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Healthcare and Higher Education in Crisis

As the Affordable Care Act comes into full effect, it seems appropriate to consider how the generational transformations in healthcare delivery mirror many of those taking place in higher education in the United States today.

Writing for the Harvard Business Review, Robert Kocher and his colleagues found that “from 1990 to 2012, the number of workers in the U.S. healthcare system grew by nearly 75%,” yet almost “95% of this growth was in non-doctor workers.” For every doctor in the United States today, Kocher notes, there are 16 non-doctor workers. Moreover, only 6 in 16 of these “non-doctor workers have clinical roles,” while 10 of the 16 of them “are purely administrative and management staff, receptionists and information clerks, and office clerks.” This marginalization of the professional medical doctor parallels that of the tenured professor who finds herself surrounded by staff and administration who are often far removed from the classroom.

Dr. David Scher believes that both “healthcare and education are at the precipice of complete collapse.” He notes that both systems deliver poor results, in an international context, given our level of spending on them. Writing in the American Conservative, Patrick Deneen points out that “there is something fundamentally amiss with making provision of health and higher education contingent on market models and profit calculus, as both seem to be goods that are not subject to the same kind of calculus as automobiles and bubble gum.”

I would agree that education and healthcare are two American institutions where much vaunted business models of centralization contribute to their declining stature in the world. Perhaps, the decay of healthcare delivery and higher education are indicative of a broader loss of American hegemony in the twenty-first century.

Whatever the case may be,“health outcomes in this country are no better—and in some cases, much worse—than those in other developed nations,” Darrell Kirch argues, and the “United States pays more than twice the average among its peers for health care, yet it lags in key outcome indicators such as life expectancy and infant mortality.”

Likewise, outcomes in U.S. higher education lag behind those of other nations, despite the comparatively high cost of it. The Center for Budget and Policy Priorities notes that while tuition has increased to make up for shortfalls in state and federal support, public colleges and universities “have cut faculty positions, eliminated course offerings, closed campuses, shut down computer labs, and reduced library services.”

Similarly, administrative executives at Indiana University Health Hospitals seek to eliminate a billion dollars from the budget by cutting 800 positions despite rising operational income. Vanderbilt University Medical Center is cutting almost a 1,000 jobs (under the Orwellian slogan “Evolve to Excel”), while St. Vincent Health in Indiana aims to eliminate 865 jobs across the state. As is the case in higher education, CEO salaries continue to rise even at non-profit hospitals as lower level-positions are eliminated as “non-essential.”

As a result, nurses are increasingly working longer hours and tending to more patients. A recent U.S. Department of Health and Human Services study asserts that hospitals “with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections.” Shana Camphor, in her literature review of safe staffing practices notes that “nurse staffing poses substantial issues at the clinical level” and has a “tremendous impact on patient mortality, patient satisfaction, increased incidence of medical errors, and nurse dissatisfaction and burnout.” Yet, when it’s time for austerity, nary does one hear of CEO’s cutting executive pay or streamlining administrative bloat.

In my next post, I will address the American obsession with quantification. However, when administrators and their staff outnumber medical doctors and university professors—it’s an ominous sign. One wonders how long we, as a nation, will continue to pay outrageous prices for the delivery of a healthcare, and higher education, “product” that increasingly does not measure up.

Demand more tenure-track appointments at your college or university! Make the choice to attend an institution that invests in you by investing in the faculty!

 

 

Copyright © 2014 Mark S. Ferrara, All rights reserved.


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