Hospital Downsizing
The modernization of hospitals and hospital services can be traced back to 1840 when facilities began to change their focus from caring for the impoverished and mentally ill, to becoming a place known for providing complete health care to the population. After the Second World War, the government identified a deficiency in the health care system and the response to was passage of the Hill-Burton Free and Reduced Cost Health Care Act in 1946.
The Hill-Burton Act provided government subsidies to aid in the construction and modernization of local government hospitals as well as not-for-profit facilities. Hill-Burton established a goal ratio of 4.5 beds for every 1000 people; the greatest period of hospital growth due to this legislation was from 1947 to 1971 when an estimated $33 billion
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With improvements in home health care and other services available to provide subacute continuity of care outside of the hospital setting, early discharge became one of the means by which hospitals have been able to reduce the overall length-of-stay to remain profitable (Shi & Singh, 2015).
Because of the improvements in delivery of health care, the beds to patient ratio established by the Hill-Burton Act has been below the established goal since 1998. The decline in the number of available beds may be attributed to the closures, mergers, and acquisition that have affected over 700 facilities since the 1980’s (Shi & Singh, 2015). However, this is balanced by the increasing efficiency in utilization of available resources, due in part to the advances in medical technology and improvements in the types of services available to patients on an outpatient basis.
The Effect of Managed Care on Hospital
The NHS began in 1948 as a result of an act of Parliament in 1946, under the guidance of Aneurin Bevan, then a Minister of the incumbent Labour Government, and in response to the Beveridge Report on The Welfare State of 1942. Most hospitals in the UK had previously been operated as non-profit making concerns. About two-thirds of them had been run by Local Authorities (the bodies also responsible for local Fire Services, Schools, Roads etc), with about one third of them run independently as Voluntary Hospitals. With the NHS act, these were all compulsorily acquired and subsequently administered by the State, and all treatments became universally available at no cost at the point of provision, the whole being centrally funded by taxation. From 1948 onwards all hospital doctors, hospital nurses and all other hospital staff became salaried employees of the State.
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
The challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
Many pivotal events over the last century have brought our healthcare system to where it is today. Some were indirect, such as World War II (and how it led to direct events such as medical advances that shifted focus from critical care and managing contagion to preventive medicine and health insurance as an employee benefit) and the internet (which has provided a wealth of tools and resources that were once only available to healthcare providers and has served to foster technological advancements such as Electronic Health Records and telemedicine). Others were targeted interventions, such as the Hill-Burton Act, which was enacted in 1946 and provided infrastructure dollars to healthcare facilities that agreed to provide a significant volume of free or reduced cost services to those with limited ability to pay (HRSA, 2014). Perhaps the most influential targeted event was the passage of Medicare and Medicaid programs, which was the point at which the government became the administrator for insurance programs for the poor, creating a system that would continuously grow and impact service delivery through regulatory control.
The American people needed help more than ever. Due to the Great Depression and war, many hospitals became obsolete and over 40% of the nation’s countries didn't have any hospitals. Luckily, a new law passed by Congress would solve that problem. Following the Great Depression and war, the Hospital Survey and Construction Act, also known as the Hill-Burton Act was passed in 1946. The Hill-Burton Act was to provide grants and loan to facilities for the construction of nursing homes, rehabilitation centers, hospitals and health centers (Health & Human Services, 2000). Facilities receiving these funds had three rules to follow: they weren’t allowed to discriminate based on race, color, national origin, or creed, though some ‘separate but equal’ facilities were allowed, provide a ‘reasonable volume’ of free care each year for those residents in the facility’s area who needed care but could not afford to pay and states and localities were also required to prove the economic viability of the facility in question (Newman, 2004).
The Crowded Clinic: Critical Analysis The Crowded Clinic Case Study (Colorado State University - Global, n.d.) discusses the issues of practice management as they apply to access to care. Access to care may be as inconvenient as lengthy patient wait times to issues far more serious that may have a profound effect on the health and well-being of a single patient or an entire cohort. In order to properly address the issue and look for a remedy, it is necessary to understand the underlying conditions that create the problem before creating the means to manage the change required to correct the problem. The Crowded Clinic has multiple issues, including social and operational, which are creating the associated inaccessibility to services.
There has been a shortage of physicians, lack of inpatient beds, problems with ambulatory services, as well as not having proper methods of dealing with patient overflow, all in the past 10 years (Cummings & francescutti, 2006, p.101). The area of concern that have been worse...
The purposes of hospitals in the 18th century served a different purpose than the 21th century hospitals. The United States hospitals arose from “institutions, particularly almshouses, which provided care and custody for the sickly poor. Entrenched in this tradition of charity, the public hospital traces its ancestry to the development of cities and community efforts to shelter and care for the chronically ill, deprived, and disabled” ("America 's Essential Hospitals,2013").Hospitals in the earlier years in the United States are far more different than they are today.
Nevertheless hospitals need beds to work with the demand of care. And from admittance to discharge can be a long time. If all trusts prioritised elderly care it would free up 5,700 beds across hospitals and ensure elderly people like Mr Bates were not kept in hospital unnecessarily. (Imison, Thompson, and Poteliakhoff, 2012). This would benefit him as long stays prolong the start of recovery and normalisation. To start his recovery sooner he could be admitted him to a step down bed. This is a cost effective way to getting preparing him for home without having a long hospital stay. A stepdown care bed is a less clinical setting and is easier to start returning to normality (Boyd et al, 2012).
Both report feeling safer and patients appreciate feeling more attended to (Cho et al., 2011). Furthermore, patients tend to report higher rates of satisfaction when they have shorter hospital stays & direct correlations between length of stay & more nursing time at the bedside have been established (Chan et al., 2011).
In 1983 the entire health care industry was affected by the changes that the U.S government made in how to reimburse hospitals for Medicare patients (40% of all hospital patient days). So, let's see how the situation was before and after these changes.
This paper includes a comparison between Pioneers Memorial Hospital in Brawley, California and the average U.S. Hospital.
Regional Market: During the 1960’s, the hospital industry boomed with billions of dollars for hospital construction with additional funds for expansion and construction of medical schools. Government sought to reduce health care costs through cutbacks in subsidy programs and cost-control regulations. Innovations in health care delivery severely reduced the number of patients serviced by hospitals.
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
The cost of Medical equipment plays a significant role in the delivery of health care. The clinical engineering at Victoria Hospital is an important branch of the hospital team management that are working to strategies ways to improve quality of service and lower cost repairs of equipments. The team members from Biomedical and maintenance engineering’s roles are to ensure utilization of quality equipments such as endoscope and minimize length of repair time. All these issues are a major influence in the hospital’s project cost. For example, Victory hospital, which is located in Canada, is in the process of evaluating different options to decrease cost of its endoscope repair. This equipment is use in the endoscopy department for gastroenterological and surgical procedures. In 1993, 2,500 cases where approximately performed and extensive maintenance of the equipment where needed before and after each of those cases. Despite the appropriate care of the scope, repair requirement where still needed. The total cost of repair that year was $60,000 and the repair services where done by an original equipment manufacturers in Ontario.