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Selective, self-serving information distorts health care debate

Reform, while desirable in the case of indigent health care in Louisiana, will threaten certain entrenched interests. Thus it is understandable why Michael Butler, LSU Health Sciences Center chief medical officer, might try to present a skewed picture of the quality of indigent care in the state.

Changing the system from a money-given-to-the-institution to a money-follows-the-person regime would pose problems for the charity hospital system run by the Louisiana State University system. Money would flow away from that organization into for-profit and nonprofit providers, in part because patients will choose these other options because of the services available and/or quality of care, and LSU and other state politicians do not want to see that happen because it would mean fewer jobs and less power.

Butler did his best to deny this reality by arguing at a press conference that “[c]ontrary to popular belief, the public hospitals ... are a valued asset for patient care. When people say we are not delivering high quality care, they are not being honest. Most are just too lazy to dig in deeper and pay attention.” Further, he said “There is evidence that charity does better than private.” In fact, as federal statistics show, it is Butler who is not being honest and needs to dig a little deeper and pay attention.

Note that Butler tries to establish two different arguments here, that the charity system is “high quality” and in some ways it is better than the private sector. The first is somewhat misleading: it all depends on how you define “high quality” but, more importantly, what if one could have “highest quality” instead that could come only from outside government hospitals? That connects to the second argument, that if we define the charity system as doing as well as the non-government sector, then perhaps that means there is the “high” or “highest quality” and no significant advantage there could be obtained by shifting more care to private institutions.

But when reviewing federal statistics in four areas, using just as an example the flagship institution in the system, the Medical Center of Louisiana New Orleans (“Big Charity”), it comes up short. These statistics deal with quality in the areas of heart attacks, heart failure, pneumonia care, and surgical care improvement/infection prevention. While Big Charity slightly outperforms New Orleans-area non-government hospitals on the first category, it does worse, sometimes much worse, on the other three. The news gets worse for other system hospitals. The other major facility, LSU Health Science Center Shreveport, does a little better relative to its area institutions, but the smaller ones seldom do as well, and sometimes much more badly, on average than their surrounding non-government institutions.

Conclusions drawn in the draft report by the Public Affairs Research Council also cast doubt on the quality of charity hospital indigent care. To quote it, “Overcrowded emergency room and outpatient clinics have caused diagnosis and treatment to be delayed for countless uninsured patients …. Louisiana charity hospitals since the mid-1990s show significant decreases in services delivered while budgets continue to rise.” Butler apparently disputed none of this at the press conference.

Butler trotted out some indicators showing in some areas the system does decently, perhaps even better than the non-government sector. However it is selective and he certainly ignores the substantial evidence that charity hospital performance lags that sector. In doing so, Butler does a disservice to the debate over this issue and appears more as a champion of vested interests than in improving indigent health care in Louisiana.

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