International patients and the fight for high-margin care

thanks to my dad for forwarding this article from the Boston Globe:

https://www.bostonglobe.com/business/2016/09/11/children-expansion-raises-questions-about-impact-health-costs/8vQN85x0hZuwrr3e0tNxyH/story.html

The issues Priyanka Dayal lays out are not new.  Are these new beds really going to be used to accommodate patients who need highly specialized care that can only be provided at a few centers around the country - or the world?  In Waltham?  

That said, when you work in almost any hospital you see the ironies of the health-care finance system.  Much of the time-consuming and highly-skilled care is under-reimbursed.  Every hospital fights for the routine, high-margin procedures - in part to cross-fund poorly supported mission-driven care.  But, sometimes the fight for high-margin care becomes an end in itself.  Sometimes we get the calculus backwards:  Hospital service X is generating lots of net income, that means the physicians and administrators who work their must be the most worthy.  Really, they are often the most lucky.  If some procedural specialists makes 4X what a psychiatrist makes - that does not make them a 4X better doctor.  

Also, I just have to comment on this quote by a leader at MGH:

“If the marketplace becomes monopolized by one institution, then we and the other providers of tertiary care for kids won’t have a sustainable model to maintain these services,” said Dr. Ronald E. Kleinman, physician-in-chief at MassGeneral Hospital for Children. “We’ll then have a situation where there is only one player in town and it provides the most expensive care possible.”

Chutzpah anyone?