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10 Reasons Public and Private Hospitals
Should Consider a Partnership Before
2014
)ecember *010 + (' ,ebecca (ales- .P!- !!
(et&een no& and *01/- public hospitals in this countr' are doing one o0 three things1 12
3etting read' 0or healthcare re0orm- so ne&l' insured patients &ill select them in *01/4
*2 5inding a partner to help them prepare 0or healthcare re0orm and split up the
continuum o0 care and services bet&een the partners4 and 32 3etting out o0 the business
grace0ull' over the ne6t three 'ears- rather than spend millions to create the in0rastructure
0or healthcare re0orm.
7ere are ten issues 0or the private and public sector to consider1
1. Most of the surviving public hospitals have etensive eperience i!ple!enting
and eecuting "ualit# i!prove!ent progra!s. !ccustomed to operating in an
environment o0 declining government 0unding and increasingl' limited access to capital
markets- public hospitals have long been 0ocused on cost containment and 8ualit'.
!ccording to 8ualit' per0ormance data 0rom #.9 7ospital #ompare &ebsite- &hich
includes data through :ul' *00;- members o0 %ational !ssociation o0 Public 7ospitals
<=%!P7=2 outscore the average 0or all ".. hospitals in 18 o0 */ measures. !dditionall'-
%!P7 members improved their scores 0or all *1 measures since *00> <the measures &ere
introduced in *0082.
2. Man# public hospitals have epertise in coordinating and !anaging the full
continuu! of patient care $ithin co!!unities. !s currentl' planned- healthcare
re0orm &ill make 0ederal 0unding available to develop medical homes &ith the goal o0
improving access to primar' care and coordination o0 care 0or chronicall' ill patients. !
*008 surve' o0 %!P7 members 0ound /6 e6isting medical home programs.
%. Public hospitals have eperience in dealing $ith high levels of
Medicaid&underinsured patients. "nder health re0orm- there is pro?ected to be a
substantial increase in the covered population during *01/ and be'ond as health
insurance mandates kick in along &ith subsidies and ta6 credits. .an' o0 those currentl'
&ithout insurance are e6pected to gain coverage through .edicaid. This &ill result in an
increase in .edicaid covered patients 0or man' private health s'stems. Public hospitals
should be &ell prepared 0or this surge given their e6perience in treating .edicaid@based
patients- &ho have increased signi0icantl' since the recession started in *008 <ever' 1
percent rise in unemplo'ment has resulted in an increase o0 1-000-000 ne& .edicaid
enrollees- according to the Aaiser #ommission on .edicaid and the "ninsured2. 5or
private hospitals- this allo&s them to partner &ith providers that alread' kno& ho& to
take care o0 the appro6imatel' 30 million uninsured &ho &ill be insured in *01/.
4. Most public hospitals have strong' long(standing acade!ic affiliations in place. $n
*008- %!P7 members trained *1 percent o0 doctors and more than 36 percent o0 allied
health pro0essionals &ho received their training at acute care 0acilities- despite
representing onl' * percent o0 the acute care hospitals in the countr'. These a00iliations
also provide opportunities 0or public hospitals to access ne& 0ederal health re0orm grant
monies available 0or ph'sician and allied health training.
). Public hospitals have access to safet# net funds and grants. T'picall' B0 percent o0
a public hospital9s unreimbursed costs are covered b' supplemental .edicaid and
.edicare pa'ments- such as disproportionate share hospital <=)7=2 and other sa0et' net
programs. With their e6perience in establishing clinics- medical homes- and emergenc'
departments- public hospitals are &ell positioned to secure 0ederal 0unding in these areas
as &ell- at least bet&een no& and *01/.
*. Private hospital s#ste!s bring !anage!ent and operational epertise. .ost public
hospitals are stand@alone and &ould bene0it 0rom the resources o00ered b' nonpro0it and
0or@pro0it health s'stems. The civil service s'stems and the operational comple6ities o0
government o0ten make it di00icult to attract the most e6perienced emplo'ees in
management and technical positions. ! private partner can supplement or provide
support s'stems in areas such as in0ormation technolog'- revenue c'cle management-
purchasing- and pa'er contracting.
