I think we need to distinguish between scopes at hospitals and scopes at a GI's office. Propofol (a) has to be administered by an anesthesiologist, and (b) is 15 times more expensive than conscious sedation. The profitability of administering Propofol has led to scams and I have personal experience with one. The scam is perpetrated by the anestheologist who insinuates himself or herself into a business relationship with a GI who does scopes all day. They sell the GI on Propofol being better but the TRUTH is it's not better, it's more money for the anesthesiologist than if the Doc gives the conscious sedation to his own patients (yes, and you don't have the grogginess).
The problem is people soon realize that $1500 vs. $100 is a lot of money when the insurance carrier isn't covering it. They then squawk about the needlessness of this and the scam is shut down. I was part of seeing one get shut down. It was all sales pitch and at the end of the day people were needlessly getting Propofol, complaining about bills, when Doc has to choose between angry patients and firing the anesthesiologist guess who wins?
Hospitals are in business to make money and to pay you and the anethesiologists they need to keep them busy and Propofoling people is one way to do that, like I said, it is 15X as much which is huge. And I am not sure why insurance carriers don't squawk because at the end of day someone has to pay the bill for 15x more expensive.
I am pretty sure at Yale that conscious sedation is the standard based on what I witnessed being put in the recovery room there BEFORE the procedure due to my Doc being late. I had always assumed it was due to costs although the other side of it is that it is easier to communicate with a patient who is not groggy. In any event I am stuck on the cost and I think Propofol is a needless waste of money for a flex sig and the only reason it's being done is to keep anesthesiologists busy and paid.
If anyone is wondering why Healthcare is headed towards being 33% of the GNP of the USA, there you have it. It's the easiest business in which to sell people things they don't need. You are selling to sick people, and they want to believe that what you tell them they need IS what they need, even if it isn't.