Hospitals
When most Americans think of a hospital, they do not make a distinction among the three very different and general types of hospitals that are in operation in the United States: public, for-profit, and non-profit. While all three types of hospital provides essential services, each kind of hospital focuses on providing their service in very different ways to a different variety of patients. There are also differences in where the hospitals are found, as well as the who the primary people to whom they provide service. The patients of each kind of hospital varies in terms of insurance level, household income, as well as coming from a wide variety of a demographics.
Public hospitals are also known as government hospitals. A public hospital receives its funding from the government. despite the fact that most hospitals in other countries, such as the United Kingdom, are considered public hospital, this is not the case in the United States. A public hospital is a hospital that receives all or a large majority of its funding from subsidies provided by the government. These hospitals also charge Medicare and Medicaid when the patients are eligible for these services, and also charge private insurance when it is available. In the United states there are very few of this kind of hospital that are not associated with a medical school. In fact, the largest system of public hospitals is associated with the School of Medicine at New York University. The majority of public hospitals can be found in major urban centers. A much larger portion of the care provided by these institutes is provided by graduate medical personnel. In addition, these hospitals also provide a large amount of care for which they are not compensated, or not fully paid for, due to the inability of their patients to provide full payment for services rendered. In most cases the clientele in these facilities are either uninsured or eligible for Medicaid. There has been a steep decline in the presence of public institutions in suburban settings. Many of these hospitals have run into budgetary problems because they are the primary providers of essential services to people already struggling to make ends meet. As a result of being the primary point of treatment to the sixty-seven million Americans who do not have adequate health insurance, they often do not receive the proper compensation that they charge for their services. Since they do not receive full payment of the care that they provide to their patients, recent years have seen a rise in the rate at which these hospitals have been force to close their doors and deny service to those in dire straits. Without the continued existence of a public option for care for the most poverty-stricken in America, the plight of the poor will only worsen if they are forced to pay as much as those with access to private insurance or some other recourse to providing compensation for the care they receive. More than half of the patients receiving care at these are members of a minority, whether that minority is racial or ethnic. Given the number of hospitals of this kind that exist in the United States they provide an out sized portion of emergency care. This care includes emergency care treatment, such as caring for people in need of remedying trauma and burn injuries. Despite limited budgets their personnel are often those which respond first to emergency situations such as hurricane response, blizzard conditions, and large scale calamities, such as bridge collapses. The services provided by these hospitals is generally not that profitable when compared to those offered by the two other kinds of hospitals. These hospitals are often referred to as providing a safety-net for American medical care.
Hospitals which are non-profit provide a middle ground in the types of and level of care which they provide, as well as having the broadest slices of society which receive their care from this kind of hospital. In 2003, sixty-two percent of all non-federal hospitals fell into the non-profit categorization. These hospitals have been traditionally associated with a variety of religious institutions, and have provided the longest running tradition of care throughout American history. These hospitals are incorporated as non-profit corporations. They have a tradition of providing care on a charitable basis, but still charge for the services they provide. In addition to being the providers of care for the middle ground of Americans in terms of demographics, these hospitals also provide a median level of the both the expenses of the service they provide and profitability of those services. While not by necessity not being as expensive as for-profit hospitals, the cost of care provided by these institutes generally is higher that that provided by a public hospital. These hospitals have generally been granted tax-free status by the government, which the courts have upheld despite lawsuits filed against the hospitals by poor patients billed for treatments that the hospitals provided but for which the patient was unable to provide full payment.
For-profit hospitals have been criticized for their business approach to medical care. These hospitals are run with an eye to the bottom line. Investor-owned and operated hospitals are a relatively development, only coming into existence in the late part of the Twentieth Century. Supporters of this model of hospital organization claim that these hospitals are able to provide lower cost, high quality care due to increased efficiency. Supporters claim that they have to work their way through far less bureaucracy than public hospitals do. Detractors however argue that the reason for-profit hospitals are even able to turn a profit in the first place is due to avoiding areas of treatment which do not provide a substantial profit margin for their shareholders. These hospitals generally focus on high profit areas of medicine such as medical rehabilitation, cardiology, and a variety of elective procedures, including but not limited cosmetic surgery. These institutes generally do not provide emergency medical care, leaving the burden to fall primarily to public hospitals and the occasional non-profit hospital. For profit hospitals have traditionally been on very quick to cease providing medical services which did not deliver large enough profit margins to satisfy their shareholders. The primary patients in these hospitals are covered by private insurance. These patients generally seek out these specific hospitals to receive the treatments of which they are in need.
Despite the difference in organization, all three hospitals share many of the same objectives. They all utilize doctors seeking to remedy the illnesses which their patients present themselves. Just because a patient goes to a public hospital does not mean they are deprived of perfectly capable doctors and medical staff or medical technology. While for-profit centers will clearly have the more cutting edge technology due to the different budgetary restriction of the institutes does not mean that a public hospital is hopelessly outdated. All three hospitals also are constantly seeking to improve the care they provide on several fronts. There are six fronts upon which these hospitals seek to improve their care. The first is to provide more safe care, which means seeking to reduce both the volume and severity of patient injuries. They also try to provide more effective care.
Making the care they provide more effective means reducing the number of wasteful and unnecessary procedures, and only provide evidence based care. The third way they strive to improve care is by making the care more patient based, ensuring that the care is attentive to the needs, desires, and values of the patient in their care. There is also an effort to provide more timely care, thus reducing the wait time for all services rendered. More efficient and less wasteful care is another goal. The final way they try to improve care is by making it more equitable, meaning that the hospital staff will make they care the patient receives ignorant of the gender, race, ethnicity, geographic location, primary language spoken, or socioeconomic status of the patient in their care.
All three kinds of hospitals are facing concerns of budgetary shortfalls and funding issues during this economic downturn, just as the rest of the United States is. Every hospital is concerned both about its ability to cover its own operating costs, as well as the declining ability of the sections of America that they serve to provide payment for the services that they receive. There will have to be a wholesale change to the way that hospitals go about billing for the care they provide if they will continue to help people in the future. It is possible that the passage of Health Care and Education Reconciliation Act by the Congress will have an impact by forcing the widespread enrollment of American into insurance plans, changes will have to be more widespread. Some way will have to be found to lower the operating costs for hospitals, especially for public hospitals if these primary care institutions are to continue to provide the essential service that treat Americans when they fall ill.