Health care delivery in the United States is a large, unique industry, and one that is in transition. Health care is provided in a number of settings Physicians offices, Dentistsâ€™ offices, Local health departments, Health maintenance organizations, and Home health agencies. The hospital is the most intricate setting and is â€œthe institutional center of the health care delivery systemâ€.
Magnitude of the industry:
The health services industry has grown significantly over the past several decades. In 1983, health care expenditure totaled $355.4 billion, accounting for 10.8 percent of the Gross national Product (GNP).This translates into an annual expenditure of $1,459 for every man, woman, and child in the United States. Forty one percent of these expenditures were for hospital care. The number of people employed in the health care industry in 1983 was 7.9 million; of these, 4.3 million were employed by hospitals.
Types of Hospitals:
There are over 6,700 hospitals in the United States; of these 6,100 are short stay, general hospitals, the type of community facility that is typically though of as a â€œhospital.â€ But hospitals vary a great deal in size, average length of stay, type of specialty care provided, ownership, and teaching affiliation. Although all hospitals have much in common, specific management problems vary according to the types of hospital.
Size of Hospital:
Hospital size refers to the number of beds available for patients. A hospital in small, rural community may have as few as 50 beds; a hospital in a metropolitan area or an academic medical center may have in excess of 1,000 beds .the typical community hospital has 200 to 300 beds.
Length of stay:
Length of stay may be short stay, were the average number of days the patient spends in the hospital is less than 30 days, or long term, where the average length of stay is longer than 30 days. Most long term hospitals are psychiatric or rehabilitation centersâ€™ a few are for treatment of tuberculosis or other respiratory ailments.
Type of Specialty Care Provided:
The majority of hospitals are general hospitals where a full range of inpatient medical and surgical treatment is provided. Out patient care may also be available in emergency departments and clinics. Some hospitals offer only specialized care, such as orthopedic, pediatric, obstetrical, or psychiatric.
Ownership may be public (federal, state, or local government) or private (not-for-profit or proprietary). Because of their service tradition, most hospitals originated and remain not-of-profit, community-owned institutions, many are church affiliated. However, in the past few decades, for profit hospitals have emerged, and some not-of- profit hospitals have developed for-profit subsidiaries. Some community owned hospitals are being purchased by for profit hospital chains.
A number of community hospitals are affiliated with training programs for physicians, nurses, or other health care givers. Some hospitals are academic medical centers, owned by state or private universities where education and research as well as health care are primary goals.
More and more hospitals are coming to be thought of and to be managed as businesses. In the past, hospitals were largely social institutions and their social history and service orientation continue to influence them today. During the Roman Empire, the Christian belief in obligation to care for the sick ad needy extended to the whole community, and early hospitals flourished as social service centers for the sick, the poor, and the religious pilgrim. Only the rudiments of nursing care were provided. Even after many hospitals changed to secular hands and public philanthropy during the Renaissance the hospitalâ€™s philosophy remained one of social service. Hospitals were where the aged, mentally incompetent, crippled or orphaned were kept. The sick, who are not poor were cared from at home.