Hospital, institution that provides a broad range of medical services to sick, injured, or pregnant patients. Hospitals employ medical, nursing, and support staff to provide inpatient care to people who require close medical monitoring and outpatient care to people who need treatment but not constant medical attention. Hospitals provide diagnosis and medical treatment of physical and mental health problems, surgery, rehabilitation, health education programs, and nursing and physician training. Many hospitals also serve as centers for innovative research and medical technology.
Today the United States is home to 6,021 hospitals that contain over 1 million hospital beds. U.S. hospitals annually admit some 34 million patients who are assigned a bed and receive medical or surgical treatment as inpatients. Hospitals also provide outpatient treatment in clinics or other walk-in, or ambulatory, settings for an additional 483 million patients every year.
TYPES OF HOSPITALS
Hospitals in the United States are classified by the services they provide (general or specialized), the length of stay they offer patients (short stay or long-term care), and by their ownership (not-for-profit, proprietary, or government owned). Although most U.S. hospitals are classified as not-for-profit, any one hospital will fall into several of the above categories. For example, Methodist Hospital in Houston, Texas, with more than 300,000 sq m (3 million sq ft) of space, is one of the largest short-stay, not-for-profit, general hospitals in the country.
Services Provided by Hospitals
General hospitals, regardless of their size, provide patients with a wide range of services, including emergency treatment, surgery, and medical and nursing care. Specialized hospitals, in contrast, may concentrate on a particular group of patients, such as children, or a disease, such as cancer . Some specialized hospitals combine treatment and research. For instance, Roswell Park Cancer Institute in Buffalo, New York, offers 37 specialized cancer treatment centers, including centers for acquired immunodeficiency syndrome ( AIDS )-related cancers, brain tumors, and ovarian cancer, and provides state-of-the-art treatments for these cancers that are not generally available in other hospitals. The institute also conducts research on new cancer drugs and procedures, such as photodynamic therapy, which uses a laser to activate cancer-killing chemicals inside tumors.
Some general and specialized hospitals also function as tertiary care centers, treating the most difficult and complex cases or the most seriously ill patients. These may include patients who need heart, lung, or liver transplants (see Transplantation, Medical). Many hospitals that serve as teaching institutions train residents (medical school graduates who are doing postgraduate training) in general medicine or specialty areas. Teaching hospitals also train others interested in a health care career, including nurses and laboratory specialists. Although some of these hospitals are relatively small and train only a few doctors in teaching programs that are affiliated with medical schools, approximately 300 hospitals are university-based academic medical centers that offer both medical training and opportunities for medical research.
Academic medical centers are usually massive urban hospitals linked closely with major medical schools. Although academic medical centers represent only 6 percent of all U.S. hospitals, they care for about 20 percent of all patients nationwide because they serve as referral centers for specialized consultation or for advanced diagnostic and therapeutic procedures for patients in wide regional areas. The Medical Center of the University of California at San Francisco, annually admits almost 27,000 patients and treats about 340,000 outpatients in its clinics and 53,000 patients in its emergency room and trauma center.
Length of Stay
The American Hospital Association (AHA), a national organization that promotes organizational and legislative issues of interest to hospitals, classifies hospitals by the length of stay they offer patients. AHA categorizes hospitals as short-stay or acute-care centers if their patients receive 30 days or less of inpatient treatment. In contrast, AHA classifies hospitals as long-term care institutions if their patients require more than 30 days of treatment, as is available in rehabilitation facilities or nursing homes.
AHA makes the distinction between short-stay and long-term care facilities to reflect not only the difference in length of stay but also the scope and intensity of services provided by an institution. Short-stay hospitals are geared for quick intervention and constant monitoring of serious, often life-threatening illnesses. These hospitals provide immediate attention until a patient is stabilized enough to be treated at home or in a health care setting that can provide a longer stay. Long-term care institutions treat physical diseases or injuries that are debilitating and require prolonged medical intervention or physical therapy and regular skilled nursing care. Some long-term care facilities are psychiatric institutions for the mentally ill who cannot be cared for at home.
Ownership of Hospitals
Not-for-profit, or voluntary, hospitals, which represent about 84 percent of the hospitals in the United States, are charitable institutions that exist to serve the best interests of their communities. Although not-for-profit hospitals do not receive funding from tax dollars, they are exempt from local, state, and federal taxation. Many not-for-profit hospitals were founded and continue to be run by religious groups, such as members of the Catholic Church, Presbyterian or Methodist ministries, or Jewish organizations. A small number of private charitable hospitals were spearheaded by individuals. Probably the best known of these is the Mayo Clinic in Rochester, Minnesota, established by American physician William Mayo and his two physician sons (see Mayo [family]). Most not-for-profit hospitals, however, were established by members of their local community and continue to be governed by community representatives.
