Voluntary dining in hospitals

by on April 6, 2017 at 2:07 pm in Food and Drink, Medicine | Permalink

Label this not The Department of Why Not but rather The Department of Why?

The Howsers are far from the only regulars at the Castle Creek Cafe, located inside Aspen Valley Hospital. It’s a popular breakfast spot for city workers. It also feeds people on both sides of the law; police officers visit daily, and the cafe delivers to inmates at the local jail 7 days a week. The cafe makes a point of welcoming community members with no hospital affiliation. And its menus, made available to view a month at a time, include items like herbed farro pilaf, corn soufflé, and panko crusted cod. We’re a long way away from institutional slop. [TC: speak for yourself, buster!]

The Howsers discovered the cafe, which Mary calls “the best kept secret in Aspen,” after having some tests done in the hospital. She says, “Never in my wildest dreams did I think hospital food could be tasty!” The experience has even inspired them to check out restaurants at other hospitals.

One Colorado hospital restaurant that should be next on their list is Manna, within Castle Rock Adventist Hospital.

I am sorry people, but I am going to stick with theory on this one.  No data will be sampled, unless you count this enthusiastic description from Tim Davis as evidence of sorts:

“Their menu has real gourmet style food you would expect from a high priced restaurant, but sold to you at a much more affordable price,” he says. One dish is maple glazed duck confit, consisting of a maple glazed duck leg served with swiss chard and spätzle, for $9. The grilled Thai cabbage steak, with marinated cabbage, spicy lime dressing, and shishito pepper, is even cheaper. Their burger buns even come adorned with a monogrammed M.

A further advantage is that the staff don’t push you out the door to leave, in addition the dining rooms are spacious and somber.

Mises was right about the a priori!

Here is the article, with further testimonials, and for the hat tip I thank Steve Rossi.

1 Paul Fallavollita April 6, 2017 at 2:13 pm

I worked across from a hospital once. I used to drop by their cafeteria for lunch since they served a lot of good food (i.e. not “healthy”). I particularly liked their burgers and fries. I recall one of the emergency room doctors once commenting that they expected to see me in their ER at some point in the future.

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2 E. Harding April 6, 2017 at 10:40 pm

I won’t be spamming you with the Marginal Counterrevolution anymore because I have deleted it. #NeverTrump

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3 JWatts April 6, 2017 at 2:15 pm

Since this is posted on an economics blog, it would have been nice to know if the restaurant actually turns a profit, or at least breaks even.

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4 Jeff R April 6, 2017 at 2:18 pm

I would hope so; they have a pretty captive market.

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5 Anon April 6, 2017 at 3:29 pm

Plus continuing cycles of boom food and bust health.

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6 JWatts April 6, 2017 at 5:49 pm

“I would hope so; they have a pretty captive market.”

No, not really. The food services that delivers to the patients has a captive market. But the restaurant itself depends on staff and visitors who, at least to some degree, have other choices. As such, the amount they can charge for meals is limited. In additiona hospitals typically give their staff discounts and often pay a much higher rate for food service employees than at normal restaurants.

I suspect that there’s so fairly serious subsidies that get shunted towards these restaurants.

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7 BenK April 7, 2017 at 12:33 pm

Here’s my suggestion:

The hospital used to treat patients as a captive market and obtain the greatest profit margin from them.
Now, they use that steady cash flow to enable service upgrades; thus the food service can compete in markets that are not captive.

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8 mulp April 6, 2017 at 3:44 pm

It does not matter. It must exist. Unless you think patients who must demonstrate they can eat, digest, metabolize, and expel food must not be allowed to live.

Given the necessity the hospital pay dieticians and staff to prepare food based on medical orders, including consulting with patients with advice on how to prepare food and eat at home, they might as well be used to prepare “good food”.

And nothing is wrong with burgers and fries unless they are making them in portion sizes sufficient to meet a full day calorie count. Were you going to the hospital dining hall to buy super-sized triple patty burgers with bacon and cheese, a half pound of fries, and two liter soda, plus a milk shake (with zero dairy)?

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9 BC April 6, 2017 at 4:33 pm

Tyler mentions sticking “with theory”, by which I assume he means that hospitals shouldn’t be expected to serve good food for a good price due to their captive customers (patients). However, that hypothesis doesn’t consider all of the subsidies that hospitals receive: workers’ tax-free health insurance, Obamacare subsidies and insurance mandates, etc. All subsidize demand for, and thus predictably steer economic resources towards, the health care industry. But, should we expect that healthcare facilities use those subsidies to enter non-health industries like food service (for non-patients)? It probably depends on how conditional those subsidies are and how easily the healthcare side can cross-subsidize the non-healthcare side.

