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 ...

1. 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

2. 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

3. 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%

4. 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 %

5. 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-Profit7.7 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

6. 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

7. Market Penetration Purchase / Merge with
Competitors
Market Development Expand to Peripheral Areas
Community Hospitals Alegent Approach
Specialty Hospital & SatellitesMethodist / NMC Approach
Introduction to Health Care Administration
Background
Background
Predominant Health Problems
19th Century Epidemics in Groups
1900 - 1950 Acute Problems in Individuals
1950 - 2000 Chronic Physical Illnesses
The Future Chronic Behavioral Illnesses
*
Background
Predominant Technology
19th Century Biology & Chemistry
1900 - 1950 Xrays, Drugs & “Techniques”
1950 - 2000 Dx / Surgical Procedures
& Electronics

8. The Future Genetics
*
Background
Predominant Delivery Systems
19th Century Itinerant Practitioners
1900 - 1950 Hospitals / MDs
1950 - 2000 Med CTRs / Group Practices
The Future Health Care Systems
*
Background
Predominant Payment Systems
19th Century Out-of-Pocket & Charity
1900 - 1950 Out-of-Pocket & Charity
1950 - 2000 Public & Private Insurance
The Future Managed Care / NHI
*
Background
Key Health Care Issues
Financing Technology Information / Communications People -

9. Health Care Workers & Patients Value
*
Background Change the Playing Field Foresight Innovation
Timing Speed Mass Customization Re-Engineering Managing
Diversity Empowerment Learning Organizations
Key Health Care Strategies
*
Background
Why Are We Here?
Health Care Is Expensive Health Care Is Education & Research
Based Health Care Is Labor-Intensive Health Care Serves the
Vulnerable
Background
Why Are We Here?
Fiduciary Responsibility to Society Professional Responsibility
to the Field Managerial Responsibility to HC Workers Personal
Responsibility to Patients
Background
The Good Samaritan
Luke 10:25-37

10. 25 On one occasion an expert in the law stood up to test
Jesus. "Teacher," he asked, "what must I do to inherit eternal
life?"
Background
The Good Samaritan - Luke 10:25-37
26 "What is written in the Law?" He replied. "How do you read
it?"
27 He answered: "`Love the Lord your God with all your heart
and with all your soul and with all your strength and with all
your mind'; and, `Love your neighbor as yourself.'"
Background
The Good Samaritan - Luke 10:25-37
28 "You have answered correctly," Jesus replied. "Do
this and you will live."
29 But he wanted to justify himself, so he asked Jesus, "And
who is my neighbor?"
Background
The Good Samaritan - Luke 10:25-37
30 In reply Jesus said: "A man was going down from Jerusalem
to Jericho, when he fell into the hands of robbers. They
stripped him of his clothes, beat him and went away, leaving

11. him half dead.
Background
The Good Samaritan - Luke 10:25-37
31 A priest happened to be going down the same road, and when
he saw the man, he passed by on the other side.
32 So too, a Levite, when he came to the place and saw him,
passed by on the other side.
Background
The Good Samaritan
Luke 10:25-37
33 But a Samaritan, as he traveled, came where the man was;
and when he saw him, he took pity on him.
Background
The Good Samaritan
Luke 10:25-37
34 He went to him and bandaged his wounds, pouring on oil
and wine. Then he put the man on his own donkey, took him to
an inn and took care of him.
Background
The Good Samaritan - Luke 10:25-37

12. 35 The next day he took out two silver coins and gave them to
the innkeeper. `Look after him,' he said, `and when I return, I
will reimburse you for any extra expense you may have.'
Background
The Good Samaritan - Luke 10:25-37
36 "Which of these three do you think was a neighbor to the
man who fell into the hands of robbers?“
37 The expert in the law replied, "The one who had mercy on
him.” Jesus told him, "Go and do likewise."
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