Introduction to Hospitals: Part 1

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來自 University of Pennsylvania 的課程

The Economics of Health Care Delivery

21 個評分

University of Pennsylvania

The Economics of Health Care Delivery

21 個評分

課程 2（共 4 門，Specialization The Business of Health Care）

In this course, you’ll learn about the key components of health care, and the economics behind their principles and pricing strategies. Professors Ezekiel Emanuel of Penn Medicine and Guy David of the Wharton School have designed this course to help you understand the complex structure of the health care system and health insurance. Through study and analysis of providers and insurance through an economic lens, you’ll learn how basic economic principles apply to both principles and payment methods. By the end of this course, you’ll be able to identify different types of health care providers and understand the dynamic between the providers and patient so you can employ best practices and maximize profit for your health care organization.

從本節課中

Module 3

In this module, you’ll examine the role of the physicians and hospitals in the health care ecosystem. You’ll explore the different types and payment methods for both physicians and hospitals, and how hospitals utilize these methods to maximize profit. Through analyzing the Health Care Value Chain and Principal-Agent Problem from Economics, you’ll be able to establish the unique importance of physicians in the health care markets as a perfect agent, and the different approaches and implications of this relationship. You’ll also gain a general overview of the characteristics that define hospitals, the effects of different trends on the decline in number of beds in hospitals, and two common hospital practices to address this issue: cost shifting and cross subsidization. By the end of this module, you’ll be able to better understand the role of physicians and hospitals in health care markets and employ best practices and maximize profit for your health care organization.

Physician Agency9:22

Introduction to Hospitals: Part 16:28

Introduction to Hospitals: Part 26:58

Cost Shifting9:54

Cross Subsidization9:07

與講師見面

Ezekiel J. Emanuel, MD, PhD
Diane v.S. Levy and Robert M. Levy University Professor
Department of Medical Ethics and Health Policy
Guy David, PhD
Gilbert and Shelley Harrison Associate Professor of Health Care Management
Department of Health Care Management

This segment marks our transition into a discussion of hospitals.

You should now be familiar with the major economic issues relating to both insurance

and physicians.

In this segment, I will provide you with a general overview of hospitals in the US,

as a basis for understanding their characteristics and organization.

According to the American Hospital Association,

there are more than 5,500 hospitals in the US.

Most of them are short-term, general community hospitals.

These hospitals span over 780,000 inpatient beds,

admit over 33 million patients every year, and

account for over $850 billion in annual spending.

More than 60% of these community hospitals are in urban areas,

and two-thirds of them are part of a multi-hospital health care system.

A multi-hospital system is two or more hospitals owned,

leased, sponsored, or contract managed by a central organization.

Hospitals also differ by ownership type.

Roughly 60% of community hospitals are private non-profit,

20% are private for-profit, and 20% are owned by the government and

typically operated by a state, a county, or a city.

The modern hospital serves as a place where the sick and

injured are treated, but it is also in many cases, a research facility,

an educational institution, and a major employer within the community.

But things were very different when hospitals emerged back in the middle

of the 18th century.

During the 18th century, the seaport cities of Philadelphia, New York, and

Boston were the largest cities in the nation.

While medical care in those days was predominately delivered at home, sailors

suffering from various contagious diseases were put in hospitals, which served

as quarantine stations to segregate the sick and prevent the spread of disease.

Because these facilities were not intended to be used by the local citizens,

hospitals were associated with horrible conditions,

poorly kept rooms, and barely trained personnel.

This is not surprising, as all of this early hospital care was focused on

the ill-fated low-income populations, who suffered physical and mental illness.

It it important to note that while the quality of care was dreadful, these

hospitals helped establish the concept of charity care and public responsiblity

in the U.S., an issue that still take front and center in health care debates.

Things did improve when physicians as opposes to city officials

began running hospitals.

The first three hospitals in the US were Pennsylvania Hospital in Philadelphia,

New York Hospital in New York City, and Mass General in Boston.

All were founded by physicians as charitable hospitals.

On the demand side, with urbanization and growth of the middle class,

it became difficult to afford house visits,

as well as effectively provide treatment in small city apartments.

On the supply side, with the discovery of anesthesia, the x-ray, the need for

sterile environments for surgeries, and

many other technological developments, tools became more expensive, and

care became more expensive to provide in the home.

So hospitals became the central location for medical care.

Pennsylvania Hospital was founded in 1751.

120 years later in 1873, there were 178 hospitals in the U.S.,

and only 3.5 decades later, in 1909,

the number of hospitals in the US was 4,359,

almost 25 times the number of hospitals in 1873,

and surprisingly, not all that different than the number of hospitals today.

But many of these hospitals were small,

proprietary hospitals, not the messy facilities we see today.

One of the biggest contributions of the growth and

expansions of hospital was the Hill-Burton Act of 1946.

The act was passed by Congress, following the Great Depression and

World War II, to address concerns that there wasn't insufficient number of

hospital beds available, especially in rural and poor communities.

Researchers have concluded that 344,000 new beds in the US,

about 40% of beds today, can be attributable to the Hill-Burton Act.

The act gave preferential allocation of funds to hospitals that would

be built in rural areas or serve low income communities, and

required funded hospitals to provide free or low-cost care to poor patients.

The number of hospitals peaked in the late 70s and has been declining ever since.

The same is true for hospital beds.

Why is that?

Consider the following equality.

Number of beds in a hospital times the occupancy rate

in this hospital always equals the average length of stay

times the number of daily admissions to this hospital.

The left hand side of the equation is called bed days, that is,

how many beds are filled on a given day.

The right hand side of the equation is called patient days, that is,

how many patients fill these beds on a given day.

Since this equality has to hold by definition,

it helps identify the dimensions that can support a decrease in the number of bed.

It could be an increased occupancy,

it could be a decreased length of stay, and it could be a decrease in demand,

that is, a reduction in the number of inpatient admissions.

To determine which of these elements contributed to the decline in hospital

beds, we need to inspect each scenario separately.

We will do that in the next segment.

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