Hospitals used to be a place where patients who were sick could seek care. Funded by wealthy donors and religious organizations, their mission was focused on health for all. No one was turned away and ability to pay was not a factor. The first private, non-profit, teaching hospital, in the United States, Pennsylvania Hospital in Center City, Philadelphia, was founded on May 11, 1751 by Benjamin Franklin and Thomas Bond. Originally conceived as a, “institution for the reception and cure of the sick and the poor,” it was free of charge to the patients and funded by a “matching grant” to donations by the people of Philadelphia. Other early hospitals were founded and funded by similar charitable organizations, religious groups, or community initiatives. Today those same hospitals are struggling to survive. Many have not.
The goal of a not-for-profit hospital corporation, from the beginning has s been to serve the public by working to prevent and manage disease, and educate the people. Excess revenue from patient services generally was reinvested to improve operations and serve the local community. In the mid-19th century and throughout the 20th century, hospitals transformed into the expensive, model institutions of science and technology, and increasing the number of paying middle-class patients. In the 21st century all of that has changed for a number of reasons:
- There are vast shortages of available trained personnel –not enough doctors, nurses and technical staff to meet the needs of an increasing large population of individuals needing healthcare. These positions are notoriously underpaid.
- Hospitals of today operate in a competitive environment where attracting executives, requires multi-million-dollar salaries. On return, these executives are more preoccupied with how to increase profits than provide the best treatment for their patients.
- The trend of keeping pace with expensive diagnostic equipment continues while pressure to maintain patient safety and high-quality care in a system where hospitals are subject to complex state and federal regulations has become burdensome.
- A health system that depends upon payments from private health insurance, Medicare for the elderly, Medicaid for the poor and the handicapped, in an environment where political whim, deal-making and outrageous billing practices are the norm, is found to be unwieldy
- A large number of uninsured members of the population whose last resort for healthcare is the most expensive route – The Emergency Room – where they arrive really sick due to a lack of resources to take care of themselves.
There have been 13 hospital closures since the beginning of 2024 reported by Becker’s Hospital Review, a medical industry trade magazine published by ASC Communications, Inc, that does its own research, supplemented with government-released data and U.S. News & World Report rankings. Over 100 rural hospitals have closed over the past decade, and nearly 700 additional rural hospitals — over 30% of all rural hospitals in the country — are at risk of closing in the near future.
American College of Healthcare Executives Top Issues Confronting Hospitals in 2022, Chicago, Feb 4, 2022
A recent survey by KFF, with support from the Robert Wood Johnson Foundation, provides some hints at the scope of the problem for US consumers. Findings from interviews with a nationally representative sample of 3605 privately and publicly insured adults reveal that many are perplexed and overburdened with their health care plans. Almost 6 in 10 people with insurance reported a problem with using their health insurance during the past year. The share increases to two-thirds for people in fair or poor health, three-fourths for those who need mental health services, and almost 8 in 10 for people who use the health system the most. The result is that many patients delay or skip care or accumulate bills they cannot afford. This adds to the dysfunction and high cost of care that is unaffordable to the majority of the American public. There is no easy way out of this dysfunctional mess. It would require a huge infusion of funds on the Federal level and the expansion of community clinics though the nation to resolve the problem of patient care in America. Not likely at this time.