Category: Hospitals

Last Friday’s employment report demonstrated once again that Obamacare is not having the effect that the health services industry overall hoped for: Employment in health care is increasing at pretty much the same pace as in the rest of the economy. There is no evidence of an Obamacare jobs bump.

As shown in Table 1 and Table 2, the monthly increase in health jobs for December was 0.23 percent (34 thousand jobs), which is slightly greater than the 0.17 percent increase in non-health, nonfarm payroll. However, those figures are just reversed from November. In the twelve months since December 2013, the rate of growth in health jobs has been exactly the same as non-health jobs.

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Hospitals, inveterate lobbyists for Obamacare, have responded rationally to its incentives: They have increased use of their emergency departments, and cut charity care.

NPR had a feature on hospitals’ using online services to allow frequent flyers to book appointments at the ED:

Three times in one week, 34-year-old Michael Granillo returned to the emergency room of the Northridge Hospital Medical Center in Southern California, seeking relief from intense back pain. Each time, Granillo waited a little while and then left the ER without ever being seen by a doctor.

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This headline comes from that notorious member of the right-wing conspiracy, Kaiser Health News. Here’s the story:

An increasing number of seniors who spend time in the hospital are surprised to learn that they were not “admitted” patients — even though they may have stayed overnight in a hospital bed and received treatment, diagnostic tests and drugs.

The distinction between inpatient status and outpatient status matters: Seniors must have three consecutive days as admitted patients to qualify for Medicare coverage for follow-up nursing home care, and no amount of observation time counts for that three-day tally. That leaves some observation patients with a tough choice: Pay the nursing home bill themselves — often tens of thousands of dollars — or go home without the care their doctor prescribed and recover as best they can.

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One of the under reported causes of the high cost of health facilities, especially hospitals and nursing homes, is the high rate of unionization in the sector. In the glory days of spending growth, unions staged great campaigns to organize healthcare workers. Conflict erupted, for example, between the California Nurses Association and the Service Employees International Union to sign up nurses.

After Obamacare, things are different. Moody’s recently reported that non-profit hospitals’ top-line revenue growth was just 3.9 percent last year, an “all-time low.” For many businesses, 3.9 percent revenue growth in the Obama economy would be relatively rosy. However, it’s not what hospitals are used to:

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We’ve been observing an interesting trend for a few months: healthcare employment is growing apace, but hospital employment is lagging. The latest Bureau of Labor Statistics monthly report confirms the trend. At Forbes, Dan Diamond has a chart and an explanation:

What’s the culprit behind hospitals’ incredible slowth? There are a few factors — for one, the hospital industry is relatively large (hospitals employ four times the number of workers as home health agencies) and mature, which acts as a constraint on its growth.

But more importantly, the jobs trend line reflects the pressures on hospitals generally and inpatient care specifically:

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