Fluent Essays

The discussion requires a minimum of 300 words, 3 scholarly sources, including the textbook. Make sure that you use APA style with your references. Under no circumstances use any direct quotes. Any directly quoted or copied material will result in a zero for the assignment. Let’s be sure to write it in own work 100\% and give appropriately when using someone’s else work. Reference for textbook attached: Williams, S. J., & Torrens, P. R. (2008). Introduction to health services (7th ed.). Clifton Park, NY: Thomson Delmar Learning. Compare and contrast horizontal and vertical integration of health care organizations (hospitals and health systems). Why would one type of integration be preferred over the other? In your response, please consider the major trends that have occurred in this segment of health care over the last 5-10 years. 1,500 word count and there is a total of 6 questions each (not including in-text citation and references as the word count), a minimum of 4 scholarly sources are required in APA format. For the 4 scholarly sources, one from the textbook that’s posted below and the other two from an outside source . Let’s be sure to write it in own work 100\% and give appropriately when using someone’s else work. Under no circumstances use any direct quotes. Any directly quoted or copied material will result in a zero for the assignment. Reference for textbook attached: Williams, S. J., & Torrens, P. R. (2008). Introduction to health services (7th ed.). Clifton Park, NY: Thomson Delmar Learning. Knowledge: What are the key things to know about each of the 3 systems discussed? Why are they “key” issues? Comprehension: What is your understanding of why there are three different / separate models? Application: Give an example of one of the three systems as to how it works in real life. A personal story of yours / someone you know or a case study from the research or an example from your work. Analysis: From the example you gave what are the pros and cons of the experience? What casued the events you describe to happen? Synthesis: Offer a new and unique idea of yours or from the research as to how the example you gave could have been handled better. What could have been improved? Your own new idea or a known best practice. Evaluation: Why would your idea be better / same / worse than what happened in your example? Has your idea been tried / practiced before? How did it work out? Or why hasnt it been tried? Obstacles? hca501unit4.pdf Unformatted Attachment Preview CHAPTER 8 Hospitals and Health Systems Stephen J. Williams and Paul R. Torrens CHAPTER TOPICS History of the Hospital The Scope of the Industry R I C A R D , LEARNING OBJECTIVES Upon completing this chapter, the reader should be able to 1. Understand the role of the hospital in today’s health care system. Structure of Hospitals and Health Systems Hospital Organization The Hospital and Medical Staff Key Issues Facing the Hospital Industry A D R I E N N E 2. Appreciate the historical trends that have shaped the hospital industry. 3. Understand the types of hospitals, ownership patterns, and differentiating characteristics of various hospitals. 4. Comprehend the development of health systems and the role of hospitals in such systems. 5. Follow the impact of competitive pressures and other developments on the structure and operation of hospitals and health systems. 6. Understand the internal organizational structure of hospitals. 1 9 0 2 T S 182 Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 8 Hospitals and Health Systems The hospital’s role in the nation’s health care system has changed dramatically over the years. The hospital originated as an institution for the poor, offering little in the way of therapy, and then evolved into the center of the system and the primary technology focus of health care. Now the hospital is a provider of highly specialized services and the hub of an assortment of other activities. The traditional independence of each hospital has been dramatically altered by horizontal and vertical integration within the health care system such that today few R technolhospitals are truly freestanding entities. The ogy to manage hospitals has likewise changed with I an information systems focus and the application of C complex parameters of performance measurement. Aand payExpectations of consumers, providers, ers have also changed dramatically over the years R with the anticipation of more effective interventions at more efficient and competitive pricing.DFinally, as has always been the case in the past, the hospital in, dustry continues to face immense challenges, opportunities, and expectations for the future. The hospital has also changed fromAan island of care to an institutional octopus, with tentacles D affiliatspringing out throughout the community, ing with other institutions and providers, R and providing outreach services for consumers. On the inpatient side, hospitals are increasinglyI providing the most complex of care to the most critically ill E patients. On the outpatient side, most hospitals are N broadening the array of services that they offer to better compete. N Hospitals face the challenges of sick and dying E patients, demanding payers, government officials seeking accountability, physicians demanding the availability of the latest equipment and 1 support, and many other crosscurrents. Some hospitals are 9 for-profit entities, while others are not-for-profit. Some