Why is hospital food so nutritionally bad?

by on October 3, 2010 at 8:00 am in Economics, Food and Drink, Medicine | Permalink

Mario Rizzo asks me:

Why is hospital cafeteria food so poor from a nutritional point of view? Fried chicken, preservative-filled cold cuts, cheese everywhere, etc. Keep in mind I am not talking about the food served patients who may have appetite problems. It is food they serve everyone else including doctors and nurses, many of whom know better.

You'll find some proximate answers here, referring to the institutional arrangements for supplying the food.  Here is a UK discussion.  Here are some signs of progress.  I would make a few more fundamental points:

1. Few people choose a hospital on the basis of the food or on the basis of the food their visitors can enjoy.  Furthermore the median American has bad taste in food and the elderly are less likely to enjoy ethnic food or trendy food.  You can't serve sushi.  They are likely to use the same food service contract for the patients and the visitors.

2. For the patients, some of the food is designed for the rapid injection of protein and carbohydrates.  For a terminally ill patient who is losing weight and wasting away, this may have some benefits.  Since healthier people tend to have very brief hospital stays, they can undo the effects of the fried chicken once they get out.  Many of the sicker patients in for longer stays have trouble tasting food properly at all.

3. Taxing hospital visitors is one way of capturing back some of the rents reaped by patients on third-party payment schemes.

4. I would be interested to know more about the insurance reimbursement rates for hospital food, but at the very least I suspect there is no higher reimbursement allowed for higher quality.  Combine third party payment with a flat price for rising quality and see what you get.  Furthermore, low quality food is another way the hospital raises its prices to inelastic demanders, again circumventing relatively sticky reimbursement rates from the third party financiers.  It's one sign that the net pressures are still in inflationary directions.

5. You can take the quality of the food as one indicator of the quality of other, harder-to-evaluate processes in the hospital.

Bob Knaus October 3, 2010 at 8:26 am

Tyler, you missed Mario’s question. He’s asking about the hospital food served in cafeterias to staff and visitors, not the food served to patients.

My impression is that some hospitals are trying to make their visitor and staff experiences better, for instance with comfortable seating, pianos, aquariums, and ferns in the lobby. Better food service is part of that too. For an example, visit Emory Medical Center near downtown Atlanta. The cafeteria has all the healthy choices that an enlightened health professional could want… and a good selection of “soul food” as well.

Personally, I enjoyed the fried chicken livers and collard greens.

Andrew October 3, 2010 at 8:52 am

When my child was born I had to find the loading dock myself and carry the cord blood myself to be taken to the cord blood bank.

5. They don’t give a f&*#$.

Maybe that is just an expansion of 1 and 4.

Rob O. October 3, 2010 at 10:15 am

Some hospitals – especially the ones who focus heasvily on diabetes care – are shifting to lower-carb, more nutritious fare. In fact, some progressive hospitals limit the options of what a patient can choose from based on admission or care codes so that, for example, a diabetic patient doesn’t have higher-carb selections on his/her list at all.

Sunset Shazz October 3, 2010 at 10:37 am

Wanted to point out that these categories aren’t quite Platonic: at this very second, in San Francisco or New York, fried chicken = trendy food.

Danny October 3, 2010 at 10:55 am

I think the easiest answer is as follows:
1) Hospital administrators don’t want to worry about food, so they outsource the service to other companies.
2) Hospitals are for emergency and critical purposes, and nutrition quality doesn’t matter much in the short term.

TomHynes October 3, 2010 at 11:55 am

Compared to what?

Suppose you are in the business of running cafeterias and restaurants. Your job is to give the customer what he wants and make money at it.

Is the customer at a hospital – staff or someone visiting a patient – fundamentally different than the customer at any other restaurant or cafeteria?

Are they different in that situation “I am visiting sick uncle Ned, so I will have a tofu salad today?”

Is there any evidence that hospital staffers like to eat healthier than other people?

mushroom October 3, 2010 at 12:44 pm

The food at Chinese hospitals are also nutritionally bad.. They taste bad too.

