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.