Hospital Services

Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Morbidity and mortality rates

Definition

Hospital services is a term that refers to medical and surgical services and the supporting laboratories, equipment and personnel that make up the medical and surgical mission of a hospital or hospital system.

Purpose

Hospital services make up the core of a hospital’s offerings. They are often shaped by the needs or wishes of its major users to make the hospital a one-stop or core institution of its local community or medical network. Hospitals are institutions comprising basic services and personnel—usually departments of medicine and surgery—that administer clinical and other services for specific diseases and conditions, as well as emergency services. Hospital services cover a range of medical offerings from basic health care necessities or training and research for major medical school centers to services designed by an industry-owned network of such institutions as health maintenance organizations (HMOs). The mix of services that a hospital may offer depends almost entirely upon its basic mission(s) or objective(s).

There are three basic types of hospitals in the United States: proprietary (for-profit) hospitals; nonprofit hospitals; and charity- or government-supported hospitals. The services within these institutions vary considerably, but are usually organized around the basic mission(s) or objective (s) of the institution:

• Proprietary hospitals. For-profit hospitals include both general and specialized hospitals, usually as part of a healthcare network like Humana or HCA, which may be corporately owned. The main objective of proprietary hospitals is to make a profit from the services provided.
• Teaching or community hospitals. These are hospitals that serve several purposes: they provide patients for the training or research of interns and residents; they also offer services to patients who are unable to pay for services, while attempting to maintain profitability. Nonprofit centers like the University of California at San Francisco (UCSF) or the Mayo Clinics combine service, teaching, and profitability without being owned by a corporation or private owner.
• Government-supported hospitals. This group includes tax-supported hospitals for counties, communities and cities with voluntary hospitals (community or charity hospitals) run by a board of citizen administrators who serve without pay. The main objective of this type of hospital is to provide health care for a community or geographic region.

Demographics

As of 2006, the total number of hospitals in the United States, including military and prison hospitals, is over 7,569. Of this total, approximately 3,000 are non-government-related nonprofit hospitals; almost 800 are investor-owned; and 1,156 are government (state, county, or local) hospitals.

Description

Over the past two decades, hospital services in the United States have declined markedly as a percentage of health care costs, from 43.5% in 1980 to about 31% in 2005. This decline was due to shortened lengths of

KEY TERMS

Auxiliary hospital services— A term used broadly to designate such nonmedical services as financial services, birthing classes, support groups, etc. that are instituted in response to consumer demand.

Health maintenance organization (HMO)— A broad term that covers a variety of prepaid systems providing health care within a certain geographic area to all persons covered by the HMO’s contract.

Intensivist— A physician who specializes in caring for patients in intensive care units.

Nonprofit hospitals— Hospitals that combine a teaching function with providing for uninsured within large, complex networks technically designated as nonprofit institutions. While the institution may be nonprofit, however, its services are allowed to make a profit.

Proprietary hospitals— Hospitals owned by private entities, mostly corporations, that are intended to make a profit as well as provide medical services. Most hospitals in health maintenance organizations and health networks are proprietary institutions.

Teaching hospitals— Hospitals whose primary mission is training medical personnel in collaboration with (or ownership by) a medical school or research center.

hospital stay, the move from inpatient to outpatient facilities for surgery, and a wave of hospital mergers in the 1990s that consolidated services and staff. Since 2001, however, spending on hospital care in the United States has been growing faster than other sectors of the economy as a result of increasing demand for hospital services. Forty percent of the rise in spending on hospital care is due to escalating costs for hospital services attributed to population growth, the aging of the general population, and growing discontent with the limitations imposed by managed care. In addition, new medical technologies have allowed hospitals to provide life-saving diagnostic and therapeutic alternatives that were unavailable in the 1990s.

At the same time that the use of hospital services is increasing nationwide, government support of hospital services with Medicaid and Medicare has been decreasing, putting pressure upon hospitals to treat the uninsured and make up for $21.6 billion in uncompensated care (year 2002). This trend has put pressure on for-profit, not-for-profit and teaching hospitals to provide a broader range of community services or such “low-end” services as mental health care, preventive health services, and general pediatric care. In addition, very recent changes in Federal laws governing the entry of hospitals into new markets—Certificate of Need laws—allow health care providers to offer new hospital services, resulting in the growth of ambulatory surgical centers, special tertiary surgery centers and specialty hospitals that treat a single major disease category. These legislative changes encourage the offering of “high-end” services that are increasingly demanded by consumers.

Hospital services define the core features of a hospital’s organization. The range of services may be limited in such specialty hospitals as cardiovascular centers or cancer treatment centers, or very broad to meet the needs of the community or patient base, as in full service health maintenance organizations (HMOs), rural charity centers, urban health centers, or medical research centers. Hospital services are usually the most general in large urban areas or underserved rural areas, broadly encompassing many services ordinarily offered by other medical providers. The basic services that hospitals offer include:

• short-term hospitalization
• emergency room services
• general and specialty surgical services
• x ray/radiology services
• laboratory services
• blood services

HMO hospitals add a number of special and auxiliary services to the basic list, including:

• pediatric specialty care
• greater access to surgical specialists
• physical therapy and rehabilitation services
• prescription services
• home nursing services
• nutritional counseling
• mental health care
• family support services
• genetic counseling and testing
• social work or case management services
• financial services

Hospitals funded by state, regional, or local government, as well as charity hospitals and hospitals within research and teaching centers, are pressed by community needs to provide for the uninsured or underinsured with more basic services:

• primary care services
• mental health and drug treatment
• infectious disease clinics
• hospice care
• dental services
• translation and interpreter services

Diagnosis/Preparation

Most hospitals have extensive surgical services that include preoperative testing, which may include x rays, CT scans , ultrasonography, blood tests, urinalysis , and/ or an EKG. Medication counseling is offered for current patient prescriptions and how they should be taken during and after surgery. Informed consent forms are made available to patients, as well as patient advocate services for questions and assistance in understanding the consent form and similar documents. An anesthesiologist or an assistant discuss with the patient the patient’s history of allergies, previous reactions to anesthesia and special precautions that will be taken. Intravenous medications are usually begun in the patient’s room before surgery to relax the patient, with general anesthesia administered in the operating room.

