• Infection control committee—A medical committee that is responsible for reviewing policies
and procedures for minimizing infections in the hospital.
• Informed consent—A fundamental patient right. A patient, who has the capacity to understand
information being given, must give a written consent before any treatment or procedure is
performed, or medication is given.
• Long-term care hospital (LTCH)—Medicare designation for a hospital that is licensed for acute
care but has an average length of stay (ALOS) greater than 25 days. The patients served by these
hospitals have complex chronic conditions.
• Magnet hospital—A special designation by the American Nurses Credentialing Center, an
affiliate of the American Nurses Association, to recognize quality patient care, nursing
contractually managed by a central organization.
• Occupancy rate—The percentage of a hospital’s total inpatient capacity that is actually utilized.
• Patient-centered care—Provider mindsets and organizational culture that emphasize involving
patients in medical decisions, respecting patient preferences, and creating an environment in
which patients’ inputs and need for information are solicited.
• Rehabilitation hospital—A hospital that specializes in providing restorative services to
rehabilitate chronically ill and disabled individuals to a maximum level of functioning.
• Rural hospital—A hospital located in a county that is not part of a metropolitan statistical area.
• Short-stay hospital—A hospital in which the average length of stay is less than 25 days.
• Specialty hospital—A hospital that admits only certain types of patients or those with specified
REVIEW QUESTIONS
1. What is the difference between inpatient and outpatient services?
2. As hospitals evolved from rudimentary custodial and quarantine facilities to their current
state, how did their purpose and function change?
The changing purpose and function of hospitals can be divided into five main stages.
a. Before hospitals became institutions of medical care delivery, they mainly fulfilled a social
3. What were the main factors responsible for the growth of hospitals until the latter part of
the 20th century?
Six main factors have been significant in the growth of hospitals in the United States.
a. Advances in medical science.
4. Name the three main forces that have been responsible for hospital downsizing. How has
each of these forces been responsible for the decline in inpatient hospital utilization?
The three main forces responsible for hospital downsizing are (1) changes in reimbursement, (2)
growth of managed care, and (3) hospital closures. Medicare no longer paid hospitals on a cost
basis. Under the prospective payment system (PPS), which was also adopted by other payers,
5. What is a voluntary hospital? Explain. How did voluntary hospitals evolve in the United
States?
Voluntary hospitals are non-government, privately-owned hospitals that are operated on a
nonprofit basis. They are owned and operated by community associations or other non-
6. Discuss the role of government in the growth, as well as the decline, of hospitals in the
United States.
The government played a direct role in the expansion of hospitals through the Hill-Burton
7. What are inpatient days? What is the significance of this measure?
An inpatient day (also referred to as a patient day or a hospital day) is a night spent in the
8. How does hospital utilization vary according to a person’s age, gender, and
socioeconomic status?
Hospital utilization increases with age. For example, the elderly age 85 and over have the highest
utilization. Among younger age groups, children under 1 year of age have the highest utilization.
9. Explain the factors that affect hospital employment.
Hospital employment is affected by changes in the size and nature of the US population,
advances in medical technology, and changes in health insurance. Population growth and aging
10. Discuss the different types of public hospitals and the roles they play in the delivery of
healthcare services in the United States.
Public hospitals are operated by the federal, state, and local governments. Federal hospitals serve
11. What are some of the differences between private nonprofit and for-profit hospitals?
Nonprofit
a. Owned by community associations or other non-government organizations
b. Operated primarily for the benefit of the community
12. What is a long-term care hospital (LTCH)? What role does it play in health care delivery
in the United States?
Medicare has created the designation of LTCH for certain small rural hospitals. To qualify, an
LTCH must meet Medicare’s conditions of participation for acute (short-stay) hospitals, and
13. The table below gives some operational statistics for two hospitals located in the same
community. Answer the questions following the table.
a. Calculate the following measures for each hospital (wherever appropriate, calculate the
1. Hospital capacity: There is no calculation needed for this measure. For hospital A, the
2. ALOS
Hospital A: Overall ALOS = 72,421/12,051 = 6.0; Medicare = 36,935/5,130 = 7.2; Medicaid =
23,175/3,565 = 6.5; Private insurance = 12,311/3,356 = 3.7
Hospital B: Overall ALOS = 51,684/9,230 = 5.6; Medicare = 26,359/3,876 = 6.8; Medicaid =
12,921/2,118 = 6.1; Private insurance = 12,404/3,236 = 3.8
3. Occupancy rate:
Hospital A: Average daily census = 72,421/365 = 198.4; Occupancy rate = (198.4/320) x 100 =
62%
Hospital B: Average daily census = 51,684/365 = 141.6; Occupancy rate = (141.6/240) x 100 =
59%
Hospital A on average utilized 62% of its total capacity; hospital B utilized 59%. This means that
d. Do you think the hospitals have a problem with excess capacity? If so, what would you
recommend?
Yes, both hospitals have a problem with excess capacity. (1) Take some of the beds out of
14. Why have physicians developed their own specialty hospitals? What legal issues can
arise when physicians have an ownership interest in a hospital?
Physicians get part or full ownership in such hospitals. They find such specialized hospitals more
15. What criteria does Medicare use to classify a hospital as a rehabilitation hospital?
To be classified as a rehabilitation hospital according to Medicare rules, 75% of a hospital’s
16. How do you differentiate between a community hospital and a non-community hospital?
A community hospital is a nonfederal short-stay hospital whose facilities and services are
available to the general public. Its primary mission is to serve the general community. Non–
17. What is a Critical Access Hospital (CAH)? Why was this designation created?
Certain rural hospitals can be classified as Critical Access Hospitals (CAH) if they have no more
than 25 acute care beds, if they provide emergency medical services, and meet a distance test in
18. What are some of the main differences between teaching and nonteaching hospitals?
There are three main differences between teaching and nonteaching hospitals. First, teaching
hospitals provide medical training to physicians, research opportunities to health services
19. Discuss some of the issues relative to the tax-exempt status of nonprofit hospitals. What
does the Internal Revenue Service require from these hospitals in terms of
documentation?
Nonprofit hospitals are given tax exemptions under the assumption that nonprofit facilities would
20. Discuss the governance of a modern hospital.
Hospital governance has traditionally followed a tripartite structure. The three major sources of
authority in hospital governance are the board of trustees, the CEO, and the hospital’s medical
staff. Over time, power dominance has shifted from the trustees to the physicians, and, more
21. In the context of hospitals, what is the difference between licensure, certification, and
accreditation?
Licensure of healthcare facilities is carried out by the state governments, and each state sets its
own standards for licensure. All facilities must be licensed to operate, but they may or may not
be certified or accredited. Licensure standards place heavy emphasis on hospitals’ physical
22. What can a hospital do to address some of the difficult ethical problems relative to end-
of-life treatment?
Advance directives play a significant role in end-of-life treatment, especially when the patient is
or becomes mentally incompetent. The hospital should have procedures for explaining, on