Proprietary, or for-profit, hospitals are owned by corporations and their shareholders. Although only about 770 U.S. hospitals are for-profit institutions, these hospitals are typically part of large investor-owned hospital chains. For instance, Hospital Corporation of America (HCA), the largest for-profit hospital chain in the United States, has more than 200 hospitals in its network. HCA is listed on the New York Stock Exchange, just as any other for-profit company; company executives seek to reward shareholders who invest in the company by applying standard corporate management techniques, likely to yield corporate profits, to hospital administration.
A health maintenance organization (HMO) pays for and provides medical care to enrolled patients. For a fixed payment, HMOs deliver health services by establishing panels of doctors and hospitals that provide all the treatment their members require. The first HMO in the country, not-for-profit Kaiser Permanente of Oakland, California, has operated ten hospitals in California since the late 1980s. Although some HMOs, like Kaiser, purchase the hospitals they use, other HMOs only contract with hospitals to treat HMO patients. When a hospital contracts to meet the health care needs of an HMO’s patients, it retains its ownership status.
Cities, counties, states, and the federal government also own hospitals. About 1,000 public hospitals are owned by their cities or counties and are supported by local tax dollars. The vast majority of city hospitals are in small or moderate-size communities, and they offer services that are similar to those provided in small, general, not-for-profit hospitals. About 150 municipal or county hospitals are found in major cities, such as Cook County Hospital in Chicago, Illinois. These large, urban, public institutions provide most of the care for the poor in their communities. They also often offer comprehensive, high-tech care for certain categories of gravely ill patients, such as trauma and burn victims, as well as intensive care for newborns who are premature or who have severe birth defects. In contrast to the many city and county hospitals in the United States, only a small number of hospitals are run by state governments, and most of these are long-term psychiatric or chronic care institutions.
Federal hospitals care for specific types of government program beneficiaries, such as the hospitals on reservations that care for Native Americans. Walter Reed Army Medical Center, in Washington, D.C., and other military hospitals provide treatment for military personnel and high-ranking members of the government, including the president of the United States. Hospitals run by the Department of Veterans Affairs are located throughout the United States and treat illnesses of military veterans and their dependents.
EDUCATION AND PRACTICE
In the United States, colleges of pharmacy offer five- or six-year programs leading either to a bachelor of science degree in the pharmaceutical sciences or the doctor of pharmacy degree. Licenses are granted by states after the following requirements have been met: graduation from one of the 82 colleges and schools of pharmacy with programs accredited by the American Council on Pharmaceutical Education; participation in an internship under a registered pharmacist; and satisfactory completion of a national licensing examination. Pharmacists may practice their profession in a pharmacy located in a hospital, nursing home, or community-based pharmacy. Pharmacists may also work for managed care organizations, consulting firms, or pharmaceutical companies, which may hire these professionals to conduct scientific research or to participate in the development and production of new pharmaceutical products. >> EDUCATION AND PRACTICE
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Human Disease
Human Disease, in medicine, any harmful change that interferes with the normal appearance, structure, or function of the body or any of its parts. Since time immemorial, disease has played a role in the history of societies. It has affected—and been affected by—economic conditions, wars, and natural disasters. Indeed, the impact of disease can be far greater than better-known calamities. An epidemic of influenza that swept the globe in 1918 killed between 20 million and 40 million people. Within a few months, more than 500,000 Americans died—more than were killed during World War I (1914-1918), World War II (1939-1945), the Korean War (1950-1953), and the Vietnam War (1959-1975) combined.
Diseases have diverse causes, which can be classified into two broad groups: infectious and noninfectious. Infectious diseases can spread from...
Drug, substance that affects the function of living cells, used in medicine to diagnose, cure, prevent the occurrence of diseases and disorders, and prolong the life of patients with incurable conditions.
Since 1900 the availability of new and more effective drugs such as antibiotics, which fight bacterial infections, and vaccines, which prevent diseases caused by bacteria and viruses, has increased the average American’s life span from about 60 years to about 75 years. Drugs have vastly improved the quality of life. Today, drugs have contributed to the eradication of once widespread and sometimes fatal diseases such as poliomyelitis and smallpox.
