The last time I stepped on a plane for vacation, for fun, was more than three years ago. I haven‚Äôt been able to visit California, whose coast I adore. Nor Rome, where my husband and I lived for some time.
And yet, I‚Äôm told, I‚Äôve been on a journey. Two journeys, actually: First, a ‚Äú,‚ÄĚ experienced at Johns Hopkins Hospital after I banged my head and developed trouble with my balance and gait. More recently, I‚Äôve been a traveling companion on my husband‚Äôs ‚Äú‚ÄĚ at Memorial Sloan Kettering, in New York City.
These are two of the highest-ranked hospitals in the country. The care was excellent in both places. But neither of these journeys resembled our bike ride in Ireland or the wine-tasting trip in Sonoma a few years before.
So much of being seriously ill has been rebranded in American health care as a kind of adventure. Experts speak of . Hospital systems invite people on journeys. The language has trickled down into advertising: Take a journey or a weight loss journey (newly popular because of ). The even comes with a map.
A map? But on these journeys, you don‚Äôt get to go anywhere ‚ÄĒ except maybe the hospital or doctor‚Äôs office, which is likely, too, to have bought into the travel concept. In the past two decades, American hospitals have gotten into the business of hotel-like hospitality (illness can be fun!) rather than confine themselves to the business of disease (what a downer). And although the care might stay solid, the focus on luxurious amenities and the fancy new buildings that house them is one of the factors that have helped send costs for patients soaring that much higher, to prices well above those in other developed countries.
In this version of health care, I‚Äôm no longer a patient. I‚Äôm a client, a customer, or (worse) a guest, no matter that I didn‚Äôt choose this journey cum illness. I appreciate a little luxury and privacy as much as the next person. But, at a time when Americans‚Äô life spans are getting shorter and say they‚Äôve delayed or gone without necessary care because of cost, is it worth it?
In recent years, tight budgets, staffing shortages, and burnout have hit American hospitals. At the same time, many health centers in the U.S. ‚ÄĒ including the most prestigious ones, and even some community hospitals ‚ÄĒ have morphed into seven-star hotels. New hospital buildings, such as recent projects at the and Valley Hospital in Paramus, New Jersey, offer all-private rooms, in many cases with couches and flat-screen TVs. A hospital might now boast about its views, high-thread-count sheets, or food provided chef.
Those commissioning and designing these pavilions showing that private rooms are better for healing, because they offer a better chance at sleep and a lower chance of infection. (Actually, the .)
But we‚Äôre suckers for this type of thing, and that even small comforts can make us feel better, regardless of whether we‚Äôre actually getting better. In 2008, researchers at the National Bureau of Economic Research estimated that a hospital investing in amenities would increase demand by 38%, whereas a similar investment in clinical quality would lead to only a 13% increase. More recently, that the hospitals have moved in this direction is that ‚Äúpeople‚Äôs expectations have changed,‚ÄĚ and it creates a ‚Äúcompetitive advantage‚ÄĚ that can be marketed to potential customers.
And so the Mayo Clinic now offers services, which can help with recommending nearby restaurants and finding pet care. I think that‚Äôs the hospitality version of what used to be called the hospital ‚Äúhelp desk,‚ÄĚ whose function was merely to explain to visitors how to get to patient rooms. Cleveland Clinic, which employs a team of curators, owns one of the largest in the region, and its leaders see that collection as one tool for ‚Äúpositively affecting patient outcomes.‚ÄĚ Patients at Cedars-Sinai can experience its ‚Äútherapeutic art collection‚ÄĚ .
Hospital food has gotten so good that in some areas people go to their local rather than medical needs. And when you look at the numbers on your hospital bill, remember that all of this adds up. For the amount that American patients (or their insurers) pay for some luxury hospital journeys, they could sign up for a Virgin Galactic suborbital joy ride.
This transformation from hospital to hospitality has filled up hospital C-suites with , whose function is to ‚Äú throughout their healthcare journey,‚ÄĚ as described by the publication HealthTech. The Cleveland Clinic was the first major academic medical center to add one, back in 2007; now some health systems hire for this and similar positions directly from the hospitality industry, picking people who‚Äôd previously been managers at a Ritz-Carlton or a Trump hotel.
The American Hospital Association acknowledges and defends the transformation. ‚ÄúThese are not just ‚Äėnice to haves,‚Äô‚ÄĚ Nancy Foster, AHA‚Äôs vice president of quality and patient-safety policy, wrote to me in an email. ‚ÄúActions hospitals can take to reduce stress and provide other psychological support can have a meaningful impact on one‚Äôs physical and behavioral health, including the ability to recover more rapidly.‚ÄĚ But pretending that illness is an Abercrombie & Kent safari is harmful. These amenities have a cost, and they are not worth nearly what we‚Äôre paying for them as we‚Äôre billed for $100,000 joint replacements and $9,000 CT scans. Room charges in many hospitals can exceed $1,000 a night. And ‚Äúfacility fees‚ÄĚ for outpatient procedures and even office visits can reach hundreds of dollars, and simply don‚Äôt exist elsewhere. A hospital‚Äôs function is to diagnose and to heal, at a price that sick people can afford. I dream of a no-frills Target- or Ikea-like hospital for care.
That doesn‚Äôt mean hospitals need to resemble prisons. Hospitals certainly have room to improve on breakfasts featuring Lilliputian plastic cups of orange juice and rubbery eggs. But to understand one of the many reasons Americans pay so much for health care, consider this: The best hospitals in Europe are utilitarian structures that most resemble urban high schools. When I got stitches for a deep cut in my forehead in Gemelli Hospital ‚ÄĒ where the pope gets health care ‚ÄĒ I sat on a gurney in a big, dark room with other patients.
Instead of providing free coffee and a piano in a soaring, art-filled marble lobby, how about focusing on the very basic things that health systems in the U.S. should do, but ‚ÄĒ in my experience ‚ÄĒ in many cases do not, like making it easier for patients to schedule appointments? Shortening the now lengthy to see physicians who take insurance plans? Paying for adequate staffing on nights and weekends, so patients don‚Äôt linger in bed pointlessly for two days until social workers return on Monday? Or ending those two-day stays in emergency rooms when all inpatient beds are full? (Hotels aspire to run at full occupancy to maximize revenue; hospitals, I‚Äôd argue, should not.)
This winter, I‚Äôm planning a journey for which I look forward to some good food and art. We haven‚Äôt yet determined the exact destination, but it will not be a U.S. hospital.