When gaming occurs, hospitals may prematurely admit patients to intensive care units to bump them up the waiting list. This leads to added and unnecessary medical expenses and procedures, the study authors point out. In addition, when less acutely ill patients are placed higher on the list, available organs might not always go to the sickest patient.
While the researchers in this study looked specifically at gaming of heart transplant patients, they say they same problems exist for other organs. In 2003, the University of Illinois settled a $2.3 million lawsuit alleging it gamed the system to increase liver transplants at its hospital in the late 1990s, although the hospital admitted no wrongdoing. Rules for ranking liver transplant candidates have also changed recently to make gaming more difficult.
"The new heart patient waiting list policies reduce ambiguity and discretion, and appear to be effective regulators. Tightening rules for other organs where competition is intense may also be necessary," Scanlon says.
"Even with these new guidelines for heart transplants, there's still suspicion of gaming," Ubel adds. "It might just be a matter of time before people learn to game the new system. We must continue to monitor the system and remain vigilant."
In addition to Scanlon and Ubel, study authors are Dr. Christopher S. Hollenbeak, assistant professor of surgery and health evaluation sciences, Penn State College of Medicine; Woolton Lee, doctoral candidate in health policy and administration, Penn State College of Health and Human Development; Dr. Evan Loh, assistant vice president of cardiovascular/infectious disease, Wyeth Corp.
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Contact: Nicole Fawcett or Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
9-Mar-2004