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Hospitalization
on the Motorway
A
lot of nasty accidents usually take place on the motorway, probably
the worst. It ensues that it is advisable to stay the least possible
time on the motorway, and therefore it is better to drive along it as
fast as one can... It is a syllogism where something does not tally.
It is somewhat like in Italy, where the National Health Service, in
order to try to balance the accounts, continues to reduce stays in hospital.
It is true that statistical data show a longer survival for the oncological
patients sent back to their family as compared to those kept in hospital...
But let's come back to year 2000 and in Great Britain, where the British
Med. J. 320; 461-3 has calculated that the number of beds for “acute”
patients has decreased from 5.2 every 1,000 people in the 1980s to around
3 in 1997, and likewise in other Western countries from 6 to 4.
On
these bases the English government has planned by 2003-4 the setting
up of at least other 2,000 beds for subacute diseases and the increase
of at least 1,000 new posts for general practitioners for basic health
services in order to coordinate hospitalizations, mainly for the elderly
people.
“At
least two days of stay in hospital”: this is what the evolving US health
system recommends (and refunds) for deliveries taking place in public
hospitals. US responsible reply to possible critics from taxpayers by
explaining that “this is no waste of money, but rather an investment
in the future health of mother and son, as well as reducing the costs
arising from eventual problems and complications that would take mother
and baby back to hospital.” But at least in Italy these things do not
happen: on one hand the National Health Service spends billions lire
and on the other it keeps saying that “the number of hospitalizations,
even though is decreasing, is still above the programmed ceiling”.
And
despite “stays in hospital have significantly decreased from 8.5 days
in 1995 to 7.15 in 1998”, this reduction still is not sufficient. Coming
back to the motorway paradox, we may wonder: “Considering that a country
where the rate of hospitalization is not too high is certainly a country
with a good level of welfare, could we also define advanced a country
where a person is forbidden by law to go into hospital”?
And
talking again about paradoxes: just think of our country where a person
must wait for months for a diagnostic test, and even more for eventual
hospitalization, but once that he has patiently waited for months before
being hospitalized, our efficient health service hastily throws him
out of hospital. But fractions and decimals are very important, mainly
when economists, for whom we are only numbers, manage the health service.
How is a fraction of life of a person worth? What is the cost of giving
him 6 thousandths of year of life more? A retrospective polycentric
statistical analysis (USA, Canada, Netherlands, New Zealand) carried
out on 22,361 cases of cardiac infarction “with no complications for
at least 72 hours after the thrombolisis operation” has appeared in
the New Engl. J. Med. 342; 749-55.
The
aim of this statistical re-examination, which was carried out using
models and computer-aided simulations that reworked the clinical and
epidemiological data of available follow-ups, was to establish “whether
a deferment, beyond 72 hours, of 24 hours more of hospitalization in
the coronary unit could mean prolonged medium-term survival for the
patient, thanks to the immediate resuscitation operations eventually
carried out in this additional day”.
The
results: the additional day of hospitalization in a well-equipped hospital
implied an additional 0.006 year of life for each patient, with a global
cost of 105,629 dollars.If one does calculations on a single patient's
life, that amounts to about 10,000 lire for an additional 2 hours of
life. Who is not ready to pay 10,000 lire for 2 hours of life more?
It
is easy to answer: those who calculate the costs of the health service
at the expense of other people's life.
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