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   • Inpatient- an overnight stay in a health care facility, such as a hospital.

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   • Outpatient-refers to services provided while the patient is not lodged in a health care facility

What were the main factors responsible for growth of hospitals until the latter part of the 20^th century?

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   • Development of Professional Nursing- the benefits of having trained nurses in hospitals became apparent as increased efficacy of treatment and hygienic improved patient recovery. Hospitals came to be regarded as places of healing and found acceptance in upper and middle class.
   • Growth of Private Health Insurance- after Great Depression hospitals were forced to close and the growth of private health insurance became a way for people to pay for hospital services. At this time insurance plans provided generous coverage for inpatient care. There were few restrictions on this plan.
   • Role of Government- perhaps played the most important role in expansion of hospitals. Medicare and Medicaid provided indirect funding to the hospital industry expanding public health insurance.

Name the three main forces that have been responsible for hospital downsizing. How has each of these forces been responsible for the decline in inpatient hospital utilization?

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   1. Changes in Hospital Reimbursement- this had the most dramatic effect on hospitals- Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982- conversion of hospital Medicare reimbursement from cost-plus to a prospective payment system (PPS marked a major change in the way hospitals were paid for). Several states adopted prospective methods to reimburse hospitals for Medicaid enrollees. Private payers also resorted to competitive pricing and discount fees and monitored and how long patients would be hospitalized
   2. Rural Hospital Closures-1990’s-small rural hospitals had to close because of economic constraints. Hospitals had to close entire wings and convert beds to long-term care and psychiatric care. Health Care Financing Administration (HCFA) created a swing bed program for rural hospitals. Swing bed- program created additional revenues for small rural hospitals by allowing them to switch the use of hospitals beds between acute-care and long-term care skilled nursing facility.
   3. Impact of Managed Care-1990’s-inpatient care can be costly and managed care has emphasized alternative delivery settings: outpatient treatments, home health care and the use of nursing homes. This has had major impact on limiting the utilization of inpatient services and down sizing individual hospitals. On the other hand, hospitals have employed consolidation strategies to deal with external pressures.

What is a voluntary hospital?

§         Voluntary Hospitals- nongovernmental and privately owned hospitals that are operated on a nonprofit basis. They are owned by the community and other nongovernment orgs.

§         The Hill Burton Act- was instrumental in promoting non profit because it required that hospitals constructed with federal funds must provide a certain amount of uncompensated care. Competition led smaller for profit hospitals to closure.         

           What are some of the main differences between teaching and non-teaching hospitals?

1. Provide medical training to physicians, research opportunities to health services researchers and specialized care to patients
2. Teaching hospitals have a broader and more complex scope of services than non teaching hospitals
3. Location of these hospitals are located in the poor, inner city areas and usually owned by state or local governments

      Why are hospitals among the most complex organizations to manage?

§         A hospital is generally more responsible to numerous stakeholders in its external environment. These stakeholders include the community, the government, insurers, managed care organizations and accreditation agencies.

§         The organizational structure is different from other organizations. The CEO receives authority from the Board and is responsible for managing the organization with help of senior managers. Senior managers carry the title of services such as nursing services, rehabilitation servicers, human resources, finance and so on.

§         The Medical Staff has a separate organization that parallel with the administrators. This dual structure causes conflict when these lines of authority cross lines. EX: nursing service, pharmacists, diagnostic technicians and dietitians are ADMINISTRATIVELY accountable to the CEO but PROFESSIONALLY accountable to medical staff.

Chief Executive Officer  (Administrator)

Vice-Presidents for Operations:

• q
• q
• q
• q
Quality Management / AccreditationClinical Support Functions   (central supply, health information, dietary, housekeeping, etc) Ancillary functions   (lab, imaging, pharmacy, respiratory, etc) Nursing units and functions  (Chief Nursing Officer)