Patient Care Versus Efficiency: Pressures On Hospitalists--Responses Include Unionization, Demoralization

Doctors Unionize To Resist The Medical Machine by Noam Scheiber.  The New York Times.  January 9, 2015. 

Institutes of Medicine Identifies Sources of Excess Costs

 Best Care At Lower Costs: The Path to Continuous Learning Health Care in America by Mark Smith, Robert Saunders, Leigh Stuckhardt, J. Michael McGinnis, Editors;  Committee on the Learning Health Care System in America;  Institute of Medicine.

The Institute of Medicine examines policy matters pertaining to the health of the public and was established by the National Academy of Sciences.  This 381 page report contains a wide-ranging discussion of healthcare costs.  It categorizes excess healthcare costs in 6 broad categories for the year 2009.

1.  Unnecessary services resulting from overuse, discretionary use beyond established benchmarks, and unnecessary choice of higher costs services.  210 billion

2.  Inefficiently Delivered Services resulting from mistakes, care fragmentation (lack of coordination, use of unnecessary high cost providers, operational inefficiencies.  130 billion

3.  Excess Administrative Costs resulting from insurance paperwork, insurance administrative inefficiency, inefficiency of care documentation.  190 billion.

4.  Prices That are two high resulting from service and product prices beyond benchmarks.  105 billion.

5.  Missed prevention opportunities.  55 billion

6.  Fraud from all sources.  75 billion.