A of specialized technology, advances in medical education, development

A long time ago, hospitals were simply an institution
used to house the homeless, the poor, or the mentally unstable individuals.
Eventually hospitals drastically changed to an institution that provided the
latest, most modern technological advancements that would serve to treat the
critically ill and injured individuals. Over the years, there are many
significant factors that not only attributed to the change in hospital
structure, but also to the development and deterioration in the amount of
hospitals available. Allegedly the government has accounted for the biggest
role in the growth of hospitals, but also the decline in hospitals as well.


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and Dowling (1993) pointed to six significant factors in the growth of
hospitals: advances in medical science, development of specialized technology,
advances in medical education, development of professional nursing, growth of
health insurance, and the role of government” (Shi & Singh, 2015, p. 296). Historically, major
occurrences in the United States have attributed to overall changes in society,
and many laws that were put into places years ago still effect how healthcare
is distributed today. For instance, World War II and the Great Depression
created major problems for U.S. citizens, and also caused a vast impact in the
delivery of healthcare and the shortage of hospitals available. (Shi &
Singh, 2015, p. 296) Therefore, the Hill-Burton Act of 1946
was formed to aid in the growth and development of available hospitals in order
to offset the deficit caused by these tragic events. (ONS News, 2000) This program provided grant funds and
loans in order to help communities increase the growth of hospitals and
hospital beds across the country, and required that these hospitals assist in
the healthcare of the poor and uninsured populations. (Mason, 2016)
This legislation required that states annually reviewed and upgraded health
facility construction in order to achieve accountable beds per a certain
population. (Shi & Singh, 2015, p. 297) Due to the mandates
associated with this program, many smaller communities were also able to create
their own hospitals. (Shi & Singh, 2015, p. 297) The Hill-Burton Act
was also influential in stimulating the growth of nonprofit hospitals, mainly
because it required the newly constructed or revamped hospitals to provide
charitable work to the local communities. (Shi & Singh, 2015, p. 297) “The act not only
led to our health care system’s current emphasis on the acute-care hospital as
the primary site of health care delivery, but it also had a profound effect on
nursing, fully involving the profession in an acute-care world” (Mason, 2016). As evident, not
only did this legislation effect the number of hospitals available, but it also
changed the way healthcare was being administered.  Even though the Hill-Burton Act was
terminated in 1974, many believe it was one of the most momentous influences
that molded the healthcare system in place for today’s society.


            The most
influential change in the decline of hospitals over the years has been proven
to be the effects of hospital reimbursements. In 1982, The Tax Equity and
Fiscal Responsibility Act (TEFRA) required hospitals to shift reimbursement
methods from a cost-plus system to a prospective payment system (PPS). (Shi &
Singh, 2015, p. 299) A PPS requires that hospitals are
reimbursed a fixed amount based on the individuals primary admitting diagnosis,
and does not take into account how many days the individual spends in the
hospital. (Shi & Singh, 2015, p. 299) Therefore, this type
of payment system put increased volumes of strain on the hospitals to decrease
the length of stay for patients so there wouldn’t be a decrease in the overall profits.
(Shi & Singh, 2015, p. 300) Eventually hospital
beds started to deteriorate, which progressed to hospitals closing due to the
strain incurred.

Affordable Care Act (ACA) has also played a major role in the decline of
available hospitals across the United States. While many believe the ACA has
incentives in place to improve the total healthcare delivery and expenditures
in 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, and
has increased penalties for defiance, which has caused many headaches and
closures of hospitals. (Abbott & Stevens, 2014) Specifically, the
Hospital Readmission Reduction Program (HRRP), which came about during the ACA
implementation, has reprimanded numerous hospitals and caused an abundance of
financial strains. The overall goal of this program was to improve healthcare delivery
by joining payment with the quality of hospital care provided. (Healthcare Financial Managment, 2016) However, hospitals
dealing with Medicare patients have experienced a great deal of payment cuts
which have in turn affected overall profit generated. (Healthcare Financial Managment, 2016) The types of
stresses mentioned, caused by changes in reimbursement methods, have obviously
been influential in the closing of many hospitals over the years in the United