By Dr. Spencer PriceWhy do hospitals charge 10 bucks for an aspirin? If you’ve ever been a patient in a hospital, you’ve probably asked yourself that very question after reviewing your bill. And it’s a valid question. After all, if you can buy a bottle of aspirin at the drug store for pennies per pill why, then, does a hospital find it necessary to charge 10 dollars for one? Is it a rip-off, a scam perpetrated on ill and vulnerable patients by heartless hospital administrators bent on making a profit regardless of the economic hardship thrust upon individual patients and society at large? Hardly. As angry as you might be at the notion of a hospital charging $10 for an aspirin, the reason they do so will truly make your blood boil.Hospitals determine what to charge for an aspirin through a process called ‘cost accounting.’ It’s a complex process that ‘accounts’ for, or assigns, costs to the myriad steps involved in getting an aspirin from the manufacturer to your blood stream. First of all, the hospital must purchase the aspirin ‘“ likely a nominal cost in itself due to the hospital’s bulk purchasing power. But, then, a worker in the receiving department or pharmacy must unpack the aspirin (bottle) and store it in the proper place within the pharmacy. When an order comes in for an aspirin, a pharmacist or pharmacy technician must retrieve the aspirin and forward it on to the patient’s floor (some hospitals have a medication storage device on the wards from which nurses can retrieve medicines directly but these still must be stocked by a pharmacist or pharmacy tech).Eventually, a nurse obtains the aspirin and gives it to the patient. She or he must then catalogue the act of dispensing the medicine in order to establish a record or ‘paper trail’ of the act itself. From time to time, other hospital personnel review patient charts in order to confirm that the appropriate medicines were, in fact, dispensed. As mentioned above, the act of giving a patient an aspirin (or any other medicine for that matter) is a complex process with associated costs beginning with its purchase and extending even beyond the point at which the patient swallows the pill. As many as ten people, or more, are often involved in what otherwise seems to be a rather simple process. All these costs must be met and all these people must be paid (including hospital overhead such as utilities, supplies, maintenance and repairs, new equipment purchases, etc.).Nevertheless, although the apparently simple act of giving an aspirin to a patient is, in fact, a complex and expensive process, it still only ‘accounts’ for less than half the total cost of the aspirin ‘“ say $3 or $4 of the total $10 cost. So, from whence do the additional charges arise? Yep, you guessed it ‘“ from those patients who ultimately don’t pay their bills. There are, as the old saying goes, ‘no free lunches.’ Someone has to pay those unpaid bills. These costs are spread among other charges within the hospital, such as the $10 aspirin. So, in truth, it isn’t the hospital’s fault for an aspirin costing $10 but, rather, those patients who cannot, or simply choose not, to pay their bills.A substantial percentage of these non-pay patients are seen in America’s emergency rooms. In fact, unpaid bills arising from the emergency room are often a hospital’s largest annual unpaid expense. And hospitals across America are struggling under the economic strain caused by non-pay patients inappropriately utilizing emergency rooms for non-emergency conditions such as colds, insomnia, or chronic aches and pains, and medication refills. Such non-emergency conditions should be handled at the patient’s doctor’s office. But visiting a doctor at his/her office often means paying a nominal co-pay. Why would a patient do that when they can just go to the emergency room for ‘free?’In this age of ‘healthcare reform,’ the regrettable truth is that the government has missed (or chosen to ignore) a key point in the overall problem of rising healthcare costs ‘“ that inappropriate utilization of healthcare resources by those having no intention whatsoever of paying for them is a major factor driving the rise in healthcare costs. Until these individuals are forced to assume financial responsibility for their own healthcare needs, productive Americans will continue to bear the burden of these costs.Why do politicians continue to ignore this obvious and egregious problem? Because it is politically uncomfortable for them. Most politicians are concerned, first and foremost, about their re-election. Therefore, they don’t want to risk alienating part of their constituency by supporting measures that would require these patients to become responsible consumers of healthcare resources like the rest of us. Until these politicians alter their focus and become true leaders, we can expect to continue paying $10 for an aspirin.