+. Private hospital s#ste!s can bring an infusion of !uch needed capital. !0ter
struggling 0or 'ears to 0und their capital needs and access the bond market- )etroit
.edical #enter got a commitment 0rom the private sector to invest C8B0 million in
capital improvements during the ne6t 0ive 'ears &hen the' agreed to be ac8uired b'
Danguard 7ealth 'stems $nc.- &ho also agreed to retire C/1> million in outstanding
debt. ! sale or partnership &ith a private s'stem can relieve the district- state- or count'
0rom being both the pa'er and provider in healthcare.
,. Private hospital s#ste!s can create econo!ies of scale. With larger purchasing
volumes- private hospital s'stems can create bargaining leverage to ma6imiEing savings
on vendor negotiations. !s stand@alone healthcare entities- most public hospitals do not
have the volume to generate signi0icant savings through group purchases and bundling.
-. Most public hospitals have achieved ph#sician integration. ince man' ph'sicians
&ill not accept .edicaid or uninsured patients- public hospitals have al&a's emplo'ed or
contracted &ith ph'sicians across a &ide range o0 specialties to better care 0or their
patients. $n states &here hospitals are prohibited 0rom emplo'ing ph'sicians- public
hospitals are t'picall' e6empted- and their linkages to teaching programs make it easier
to access and engage seasoned 0acult' members and resident ph'sicians.
10. Public(private partnerships can create governance !odels that are !ore agile
and infor!ed than boards co!posed of elected officials. Partnering &ith the private
sector can result in an advisor' board or actual decision@making board that has a broader
perspective on business and communit' issues- potentiall' includes members &ith
healthcare e6perience- and is more in0ormed on current healthcare matters and trends.
ome public hospitals- such as #ook #ount' in $llinois and .ontere' #ount' in
#ali0ornia- have bene0ited 0rom 0orming non@elected advisor' boards &ithout changing
o&nership o0 their core services.
For more information on public hospitals, please contact Rebecca Bales at 310.320.3990
or rbales@thecamdengroup.com

F *01/ 7ealthcare #onsulting G The #amden 3roup !ll right reserved.
Privac' Polic'
Terms and #onditions
ite .ap
10 Reasons Public and Private Hospitals
Should Consider a Partnership Before
2014
)ecember *010 + (' ,ebecca (ales- .P!- !!
(et&een no& and *01/- public hospitals in this countr' are doing one o0 three things1 12
3etting read' 0or healthcare re0orm- so ne&l' insured patients &ill select them in *01/4
*2 5inding a partner to help them prepare 0or healthcare re0orm and split up the
continuum o0 care and services bet&een the partners4 and 32 3etting out o0 the business
grace0ull' over the ne6t three 'ears- rather than spend millions to create the in0rastructure
0or healthcare re0orm.
7ere are ten issues 0or the private and public sector to consider1
1. Most of the surviving public hospitals have etensive eperience i!ple!enting
and eecuting "ualit# i!prove!ent progra!s. !ccustomed to operating in an
environment o0 declining government 0unding and increasingl' limited access to capital
markets- public hospitals have long been 0ocused on cost containment and 8ualit'.
!ccording to 8ualit' per0ormance data 0rom #.9 7ospital #ompare &ebsite- &hich
includes data through :ul' *00;- members o0 %ational !ssociation o0 Public 7ospitals
<=%!P7=2 outscore the average 0or all ".. hospitals in 18 o0 */ measures. !dditionall'-
%!P7 members improved their scores 0or all *1 measures since *00> <the measures &ere
introduced in *0082.
