Hap100
japjap987
hospital_ownership.pptHOSPITALS
ORIGINS
In the 1700s - Care Was Provided . . .
Home Acute Illness
Almshouse Orphans / Aged
Homeless / Poor Chronic Illness / Mental Illness
Jail Mental Illness
Pest House Contagious Illness
Private Billet Seamen, Soldiers & Veterans
ORIGINS
By the 1800s - Hospitals Became Sites for Obstetrics & Surgery, Medical Education & Care of the Poor
The Pennsylvania Hospital Philadelphia 1751
New York Hospital New York City 1773
Johns Hopkins Hospital Baltimore 1789
Massachusetts General Hospital Boston 1816
New Haven Hospital New Haven 1826
ORIGINS
Charitable Roots - Catholic Sisters & Protestant Deaconesses
Sisters of Charity
Mother Seton 1809
The Crimean War
Florence Nightingale 1854
The Civil War
Dorothea Dix 1860
Nursing Schools 1873
Bellevue / New Haven
Mass General
ORIGINS
Forces Affecting Hospital Development
1840s Anesthesia / Surgery
1860s Sterilization
1890s Labs / Xrays
1900s Transfusions
Flexner Report
1930s Specialization
ORIGINS
Forces Affecting Hospital Development
1940s Antibiotics
1960s Bypass Surgery
1970s Chemotherapy
1980s Electronics
1990s Computerization
2000s Genetics
HOSPITAL OWNERSHIP
Not-for-Profit
Private, Community-Based Board of Directors
Tax Exempt
Officially Charities
Fiduciary
Profits Used for Expansion & Repayment of Debt
HOSPITAL OWNERSHIP
For--Profit Stockholder-Appointed Board of Directors
Taxable
Pay Corporate Taxes
Non-Fiduciary
Profits Used for Expansion & Stockholder Dividends
HOSPITAL OWNERSHIP
Public
Government-Appointed Board of Directors
Tax Exempt
Officially, a Government Institution
Fiduciary
Profits Used for Expansion & Reduction of Tax Subsidies
HOSPITAL CHARACTERISTICS
Number of Hospitals –
Type 1980 1995 2003 %
TOTAL 6,965 100% 6,291 100% 5,764 100% -17.2%
Not-for-Profit 3,322 47.7% 3,092 49.1% 2,984 51.8% -10.2%
For-Profit 730 10.5% 752 12.0% 790 13.7% 8.2%
State / Local 1,778 25.5% 1,350 21.5% 1,121 19.4% -37.0%
Federal 359 5.2% 299 4.8% 239 4.1% -33.4%
Other 776 11.1% 798 12.7% 630 10.9% -18.8%
HOSPITAL CHARACTERISTICS
Number of Inpatient Admissions –
Type 1980 1995 2003 %
TOTAL 38,892 100% 33,282 100% 36,611 100% -5.9%
Not-for-Profit 25,566 65.7% 22,557 67.8% 25,668 70.1% 0.4%
For-Profit 3,165 8.1% 3,428 10.3% 4,481 12.2% 41.6%
State / Local 7,413 19.1% 4,961 14.9% 4,634 12.7% -37.5%
Federal 2,044 5.3% 1,559 4.7% 973 2.7% -52.4%
Other 704 1.8% 777 2.3% 855 2.3% 21.4%
* In 1,000s
HOSPITAL CHARACTERISTICS
Number of Outpatient Visits –
Type 1980 1995 2003 %
TOTAL 262,951 100% 483,195 100% 648,560 100% 146.6%
Not-for-Profit 142,156 54.1% 303,851 62.9% 424,215 65.4% 198.4%
For-Profit 9,696 3.7% 31,940 6.6% 44,246 6.8% 356.3%
State / Local 50,459 19.2% 78,554 16.3% 94,725 14.6% 87.7%
Federal 50,566 19.2% 59,934 12.4% 74,240 11.4% 46.8%
Other 10,074 3.8% 8,916 1.8% 11,134 1.7% 10.5%
* In 1,000s
HOSPITAL CHARACTERISTICS
Average Length of Stay –
Type 1980 1995 2003 %
TOTAL 9.9 7.8 6.6 -33.3%
Not-for-Profit 7.7 6.4 5.5 -28.6%
For-Profit 6.5 5.8 5.3 -18.5%
State / Local 7.3 7.4 6.6 -9.6%
Federal 16.8 13.1 11.5 -31.5%
Other N/A N/A N/A N/A
* In Days
HOSPITAL LOCATIONS
Local Gov’t Owned
Rural Areas
Very Small Hospitals Largest Employers in Community
Specialty & Teaching
Urban Areas
Low Income, Declining Areas
Community Hospitals
Suburban Areas
Higher Income, Growth Areas
For-Profit Hospitals
South & Southwest
HOSPITAL SYSTEMS
Economies of Scale
Purchasing Programs
Quality Improvement
MD Practice Enhancement
Rural Hospital Partnerships
Reduction of Competition
Negotiating Power
Standardization
MD Practice Ownership
Referral Network Protection
VERTICAL INTEGRATION
Cost Management Laundries / Purchasing Programs
Patient Acquisition MD Practices / Referral Services
Insurance HMOs / PPOs
Post-Acute Services SNFs / Nursing Homes
Regional Partnerships Rural Hospitals
HORIZONTAL INTEGRATION
Market Penetration Purchase / Merge with
Competitors
Market Development Expand to Peripheral Areas
Community Hospitals Alegent Approach
Specialty Hospital & Satellites Methodist / NMC Approach