Aftercare

According to the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC), 44.9 million inpatient surgical procedures were performed in the United States in 2005, followed closely by 31.5 million outpatient surgeries. The procedures that were performed most frequently included:

• appendectomy
• breast biopsy
• carotid endarterectomy
• cataract surgery
• cesarian section
• gall baldder surgery
• debridement of wound, infection, burn
• dilatation and curettage or d & c
• hemorrhoidectomy
• hysterectomy
• hysteroscopy
• inguinal hernia repair
• lower back surgery
• mastectomy
• colectomy
• revision of peritoneal adhesions
• tonsillectomy

Inpatient aftercare

After inpatient surgery, most patients are taken to a recovery room and monitored by nursing staff until they regain full consciousness. If there are complications or if the patient develops respiratory or cardiac problems, he or she is transferred to a surgical intensive care unit equipped to deal with acute needs. Intensive care units (ICU) are highly advanced facilities in which patients are monitored by special equipment that measures their heart rate, breathing, blood pressure, and blood oxygen level. Some patients require a respirator to breathe for them and additional intravenous lines to deliver medication and fluids. Once stabilized, patients are transferred to their hospital room.

After returning to the room, the patient is encouraged to sit up, start walking, and do as much as possible to return to a normal level of activity. Special diets may be provided, as well as pain-killing medications and antibiotics if needed. A respiratory therapist will usually visit the patient with breathing equipment intended to help the patient’s lung function return to normal. A physical therapist may introduce the patient to an exercise program or to skills needed to manage with temporary or permanent physical limitations.

Discharge personnel help the patient plan to go home. Some hospitals follow up with an outpatient nurse or social worker service. Pharmaceutical services may be offered to fill take-home prescriptions without the requirement of visiting an outside pharmacy. Medical equipment, like wheelchairs or crutches and other durable equipment, may be provided by the hospital and then purchased by the patient for use at home.

Outpatient aftercare

Outpatient or ambulatory surgery services make up almost half of all surgeries in the United States as a result of advances in surgical equipment and technique that allow for laser treatments and other minimally invasive procedures. Outpatient procedures require comparatively little aftercare for the patient due to both the nature of the surgical procedure and the advantages of being able to use regional or local anesthesia. Aftercare in hospital outpatient clinics, ambulatory surgery centers, or office-based practices requires that patients recover from anesthetics in the facility. After the anesthetic has worn off, the patient is briefly monitored for complications and released to go home. Many surgical procedures now allow patients to go home after a short recovery period on the same day as the surgery, and benefit from minimal pain and a speedier recovery.

Morbidity and mortality rates

According to a health consumer organization, 195,000 people die each year in America’s hospitals as a result of medical errors. In recent years, many hospitals have introduced special safeguards to cut down on the number of mistakes in medication and surgical services. Two new practices have been adopted by quality hospitals. Computerized order entries for medications cut down drastically on the number of misread prescriptions. The other innovation reduces the number of medical errors in intensive care units by using specially trained physicians— intensivists—in the unit. Hospitals that have introduced these patient safety features can be found on the Internet at conssumer health sites.

Proprietary hospitals generally offer more services and “high end” care than government or community hospitals, with teaching hospitals offering the most highly developed new procedures and techniques along with services for the poor and special populations. For-profit hospitals, however, do not have lower rates of morbidity or mortality in their delivery of hospital services. One study in 2000 published by General Internal Medicine found that patients at for-profit hospitals suffered two to four times more complications from surgery as well as delays in diagnosing and treating illness than did patients in nonprofit hospitals. Previous research has shown that death rates are 25% higher in proprietary hospitals than in teaching hospitals, and 6–7% higher in proprietary hospitals than in nonprofit institutions.

Resources

PERIODICALS

Birkmeyer, J. D., E. V. Finlayson, and C. M. Birkmeyer. “Volume Standards for High-Risk Surgical Procedures: Potential Benefits of the Leapfrog Initiative.” Surgery 130 (September 2001): 415–422.

Relman, Arnold, MD. “Dr. Business.” The American Prospect 8 (September 1, 1997).

ORGANIZATIONS

Accreditation Association for Ambulatory Health Care (AAAHC). 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091-2992. (847) 853-6060. www.aahc.org.

American Hospital Association. One North Franklin, Chicago, IL 60606-3421. (312) 422-3000. www.hospitalconnect.com.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). One Renaissance Blvd., Oakbrook Terrace, IL 60181. (630) 792-5000 or (630) 792-5085. www.jcaho.org/.

OTHER

Employee Benefits Research Institute (EBRI). “The Role of the Health Care Sector in the U.S. Economy.” www.ebri.org/press/.

HealthPages.com. “All Hospitals Are Not Created Equal.” www.healthpages.com.

HealthScope.com. “Hospitals.” www.healthscope.com.

Nancy McKenzie, PhD