Thursday, September 9, 2010


As a seasoned patient, and a hospital connoisseur for having spent so much time in them, I’d like to touch on waste in American health care.

Half of my hospital time was spent in Germany, the other half here, in the United States. With health care in this country poised to change in a couple of years, I’ve been thinking more and more about fundamental differences.

Most German hospitals are equipped with state-of-the-art instruments, machines and diagnostic tools. Hospital doctors get a salary. On average, they make 1/3 less than American doctors. Still, they are among the best earners in the country. Administrative costs are 50% less than in U.S. hospitals.

When you’re admitted to a German hospital, you bring your pajamas or nightgown, slippers, bathrobe and towels. You only get a gown at the time of the procedure. The rooms are comfortable. Besides the bed and nightstand, usually there are curtains on the windows, an armchair, a table and chairs. Linens are changed every two or three days.
Should you need some tissues, the nurse will hand you the tiniest pack of “Tempo” (that’s the German equivalent of Kleenex. Like Kleenex, it has become a generic word). If you need more, you’ll get more, but why waste ahead of time? Should you need a band-aid, you’ll get a band-aid, not two or three, just one. Should you want a pitcher of water, (no ice of course) it’s a glass pitcher and a glass out of glass. Meals are served on porcelain, ceramic, or glass. Whatever it is, it isn’t plastic. Around 4pm, patients have coffee and cake. No Styrofoam to be found anywhere.
Anything given, or in use is done sparingly. Everyone in the hospital, and indeed in the medical system including doctors, is motivated to keep costs down. Frugality is the order of the day.
Don’t get me wrong. Patients receive excellent care and get whatever they need, just not more than they need. Nothing is left out in the open in a German hospital. Not in intensive or regular care. Why? The incentive to use resources wisely is ingrained in the German culture. In addition, their medical system is set up for checks and balances and oversight.

Germany has universal health care. It’s a social democratic country, which means the good of the whole is as important as the good of the individual. The present day health care was created in 1883, at the time of chancellor Otto von Bismark. Over the years, it has been tweaked to match medical advancement. Employee and employer pay a percentage (15% split between the two) to a non-profit company called “Krankenkasse”, or translated verbatim “sick fund”. This percentage varies according to your income: the rich pay more, the poor pay less. In this fund there are more than 200 insurance companies, which compete for the consumer’s dollar, and negotiate directly with pharmaceutical companies for the lowest drug prices in order to keep costs down. You can opt out of the sick fund, and buy private insurance if you so choose. The government regulates, private insurcance, the fund and the hospitals. Hospital regulations come in the form of diagnostic norms. This means there’s an average cost for 1100 different possible illness scenarios. These 1100 diagnostic norms don’t limit patient care. They are simply a standard to which hospital try to hold themselves, thus managing cost.

Now to American hospitals. Every day you change into a new hospital gown. Usually you wear two, one to cover your butt. Linens are changed every day as well. Extra linens and extra gowns are in the closet as are extra blankets, extra pillows, extra slippers and extra toilet paper. Mouthwash, tissues and lotion stand on the shelf in the bathroom. About two or three towels hang on the rack. If you ask for an alcohol swab, you’ll get a box. If you ask for a band-aid, you’ll get a box. You wipe your hands on paper towels. The dispenser is right next to the sink and the extra pack is on top. Latex gloves and face masks will be somewhere in the room, perhaps on your tray or in the bathroom. And yes, extra boxes of those will be in the closet as well.
Food is served on plastic plates with plastic knives and forks. Hot drinks come in Styrofoam, cold drinks in waxed cups, 5 or 6, or more. Thermometers are often plastic strips (with little dots sensitive to temperature). Some of those will be lying around the room as well (you know, in case the nurse forgets to bring more next time).

I remember thinking, I’m just one patient. If we all have the same “stuff” in our rooms, that’s an incredibly large amount of stuff. Multiply this by hospitals and we’re talking millions of tons of stuff.
If one patient uses two gowns and a set of linens per day, and every patient in every hospital does the same, how much electricity, water, detergent, and cloth is being consumed? And wouldn’t it be cheaper in the long run to have patients eat out of dishes that can be washed and reused? Certainly it would be better for the environment.

Oh, and by the way, those cotton or alcohol swabs, thermometers, latex gloves and masks, basically anything that crosses the threshold to your room, you’re paying for through your insurance company (if you’re lucky enough to have insurance). Here’s the problem: unlike German hospitals, which are regulated, American hospitals never have enough money. They charge insurance companies exorbitant prices for everything. The insurance company passes the cost on to us, the consumer. When I insisted on only one alcohol swab, the answer was, “It comes in a box; we have to give you the whole thing.” The subtext of that remark was, “Don’t worry about it, your insurance is paying!”

Once I realized that I, through my insurance, was paying for everything that was brought to my room, and in the case of my second transplant (12 years ago) it was quite a bit of “stuff” (all of the above and plenty more), I decided to take it home with me. I left the hospital with a trunk full of “stuff”. My housekeeper made use of the latex gloves for years; the Betadine and alcohol swabs came in handy when the boys’ had skateboard accidents. The boxes of tissues were the perfect size to keep in the car. Some stuff from that time I still have: zinc oxide, 6-inch q-tips etc.

Whether you’re for, or against health care reform, one thing is sure: more than health care, we first need to deal with waste care. Let’s start at the most basic level: if I ask for an alcohol swab, open the box and give me one. Then, charge my insurance company for…one. 

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