6, 7

What is the foundation of the HC system?

Hospitals

Inpatient services

overnight stay of a patient

Manhattan Island

claimed the first U.S hospital in 1663 for ill soldiers

Hospitals were:

the precursor of almshouses or poor houses

Philadelphia General Hospital

- the first almshouse

Pennsylvania Hospital

1st incorporated hospital in America

Greek Temples

- 5,000 years ago
- were the 1st type of hospitals with similar institutions in Egyptian, Hindu, and Roman cultures.

During the 1930s/40s: ownership of hospitals changed from?

Physician owned--> church related and government operated.

Public Hospital of Baltimore

John Hopkins Hospital- one of the best hospitals in the U.S

Certificate of Need (CON)

- encouraged state planning to ensure their medical systems are based on NEED.

3 Major Types of Hospitals by Ownership:

1. Public- oldest; owned by fed, state, and local governments.
2. Voluntary/Community- privately owned and for NON-profit.
- financial support is result of community organizational efforts.
3. Proprietary- investor owned hospitals
- for PROFIT institution

Acute Care Hospitals

Less than 30 days in the hospital

Long Term

More than 30 days in hospital
- usually rehab and chronic disease hospitals

Urban Hospitals offer:

higher salary and more complex care.

Rural Hospitals are for:

seeing more poor + elderly patients
- they have financial issues

Critical Access Hospitals

- if no more than 25 acute care beds - enables them to receive additional Medicare reimbursement= Cost Plus.

Hospitals are governed by:

- Chief executive officer (CEO)
- board of trustees or board of directors
- chief of medical staff

CEO

provides leadership to achieve their mission and vision.

Trustees

responsible for hospital operations
- often form different committees.
ex: finance, quality

Operational Staff:

manages non medical staff

State Licensure

focuses on building codes, sanitation, equipment, and personnel.

Certification

is mandated by HHS.

Accreditation

private standard developed by accepted organizations as a way to meet certain standards.
- process of evaluation

Patient Self-Determination Act

-1990
- to inform patients of their rights

6 Domains of Quality in Health Care:

1. Safety
2. Patient Centeredness
3. Efficiency
4. Effectiveness
5. Equity
6. Timeliness
(Lean Six Sigma)

Outpatient Services

- "ambulatory care"
- physician offices, hospital emergency services, care centers
- ASC (Ambulatory Surgery Centers)- for surgeries that do not require an overnight stay.

Health Centers:

-1960s
- for the uninsured, minorities, infants, homeless, etc.