HOSPITALS 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% 19 ...