Ebook Hospitals and health systems: Part 2
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Ebook Hospitals and health systems: Part 2
<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2S■Describe how the healthcare system in the United States emerged from a historical perspective.■Explain the complex rationale for and the implications of hospital mergers in the United States.■Highlight the different classifications of hospitals including: religious, academic, government, and criti Ebook Hospitals and health systems: Part 2cal access.■Differentiate between not-for-profit (NFP) and for-profit run hospitals based on ownership.KEY TERMSCertificate of Need (CON) For-profitMeEbook Hospitals and health systems: Part 2
rgerNot-for-profit► IntroductionA hospital system is composed of two or more hospitals that are owned, sponsored, or contract-managed by a central org<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2viders together in a geographic area. In addition, the rationale behind long-existing systems consisting of affiliations such as religious and government will be explored. This chapter continues by examining the effects of system competition and the extent to which it may or may not benefit patients Ebook Hospitals and health systems: Part 2, and addressing the apparent reasons for system membership.1 IQ120Chapter 9 The Health System Emerges►History of Health Systems in the United StatesHEbook Hospitals and health systems: Part 2
ospitals in the modern sense have only existed for roughly 100 years and were originally designed to treat the poor (Fillmore, 2009). As the healthcar<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2(World Health Organization [WHO], 2000). Health systems have continued to lake over independent facilities with the proportion of acute care hospitals controlled by the largest 25 health systems growing from 23% to 33% in a 15-ycar lime period (Khaikin, Lilley, & Winkler, 2016). Currently, there arc Ebook Hospitals and health systems: Part 2 approximately 5,500 hospitals in the United Stales (American Hospital Association, 2017).►Rationale for Hospital MergersHospital mergers have accelerEbook Hospitals and health systems: Part 2
ated over the last 30 years for a number of reasons, including an inability for independent facilities to remain competitive with larger systems, a ne<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2onsolidate resources such as technology and staffing, and most recently, to meet the value-based stipulations of the Affordable Care Act (ACA) (American Hospital Association, 2017; Calem, Dor, & Rizzo, 1999; Cutler & Morton, 2013; Dafny, 2014; Vogt, Town, & Williams, 2006). However, mergers have led Ebook Hospitals and health systems: Part 2 to complications including not-for-profit hospital closures, insufficient oversight (e.g., limitations of Certificate of Need [CONI programs), and ruEbook Hospitals and health systems: Part 2
ral and critical access hospital (CAH) closures.Mergers may also be beneficial to patients if the facilities offer different services that will provid<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2ease in price for consumers of health services, a trend that seems to be continuing regardless of anti-trust efforts (Gaynor & Town, 2012; Ginsburg, 2016).In 1984, to control costs, the Centers for Medicare and Medicaid Services (CMS) instituted the Inpatient Prospective Payment System (ĨPPS) which Ebook Hospitals and health systems: Part 2dictated Medicare reimbursement levels to hospitals based on diagnosis-related groups (DRGs). The TPPS made hospitals financially responsible for theEbook Hospitals and health systems: Part 2
care provided related to specific diagnoses. Although initial reimbursements were high, by the 1990s, hospitals were losing money under this reimburse<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2mately ended up hurting the hospitals’ bottom line. These changes led to hospitals looking for innovative ways to gain market power and reduce costs—this opened the door to an increase in hospital mergers and acquisitions (Dalny, 2009).From 2008 to 2016, the portion of hospitals that were part of a Ebook Hospitals and health systems: Part 2health system or an integrated delivery network increased by 10 percentage points, from 55% in 2008 to 65% in 2016 (FIGURE 9.1).Hospital CiubbuiLuuutiEbook Hospitals and health systems: Part 2
b IXIYearFIGURE 9.1 System Membership among U.S. I lospitals from 2008 to 2016Him iron Ihr Amtrxan llmptal >U\nittn016.► Hospital<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2p. In many cases, patients may not understand or feel the impact of how a hospital is classified. However, the type of hospital does serve a unique purpose and differs based on whether the focus is religious, academic, government, or critical access. Studies have shown that ownership type impacts th Ebook Hospitals and health systems: Part 2e accountability hospitals provide in regards to their communities (Alexander, Weiner, & Sued, 2000).Religiously AffiliatedThe first hospitals were opEbook Hospitals and health systems: Part 2
ened and run by religious organizations to care for the poor and those in need (Ferdinand, Epane, & Menachemi, 2014). Today, religiously affiliated ho<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2 in the United Slates (FIGURE 9.2). In addition to their operational duties, religious hospitals must also integrate their religious principles into their culture. One challenge these organizations lace is the conflict that results as religious policy and clinical perspectives conflict. One study fo Ebook Hospitals and health systems: Part 2und that 19% of physicians had personally experienced this type of conflict (Slulberg el al., 2010). Religious hospitals arc more likely to refuse cerEbook Hospitals and health systems: Part 2
tain procedures or treatments based on their moral beliefs (especially, reproductive health) (Bassett, 2001). However, although religious hospitals ma<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVES Ebook Hospitals and health systems: Part 2her types of hospitals (Ferdinand el al., 2014).Teaching HospitalsTeaching hospitals tend to focus on biomedical research and development (Simpson, 2015). Teaching hospitals provide job and training opportunities to their Ebook Hospitals and health systems: Part 2<’sudoklAÓTCiy Imac^-.CHAPTER 9The Health System EmergesMeghan Gabriel, Kendall Cortelyou-Ward, Timothy Rotarius, and Reid M. OetjenCHAPTER OBJECTIVESGọi ngay
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