1 Inpatient Care

History

To gain a better understanding of inpatient care in America’s healthcare system today, it’s important to take a look at its history in America. Understanding the history will provide a better insight into why our policies and procedures exist the way they do. The Delivery of Healthcare in America: a system’s approach defines inpatient care as a term to describe “an overnight stay in a healthcare facility, such as a hospital.”(5) It further tells us that hospital care consumes the biggest share of national health care spending. We need to learn from the past and push for a system that gives quality service for the vast amount of spending we put into it every year.

Inpatient care originally began as an institution of social welfare. Almshouses or pesthouses were financed through the government funds. According to Carole Haber, “…only the most destitute of the orphaned, insane, diseased, and elderly were sent to the poorhouse.”(1) Care was not specialized and came secondary and was quite primitive. By the late 1800’s, the poor houses were turned into independent institutions. Most of these institutions served mainly the poor population while a select few hospitals served the sick. It wasn’t until the advancement of medical science that transformed hospitals into institutions of medical practice.

From the late 1800’s to mid 1980’s, hospitals went through a period known as the expansion phase. The growth of hospitals caused an increase in surgical practice which ultimately increased profits and allowed the building of small hospitals. The availability of these beds being built essentially ensured that patients would be admitted and hospitals would treat them. Nursing schools were being established during the later portion of the 19th century and inpatient care become primarily focused with healing the sick and diseased. Practices based on scientific evidence was on the rise and medical treatment improved tremendously from previous decades. John W. Peacock notes in his article that traditional ways of caring for sick people, not susceptible to scientific investigation and intervention, were either
abandoned or discouraged.(3)

It wasn’t until after the Great Depression that health insurance was introduced to inpatient care. It was used as a tool to provide care for those unable to support themselves financially as well as a way to revive the financial stability of the hospitals. The post effects of the Great Depression caused a national shortage of hospitals. The Hill-Burton Act introduced in 1946 provided federal grants to states to construct community hospital beds. Hospitals & Health Networks states stated that the bill was ultimately responsible for stimulating the growth of hospital planning across the country. (2) The increase in the nations bed supply ultimately allowed remote communities to gain access to healthcare services. The act also was responsible for advancing the growth of non-profit community hospitals. Nonprofit community hospitals in America eventually took over and outnumbered all other types of hospitals.

From the Mid-1980’s to present inpatient care went through what Leiyu Shi and Douglas A Singh describe as the downsizing phase. This downsizing is a result of a decline in the number of community hospitals and the number of beds. It also can be attributed to the reduced average length of stay of patients in the hospital and also a significant shift from inpatient to outpatient care. In the 1990’s, managed care became a factor in influencing the delivery of healthcare services to outpatient care. Since managed care focuses on cost containment and the efficient delivery of services, the high cost of inpatient care has put emphasis on delivering care to outpatient facilities. This has reduced inpatient services and the downsizing of individual hospitals.

Through the past two centuries, we have come a long way in acquiring new technologies and practices to enhance our care to patients. The problem still remains that patients still aren’t receiving the quality services they deserve. Robert A. Phillips and Julia D. Adrieni state in their article that “…although we have more medical knowledge and better technology, there is evidence that inpatient medical care is becoming more disjointed...”. (4) Let’s continue to grow from our past and push to lessen the number of patients in inpatient care and strengthen the relationship with doctors and the patients and not insurance companies.

Works Cited

1. Haber, Carole. "And the fear of thee poorhouse: Perceptions of old age impoverishment in early twentieth century." Generations 17.2 (1993): 46-51.

2. H&HN: Hospitals & Health Networks; 81.3 (2007): 13-13.

3. Peacock, John W., and Peter S. Nolan. "Care under threat in the modern world." Journal of advanced nursing 32.5 (2000): 1066-070.

4. Phillips, Robert A., and Julia D. Adrieni. "A New Model for Inpatient Care in the 21st Century." Archives of Internal Medicine 167.19 (2007): 2025-026.

5. Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America: A systems approach. Sudbury: Jones and Bartlett, 2007.

Beliefs, Values, and Political Stance...

Inpatient care is at the heart of our healthcare system. Other healthcare elements such as the workforce, technology, financing, and managed care systems, center on the question of cost and access of inpatient care. In a disease focused system that also values market justice, profits are made off of new expensive technology, which may not be necessary or may even be harmful for individuals. These situations increase costs for inpatient care. One example of such technology is drug companies. According to Peterson, “experts estimate that more than a hundred thousand Americans die each year not from illness but from their prescription drugs…making medicines one of the leading causes of death in the United States”3. In the United States in 2005 we spent $250 billion on prescription drugs. However Peterson goes on to describe that, “only about 10 percent of the price of most brand name pills goes to cover the cost [of making prescription drugs]”, the rest is used for marketing and salaries of executives3. Left in a market justice system, this could be allowed to continue. This produces high cost for individuals who use prescription drugs. This includes individuals who use those drugs to stabilize their conditions (which decrease costs of care in an inpatient facility) but also for those experiencing inpatient care. If these technologies were not left to a market system then the profit could be returned back into the system it was originally intended. In this current system managed care systems are allowed and feel justified in focusing cost cutting on hospital stays. For instance, one initiative policy provided by one managed care system was “authorizing just one day of hospital care for new mothers who had normal deliveries”1. Inpatient care would only NOT be a vital part of the system if there was never any incidence of injury, accidents, mental illness, disability, or disease. While, I am sure that is a world we would all like to be a part of, it is not one that we fathom actually existing. Therefore inpatient care remains at the heart of healthcare.


