Hospitals: History and Organization
Hospital History
• Overview • Pennsylvania Hospital (1751)
– Oldest voluntary hospital
• Focus on sick, poor, homeless • Not a focus of care for physicians
– Primary care in home/office
• Mental illness
– First mental hospital in 1772
1
Hospital History (cont.)
• Growth of urban areas
– Growth of hospitals – Focus on research, teaching, medical schools
• Major discoveries
– Anesthesia
• Ether
• Antibiotics
• Sulfa Drugs, penicillin (decreased infection rates and mortality)
• Ambulatory/outpatient care • Transplants (kidney 1954, liver/heart 1967) • Hill Burton (1948)
– Commitment to the poor in return for federal funding for building assets
2
Hospitals - Statistics
• Number in the US = 4,908 • Types: – Community (non federal, short term, specialty) = 4,919 – For-profit (investor owned) = 754 – Non-profit = 2,998 – Government = 1,156 • Statistics – Beds = 826,000 – Beds staffed = 808,127
3
Hospitals – Statistics (cont.)
– – – – – – – – – – Total admissions = 36,941,951 Spending per capita = $5,276 40+ million people without health insurance coverage Total Expenses = $445,700,000,000 Admissions = 33,814,000 Average length of stay = 5.7 days Cost per day = $1,217 Outpatient surgeries as a percent of total = 63% Outpatient Visits = 539,316,000 Annual change in health insurance premiums = 13.9%
4
Hospitals – Trends
• • • • Decrease in the number of hospitals Decrease in inpatient admissions Increase in outpatient visits Average length of stay, patient days, and number of hospital inpatient beds all have decreased • Changes in expansion/growth strategies • Changes in affiliations, increase in systems • Increase in health care costs for providers, consumers, government, insurance industry
5
Hospital Organization
Typical Structures
• Hierarchical form
– Senior Management (CEO, COO, CFO, CNO) – Middle Management (Division and Department Heads) – Supervisors (Managers, Assistant Directors, Charge Nurse) – Staff, line
• Overview • Pennsylvania Hospital (1751)
– Oldest voluntary hospital
• Focus on sick, poor, homeless • Not a focus of care for physicians
– Primary care in home/office
• Mental illness
– First mental hospital in 1772
1
Hospital History (cont.)
• Growth of urban areas
– Growth of hospitals – Focus on research, teaching, medical schools
• Major discoveries
– Anesthesia
• Ether
• Antibiotics
• Sulfa Drugs, penicillin (decreased infection rates and mortality)
• Ambulatory/outpatient care • Transplants (kidney 1954, liver/heart 1967) • Hill Burton (1948)
– Commitment to the poor in return for federal funding for building assets
2
Hospitals - Statistics
• Number in the US = 4,908 • Types: – Community (non federal, short term, specialty) = 4,919 – For-profit (investor owned) = 754 – Non-profit = 2,998 – Government = 1,156 • Statistics – Beds = 826,000 – Beds staffed = 808,127
3
Hospitals – Statistics (cont.)
– – – – – – – – – – Total admissions = 36,941,951 Spending per capita = $5,276 40+ million people without health insurance coverage Total Expenses = $445,700,000,000 Admissions = 33,814,000 Average length of stay = 5.7 days Cost per day = $1,217 Outpatient surgeries as a percent of total = 63% Outpatient Visits = 539,316,000 Annual change in health insurance premiums = 13.9%
4
Hospitals – Trends
• • • • Decrease in the number of hospitals Decrease in inpatient admissions Increase in outpatient visits Average length of stay, patient days, and number of hospital inpatient beds all have decreased • Changes in expansion/growth strategies • Changes in affiliations, increase in systems • Increase in health care costs for providers, consumers, government, insurance industry
5
Hospital Organization
Typical Structures
• Hierarchical form
– Senior Management (CEO, COO, CFO, CNO) – Middle Management (Division and Department Heads) – Supervisors (Managers, Assistant Directors, Charge Nurse) – Staff, line