bariatric surgery is a revenue source for a growing number of hospitals. For some patients, the procedure may be essential in order to prevent death from other causes. And I’m not saying that the procedure hasn’t changed many lives for the better, or that it should never be done, or that seeing a nutritionist is a sure-fire solution to obesity. But in many cases, eating a healthful diet and changing other habits may be just as essential and effective as bariatric surgery. 

Even when this is the case, the bottom line is that nutritional counseling isn’t going to make a hospital the kind of profit that bariatric surgery can promise. We need to change what care we pay for and how we pay for it if we’re going to produce a health care system that focuses on providing what patients need rather than what garners the greatest profits for a few hospitals or physicians.

Editor’s note: An op-ed piece in the NY Times published today drives home Diana Mason’s point about the need to change eating habits if we’re ever going to control health care costs in the United States, many of which can be directly attributed to rising obesity rates: “The American way of eating has become the elephant in the room in the debate over health care.”

3 comments

  1. And what is the percentage of people who have had the surgery and gain the weight back? Bariatric surgery may be warranted for some but my point is that my insurer will cover that surgery but not seeing a nutritionist for weight loss. Behavioral change is possible (I’ve lost 40 pounds over 2 years with a nutritional coach) but it won’t be by physician-led efforts. They seldom know how to coach — and only some nurses do. We need to strengthen the knowledge and skill of all health care workers to learn how to coach for behavioral change–and it will be less costly than the surgery.

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  2. I am a Bariatric Coordinator, and our program is focused primarily on weight loss surgery. Personally, I practice a healthy lifestyle and maintain a healthy BMI. However, for those who are morbidly obese there a multiple factors that contribute to the disease. It is not simply a lack of will power. I wish all my patients could meet with a dietitian and that would lead to sustained weight loss. But the research tell us that up to 98% of weight loss attempts fail, even physician-directed ones that include pharmacological intervention. Behavior change is extremely difficult for anyone. Currently the only option that can advertise without having to include the disclaimer “results not typical” is the “gold standard” in weight loss surgery – Roux-en-Y gastric bypass.

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  3. Bingo! You hit the problem right on Diana!

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