hospitals are highly specialized while 0 others offer a broad range of services. Hospitals are often major employers in their communities 2and many provide the bulk of indigent care for low-income T and disenfranchised citizens. Through it all, the S backbone of hospital management has increasingly adopted the managerial principles of commercial 183 industry, seeking to provide services in an efficient, but cost-effective manner, and to offer competitive pricing to third-party and governmental payers. The challenges of this industry are immense and unlikely to recede in the decades that follow. HISTORY OF THE HOSPITAL Although the hospital today is in the forefront of technology and clinical medicine, the history of the nation’s hospitals actually began as facilities for housing the poor and the ill. These institutional warehouses for human suffering were the almshouses, the pest houses, the poor houses, and the workhouses that sheltered the homeless, the poor, the mentally ill, those with serious degenerative diseases, and others for whom there was little to offer in the era before modern medicine. Isolation of individuals during epidemics of cholera and typhoid, among other diseases, also led to the utilization of these institutions. Little medical knowledge was available and few individuals received any significant treatment. The middle class avoided these institutions and received their care at home. Not until the 1700s and 1800s did hospitals emerge with a mission of providing some form of clinical medical care. Many of these early hospitals were supported by philanthropic efforts and religious organizations. Also during this period, many public hospitals were established in various cities to provide for the social needs of local populations, laying the groundwork for our modern acceptance of local government as the provider of last resort. Finally, by the early 1900s, with the introduction of scientific method in medical practice and the recognition that hospitals and clinical medicine must adhere to a stricter formulation of practice focused on scientific discovery, was the era of the truly modern hospital established. Throughout the twentieth century, the escalating advance of knowledge accelerated the focus of the Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. 184 hospital as a center for medical technology. After World War II, the hospital’s role as a center of technology and innovation became firmly established. At this point, the practice of medicine itself was increasingly dependent on scientifically valid knowledge and training. Finally, over the past 30 years the degree of rigor of clinical practice and the scope of scientific knowledge has escalated greatly, and the hospital has become a center of high standards, scientific applications, and advanced technological capability. At the same time, the increasing shift of servicesR to an ambulatory care arena facilitated by technological I advancement itself has left the hospital with an everC more complex base of patient care, higher acuity, A and higher costs. In addition, pressure from payers, as noted previously, has escalated greatly as has the R expectation of providers and consumers alike. IndusD try consolidation, vertical and horizontal integration, public policy concerns, and quality assessment , and assurance have placed the operation of the nation’s hospitals under tremendous scrutiny. Yet, through it all, the nation’s hospitals have risen to the A challenge of providing superlative care overall in a D high-intensity, stressful atmosphere that has significantly contributed to our improved health status and R well-being. This is a remarkable achievement in light I of countervailing financial and political pressures that have always buffeted the hospital industry. We E owe a great debt of gratitude to the nation’s hospitals N and to those dedicated individuals who work within these institutional walls for achieving so much in N an environment that started as a warehouse for the poor E and sick, left to die without care and concern. 1 9 THE SCOPE OF THE 0 INDUSTRY 2 Although the hospital industry has seen its share T of the nation’s health care dollar decline someS what, hospital systems are still immense segments of the industry and of our nation’s economy. (See Table 8.1.) PART THREE Providers of Health Services Table 8.1. Hospital Expenditures by Source of Funds: United States, Selected Years Source of Funds Hospital care expenditures All sources of funds Out-of-pocket payments Private health insurance Other private funds Government Medicaid Medicare 1960 1990 2003 Amount in billions $9.2 $253.9 $515.9 Percent Distribution 100.0 100.0 100.0 20.8 4.4 3.2 35.8 38.3 34.4 1.2 4.1 4.1 42.2 53.2 58.3 — 10.9 16.9 — 26.7 30.3 In 2003, the hospital industry alone accounted for more than $500 billion of expenditures. In 1960, the industry counted for only $9.2 billion of economic activity annually. The growth of private health insurance and government entitlement programs, particularly Medicare, has shifted the burden of paying for hospital care to third parties. In 1960, more than 20 percent of the hospital bill was paid by people out of their own pockets; by 2003, this percentage had dropped to 3.2 percent. Private health insurance now accounts for a little more than one-third of all hospital expenditures while government programs account for nearly 60 percent. Medicare alone counts for nearly a third of all hospital