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Monday, May 12, 2008

The Cost of Efficiency

Modern hospitals have become much more efficient than they were in 1957 or 1968 when we had our last pandemics. Today, hospitals are run more like a business than they ever were. Even non profit hospitals and hospitals in countries with socialized medicine or single payer systems have had to run more efficiently. This is not entirely a bad thing. Hospitals have had to become more efficient as the ongoing improvements in health care technology became more readily available. Many more high tech health options are possible today, and they are generally more expensive. We treat heart disease, cancer, trauma, premature birth and organ failure much more aggressively than we did 40 or 50 years ago. We can also routinely save or extend more lives than we did back then. Efficiency is how we afford it.

To make hospitals more efficient we utilize space, supplies and staffing as much as we can. We do not have empty rooms. If too many rooms are unused we close wings and convert them to outpatient departments or offices or close some hospitals. We do not let equipment sit idle, we buy just what we need and rent some extra to get us over the peaks. We use just in time supply systems to reduce excess inventory and waste. We hire fewer full time staff and use temporary staff or pay a bit of overtime here and there to handle the peaks. The average length of a hospital stay has been dramatically reduced.

We no longer have any excess capacity left. We designed it that way. Any hospitals that resisted this change in the past were closed and branded inefficient. This efficiency has a cost though. Our efficient health care systems could no longer handle a pandemic even of the type seen in 1968. Pandemics require far more resources than the ordinary ebb and tide of daily business. Too much efficiency can be deadly.

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