“America’s health care system is neither healthy, caring, nor a system.”
– Walter Cronkite

Hospitals, revered as places of healing and recovery, hold secrets and harbor mistakes that can take a heavy toll on patients. These hidden truths, often concealed behind the walls of health care institutions, come with dire consequences. Supported by alarming statistics and credible sources, this exploration unveils some of the most unsettling aspects of the health care system.

As a patient, there are several hospital secrets that you may not know about. Here are a few examples:

Quality of care varies widely. While hospitals have to meet specific standards of care, the quality of care can vary greatly from one hospital to another. Some hospitals may have better outcomes for certain procedures or treatments, while others may have higher rates of infection or complications. This information is often not readily available to patients, making it difficult for them to make informed decisions about where to receive care. According to a study published in JAMA Surgery, “Broken bones from falls on the rise among older dog walkers,” the variation in surgical outcomes among hospitals in the United States is substantial, with some hospitals having significantly better outcomes for certain procedures than others. The cozy and familiar community hospital you frequented all your life might be the pariah of local businesses, possibly rife with medical errors and fraudulent practices. The average patient has no way or means to know the mechanics of such faults. People in the know wouldn’t divulge these issues to the public because, as the oft-quoted saying goes (and who else quotes this more than the hospitals themselves), “Hospitals are too big and too important to fail.”

Hospital-acquired infections are common. Hospital-acquired infections are a serious problem and can occur as a result of poor hygiene or other factors. Patients may not be aware of the risk of these infections or may not know how to protect themselves from them. The Centers for Disease Control and Prevention (CDC) reports that approximately 1 in 31 hospital patients in the U.S. has at least one health care-associated infection at any given time. This risk is twice as high in hospitals than their often under-appreciated competitors, the ambulatory surgery centers. This fact, conveniently, is never mentioned by your hospital-employed primary care physicians when they refer you to their facility for surgery.

Medication errors are a concern. Medication errors can occur in hospitals and can have serious consequences for patients. Patients may not be aware of the risks of medication errors or may not know how to protect themselves from them. The Institute of Medicine estimated in a report that medication errors harm at least 1.5 to 2 million people in the United States each year. Sadly, there exists what in our lingo is called “the white wall of silence.” Hospitals will never volunteer these mistakes to the patients unless there is a possibility of imminent disclosure.

Medical billing can be confusing. Hospitals often charge for services that patients may not understand or be aware of, and the cost of care can vary widely. Patients may not be aware of the costs of their care or may not know how to navigate the billing process. A study published in Health Affairs found that nearly 90 percent of hospital bills contain errors, which can contribute to confusion and disputes over health care costs. Most patients would have no idea what these errors are, which is precisely what these institutions are banking on.

Not all hospitals are created equal. Patients may not know that not all hospitals are created equal in terms of facilities, equipment, quality of care, and patient outcomes. The Hospital Compare website by the Centers for Medicare & Medicaid Services provides data on hospital quality, including patient experience and outcomes. Patients can use this resource to compare hospitals. And the data can be frightening, showing what a massive difference in outcomes can be seen in two facilities merely a few blocks from each other.

Some hospitals prioritize profit over patients. Some hospitals may prioritize profit over patient care and may not always disclose the best options for treatment or the costs of care. Investigative reporting by various media outlets has uncovered cases where hospitals have engaged in aggressive billing practices and have been criticized for putting profits before patient well-being. A report by RAND Corporation found that private insurers often pay significantly more for hospital services compared to Medicare. This pricing disparity can contribute to hospitals focusing on higher-revenue patients. On the same note, a study published in JAMA Internal Medicine found that the average operating profit margin for nonprofit hospitals in the United States was 7.7 percent. As the old saying goes, “The house always wins.” In this instance, the hospitals are the proverbial house, and the patients are the inevitable losers.

Hospital mergers hurt you more than they help. As Bernie Sanders put it, “Hospital mergers have reduced competition in dozens of major cities, leading to higher prices for health care. Without vigorously enforcing antitrust laws, health care costs will continue to soar.” This is a self-evident truth. Large hospitals merge to create even larger behemoths, which then actively suppress, stifle, and choke out their smaller competitors. These giants also command larger insurance payouts, which is, in turn, a cost adversely passed down to the consumers. The cost of a colonoscopy, for example, can range from a few hundred dollars in an ambulatory surgery center to a few thousand dollars at the local hospital to upwards of 20K in a university hospital! A colonoscopy! And the sad part is that it’s the same doctor performing the procedure at all these facilities, using the same equipment, and with the exact same safety profile and outcome across the board. The extra fees are health care extortions, to be paid by gullible masses because they don’t know any better.

As a patient, there are several hospital secrets that you may not be aware of. Quality of care can vary widely; hospital-acquired infections are common, medication errors are a concern, medical billing can be confusing, not all hospitals are created equal, and some hospitals prioritize profit over patients. It is essential to be informed and vigilant to ensure you receive the best possible care and to ask questions if you have any doubts.

Shakeel Ahmed is a gastroenterologist.