Back from Canada

I recently returned from our annual trip to rural Quebec, a refreshing break from everything (including the internets!). Eli’s post below, about resource-intensive approaches to infection prevention that seem so attractive compared with the hard work of basic hand hygiene, reminded me of a conversation I had over dinner with a Canadian family friend. He asked for details about the current political debate over Medicare, and I explained how one side is interested in restructuring the program from a defined benefit plan to a defined contribution plan, thereby shifting the risk of future increased health costs from the government to the individual.

“What happens when you need care that you can’t afford?” he asked. I pointed out that medical illness and the associated costs were a common cause of personal bankruptcy in the United States. He sat in stunned silence for a few moments before ending our discussion with, “Well, that’s barbaric.”

That’s 1 cent for every family of three in America!

My colleague Eli Perencevich sent me a link to this article yesterday, to be published in Health Affairs. Turns out that the Medicare policy of refusing to reimburse hospitals for the costs associated with certain preventable adverse events, including selected hospital infections, is not going to net very much money (about $1 million nationally, according to their model).

The press has already noticed.

I have always thought this policy to be mostly symbolic, and I recall a SHEA plenary speaker two years ago describing even the optimistic projections of cost savings as “budget dust”.