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10 rayward April 6, 2017 at 2:19 pm

Who works in hospitals? Doctors. How does one assure the attendance of doctors at a meeting? Provide free food. If one wants lawyers to attend a meeting (I know, why would one), provide free drinks. But for doctors, it’s free food. Not necessarily good food, but free food. Bon appetit.

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11 spencer April 6, 2017 at 2:23 pm

Do they include the “rent” on the facility when calculating charges for food?

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12 Ray Lopez April 6, 2017 at 2:37 pm

But how’s the meatloaf? You can always tell the quality of hospital food from the meatloaf (sometimes though it’s the only thing on the menu). I notice BTW that northern VA hospitals have Panera Bread shops inside their facilities, sure sign that the hospital food is not that good.

Bonus trivia: Panera Bread was sold for $7B, too much, no?! Reminds me a bit of “Parmalot” and their 12 billion USD scandal from yesteryear:
https://www.bloomberg.com/news/articles/2004-01-11/how-parmalat-went-sour – how do you get rich off of commodity food? Bread, sheez, I make bread in my bread maker, and my family makes many loaves by hand, it’s easy. They don’t put enough salt in their bread and it’s too crumbly, but it’s good tasting.

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13 BenK April 7, 2017 at 12:34 pm

For an interesting corporate history, read about Au Bon Pain and Panera….

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14 The Engineer April 6, 2017 at 2:39 pm

This is proof of what ills our health care system.

Gourmet food? Hospitals that are being renovated to rival luxury hotels? These are signs that things are really out of whack in our health system.

15 years ago, when I had my first child, my wife had to share a room. Maybe 5 years after that, private rooms became the norm. Perhaps a couple generations ago, there would probably be wards, with no rooms whatsoever.

Which do you think is more efficient?

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15 Karl Johans Gait April 6, 2017 at 3:22 pm

Private beds reduce the risk of hospital acquired infection. I would guess that they are more efficient in a pure dollar sense. On top of that, patients enjoy them and they make a miserable experience slightly less miserable.

Attracting and retaining doctors, leadership, IT, etc. is costly. These people like good food. If they can just pop over to the cafeteria without deliberating where to order out from and the traveling to pick up food that seems to be a big time saver/distraction eliminator. I am guessing in many places (like Aspen in the article) patients and visitors would also prefer to pay an extra 4-5 dollars for a good meal. The cafeteria seems to be running so efficiently that even people from the non-hospital community are traveling to dine there.

Where are the examples of inefficiency in this story?

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16 The Engineer April 6, 2017 at 4:15 pm

Maybe I’m misinterpreting the story, but a “cafeteria” in a hospital is where the patients food is coming from. Most patients are not paying for the food, themselves, insurance is. Thus, that is why the food is “gourmet”.

Of course I want gourmet food when I’m not paying for it directly. Of course I want luxury hotel accomidations if I am not paying for it. Of course I want valet parking when I’m not paying for it. Etc. Etc. Etc.

There are all things that are now common at hospitals, and it is because patients are not paying for it directly.

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17 Karl Johans Gait April 6, 2017 at 5:03 pm

I would guess that a small percentage of the hospital cafeteria is feeding admitted inpatients who are billing their insurance for their meals. The hospital in Aspen that is mentioned only has 25 beds. The price value is one of the selling points for the random diners.

When was the last time you were in a hospital? It most of them that I have been too it seems like 75+ percent of people are staff or outpatients who are not required to dine on site and are paying directly for their meals.

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18 Nic April 6, 2017 at 8:08 pm

My mother worked in hospital admin for 15 years. We lived near the hospital and my brothers and I would eat there frequently. I can’t tell you how many beds, but it was good sized, 10 floor facility. At the time back in the late 90’s it was all Sysco food sourced. The portions were great and from what I remember very reasonable. Hospital staff did get a discount. It was packed all the time.

I will say that whoever operates the food facilities at a large hospital facility have a clear advantage even over closely located food options. Basically the food and/or prices would have to be of terrible value to not capture the foot traffic needed on a daily basis to turn a profit.

19 albatross April 7, 2017 at 12:11 pm

As one datapoint: I’ve eaten in the cafeteria in my local hospital several times over the last decade or so, but have never been admitted as a patient there. I ate there when there waiting for my wife (we had two kids at that hospital), visiting sick friends, and attending classes or meetings held in the hospital building. I wouldn’t make a special trip to eat at the hospital cafeteria, but as far as I can tell, it’s about as good as the cafeteria at my office (aka, perfectly fine for cafeteria food).

20 Ricardo April 7, 2017 at 12:16 am

One of the main points of the article is that the food is affordable. The hospital is not earning significant profit margins from billing your insurance for a $9 entree. Since this is Aspen and the article notes that the cafeteria is very popular among non-patients, it seems like they are simply meeting a demand and their prices are in line with the local market.