Pup, MD October 3, 2010 at 1:41 pm

I would say that “Hospital Sushi” is actually a band name waiting to happen, and yes, my first sushi ever was actually in the University of Michigan hospital cafeteria, by no means a culinary juggernaut.

anon October 3, 2010 at 2:31 pm

>>> median American has bad taste in food <<<

Isn’t that a terribly condescending thing to say? Define “good taste”?

Anthony October 3, 2010 at 2:41 pm

My experience with Kaiser hospitals is that the food served patients is reasonably nutritious and non-junky, though not terribly exciting in terms of taste. The same foods are available in the cafeteria, as are a wider variety, including many tastier and less healthy foods.

Doctors and nurses eat nutritionally bad food for the same reasons they smoke.

Andrew October 3, 2010 at 2:49 pm

I’d say the median American has about average taste in food.

BPO October 3, 2010 at 3:05 pm

“Isn’t that a terribly condescending thing to say? Define “good taste”?”

Consider the source. Foodies have issues.

agnostic October 3, 2010 at 3:06 pm

False premise — should read, “Why is hospital food so nutritional?”

“Furthermore the median American has bad taste in food”

Why are the people who say this typically fat and diabetic, have sagging and dessicated skin, and too schlubbish to climb stairs or lift things?

The median American may be a carboholic slug, but the purveyors of good taste and nutrition are hardly any better. Some are not so obese, but the high triglycerides, diabetes, terrible skin, and lack of strength never lie.

eddie October 3, 2010 at 3:18 pm

Mario’s question (Why is hospital cafeteria food so poor from a nutritional point of view?) would be better phrased as “Why do hospital cafeterias serve food that the ignorant public – i.e. people such as myself – regard as unhealthy?”

The answer, of course, is that the customers of such cafeterias haven’t been demanding “healthy” food. Just as, by and large, the demand for “healthy” food is modest among the food-eating public in general, whether at cafeterias, restaurants, or grocery stores.

Of course, eating “healthy” signals high-status, so the demand for it has been rising and naturally enough the market has been responding to satisfy this segment that has more money than sense. Hospital cafeterias are probably slower to respond to customer demands than other food service firms, since they probably only have to bid for the concession every several years, and I suspect the incumbents have a strong political inside edge and can remain entrenched.

Now that hospitals are starting to compete harder for customers, we’ll probably see more actions like Dr. Toby Cosgrove’s (see above). By loudly banishing “unhealthy” foods, he signals that the hospital “really cares”. More importantly, he signals that the hospital itself is high-status, and high-status people should want to go there for their medical treatment. It’s a great PR move. If he can find a way to quietly get fried foods back on the menu, even better… otherwise, word of mouth about how bad the food is will probably drive away as many customers as the high-status signal attracted.

eddie October 3, 2010 at 3:38 pm

nach:

While you or I may or may not confuse quality health care with marble floors, high ceilings, good cafeteria food, friendly greeters, the majority of the lay public use these as criteria for which hospital/outpatient testing center to go to since they cannot directly compare competency and effectiveness of staff/doctors and others.

Judging a hospital by the quality of its amenities is very appropriate, for two reasons. First, it serves as a proxy for the quality of its administration and the amount of resources available to the hospital – both of which will be strongly correlated to the competency and effectiveness of the resources (including staff, equipment, and processes) that the hospital can provide towards your medical treatment.

Second, for most medical conditions, most treatment providers are going to deliver the same results. There’s outliers, sure, but you can probably avoid the worst and you probably can’t obtain the best. Outside of the extremes… assuming that (for example) your broken leg is going to be correctly set and will heal in a certain amount of time no matter who sets it, why not choose the hospital based on how good the food is, how convenient the parking is, and how friendly the staff are? You’re going to be stuck there for days, so you might as well have some decent food, handy parking for your visitors, and a genuine smile and a kind word from whoever has to change your bedpan.

Bill October 3, 2010 at 3:52 pm

The title of the article should have read: “Why don’t hospitals act differently than any other mass market institution, including public or private colleges, shopping mall restaurants, etc.”

If you phrase the question differently, then hospitals are just offering what you get everywhere else, except for the posts above which show there has been changes toward healthy offerings that ARE NOT being offered elsewhere.

