Biology

The human eye can be vulnerable to fungal infections simply by being exposed to the environment. The human eye can also be vulnerable to infect internally. Using the South University Online Library or the Internet, research on eye infections.

 

Note: Ensure that your research is limited to infections not caused by direct trauma to the eye.

 

Based on your research, respond to the following:

  • How does such a sensitive organ protect itself against such common infections?
  • What are the main causes for fungal eye infections?
  • Why is an immunocompromised host more likely to get a fungal eye infection (excluding traumatic infections)?

© 2010 Jones and Bartlett Publishers, LLC

Basic Concepts of the U.S. Health Care Delivery System: Student Activity Workbook

Chapter 5

Inpatient and Outpatient Services

Nancy J. Niles

Introduction

Inpatient services are services that involve an overnight stay of a patient.

The U.S. health care industry was based on the provision of inpatient services provided by hospitals and outpatient services provided by physicians.

Over the past two centuries, hospitals have evolved from serving the poor and homeless to providing the latest medical technology to serve the seriously ill and injured.

Although their primary revenue is derived from inpatient services, as a result of cost containment and consumer preferences, more outpatient services are being offered by hospitals.

Introduction

Many hospitals have evolved into medical centers which provide the most advanced service. Hospitals can be classified by who owns them, length of stay, and the type of services they provide.

Inpatient services typically focus on acute care which includes secondary and tertiary care levels that most likely require inpatient care. Inpatient care is very expensive.

Hospitals began offering more outpatient services which do not require an overnight stay and were less expensive.

Outpatient services have become more popular because they are less expensive and they are preferred by consumers.

History of Hospitals

The word hospital comes from the Latin word “hospes” which means a visitor or host who receives a visitor. From this root word, the Latin “hospitalia” evolved which means an apartment for strangers or guests. The word “hospital” was a word in the Old French language.

As it evolved, England began a shift in the 15th century to mean a home for the infirmed, poor or elderly.

History of Hospitals

Over five thousand years ago, Greek Temples were the first type of hospital with similar institutions in Egyptian, Hindu and Roman cultures.

They were the precursor of the almshouses or poorhouses that were developed in the 1820s to serve the poor primarily.

Pesthouses, operated by local governments, were used to quarantine people who had contagious diseases such as cholera, etc. The framework of these institutions set up the concept of the hospital.

History of Hospitals

1789: the Public Hospital of Baltimore was established for the indigent. In 1889, it became Johns Hopkins Hospital, which exists today as one of the best hospitals in the world.

1850s: a hospital system was finally developed but their conditions were deplorable because there were unskilled providers. Hospitals were owned primarily by physicians.

History of Hospitals

In the early 20th century, with the establishment of more standardized medical education, hospitals became more accepted across socioeconomic classes and became the symbol of medicine.

With the establishment of the American Medical Association who protected the interests of providers, the reputation of providers became more prestigious.

In the 1920’s, the development of medical technological advances, increased quality of medical training and specialization.

History of Hospitals

During the 1930s-1940s, the ownership of the hospitals changed from physician owned to church-related and government operated.

Religious orders viewed hospitals as an opportunity to perform their spiritual good works. Several religious orders established hospitals that still exist today.

History of Hospitals: Milestones

In 1973, the first Patient Bill of Rights was introduced to represent health care consumer representation in hospital care.

In 1972, the American Hospital Association had all hospitals display a “Patient Bill of Rights” in their institutions.

In 1974, the National Health Planning and Resources Development Act: required states to have Certificate of Need (CON) laws to ensure the state approved any capital expenditures associated with hospital/medical facilities’ construction and expansion.

The Act was repealed in 1987 but 36 states still have some type of CON mechanism . The concept of CON was important because it encouraged state planning to ensure their medical system was based on need.

History of Hospitals

Hospitals are the foundation of our health care system. The first type of insurance was hospital insurance.

Although hospitals are still an integral part of our health care delivery system, the method of their delivery has changed. “Hospitalists”, created in 1996, are providers that focus specifically on the care of a patient when they are hospitalized

More hospitals have recognized the trend of outpatient services and have integrated those types of services in their delivery.

History of Hospitals

In 2000, as a result of the Balanced Budget Act cuts of 1997, the federal government authorized an outpatient Medicare reimbursement system which has supported hospital outpatient services efforts.

In 2007, hospitals employed over five million individuals, were the second largest source of private sector jobs, provided outpatient care to over 600 million patients and performed 27 million surgeries.

Hospital Types

There are three major types of hospitals by ownership: 1) public, 2) voluntary and 3) proprietary hospitals.