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21 BenK April 7, 2017 at 12:35 pm

Actually, those studies about infection are not very good and based on more recent studies, all sorts of contact precautions have been rolled back.
Basically, we still don’t do enough sequencing to track organisms causing infection.

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22 Alex Tabarrok April 6, 2017 at 2:50 pm

But at least there are no beautiful women there.

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23 rayward April 6, 2017 at 3:02 pm

Okay, it’s Aspen. That is the obvious explanation for fine dining in the hospital. Are people in Aspen actually sick? I don’t think so. I’ve never stayed in Aspen. In Basalt many times, but not Aspen. My son and I would go to dinner in Aspen. In 1994, he insisted that we go to Mezzaluna. The food was good enough, but OJ wasn’t there.

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24 Bill April 6, 2017 at 3:11 pm

I’m stickin’ to the

McDonalds

In the local hospital.

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25 Steve April 6, 2017 at 3:18 pm

In the article it mentions that the hospital subsidizes the prices of the food. You would imagine every subsidy for monogrammed plates and maple glazed duck, is less money going to improving the actual delivery of healthcare services–But hey why bother with that!–the insurance companies both public and private still pay either way–why focus on pleasing the patient, because they are not the customer anyway–most direct way to confuse the patient into thinking they are being well taken care of is to feed them steak at a reduced cost! Maybe sell them a knee replacement they don’t need while they’re there.

The other big problem highlighted here is that people like hanging out in hospitals. This is alarming. America needs to wake up to the fact that we are over-medicalized and over-treated in large part because we view consuming health care interventions as improving our health–though most do not. When its the “cool” or “in the know” thing to “eat at the hospital” you know one of the major problems with healthcare spending is simply one of American culture–we just like consuming healthcare, as we like consuming all things. Fooled by marketing, misaligned incentives from Doctors, no price signaling, all fueled by a perceived free-lunch through Medicare and Medicaid and now it’s a party.

This also speaks to a very similar phenomenon to what is happening in American higher education. Colleges use big gyms and sporting facilities, and indeed high- end cafeteria food and many other amenities to lure students. It’s an arms race of amenities to signal “this is the place you should be.” Meanwhile college tuition rises as subsides for tuition keep the student applications increasing year after year–and colleges have really no incentives to lower their spending on giving out all the goodies to students. Education doesn’t really improve but that’s beside the point. But every dollar going to this kind of spending is one dollar not going to fund scholarships etc. (See Malcolm Gladwell’s recent podcast on this)

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26 Troll Me April 6, 2017 at 3:43 pm

If there’s a subsidy it’s probably through reduced rent or something.

They aren’t paying out a dollar subsidy per plate or something are they? If they are serving at less than marginal cost that would be an issue.

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27 JWatts April 7, 2017 at 11:48 am

It depends on if the employees at the restaurant are third party employees or hospital employees. Direct hospital employees will have relatively high pay for that kind of job and extraordinary benefits.

If the employees are staff, then it’s probably a rather large implicit subsidy, since their benefits and wage may not completely come out of the operating budget.

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28 The Engineer April 6, 2017 at 4:18 pm

+1, this is the point I was trying to make. High end architecture, luxury private rooms, gourmet food, and valet parking indicate that things are out of whack in the insurance system.

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29 Andao April 6, 2017 at 8:14 pm

Good analogy. We don’t want people to spend excessive time in universities or hospitals, so why do we keep turning them into luxury destinations?

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30 Ted Craig April 6, 2017 at 3:45 pm

This is nothing new. Twenty years ago, when I was working a low-pay job, my co-workers and I used to eat regularly at the local hospital because the food was cheap.

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31 Anon April 6, 2017 at 4:06 pm

Must be a ski town thing. The hospital in Park City Utah has a great cafe. Even though it is “out of town” (it is about 2 miles; there are several bike paths that g there, and a xc ski track in the winter) it is a popular spot for people who otherwise have no reason to be at the hospital. I have eaten there (only when I otherwise had cause to be at the facility); the food is good and well priced.

It is not just the cafe. The hospital looks more like a high end ski lodge than a hospital; inside and out.

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32 Hadur April 6, 2017 at 4:18 pm

The hospital near me has an absurdly cheap café. The food is not good relative to other options nearby, but it is the cheapest eatery in the area. I do go there occasionally to save money.

Also it’s funny to see doctors and nurses eat complete junk food.

