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Hospitals aren't becoming obsolete, but their role is changing. Hospitals were once a place where patients were kept for extended periods of time; now for reas

Hospitals aren't becoming obsolete, but their role is changing. Hospitals were once a place where patients were kept for extended periods of time; now for reasons of cost, sanitation, improved surgical techniques, and patient preference they're increasingly places where patients go for medical treatment but unless they're on the verge of death (and thus may need further treatment in very short order) patients then return to the community. More surgeries; less meals and laundry. Rather than becoming obsolete, I'd say that hospitals are gaining an increased focus.

jacobolus 9y ago
What’s the relative cost of in-patient vs. out-patient care?
- lojack 9y ago
  I don't have an answer to your question, but I recently spent some time at the hospital taking care of my daughter, and my understanding is that a lot of it comes down to the fact that hospitals are able to provide good enough care to be comfortable discharging patients earlier. It used to be more common to keep patients at the hospital just in case, but they now send patients home in many of those cases. In my (unprofessional) opinion, this is a good thing. Recovery is much easier in the comfort of our own home, without the stress of being woken up at all hours of the night for tests. We're also completely avoiding a huge risk -- hospital borne infections.
- chimeracoder 9y ago
  > What’s the relative cost of in-patient vs. out-patient care? They're not directly comparable, because the care delivered is fundamentally different, but inpatient care is about two orders of magnitude more expensive. That's not to say that reduction of inpatient care is always a goal, though, because it's only a good tradeoff when the outpatient care actually would provide equivalent or better clinical outcomes. Sometimes that's true, sometimes it's not.
  - maxerickson 9y ago
    Are the costs 100x or are the chargemaster prices 100x? What are a couple of the major factors driving such a huge difference?
- kurthr 9y ago
  To give you a very round number it is several $k per day depending on where in the country ($2-5k) and what hospital for a bed in a two person room with 24h nursing floor care. That does not include doctors, meals, medications, tests, etc. If you're in an ICU or surgery it is easily 2-20x higher than that so you can't compare it. A skilled nursing facility or hospice can be less than $1k per day. In home care even with 8 to 24h nursing can be had for a similar price or lower than a skilled nursing facility ($50-100/hr) with much better quality of life and lower risk of infection if you go to reasonable efforts to keep it clean.
  - Blahah 9y ago
    This doesn't make sense to me. Please correct me if I'm wrong. A hotel can easily provide room and board (essentially the services of a hospital's basic in-patient care) for <$100 a night. The hospital also has a ton of equipment and staff that are additional, but how can it possibly be as much as $1900-$4900? I feel like in-patient care is similar to a hotel but with extra stuff that might increase the cost by a factor of (perhaps) 2-5. But not 10-25. That would suggest that there's some major inefficiency in hospitals causing the cost bloat. You said the price is before doctors, medications, tests, etc. so the service is essentially just accomodation. How can it be so expensive?
    - tetrazine 9y ago
      Hospitals have needs that hotels don't from the ground up. They have different architecture, interior design, and HVAC needs, they have different real estate needs, they need to be robust to natural disasters, they maintain services like ambulances and a vast records and bookkeeping system. Sanitation requirements are much higher, there's no reason to assume costs there scale linearly - think about night shifts. Hospital workers usually are more unionized than hotel workers (should a hotel room be <$100 a night?). I believe nurses do a lot of work that lower trained/skilled/paid workers would do in a hotel. Then you can start throwing in the inflated costs due to the American insurance system, the higher liability hospitals have compared to hotels, and other factors. I'm sure people more familiar with the medical profession could add even more exacerbating factors that I don't know about. All of this isn't to say that the hospital or healthcare system isn't inefficient, but simply that hospitals and hotels are apples and oranges.
xaldir 9y ago
>patient preference As a patient, I'm always suspicious when I see this. When I'm in a bad enough shape to go to the hospital, going home is not my priority, getting better is. As someone who also work in an hospital, pushing patients out as quickly as possible has more to do with financial objectives than anything else. (e.g. we were told that our hospital should have 25% less beds by 2020)
- kingkongjaffa 9y ago
  how and why would you plan to have less beds in the future? Is that backed by population growth and average hospital utilisation per person or some other metric?
  - frobozz 9y ago
    If you can do more outpatient work, you can reduce the bed count, the cost of having a patient taking up a bed in a hospital is very high, even if they are as close to perfect health as possible and are just waiting to be discharged. This is money that could employ another doctor or buy another piece of health-giving equipment. The sooner you can kick a patient out of hospital, the sooner they become someone else's problem, coming out of someone else's budget. In a publicly-funded system, the local authority may pay for in-home care visits and the patient's GP may be responsible for post-hospital outcomes. Stupid PFI deals can mean that the cost-per-bed is ludicrous, and that money that could be going towards patient care is being funnelled to failing companies like Carillion. In an insurance-funded system, the relationship between costs and fees comes down to negotiation between the hospitals and the insurance companies, rather than from the hospital simply coming up with the fees and the insurance companies paying them. This may mean that the income per-bed-per-night is less than it costs, whilst the income per procedure is higher than it costs. Even if the hospital is still responsible for post-discharge care, they may be able to make more profit out of expensive home visits by low-paid carers than in-ward rounds by higher-paid nurses.
- fifteenforty 9y ago
  >> patient preference > As a patient, I'm always suspicious when I see this. There are many practices in medicine that exist only because of patient perference and despite their harm. I think this is because of ongoing poor health education amongst the general public, physicians who are worn out and choose their battles and that private health care systems (at least in Aus) reward practitioners who get good feedback from patients better than those who have the best health outcomes.

