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Hospital Choice

A good state to practice medicine?

Red State

States With Expanded Health Coverage Fight Bill With tax revenues down and budgets breaking, the states including Arizona, California, New Jersey, New York and Wisconsin say they cannot afford to essentially subsidize other states expansion of health care.

http://healthinsuranceinfo.net/

State issues:
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Medical Whistleblowers Win Stimulus Breakthrough

  Hospital trustees naturally promote themselves as safe for patients and doctors.  For career-safety, we advise all doctors to practice in 3 independent hospitals:  All politics is local.  There is no way to predict which states will treat doctors well by the time you start practice ~12 years after starting college, so all this information is retrospective and speculative. 
 
  States belong to federal court circuits some of which have made decisions that bear on where to practice.  See States 2.  ~25 states have the Initiative or the Referendum.  If patients as citizens ever desire honest peer-review of their local hospitals, these measures may be relevant, but reform will take many years. 

http://www.westandfirm.org/blog/2009/02/where-does-your-state-rank.html

#2551 of 2990, Added By: An_12681977, MD, Surgery, General, 11:21PM Sep 08, 2009

States that assumed contractual obligations without establishing them as of 2000:

Colorado, see Even v. Longmont United Hosp. Ass'n, 629 P.2d 1100, 1103 (Colo. Ct. App. 1981)
Massachusetts, see Duby v. Jordan Hosp., 341 N.E.2d 876, 879 (Mass. 1976)
Mississippi, see Wong v. Stripling, 700 So. 2d 296, 300-02 (Miss. 1997)
Ohio, see Bouquett v. St. Elizabeth Corp., 538 N.E.2d 113, 115-16 (Ohio 1989)
Oklahoma, see Ponca City Hosp., Inc. v. Murphree, 545 P.2d 738, 742 (Okla. 1976)
Virginia, see Medical Ctr. Hosps. v. Terzis, 367 S.E.2d 728, 729 (Va. 1988)

States where "medical staff bylaws alone are not a contract, but, in the context of the entire relationship between the physicians and the hospital, they are enforceable as part of a larger contractual relationship":

Connecticut, see Gianetti v. Norwalk Hosp., 557 A.2d 1249, 1252-55 (Conn. 1989); Owens v. New Britain Gen. Hosp., 643 A.2d 233, 239 n.25 (Conn. 1994)

States where the medical staff bylaws are not a contract:

Georgia, see St. Mary's Hosp., Inc. v. Radiology Prof'l Corp., 421 S.E.2d 731, 736 (Ga. Ct. App. 1992)
Iowa, see Tredrea v. Anesthesia & Analgesia, P.C., 584 N.W.2d 276, 284-87 (Iowa 1998) (establishing requirements for bylaws to qualify as a contract)
Mississippi, see Sullivan v. Baptist Mem'l Hosp. - Golden Triangle, Inc., 722 So. 2d 675, 680-81 (Miss. 1998) (but see above)
Missouri, see Zipper v. Health Midwest, 978 S.W.2d 398, 415-17 (Mo. Ct. App. 1998) (but equitable relief is available under bylaws)
North Dakota, see Robles v. Humana Hosp. Cartersville, 785 F. Supp. 989, 1001 (N.D. Ga. 1992)
Ohio, see Munoz v. Flower Hosp., 507 N.E.2d 360, 365 (Ohio Ct. App. 1985) (lack of contract because lack of mutuality of obligation); Holt v. Good Samaritan Hosp. & Health Ctr., 590 N.E.2d 1318, 1322 (Ohio Ct. App. 1990)

States where hospital bylaws are contractually binding on a hospital, but not medical staff bylaws:

Iowa, see Tredrea v. Anesthesia & Analgesia, P.C., 584 N.W.2d 276, 284-87 (Iowa 1998)
Maryland, see Ishak v. Fallston Gen. Hosp. & Nursing Ctr., 438 A.2d 1369, 1372 (Md. Ct. Spec. App. 1982)
Texas, see Gonzalez v. San Jacinto Methodist Hosp., 880 S.W.2d 436, 438-39 (Tex. Ct. App. 1994) (but see above)
Tennessee rejects the distinction, see Lewisburg Cmty. Hosp., Inc. v. Alfredson, 805 S.W.2d 756, 759 (Tenn. 1991)

~4,600 hospitals:
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States of Debt
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Click here.

Ranking By Business-Costs:
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"Health Care Policy Cost Index." Click here.

Where Does Your State Rank?

By Paul Hsieh, MD
co-founder Freedom and Individual Rights in Medicine

"The Small Business & Entrepreneurship Council has come up with a handy guide to rank the 50 US states (plus the District of Columbia) based on how badly their regulation raise the cost of health insurance.

Some of the measures include the number of mandates, whether the state requires "guaranteed issue", community rating, and employer mandates, whether it allows tax-free use of Health Savings Accounts."

Here's their guide:

"Health Care Policy Cost Index: Ranking the States According to Policies Affecting the Cost of Health Care"

http://www.sbecouncil.org/uploads/SBEC%20polseries%2033%20-%20SBSI-Health%5B1%5D%202-3-09.pdf

And their conclusions:

Among the 50 states and District of Columbia, the best 15 states in terms of state health care policies are:
1) Idaho, 2) Utah, 3) Iowa, 4t) Michigan, 4t) Ohio, 6) Alaska, 7) South Carolina, 8) South Dakota, 9) Pennsylvania, 10t) Nebraska, 10t) Wyoming, 12) District of Columbia, 13) Kentucky, 14) North Dakota, and 15) Oklahoma.

Meanwhile, the worst states are: 37) Minnesota, 38) New Hampshire, 39t) North Carolina, 39t) Rhode Island, 41) Florida, 42) New York, 43) New Jersey, 44) Colorado, 45) Maryland, 46) California, 47) Vermont, 48) Connecticut, 49t) Maine, 49t) Washington, and 51) Massachusetts.

Our elected officials talk a great deal about "solving the health care crisis."

Unfortunately, the origins of the crises can largely be traced back to governmental policies that raise the costs of health care, and thereby limit the availability of health care coverage.

If policymakers are serious about having a positive impact on health care, then significantly limiting the number of mandates and regulations makes sense at the federal and state levels.

Obviously, I wish Colorado ranked higher than 44th. But at least we have the examples of lots of other higher-ranked states to point to in the public policy debate!

http://www.westandfirm.org/blog/2009/02/where-does-your-state-rank.htmlPoll: Have you seen this yes|no|

The Health Care Quality Improvement Act of 1986 permits any hospital board to ignore due process as stated in the Constitution; the United States Supreme Court has twice refused to rule in this matter (SHALLER, POLINER).  Without due process, medical practice is unsafe for patient and doctor.    Doctors can lose their career-investment before paying back their career-loans:  The risk of choosing MD over JD or MBA is too great.  The doctor-shortage is predicted to reach 200,000 by 2020. 

"Our government is the potent, the omnipresent teacher. For good or for ill, it teaches the whole people by its example. Crime is contagious. If the government becomes a law-breaker, it breeds contempt for law; it invites every man to become a law unto himself; it invites anarchy."  Louis Brandeis, United States Supreme Court
 
"The failure to change and improve the current system will continue to result in the loss of qualified and skilled physicians from their profession due to others who maliciously pervert the current peer review process for their own selfish motives."  Hall