A long time ago, hospitals were simply an institutionused to house the homeless, the poor, or the mentally unstable individuals.
Eventually hospitals drastically changed to an institution that provided thelatest, most modern technological advancements that would serve to treat thecritically ill and injured individuals. Over the years, there are manysignificant factors that not only attributed to the change in hospitalstructure, but also to the development and deterioration in the amount ofhospitals available. Allegedly the government has accounted for the biggestrole in the growth of hospitals, but also the decline in hospitals as well. HospitalGrowth “Haglundand Dowling (1993) pointed to six significant factors in the growth ofhospitals: advances in medical science, development of specialized technology,advances in medical education, development of professional nursing, growth ofhealth insurance, and the role of government” (Shi & Singh, 2015, p. 296). Historically, majoroccurrences in the United States have attributed to overall changes in society,and many laws that were put into places years ago still effect how healthcareis distributed today.
For instance, World War II and the Great Depressioncreated major problems for U.S. citizens, and also caused a vast impact in thedelivery of healthcare and the shortage of hospitals available. (Shi & Singh, 2015, p. 296) Therefore, the Hill-Burton Act of 1946was formed to aid in the growth and development of available hospitals in orderto offset the deficit caused by these tragic events. (ONS News, 2000) This program provided grant funds andloans in order to help communities increase the growth of hospitals andhospital beds across the country, and required that these hospitals assist inthe healthcare of the poor and uninsured populations.
(Mason, 2016)This legislation required that states annually reviewed and upgraded healthfacility construction in order to achieve accountable beds per a certainpopulation. (Shi & Singh, 2015, p. 297) Due to the mandatesassociated with this program, many smaller communities were also able to createtheir own hospitals. (Shi & Singh, 2015, p. 297) The Hill-Burton Actwas also influential in stimulating the growth of nonprofit hospitals, mainlybecause it required the newly constructed or revamped hospitals to providecharitable work to the local communities. (Shi & Singh, 2015, p. 297) “The act not onlyled to our health care system’s current emphasis on the acute-care hospital asthe primary site of health care delivery, but it also had a profound effect onnursing, fully involving the profession in an acute-care world” (Mason, 2016).
As evident, notonly did this legislation effect the number of hospitals available, but it alsochanged the way healthcare was being administered. Even though the Hill-Burton Act wasterminated in 1974, many believe it was one of the most momentous influencesthat molded the healthcare system in place for today’s society. HospitalDecline The mostinfluential change in the decline of hospitals over the years has been provento be the effects of hospital reimbursements.
In 1982, The Tax Equity andFiscal Responsibility Act (TEFRA) required hospitals to shift reimbursementmethods from a cost-plus system to a prospective payment system (PPS). (Shi & Singh, 2015, p. 299) A PPS requires that hospitals arereimbursed a fixed amount based on the individuals primary admitting diagnosis,and does not take into account how many days the individual spends in thehospital. (Shi & Singh, 2015, p. 299) Therefore, this typeof payment system put increased volumes of strain on the hospitals to decreasethe length of stay for patients so there wouldn’t be a decrease in the overall profits.(Shi & Singh, 2015, p.
300) Eventually hospitalbeds started to deteriorate, which progressed to hospitals closing due to thestrain incurred. TheAffordable Care Act (ACA) has also played a major role in the decline ofavailable hospitals across the United States. While many believe the ACA hasincentives in place to improve the total healthcare delivery and expendituresin the U.S., this law has also caused many issues for hospitals in particular.The ACA has changed reporting requests, has shrank the reimbursement rates, andhas increased penalties for defiance, which has caused many headaches andclosures of hospitals. (Abbott & Stevens, 2014) Specifically, theHospital Readmission Reduction Program (HRRP), which came about during the ACAimplementation, has reprimanded numerous hospitals and caused an abundance offinancial strains.
The overall goal of this program was to improve healthcare deliveryby joining payment with the quality of hospital care provided. (Healthcare Financial Managment, 2016) However, hospitalsdealing with Medicare patients have experienced a great deal of payment cutswhich have in turn affected overall profit generated. (Healthcare Financial Managment, 2016) The types ofstresses mentioned, caused by changes in reimbursement methods, have obviouslybeen influential in the closing of many hospitals over the years in the UnitedStates.