History of Hospitals Delivery of Inpatient Services

Hospitals

Health care in the United States has evolved through governmental and private answers to historical trends, starting with the first days of the United States. Often arising as responses to serious gaps in health care, these remedies traditionally build on each other and have resulted in a uniquely American health care system. The trickle of Baby Boomers into "the elderly" is now posing new challenges for both governmental and private providers, which must be met by new responses and a newly adapted health care system.

Discuss the government's role in responding to historical trends that impact the delivery of hospital care and how this has added to the expansion of hospitals in the United States.

Commencing with the very existence of our Republic, the United States government has taken a leading role in dealing with historical trends, significantly impacting delivery of hospital care and expansion of hospitals in this Country. Typically an historical trend led to government intervention, establishment and/or additional powers given to governmental agencies, and funding. For example, the American Revolutionary war created a marked need for hospital services to war veterans; consequently, the federal government established the U.S. Marine Hospital Services in 1798. In addition, in 1918, near the end of World War I, the severe need for public health services across the states, coupled with the states' lack of funding to provide those services, led to the first federal grants to states enabling them to provide public health services. After World War I, the greatly increased hospitalization needs of war veterans and the inadequacies of the existing system to fulfill those needs led to the World War Veterans Act in 1924. During the Great Depression, specifically in 1933, the Federal Emergency Relief Act was passed to provide federal funding for medical care of the elderly. In 1935, also during the Great Depression, Congress passed the Social Security Act, providing funds for maternity healthcare, child healthcare, specific types of healthcare for crippled children, the aged, the blind and the disabled. Due to pressures from the federal government, by 1948 every state had workers' compensation laws, providing in part for hospitalization. In 1956, Congress passed the Dependents Medical Care Act, setting up the CHAMPUS program. In 1959, Blue Cross negotiated to cover the healthcare costs of federal employees per the Federal Employees Health Benefit Act. In 1960, Title XVI of the Social Security Act created a program for medical assistance to the aged. In 1962, Congress passed the Health Services for Agricultural Migratory Workers Act to ensure adequate healthcare services for migrant workers. In 1965, Congress passed Title XVIII for Medicare and Title XIX for Medicaid, adding both to the Social Security Act. In 1974, Congress passed ERISA, which exempted self-insured companies from state-mandated health insurance benefits (Barton, 2010, p. 176). On March 23, 2010, the Affordable Care Act, also known as Healthcare Reform, became law and already requires a 50% discount for name-brand drugs in the Medicare "donut hole," expanded coverage for young adults, small business tax credits and pre-Existing Condition Insurance Plans. The Act will continue to "roll out," be mostly implemented by 2014. The ideal of this Act is to make adequate healthcare, including hospitalization, affordable to all individuals in the United States without financially breaking a hospitalization system that cannot afford to continue treating the uninsured and underinsured (U.S. Department of Health and Human Services, 2012). The resulting historical interaction between private healthcare providers, including hospitals, and governmental intervention/funding/agencies, has created a uniquely American healthcare system in which most healthcare is provided "privately" but is historically and currently monitored and at least partially funded by the government (Barton, 2010, p. 90).

Explain the difference between inpatient and outpatient care.

"Inpatient Care" is health care provided to a patient who is admitted to a hospital, nursing home, or other extended care facility. Inpatient hospitalization, in particular, tends to involve major diagnostic, therapeutic and/or surgical services when a patient's condition and/or response to medication must be constantly monitored (Hays Companies, n.d.). "Outpatient Care" is health care provided to a patient who is not admitted to a facility. In this instance, care may be provided in a hospital's outpatient department, in a clinic, at a doctor's office or in the patient's home (Hays Companies, n.d.).

Discuss how the growing aging population impacts hospital care.

"Baby Boomers," those U.S. residents born from the mid-1940's through the mid-1960's and who compose the largest age-related segment of our population, started reaching the age of 65 in 2011. As of 2002, 34.7 million Americans were 65 or older; however, that figure will rise to 69.4 million by 2032. In 2002, there were 9.2 million Americans who were 80 or older; however, by 2050, 31.6 million Americans will be 80 or older; finally, by 2050 there will be approximately 1 million Americans who are 100 years of age or older (Setness, 2002). Setness also observes that there will be a significant shift in the number of retirees vs. The number of employees, resulting in an "unimagined" use of Social Security, Medicare and Medicaid benefits while the traditional funding for those programs understandably shrinks along with the workforce. Finally, longevity often results in more chronic disease such as arthritis, heart disease, Alzheimer's disease and osteoporosis, and as more Baby Boomers reach later and later ages, the healthcare system will see a significant increase in the need for treatment of those chronic diseases (Setness, 2002). The three factors of aging Baby Boomers, increased use of Social Security, Medicare and Medicaid accompanied by decreased traditional funding, and a logical rise in elderly-related chronic disease will mean that hospitals will need to allocate greater resources and personnel to treating the elderly and their chronic diseases while funding for that treatment will need to be adapted by governmental and private sectors.