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Health Reform Should Tackle the Rising Threat of Hospital Infections

In a prime-time town hall meeting last week, President Barack Obama again made the case for reform of skewed market incentives that have led to skyrocketing medical costs.

[IMGCAP(1)]But so far, the president’s call to action has failed to fully address a major public health threat —one that costs the United States between $28.4 billion and $33.8 billion per year, according to the Centers for Disease Control and Prevention.

Health-care-associated infections, or HAIs, affect 1.7 million hospital patients and kill an estimated 99,000 Americans annually, more deaths than from AIDS, motor vehicle accidents or breast cancer.

According to the CDC, an estimated 70 percent of health-care-associated infections are resistant to at least one drug commonly used to treat them. These antibiotic-resistant microbes, or superbugs, causing these infections drive up the cost of health care because the patients often need multiple rounds of treatment and have longer stays in the hospital. More importantly, these infections can lead to serious illness or death.

The use of best practices in infection control can substantially reduce HAIs, and the American Hospital Association cites HAIs as a prominent target of their immediate cost-savings initiatives. Infection prevention through known practices provides policymakers a ready solution to the current health system failure that adds a hefty price tag to the nation’s annual health spending.

Department of Health and Human Services Secretary Kathleen Sebelius has urged hospitals to reduce HAIs by putting in place better infection-prevention procedures, such as wearing gowns and gloves around patients, which can prevent a superbug or another disease-causing microbe from spreading. She says $50 million from the federal stimulus package will be spent to help combat HAIs. But hospitals should already be taking these basic precautions. Stimulus money should be spent to fund coordination between health facilities so infections don’t spread from one to another, as this is an aspect of the problem hospitals have no incentive to improve.

Last month, the health industry, including hospitals, pledged to bring down the nation’s skyrocketing health care costs. But bringing down the burden of resistant infections requires that all hospitals work together toward such a goal. Can the nation really rely on a pledge by hospitals or others in the health industry to coordinate between themselves for the public good on a voluntary basis?

What’s needed is a restructuring of incentives, a consistent theme in Obama’s health care reform agenda. Superbugs have emerged in an environment in which overselling and overuse of antibiotics is common. Physicians prescribe antibiotics when they are not needed, and most hospitals do not have effective infection-prevention programs or systems to monitor antibiotic use. Finally, drug companies have oversold existing antibiotics because they have no incentives to conserve their effectiveness.

Hospitals and health professionals should be held responsible for tough infection-prevention policies that target the spread of infections regionally — and across state lines. And they should be paid to provide such services, which protect the public but are expensive. Policymakers should also provide incentives for drug companies to be aggressive in developing new drugs to replace those that are rapidly becoming useless. Such investments would magnify our efforts against superbugs and pay off in the form of greatly reduced spending.

HAIs and antibiotic resistance aren’t the only ailments of the American health care system, but they are the lowest-hanging fruit that benefit patients and cut health care costs. Addressing this problem should be an easy decision for Congress and this administration.

Ramanan Laxminarayan, Ph.D., M.P.H., is a senior fellow at Resources for the Future, an independent Washington think tank whose Extending the Cure initiative develops policy solutions to extend antibiotic effectiveness. Ed Septimus, M.D., is medical director for infection prevention at HCA Healthcare System, the nation’s largest private provider of health care services.

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