Basically, stricter cost control measures by hospitals shifts some of the work onto unpaid family members as patients are discharged far earlier than they would have in the old days.
McArdle cites her own mother as an example, recently released from the hospital after undergoing treatment for a ruptured appendix:
Thankfully, my mother is basically healthy -- except that she requires someone to hook up her IV antibiotics twice a day, and because she can't drive or move around much yet, she really needs someone nearby most of the time. It's been no problem for us -- my editors have been incredibly understanding, and I've spent many hours working from her hospital room on my laptop. But how many other people have this flexibility?(Read the full text of "What Cutting Health Care Costs Looks Like".)
This, mind you, is for a relatively benign condition. In my extended family, I've seen elderly patients with terminal cancer sent home to die with families who hadn't any ability to cope with a patient that sick. The poorer and less educated you are, the more likely this is to happen, because you don't have the knowledge -- or the social capital -- to work the system and get a few extra days...
One way to think about it is that we made a policy choice to save money by turning family and friends into parahealth professionals. In my case, I think that's the right choice: I'm happy to take care of my mother, and I understand the cost pressures that made this desirable.
The problem is, most people didn't participate in that choice. There was no public debate over whether we should send elderly patients home in terminal condition to families with no training as health workers. We just said "let's cut hospital costs!" and everyone said "Yay!" and then some folks in a back room decided that this was the way to do it...
So when we talk about "cost shifting", we should keep in mind some of the invisible cost-shifting created by government policies that induce hospitals to discharge patients quickly -- and sometimes arguably too quickly.