expenditures; in many facilities the Medicare program pays about half the bill overall. Certainly, for the nation’s seniors, Medicare is a critical source of support for paying for the enormous costs of hospitalization. The number of hospitals in the United States has decreased dramatically. Table 8.2 illustrates this decline with the total number of hospital in 1975 at 7,156 dropping by 2003 to 5,764. A small number of the nation’s hospitals are owned and operated by the federal government. These include the Veteran’s Administration Hospitals and military facilities. The vast majority of hospitals are nonfederal and are nonprofit, for-profit, or owned by state and local governments. The information in this table Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 8 Hospitals and Health Systems 185 Table 8.2. Hospital and Beds by Ownership and Hospital Size: United States, Selected Years Type of Ownership and Size of Hospital Hospitals All hospitals Federal Nonfederal Community Nonprofit For profit State-local government Bed size 6–24 beds 25–49 beds 50–99 beds 100–199 beds 200–299 beds 300–399 beds 400–499 beds 500 beds or more R I C A R D , A Dbe noted reflects hospital ownership, and it should that some hospitals, while owned by one R type of entity, may be operated under contract by another entity, such as a hospital managementI company. The largest grouping of hospitals in E the nation are nonprofit community hospitals. Although their N numbers have declined overall, they remain the primary source of hospital care for most Americans. N These hospitals are owned by nonprofit entities, E although they are sometimes operated under contract by for-profit or other nonprofit corporations that specialize in managing hospitals and 1 health systems. 9 function Nonprofit entities, including hospitals, under special provisions of corporation law 0 in each state, and under federal and state tax provisions that 2 The narecognize their community service function. tion has approximately 1 million nonprofit T entities of various sorts and hospitals have long been a traditional service provider in the nonprofitSsector. Nonprofit entities serve a community service and have special recognition under the law due to 1975 1995 2003 7,156 382 6,774 5,875 3,339 775 1,761 Number 6,291 299 5,992 5,194 3,092 752 1,350 5,764 239 5,525 4,895 2,984 790 1,121 299 1,155 1,481 1,363 678 378 230 291 278 922 1,139 1,324 718 354 195 264 327 965 1,031 1,168 624 349 172 256 their role in our society. Nonprofit entities do not have owners and are governed by a communitybased board that has ultimate authority for operation of the entity. Nonprofit entities are generally exempt from most taxes at the federal, state, and local levels including income and property taxes. Many nonprofit entities have tax exempt status under Section 501C(3) of the federal tax code, allowing individuals to make potentially tax deductible donations to these organizations. Nonprofit entities are able to raise funds through donations, retained earnings, and debt obligations, often on favorable terms. Nonprofit entities may be “sponsored” by various types of organizations. Many hospitals have traditions of religious sponsorship. However, they are not owned by such sponsors. Nonprofit entities may also affiliate with each other through various organizational arrangements. Most nonprofit hospitals operate in a manner similar to other types of hospitals by employing modern management techniques, sophisticated information systems, and other Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. 186 principles of twenty-first-century management. Nonprofit entities are generally expected to provide some indigent care and serve the community in a variety of ways as well. A much smaller percentage of the nation’s hospitals are operated as for-profit businesses. Forprofit entities have owners and issue stock to those owners to reflect their equity position. For-profit entities, including hospitals, may be publicly or privately held. Publicly held for-profit entities have stock that is available for purchase by anyone, typiR cally through the nation’s various stock exchanges. A variety of accountability and registration rules I and regulations affect publicly owned for-profit C entities, generally administered by the Securities A and Exchange Commission at the federal level and similar entities at the state level. Privately held R for-profit entities also issue stock, but that stock is D not available to the general public for purchase. Accountability and other regulatory oversight are , much less for privately held entities. For-profit hospitals may be independent and historically in this country and throughout the world A today many for-profit hospitals have been owned D by the physicians who practiced in them. Today, however, due to the tremendous capital costs R of building, maintaining, and operating a hospital, I most hospitals in the United States that are for profit are part of large multihospital chains, mostE of which are publicly traded. For-profit hospitals are N not just accountable to the community but must also provide a return on investment to the shareN holders; therefore they expect to generate a profit E to pay a return to the equity investors for their capital. For-profit hospital companies may also manage not-for-profit and governmental hospitals as1a separate line of business. The third category of ownership in Table 8.29is state and