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33 Various April 6, 2017 at 4:30 pm

Sorry, but this blog post confuses me. Tyler seems to be opining in an oblique fashion, but I’m not sure what his opinion is. Is the point that the cafe’s costs are subsidized, that the food is good, that the food stinks? I’m not following

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34 Islander April 6, 2017 at 4:38 pm

This trend is hurtful to the health of hospital patients! The example food cited contains Swiss chard, which i grow in my garden every writer and know thoroughly. It contains very high levels of sodium (naturally) and oxalic acid and so is poisonous to people with impaired kidney function. A guest at a dinner party of ours figured this out the hard way:(

I think the hospital experience should stay well separated from normal life (ie tasty food) for many reasons, such as that one focuses on recovery, separates the experience from normal life and doesn’t endanger oneself with unsafe foods while possibly being immunocompromised, in danger of organ failure etc. See my dinner guest who nearly died after gorging on our fried Swiss chard gorgonzola salad.

This may all change in a few decades when medical science matures. Until then, restaurants in hospitals are more likely to do harm than good to the health of patients. Let’s stick to green jello until personalized medicine is real.

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35 Robert April 6, 2017 at 4:54 pm

I don’t understand Tyler’s comment about Mises and a priori. Please explain.

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36 Bill April 6, 2017 at 5:52 pm

Because of dietary restrictions, von Mises could only eat a certain variety of fish, named by the Italians as “a priori”, which flourished in the streams of the Austro-Italian alps.

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37 anonymous April 6, 2017 at 10:04 pm

Mises said: “Action and reason are congenerous and homogenous” (Hume would disagree). Mises was very unpopular with his contemporaries for, among other things, his explanation that economics is an a priori science (he was right). The joke in this post was, I think, that von Mises would understand, without leaving the coffee shop on the fashionable street near the Austrian or American equivalent of the Sorbonne, that when “homo economicus” chooses to go to a hospital cafeteria when there are so many great non-hospital restaurants around, he ,von Mises, like T. Cowen, would not need to investigate the hospital cafeteria to understand why (no data will be sampled). Hume would have mocked the metaphysical presumptions of Mises and Cowen : as for me, I know that the Culinary Institute of America graduates thousands of great meal preparers every decade and if one of them happens to work at the local VA building or the local government owned iatrogenic sad place for people who need to be there for medical issues, maybe I will check it out. So I am halfway between Hume and the CIA, on one hand, and Cowen and Mises, on the other hand. Cowen has higher restaurant standards than me (not being sarcastic – in any given city with which he is familiar he knows multiple places where the food is, to a vanishingly accurate degree, likely to be better than it is in a hospital. For me, that is only true of the town I live in). That being said, there are some beers that taste their best at dive bars near the mine head or the factory gate: Cowen probably knows this too, but he does not drink beer. Well MIses knew that too, so I am not sure why I brought it up. Anyway, as Pushkin said, Habit is a Gift from on High: It is our reward for losing happiness: He did not say: an ability to find the best restaurants is a gift from on high, it is our reward for losing happiness.

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38 BenK April 7, 2017 at 12:38 pm

More than the CIA or Cordon Bleu, you might encounter grads of Johnson and Wales, who learn less the art of restaurant openings and more the art of good food, on time, in quantity. Meanwhile, in the chic converted barn, will be the NECI graduate…

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39 Faze April 6, 2017 at 6:50 pm

Hospitals outsource their food services. The company that does the cafeteria may not be the same company that does inpatient food. The hospital eatery in question may be offering fancy food choices not so much to attract outside diners as it is to differentiate and compete with other vendors of hospital cafeteria food. So the story isn’t so much about healthcare, as it is about the institutional food supplier industry.

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40 AlanW April 6, 2017 at 11:03 pm

I believe it’s handled in-house at CRAH, so the differentiator really is against other hospitals in the area. The South Denver health care market is fiercely competitive.

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41 Sheree April 6, 2017 at 7:53 pm

For hospital inpatients: Food is one of the best paths to wellness and the right foods, grown/raised properly and prepared healthily, can actually hasten healing and improve outcomes. I visited the hospital in Burlington, VT, which has similar practices to what I read here about the Aspen hospital, and the medical staff raved about the better medical outcomes due to the quality of hospital food. Improving food quality leads to better medical outcomes which boosts profitability (lowers long-term costs). As for issues with certain foods (such as the cited Swiss chard issues), hospital nutrition staff actually address and take precautions to make sure inpatients are not receiving foods that are contraindicated with medical conditions and medications.

For hospital visitors: Quality food brings in health and taste conscious consumers, which includes most MDs. I mentioned the Burlington, VT hospital previously. It attracts diners from across the city (and adjacent U of Vt) who pay for meals voluntarily, no insurance involved.

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42 S April 6, 2017 at 9:47 pm

boomer cucks talking about food while Rome burns

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43 Valerie April 7, 2017 at 9:18 am

What does Tyler mean when he says “I am sorry people, but I am going to stick with theory on this one.”?

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