That is why, when it comes to inpatient care our group values 1) social over market justice5. Healthcare should not be determined by companies looking for profit but, should be a community working together to improve health. 2) We value a shift from a disease focused system to a wellness focused system5. 3) Thirdly and most importantly we value the right of all individuals to access quality treatment options that they choose in cohesion with their doctors—not chosen by a company considering costs before individual needs.


We believe 1) in order to improve cost and quality we need to put forth public health efforts to lessen the number of individuals needing inpatient care, 2) that you and your doctor, not insurance companies, HMOs, or PPOs, should be responsible for determining what medical care is necessary for you, and 3) that all options should be available for your inpatient treatment and after choosing one, should be covered/affordable to you.


We believe our beliefs and values most closely align with the Democratic Party. The GOP does have initiatives that sound reasonable and exciting for healthcare reform, such as focus on preventative measures. This would help decrease the costs of inpatient care by lowering the amount of people needing it. However many aspects revert back to market justice. For instance, they suggest bonus for states with 90% vaccine rates as part of their initiative to lower chronic disease2. They use the flu shot as an example of the importance of vaccines. Vaccines are now a part of the “drug company” community and new vaccines are not always safe to get. Besides taking away the choice of individuals (and the fact that chronic disease isn’t prevented by vaccines) but the Huffington Post notes that that the GOP’s suggestion to invest $50million annually to increase vaccine availability would actually increase costs4. Let alone the fact that this could increase the number of people needing hospitalizations if not considered closely. (see the following link for more information: http://naturalcommunitiesmag.com/?s=vaccines&cat=3)


We support the increase consumer choice when it comes to treatment and the guaranteed coverage that government insurance can offer. We support improved public health initiatives to lower chronic disease and increase wellness in our nation. We have been using a market justice system that isn’t providing access, quality, or cost efficient inpatient care. This is why our idea of reform believes in a socially just answer to our inpatient care issues.



-Lindsey Purl



Works Cited in MLA
1) Cohn, Jonathan. Sick: The untold story of America’s health care crisis—and the people who pay the price. New York: HarperCollins, 2007. Print.
2) “GOP Solutions for America: Common-sense health care reform our nation can afford”. Gop.gov. Web. 14 February. 2010. .
3) Petersen, Melody. Our Daily Meds: How the pharmaceutical companies transformed themselves into slick marketing machines and hooked the nation on prescription drugs. New York: Sarah Crichton, 2008. Print.
4) “Republican Health Care Unveiled”. The Huffington Post.com. 20 May. 2009. Web. 14 February. 2010. .
5) Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America: A systems approach. Sudbury: Jones and Bartlett, 2007. Print.

Food For Thought...

Welcome to our blog. Before diving into our political stance and beliefs about Inpatient care we felt it was important to start off by just thinking about the role of inpatient care within the U.S. Healthcare system. The following was written in 2006 and is taken from the following link (visit the website to see the whole article):

http://www.medicalnewstoday.com/articles/55912.php

According to Abramson, "[F]acts show that these enormous expenditures may be buying us the best amenities in medical care -- but not the best health." A Dartmouth Medical School study found that "perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care -- and may make things worse," Abramson writes, adding, "This means that the U.S. is wasting more than $650 billion a year -- half again more than the entire Defense Department will spend this year, including the cost of the war in Iraq -- on unnecessary and often harmful care." He says, "One factor is specialists. Both U.S. and international studies show that the more a health care system relies on primary care, the better the outcomes and the lower the cost. But American medicine is heavy on specialists and getting heavier." In addition, according to Abramson, "Our government has become almost fundamentalist in its reliance on market-based, pro-business solutions to social problems." He continues, "No politician wants to be tarred with the charge of promoting 'socialized medicine.'"

If studies show that it is benificial for cost and outcomes to rely more on primary care then that means the way we look at an handle inpatient care may need to be adjusted. How much of that "wasted" money (COST), and "unnecessary and harmful care" (QUALITY) is resulted from the way inpatient care functions? My guess is that inpatient care takes up a large portion of those numbers.

What are your reactions to this article? What are your immediate thoughts on the way inpatient care functions in our country? Share your thoughts, ideas, and beliefs!

Coming Soon: Our Beliefs and Values....stay tuned.