local government hospitals. These are 0 hospitals that are owned by state or local govern2 ments, but again, may be managed under contract by other entities, either for-profit or not-for-profit T management companies. Many local government S hospitals are owned by counties or other local government units. They are often the providers of last PART THREE Providers of Health Services resort, bearing the burden of indigent care in their communities. In the western United States, hospital districts were created much like water districts to provide infrastructure for communities as populations moved West. These local taxing districts were responsible for the construction and operation of hospitals for their communities. In recent years the taxing authority of these districts has accounted for a very small percentage of total hospital operational costs. As reflected in Table 8.2, the majority of the nation’s hospitals are relatively modest in size as measured by licensed hospital beds. The very large institutions are typically teaching hospitals, often associated with medical schools, and have a range of residency programs for postgraduate medical education. The small hospitals are typically in rural areas, raising particularly complex issues regarding financial viability. Broadly speaking, large hospitals are more prevalent in the East as the trend over time has been to build smaller rather than larger facilities. Significant numbers of smaller hospitals, particularly in urban areas, have closed over the past 25 years due to financial and competitive pressures, and to the difficulty of efficiently operating a small number of hospital beds. Specifying the optimal side of a hospital is particularly difficult given the complexity of services now offered on an inpatient basis. Most likely, the very small and very large hospitals are the least efficient. As reflected in Table 8.3, the total number of hospital beds has dropped from just under 1.5 million to just less than 1 million since 1975. This trend reflects a combination of closures and reductions in operating licensed beds among those hospitals still in operation. Large hospitals, because of their size, account for a disproportionate share of the total number of hospital beds. About 70 percent of the nation’s hospital beds are in nonprofit facilities. As reflected in Table 8.4, there are approximately 36 million admissions to the nation’s hospitals every year, of which 25 million are to nonprofit hospitals. The number of admissions has been remarkably Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. CHAPTER 8 Hospitals and Health Systems 187 Table 8.3. Hospital Beds by Ownership and Hospital Size: United States, Selected Years Type of Ownership and Size of Hospital Beds by Ownership All hospitals Federal Nonfederal Community Nonprofit For profit State-local government Bed size 6–24 beds 25–49 beds 50–99 beds 100–199 beds 200–299 beds 300–399 beds 400–499 beds 500 beds or more R I C A R D , 1975 1995 2003 1,465,828 131,946 1,333,882 941,844 658,195 73,495 210,154 Number 1,080,601 77,079 1,003,522 872,736 609,729 105,737 157,270 965,256 47,456 917,800 813,307 574,587 109,671 129,049 5,615 41,783 106,776 192,438 164,405 127,728 101,278 201,821 5,085 34,352 82,024 187,381 175,240 121,136 86,459 181,059 5,635 33,613 74,025 167,451 152,487 119,903 76,333 183,860 A Table 8.4. Hospital Admissions by D Ownership and Hospital Size: United States, Selected Years R Type of Ownership and Size of Hospital 1975 1995 I Beds by Ownership Number in thousands E 36,157 33,282 All hospitals N Federal 1,913 1,559 Nonfederal 34,243 31,723 N Community 33,435 30,945 E Nonprofit 23,722 22,557 For profit State-local government By hospital bed size 6–24 beds 25–49 beds 50–99 beds 100–199 beds 200–299 beds 300–399 beds 400–499 beds 500 beds or more 1 9 0 2 T S 2003 2,646 7,067 3,428 4,961 36,611 973 35,637 34,783 25,668 4,481 4,634 174 1,431 3,675 7,017 6,174 4,739 3,689 6,537 124 944 2,299 6,288 6,495 4,693 3,413 6,690 162 1,098 2,464 6,817 6,887 5,590 3,591 8,174 Copyright 2008 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. PART THREE Providers of Health Services 188 stable over the years, but the total number of hospital days has declined dramatically due to sharp reductions in the average length of stay. A relatively small proportion of admissions to hospitals are accounted for by the smaller hospitals. Examining hospital utilization based on population data illustrates a significant decline in discharges per thousand U.S. population as reflected in Table 8.5. Overall explanation of this trend lies in changes in the number of Americans, which Table 8.5. Discharges and Days of Care, Nonfederal Short-Stay Hospitals: United States, Selected Years Characteristic Total Age Under 18 years 18–44 years 45–54 years 55–64 years 65 years and over Sex Male Female Geographic Region Northeast Midwest South West Total Age Under 18 years 18–44 years 45–54 years 55–64 years 65 years and over Sex Male Female Geographic Region Northeast Midwest South West R I C A R D , A D R I E N N E 1 9 0 2 T S 1980 2003 Discharges per 1,000 population 173.4 119.5 75.6 155.3 174.8 215.4 383.7 43.6 91.3 99.5 145.7 367.9 153.2 195.0 104.4 135.1 162.0 192.1 179.7 150.5 127.6 117.1 125.8 103.9 Days of care per 1,000 population 1,297.0 574.6 341.4 818.6 1,314.9 1,889.4 4,098.3 195.5 339.7 477.2 735.9 2,088.3 1,239.7 1,365.2 546.7 605.2 1,400.6 1,484.8 ... Purchase answer to see full attachment