jacobolus 9y ago

What’s the relative cost of in-patient vs. out-patient care?

lojack 9y ago
I don't have an answer to your question, but I recently spent some time at the hospital taking care of my daughter, and my understanding is that a lot of it comes down to the fact that hospitals are able to provide good enough care to be comfortable discharging patients earlier. It used to be more common to keep patients at the hospital just in case, but they now send patients home in many of those cases. In my (unprofessional) opinion, this is a good thing. Recovery is much easier in the comfort of our own home, without the stress of being woken up at all hours of the night for tests. We're also completely avoiding a huge risk -- hospital borne infections.
chimeracoder 9y ago
> What’s the relative cost of in-patient vs. out-patient care? They're not directly comparable, because the care delivered is fundamentally different, but inpatient care is about two orders of magnitude more expensive. That's not to say that reduction of inpatient care is always a goal, though, because it's only a good tradeoff when the outpatient care actually would provide equivalent or better clinical outcomes. Sometimes that's true, sometimes it's not.
- maxerickson 9y ago
  Are the costs 100x or are the chargemaster prices 100x? What are a couple of the major factors driving such a huge difference?
kurthr 9y ago
To give you a very round number it is several $k per day depending on where in the country ($2-5k) and what hospital for a bed in a two person room with 24h nursing floor care. That does not include doctors, meals, medications, tests, etc. If you're in an ICU or surgery it is easily 2-20x higher than that so you can't compare it. A skilled nursing facility or hospice can be less than $1k per day. In home care even with 8 to 24h nursing can be had for a similar price or lower than a skilled nursing facility ($50-100/hr) with much better quality of life and lower risk of infection if you go to reasonable efforts to keep it clean.
- Blahah 9y ago
  This doesn't make sense to me. Please correct me if I'm wrong. A hotel can easily provide room and board (essentially the services of a hospital's basic in-patient care) for <$100 a night. The hospital also has a ton of equipment and staff that are additional, but how can it possibly be as much as $1900-$4900? I feel like in-patient care is similar to a hotel but with extra stuff that might increase the cost by a factor of (perhaps) 2-5. But not 10-25. That would suggest that there's some major inefficiency in hospitals causing the cost bloat. You said the price is before doctors, medications, tests, etc. so the service is essentially just accomodation. How can it be so expensive?
  - tetrazine 9y ago
    Hospitals have needs that hotels don't from the ground up. They have different architecture, interior design, and HVAC needs, they have different real estate needs, they need to be robust to natural disasters, they maintain services like ambulances and a vast records and bookkeeping system. Sanitation requirements are much higher, there's no reason to assume costs there scale linearly - think about night shifts. Hospital workers usually are more unionized than hotel workers (should a hotel room be <$100 a night?). I believe nurses do a lot of work that lower trained/skilled/paid workers would do in a hotel. Then you can start throwing in the inflated costs due to the American insurance system, the higher liability hospitals have compared to hotels, and other factors. I'm sure people more familiar with the medical profession could add even more exacerbating factors that I don't know about. All of this isn't to say that the hospital or healthcare system isn't inefficient, but simply that hospitals and hotels are apples and oranges.

xaldir 9y ago

>patient preference As a patient, I'm always suspicious when I see this. When I'm in a bad enough shape to go to the hospital, going home is not my priority, getting better is. As someone who also work in an hospital, pushing patients out as quickly as possible has more to do with financial objectives than anything else. (e.g. we were told that our hospital should have 25% less beds by 2020)

kingkongjaffa 9y ago
how and why would you plan to have less beds in the future? Is that backed by population growth and average hospital utilisation per person or some other metric?
- frobozz 9y ago
  If you can do more outpatient work, you can reduce the bed count, the cost of having a patient taking up a bed in a hospital is very high, even if they are as close to perfect health as possible and are just waiting to be discharged. This is money that could employ another doctor or buy another piece of health-giving equipment. The sooner you can kick a patient out of hospital, the sooner they become someone else's problem, coming out of someone else's budget. In a publicly-funded system, the local authority may pay for in-home care visits and the patient's GP may be responsible for post-hospital outcomes. Stupid PFI deals can mean that the cost-per-bed is ludicrous, and that money that could be going towards patient care is being funnelled to failing companies like Carillion. In an insurance-funded system, the relationship between costs and fees comes down to negotiation between the hospitals and the insurance companies, rather than from the hospital simply coming up with the fees and the insurance companies paying them. This may mean that the income per-bed-per-night is less than it costs, whilst the income per procedure is higher than it costs. Even if the hospital is still responsible for post-discharge care, they may be able to make more profit out of expensive home visits by low-paid carers than in-ward rounds by higher-paid nurses.
fifteenforty 9y ago
>> patient preference > As a patient, I'm always suspicious when I see this. There are many practices in medicine that exist only because of patient perference and despite their harm. I think this is because of ongoing poor health education amongst the general public, physicians who are worn out and choose their battles and that private health care systems (at least in Aus) reward practitioners who get good feedback from patients better than those who have the best health outcomes.