Module 8 lecture, part 3 Flashcards
What fraction of total hospital costs is between ages 45 and 84?
2/3
What are the two main cost drivers in hospitals?
Intensity of svcs (cost per day)
Pop growth
What were the five dominant functions through which US hospitals evolved?
Primitive institutions of social welfare
Distinctive institutions of care for the sick
Organized institutions of medical practice
Advanced institutions of medical training and research
Consolidated systems of health svcs delivery
What were the primitive institutions of social welfare?
Almshouses and poorhouses
Aspects of consolidated systems of health svcs delivery
Organizational integration
Service diversification
What collaboration occurred with advanced institutions of medical training and research?
Between hospitals and universities
What were the six factors behind expansion of US hospitals in the late 1800s to mid-1980s?
Advances in medical science
Development of specialized tech and surgical svcs
Advances in medical education
Development of professional nursing
Growth of health insurance
Role of gov’t
How did growth insurance contribute to the expansion of US hospitals in the late 1800s to mid-1980s?
Insurance allowed ppl to pay for HC
Increased the demand for HC
Role of gov’t in expansion of US hospitals in the late 1800s to mid-1980s
Hospital Survey and Construction Act (Hill Burton Act), 1946
-Federal grants to build nonprofit community hospitals
-Charitable care as a condition
-Biggest factor to increase nation’s bed supply
Public health insurance (Medicare and Medicaid)
What contributed to the hospital downsizing from the mid-1980s onward?
Changes in reimbursement
Impact of managed care
Hospital closures
How did changes in reimbursement contribute to hospital downsizing in the mid-1980s onward?
From cost-plus to prospective payment system (PPS)
Decrease in inpt utilization
How did managed care impact hospital downsizing from the mid-1980s onward?
Emphasis on cost containment
Efficient utilization of resources (care in alternative settings)
Describe hospital closures that occurred in the mid-1980s onward?
Economic constraints
Many rural and urban hospitals had to close
Other hospitals closed wings or used them for alternative purposes
What are the key utilization measures and operational concepts?
Discharges
Inpt days (pt day)
Average length of stay (ALOS)
Avg Daily Census
Occupancy Rate: % of capacity occupied
Definition of discharges
of pts discharged in a given time period, including newborns and deaths
What is an indicator of access and utilization in hospitals?
Discharges per 1,000 pop
Definition of inpt days
A night spent by a pt
Avg length of stay formula
Total days of care/total # of d/cs
What is ALOS an indicator of?
Severity of illness and resource use
What is hospital capacity determined by?
of beds set up and staffed
What percentage of US community hospitals have <300 beds?
84%
Avg bed number in 2010
161
Definition of avg daily census
Avg number of beds occupied per day
Avg daily census formula
Total inpt days/# of days during a given period
Definition of occupancy rate
Percent capacity occupied
Occupancy rate formula
(Avg daily census/number of available beds (capacity)) x 100
What is occupancy rate a measure of?
Performance
Days of care definition
The cumulative number of pt days over a certain period
