Friday, October 5, 2007

Regulatory roadblocks

The little piece of rural Arizona in which I live has one hospital, which caters to the diverse medical needs of a large area with the inherent limitations of a small, 110-bed facility and limited staff. Inevitably, conflicts arise over where the hospital should put its resources, and some areas of medical care lose out to others which have greater perceived need or louder lobbies. Specifically, the hospital has no pediatric unit; one has been planned for years, but the hospital is little closer to opening the doors of such a unit than it was when it made its initial promises to the area's first pediatrician back in 1999.

My wife, who owns the area's largest pediatric practice (OK, it's the only group practice--the other is a solo practitioner) has considered remedying that lack by opening a stand-alone pediatric in-patient facility. The facility would be dedicated to treating sick children to the best abilities of the local general pediatricians and whatever specialists might be lured in at a later date. It wouldn't be a full-service children's hospital, but it would be better than what we have now.

The problem is that, in our brave new world, you can't just put up a building, install equipment and beds and begin accepting patients. There are regulatory hoops to jump through, and those hoops increase dramatically if you keep patients for more than a day -- the magic cut-off point at which a clinic becomes a hospital in the eyes of government officials. Once that line is crossed, a whole new set of "i"s need to be dotted and "t"s must be crossed. Facilities must meet certain standards, a specified package of care must be provided, specified resources must be on-hand, and so on. It's not, strictly speaking, impossible to meet those requirements -- just really, really hard. It's certainly beyond the ability of a small-town pediatrician who wants to improve the local quality of care, but isn't backed by a large and sophisticated organization.

And still the area has no dedicated pediatric unit.

Rather than accept the care that medical entrepreneurs are willing and able to offer on their own, regulators impose mandates that perversely ensure that health care remains at a rudimentary level. We'll never know how often regulations supposedly meant to guarantee us good-quality products and services instead turn out to prevent us from receiving anything at all.

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