To expect the market of food vendors–the persons who make french fries, hash brown components, cereal companies, etc.–to make different fast food items or low labor cost items that can be reheated in the commisary is to ask too much. Do you think Sysco, ConAgra, Campbell, Ore-Ida, etc. would find it economical to make commissary food to serve this niche? Or, do you think that hospitals would invest in the manpower and overhead to make food from scratch in the kitchen to give you that Alice Waters experience? Unfortunately, the mass market dictates the offerings made to nich customers, unless they are willing to make their own food from scratch, which means they would have higher food costs because of a higher labor component from making food from scratch.

BPO October 3, 2010 at 5:31 pm

“Once we realized that the whole country (the U.S.) was becoming obese it became a talking point”

Of course, many, many, many other countries (most) have been touted for healthy diets and eating habits, and yet they, too, are rocketing toward our level of obesity.

J October 3, 2010 at 7:30 pm

“Furthermore the median American has bad taste in food”

In the absence of a definition of bad taste, that statement is meaningless.

“and the elderly are less likely to enjoy ethnic food or trendy food”

What the hell does that have to do with food quality?

“You can take the quality of the food as one indicator of the quality of other, harder-to-evaluate processes in the hospital”

No, you can’t. Indeed, if a hospital cafeteria was excessively focused on “trendy food”, you could just as easily infer that the hospital is more concerned with trendiness than quality care. Being fashionable is an indicator of competence in the fashion industry, not health care.

bovis October 3, 2010 at 9:41 pm

Bill:

I do not intend to promote the idea that a monopoly will choose unhealthy food. I do contend, however, that the monopoly is motivated by profit and therefore will choose cheap food. The resulting situation can be much of what we have now: hospitals with arguably unhealthy food.

Certainly there can be healthy choices at a similar cost. But look at who provides the food. It has always been cheaper to fill things with preservatives rather than to seek out easy and cheap food which is also healthy. Only recently have we seen a push for healthy food in schools, hospitals, businesses, and with that push will come the research necessary to deliver healthy food that is also economical. Food preparation is only as good as what has happened in the past, grabbing the easiest, cheapest food, regardless of content.

You do make a good point, that the hospital is also paying for health insurance benefits. It is possible that cheap food does not affect the employees’ health enough to be an overall cost risk to the hospital, at least not enough to merit a complete restructuring of the hospital cafeteria. If this is not the case, and the hospital has looked past the issue, shame on them.

To answer your specific inquiries all at once: Competition has a lot to do with everything you have said. Sure, doctors/staff will want to be at a place where the cafeteria is nice. Yes, I think the competitive hospitals will have better food. The situation breaks down, somewhat, if you are considering a hospital that is the only one in 100 miles. Larger cities I figure will have better food than their lonely monopolistic counterparts. They should have better everything because they will always be pressured by the competition to have the newest, best, healthiest.

I also expect food to get better at the lonely hospital, but at a slower rate. The same food service companies will be working with hospitals around the country. So, better food research to develop healthy, cheap alternatives will come first to competitive cities because they will create demand and will be able first to pay for the change. Soon the food service companies will develop only the healthy variety of foods and the monopolists will be forced to change.

Bill October 3, 2010 at 10:12 pm

Bovis, I think, if you go back to my original comment–that hospitals are purchasing the same food from national vendors as any other purchaser–you are in agreement with me when you say: “Certainly there can be healthy choices at a similar cost. But look at who provides the food. It has always been cheaper to fill things with preservatives rather than to seek out easy and cheap food which is also healthy. Only recently have we seen a push for healthy food in schools, hospitals, businesses, and with that push will come the research necessary to deliver healthy food that is also economical. Food preparation is only as good as what has happened in the past, grabbing the easiest, cheapest food, regardless of content.”