Public hospitals are the oldest type of hospital and are owned by the federal, state or local government.

Federal hospitals generally do not serve the general public but operate for federal beneficiaries such as military personnel, veterans and Native Americans. The Veterans Affairs hospitals are the largest group of federal hospitals.

County and city hospitals are open to the general public and are supported by taxes. Many of these hospitals are located in urban areas to serve the poor and the elderly.

Hospitals Types by Ownership

Voluntary hospitals are non government owned, private and not for profit and target community care. They are considered “voluntary” because their financial support is the result of community organizational efforts.

Private not for profit hospitals are the largest group of hospitals. In 2007, there were nearly 3,000 not for profit hospitals.

Proprietary hospitals or investor-owned hospitals are for profit institutions and are owned by corporations, individuals or partnerships. They have the lowest utilization rates. In 2007, there were 873 proprietary hospitals.

Hospitals by Specialty

Hospitals may be classified by what type of services they provide and their target population.

A general hospital provides many different types of services to meet the general needs of their population. Most hospitals are general hospitals.

Specialty hospitals are hospitals that provide services for a specific disease or target population such as psychiatric, children’s, women’s, cardiac, cancer, rehabilitation, and orthopedic hospitals.

Other Hospital Classifications

Hospitals can be classified by single or multi unit operations.

Two or more hospitals may be owned by a central corporation. Multi unit hospitals have resulted in the merging or acquiring of other hospitals that have financial problems.

These chains can be operated as for profit, not for profit, or government.

Other Hospital Classifications

In 2007, there were over 2,700 hospital systems.

A short stay or acute care hospital focuses on patients who stay on an average of less than 30 days.

Community hospitals are short term facilities.

Other Hospital Classifications

A long term care hospital focuses on patients who stay on an average greater than 30 days.

Rehabilitation and chronic disease hospitals are examples of long term. More than 90% of hospitals are acute or short-term.

Hospitals can be classified by geographic location—rural or urban.

Urban hospitals tend to pay higher salaries and consequently offer more complex care because of the highly trained providers and staff. In 2007, there were nearly 3,000 urban hospitals.

Other Hospital Classifications

Rural hospitals tend to see more poor and elderly and consequently have financial issues.

In 2007, there were nearly 2,000 rural hospitals (www.aha.org). As a result of this issue, the Medicare Rural Hospital Flexibility Program (MRHP) was created as part of the Balanced Budget Act of 1997.

The MRHP allows some rural hospitals to be classified as critical access hospitals.

This classification enables them to receive additional Medicare reimbursement called cost plus. Cost plus reimbursement allows for capital costs which enables facilities to expand.

Other Hospital Classifications

Teaching hospitals are hospitals that have one or more graduate resident programs approved by the American Medical Association.

Academic medical centers are hospitals organized around a medical school.

There are approximately 400 teaching hospitals including 64 Veteran’s Affairs Medical Centers that are members of the Council of Teaching Hospitals and Health Systems in the U.S. and Canada.

These institutions offer substantial programs and are considered elite teaching and research institutions affiliated with large medical schools

Other Hospital Classifications

Church related hospitals are developed as a way to perform spiritual work. The first church affiliated hospitals were established by Catholic nuns. These hospitals are community general hospitals. They could be affiliated with a medical school.

Osteopathic hospitals focus on a holistic approach to care. The emphasize diet and environmental factors that influence health. Their focus is preventive care. There are approximately 200 osteopathic hospitals in the U.S.

Hospital Governance

Hospitals are governed by a Chief Executive Officer (CEO), a board of trustees or board of directors, and the chief of medical staff.

The Chief Executive Officer or President is ultimately responsible for the day to day operations of the hospital and is a Board of Trustee member.

Hospital Governance

The Board of Trustees is legally responsible for hospital operations.

The chief of medical staff or medical director is in charge of the medical staff/physicians that provide clinical services to the hospital.

The medical staff is divided according to specialty such as obstetrics, cardiology, radiology, etc.

Licensure, Certification and Accreditation

State governments oversee the licensure of health care facilities including hospitals. States set their own standards.

State licensure focus on building codes, sanitation, equipment and personnel. Hospitals must be licensed to operate a certain number of beds.

Certification of hospitals enables them to obtain Medicare and Medicaid reimbursement.

Licensure, Certification and Accreditation

This type of certification is mandated by the Department of Health and Human Services.

All hospitals that receive Medicare and Medicaid reimbursement must adhere to conditions of participation which emphasize patient health and safety.

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