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OB/GYN Editorial SEPTEMBER 2005
Quality Health Care
Under Assault
by Ronald T. Burkman, MD
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During the past several
years, many
editorials aimed at
physicians have
focused on the need
for reform of the US tort system.
Major reasons cited include
excessive costs—which, if
not reimbursed, will lead to
decreases in the numbers of
physicians (especially OB/GYNs)
and in access to care. The net
effect will be a reduction in the
quality of health care provided
to the public.
There are other dark clouds on
the horizon that may also affect
physiciansÕ ability to practice
quality medicine. A large proportion
of the US population is middle-
aged or elderly. While today
there are about 3.5 workers for
every retiree, it is estimated that
by 2020 the ratio will be < 2:1.
Although the current administration
has focused on these projections
with regard to Social
Security, this demographic shift
will also have a substantial
impact on health care. This aging
population will not only grow in
numbers, but will live longer as
well—translating into more stress
on ambulatory and inpatient
resources and funding (eg,
Medicare). In terms of financial
health, retirees are divided like
the rest of the US population into
ÒhavesÓ and Òhave-nots.Ó The
latter group will probably need
government assistance, most
likely through some type of taxation.
Thus, a dwindling number
of workers will be required to
deal not only with retireesÕ Social
Security needs, but with their
health care costs as well.
One possible solution is to cut
benefits, but organizations such
as the American Association of
Retired Persons will mount a formidable
political opposition to
this option. Furthermore, any
such reduction would only
increase the number of uninsured
and underinsured individuals. In
the meantime, the ÒhavesÓ—who
will include most retired physicians—can anticipate being
responsible for an increasing
proportion of their own health
care costs.
Another concern is the availability
of an appropriate health
care work force. There is already
a nursing shortage, and now a
physician shortage is projected.
The average age of nurses is
increasing, and hospitals are
helping to finance nursesÕ education
and raising their salaries in
an effort to make the profession
more attractive. However, these
funds must come from a pool of
dollars that is not growing fast
enough. In fact, most major
employers are already feeling the
squeeze of rising health care
costs, and are reluctant to support
any additional funding.
Thus, hospitals and clinics forced
to make difficult financial choices
will likely spend more money on
nursing and less on equipment
and other technology. Finally,
hospitals and health care organizations
carry tremendous collective
clout in negotiations for
insurersÕ dollars, leaving physicians out in the cold as overall
funding becomes more limited.
Finally, many major cities are
facing additional crises that can
affect the ability to fund health
care. The high school dropout
rates are disproportionately high
in inner-city populations, reducing
the availability of skilled
workers. Manufacturing jobs—once the primary economic
engine for urban areas—are now
going overseas. As a result, a
large segment of the population
must now accept low-paying
service jobs that typically provide
little or no medical benefits. This
means less routine preventive care
for workers who have to pay out
of pocket, with the health care
system bearing the burden for
catastrophic care of uninsured
patients presenting to emergency
departments.
These are only some of the
problems that will affect physiciansÕ
ability to provide quality
health care in the future.
Although the picture I have
painted seems bleak, it highlights
issues that the United States must
start addressing nowÑbefore the
years fly by and the crisis overtakes
us. It is time for elected officials
from both major political
parties at the federal, state, and
local level to look beyond partisanship
to the real problems faced
by all Americans. Will they see
the light in time? We hope so, but
only time will tell.
RONALD T. BURKMAN, MD
Associate Advisory
Board Member
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