hospitals. introduction history of hospitals hospitals vs. hospice
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IntroductionHistory of Hospitals
Hospitals vs. Hospice
Hospital OwnershipPublic vs Private
Profit or Non-Profit
Type of care (primary, secondary, tertiary,)
Type of services (ASC)
Number of Public Community Hospitals, 1990-2007 Notes: Includes nonfederal (i.e., state and local government), short-term general and specialty hospitals whose facilities are available to the public. Public community hospitals represent 23% of all community hospitals, and community hospitals represent about 85% of all hospitals. Federal hospitals, long term care hospitals, psychiatric hospitals, institutions for the mentally retarded, and alcoholism and other chemical dependency hospitals are not included. Source: American Hospital Association Annual Surveys: 1990-1998 data from Hospital Statistics, 2002, Table 1; 1999-2007 data from AHA Annual Surveys, Copyright 2009 by Health Forum LLC, an affiliate of the American Hospital Association, at http://www.ahaonlinestore.com.
Principle Agent ProblemsOwners versus Managers
Market StructureMonopoliesMonopolistically CompetitiveMarket ConcentrationHerfindahl-Hirschman Index (sum of squared market shares measured in percentages) Monopoly = 10,000 ie. 100^2 >1,400 subject to antitrust.5,000 two equal market shares.
Effect of Competition on PricesUntil late 80s more competition meant higher prices. Competing on quality?
Medical Arms Race
Payer Driven Competition? HMOs lower prices
Role of GovernmentCapital AssistanceStimulus funds electronic records
Provision of Public Hospitals
Medicare and Medicaid
Government Regulations of HospitalsCertificate of Need (CON)Wisconsin (ended 2011)Effects of CONEffects of CON on Nursing Homes
2004 Per Capita Hospital ExpensesHospital Expense Per CapitaMassachusetts $2,357North Dakota $2,229New York $2,202Missouri $2,009Maine $1,936Ohio $1,932West Virginia $1,930Rhode Island $1,929Pennsylvania $1,925Delaware $1,908South Dakota $1,867Nebraska $1,862Minnesota $1,804Vermont $1,775Indiana $1,750Connecticut $1,745Michigan $1,731Iowa $1,720Wisconsin $1,710Illinois $1,709
Con states in bold
Hospitals and Medicare PPSProspective Payment System
Price DiscriminationForms of Price DiscriminationCost Shifting
Role of Charity in Modern HospitalsHospital AltruismModel ofPure vs Impure
Declining Demand for Inpatient Care
Capacity We analyze admission and discharge decisions when hospitals become capacity constrained on high-demand days, and develop a test for discrimination that, under certain circumstances, does not require controls for differences across patient groups. On high-demand days, patients are discharged earlier than expected compared to those discharged on low-demand days. High demand creates no statistically significant differences in hospitals' admission behavior. Thus, hospitals appear to ration capacity by hastening discharges rather than by restricting admissions. We could not reject a null hypothesis of no discrimination against Medicaid patients in discharges. Copyright (c) 2008, RAND.
Hospitals Probability Of Offering Psychiatric Emergency Services, By Ownership Type, 19882000. Horwitz J R Health Aff 2005;24:790-8012005 by Project HOPE - The People-to-People Health Foundation, Inc.
Hospitals Probability Of Offering Open-Heart Surgery, By Ownership Type, 19882000. Horwitz J R Health Aff 2005;24:790-8012005 by Project HOPE - The People-to-People Health Foundation, Inc.
********http://www.health.ri.gov/publications/reports/HospitalMarketConcentrationAndShare.pdf***List of states and links to their laws http://www.ncsl.org/programs/health/cert-need.htm
During 1980--2004, the average length of a hospital stay declined significantly to 5.4 days for those aged 65--74 years, 5.7 days for those aged 75--84 years, and 5.8 days for those aged >85 years. The average stay for patients aged