Editorial: When more is not better


Shands at UF.

File photo
Published: Friday, January 4, 2013 at 6:01 a.m.
Last Modified: Thursday, January 3, 2013 at 2:37 p.m.

In health care, more is not necessarily better.

The U.S. spent $8,233 on health care per person in 2010, two-and-a-half times more than the average of 33 other developed nations. Yet the U.S. does worse than most of those countries in terms of life expectancy, obesity and infant mortality.

The latest example of increased costs coming with questionable benefits is the expansion of trauma centers in Florida.

The HCA hospital chain is developing a new statewide network of trauma centers in partnership with the University of South Florida medical school.

They include trauma centers at Orange Park Medical Center and Ocala Regional Medical Center, the latter just opening last month. University of Florida-affiliated Shands and other hospitals have pursued legal action challenging the state Department of Health's authorization of those centers.

Trauma cases have actually been declining in Florida, so it's unclear whether new centers are needed. In fact, such centers add costs to the health care system without necessarily improving patient care.

A study by University of South Florida researchers found that lower-volume centers have a 9 percent higher rate of mortality from traumatic brain injuries. Apparently practice makes perfect with medical teams treating those injuries.

New centers in the region add costs for Shands and the health care system as a whole. Shands must boost the pay of its doctors to prevent them from being poached. It also loses trauma patients, while the location of new centers can mean Shands keeps a greater proportion of indigent patients whose care must be subsidized by the state.

The idea that the free market should reign and all hospitals should be able to open trauma centers ignores the reality of how they work. When someone is injured in a serious accident, they don't have the luxury of shopping around for the best health care. They're simply brought to the nearest trauma center that's able to handle their case.

In some instances, adding trauma centers may be appropriate to decrease the minutes it takes for patients to receive care. But in other cases the center might simply be built to improve prestige for hospitals.

As a result of a court decision, state health officials say they're revamping the outdated approval process for trauma centers. That's good news. Florida needs to better coordinate trauma care, ensuring the costs of new centers result in clear benefits for patients.

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