The Role of the Hospital in the Healthcare System
Ancient hospitals were shelters for the needy. Hospitals continue to provide overnight care for patients too ill to stay home, but advances in science, technology, and training have made modern hospitals not only sites of care but also sites of cure. This chapter focuses on the role of hospitals, particularly Academic Medical Centers, in the US healthcare system.
Today patients are less likely to be admitted to the hospital, and those admitted stay a shorter time, while the intensity and cost of the services provided have risen dramatically. Academic Medical Centers play a particularly important role in providing highly technical services based on their tripartite mission to educate students and residents, conduct basic and translational research, and provide direct clinical care.
Fewer hospital admissions and competition from free-standing providers of ambulatory services have placed hospitals in an economic squeeze, exacerbated by increased accountability for outcomes during and after hospitalization, and economic pressures to implement technology, expand training, and maintain research while containing costs. In response to these pressures, many previously independent organizations have begun to consolidate into more integrated delivery systems including alliances of larger Academic Medical Centers with community and rural hospitals and primary and specialty care physician practices. To achieve the goals of providing efficient and effective care to populations, these alliances can adopt the models of patient-centered primary care within a network of clinically integrated specialty providers and affiliated hospitals. Hospitals can also play a key role as economic and civic institutions working with other stakeholders to maintain community vitality.
In the modern hospital, highly trained professionals provide very technical, intensive services which will remain an essential element of care for some patients ensuring that hospitals will continue to be a critical component of the future healthcare delivery system.
KeywordsAcademic Medical Center US healthcare system Hospital consolidation Hospital utilization trends Horizontal and vertical integration Patient-centered medical home Medical neighborhood Anchor institution Value-based payment
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