The cost of differentiating itself from everyone else–finding or creating healthier food–arguably raises costs for hospitals. Is there a benefit if it does raise costs? Well, staff satisfaction (lesser turnover, healthier staff), whether or not the hospital seeks to compete on food in the cafeteria. If it is a monopolist, I can see the argument that it wouldn’t compete for customers with food. But, you have to ask yourself, even in competitive markets, do hospitals compete with each other based on food: if I have a broken bone, or an appendectomy, do I ask: what’s for dinner tonight at hospital X or Y? Will they be using egg beaters in the morning? I might be interested in other outcomes, like whether I’m more likely to get an infection at one hospital than another, or whether my doc has priveleges.

I must confess that sometimes economics gets carried to extremes in what it predicts (without seeking evidence!).. This might be one of them. Or not. But, it is a testable hypothesis, and I see no evidence, and mixed arguments, so I am an agnostic. It would be a good research study, and you might get to taste some good meals. Or not and get sick.

CriticalCat October 4, 2010 at 12:21 am

Mike M:

You raise a very good point. I’ve been feeling the same lately. Especially the needless jargon. And splitting hairs. Often it seems like he has already made up his mind on an issue but is later cherry-picking the arguments to bolster his cause. And that sometimes means he has to mutilate the argument. A lot.

bovis October 4, 2010 at 3:09 am

Bill:

I think you are correct. We do agree. I failed to make that connection between your earlier post and the quote of mine that you referenced.

I do also think that food may be a viable form of competition between hospitals, but in an auxiliary role. Doctors/staff will want to work somewhere that offers them decent pay and working conditions. After having weighed those factors the smaller perks, such as a decent coffee lounge (I think mentioned here in a post) and decent food, will play into where employees will choose to work.

There are a lot of mixed arguments here. I enjoy the debate, though, no matter how extreme or without-evidence they may be.

MattF October 4, 2010 at 8:17 am

I had a brief stay (as a patient) at Sibley Memorial (in NW DC) a couple of years ago. Sibley is in a wealthy neighborhood, its patients are the yuppiest possible, it has lots of competition… and the food was dreadful. Just awwwwful.

Candadai Tirumalai October 4, 2010 at 9:54 am

I go to the cafeteria of the Alexandria
Hospital, in Virginia, on weekends, in part
because one can have lunch in peace without a
waiter hovering over you, and read the paper.
The food is acceptable provided one chooses
with care, but I am neither a gourmet nor
a Spartan. (After eating in a Spartan mess
an Athenian declared he knew now why its
soldiers were not afraid to die) The hospital
cafeteria provides a nutritional breakdown of
items, thought not always. I agree, however,
that many hospitals carry unwholesome fare.
I suspect a good deal depends on the Food
Committeee, and how good it is. I remember
reading once that the famed Massachussets
General Hospital has menus
which, for choice and taste, would rival a
good restuarant.

Mario Rizzo October 4, 2010 at 10:55 am

Maybe the root question is: Why do doctors, nurses and hospital staff who see sick people all of the time and have access to good information on nutrition not demand “better” food? This is very relevant to the behavioral-economics claim (by Sunstein and Thaler) that people do not behave “optimally” — given their own values — when choosing what to eat. *Maybe* the evidence here suggests that they are behaving optimally — given their values.

Doc Merlin October 4, 2010 at 12:34 pm

“Furthermore the median American has bad taste in food”

I thought utility functions were subjective and ordinal and thus not directly comparable. I don’t think you can, honestly, say as a microeconomist economist that someone has bad taste, unless thats just code for signaling that you are better than them.

eddie October 4, 2010 at 5:31 pm

Bill:

http://the-riotact.com/?p=11137 – Review of a maternity stay. Review covers maternity service, room decor, linen service, and food.

http://www.yelp.com/biz/hoag-hospital-newport-beach-2 – numerous reviews for maternity, cancer, emergency, non-emergency injury, non-emergency illness, and palliative end-of-life care. The reviews cover food, valet parking, visiting hours, the harbor view, and the new paint on the walls.

Note that in all cases other than emergency, there’s plenty of opportunity to choose where to go for treatment. Amenities will definitely factor into those choices. Anecdotally: while pregnant, my wife discussed the various virtues of several different area hospitals with other women who had given birth at them, and the quality of the food was always mentioned.

Sure, it’s not Zagat… but it’s the kind of review (and internet-facilitated word-of-mouth publicity) that matters these days.

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