2. Man# public hospitals have epertise in coordinating and !anaging the full
continuu! of patient care $ithin co!!unities. !s currentl' planned- healthcare
re0orm &ill make 0ederal 0unding available to develop medical homes &ith the goal o0
improving access to primar' care and coordination o0 care 0or chronicall' ill patients. !
*008 surve' o0 %!P7 members 0ound /6 e6isting medical home programs.
%. Public hospitals have eperience in dealing $ith high levels of
Medicaid&underinsured patients. "nder health re0orm- there is pro?ected to be a
substantial increase in the covered population during *01/ and be'ond as health
insurance mandates kick in along &ith subsidies and ta6 credits. .an' o0 those currentl'
&ithout insurance are e6pected to gain coverage through .edicaid. This &ill result in an
increase in .edicaid covered patients 0or man' private health s'stems. Public hospitals
should be &ell prepared 0or this surge given their e6perience in treating .edicaid@based
patients- &ho have increased signi0icantl' since the recession started in *008 <ever' 1
percent rise in unemplo'ment has resulted in an increase o0 1-000-000 ne& .edicaid
enrollees- according to the Aaiser #ommission on .edicaid and the "ninsured2. 5or
private hospitals- this allo&s them to partner &ith providers that alread' kno& ho& to
take care o0 the appro6imatel' 30 million uninsured &ho &ill be insured in *01/.
4. Most public hospitals have strong' long(standing acade!ic affiliations in place. $n
*008- %!P7 members trained *1 percent o0 doctors and more than 36 percent o0 allied
health pro0essionals &ho received their training at acute care 0acilities- despite
representing onl' * percent o0 the acute care hospitals in the countr'. These a00iliations
also provide opportunities 0or public hospitals to access ne& 0ederal health re0orm grant
monies available 0or ph'sician and allied health training.
). Public hospitals have access to safet# net funds and grants. T'picall' B0 percent o0
a public hospital9s unreimbursed costs are covered b' supplemental .edicaid and
.edicare pa'ments- such as disproportionate share hospital <=)7=2 and other sa0et' net
programs. With their e6perience in establishing clinics- medical homes- and emergenc'
departments- public hospitals are &ell positioned to secure 0ederal 0unding in these areas
as &ell- at least bet&een no& and *01/.
*. Private hospital s#ste!s bring !anage!ent and operational epertise. .ost public
hospitals are stand@alone and &ould bene0it 0rom the resources o00ered b' nonpro0it and
0or@pro0it health s'stems. The civil service s'stems and the operational comple6ities o0
government o0ten make it di00icult to attract the most e6perienced emplo'ees in
management and technical positions. ! private partner can supplement or provide
support s'stems in areas such as in0ormation technolog'- revenue c'cle management-
purchasing- and pa'er contracting.
+. Private hospital s#ste!s can bring an infusion of !uch needed capital. !0ter
struggling 0or 'ears to 0und their capital needs and access the bond market- )etroit
.edical #enter got a commitment 0rom the private sector to invest C8B0 million in
capital improvements during the ne6t 0ive 'ears &hen the' agreed to be ac8uired b'
Danguard 7ealth 'stems $nc.- &ho also agreed to retire C/1> million in outstanding
debt. ! sale or partnership &ith a private s'stem can relieve the district- state- or count'
0rom being both the pa'er and provider in healthcare.
,. Private hospital s#ste!s can create econo!ies of scale. With larger purchasing
volumes- private hospital s'stems can create bargaining leverage to ma6imiEing savings
on vendor negotiations. !s stand@alone healthcare entities- most public hospitals do not
have the volume to generate signi0icant savings through group purchases and bundling.
-. Most public hospitals have achieved ph#sician integration. ince man' ph'sicians
&ill not accept .edicaid or uninsured patients- public hospitals have al&a's emplo'ed or
contracted &ith ph'sicians across a &ide range o0 specialties to better care 0or their
patients. $n states &here hospitals are prohibited 0rom emplo'ing ph'sicians- public
hospitals are t'picall' e6empted- and their linkages to teaching programs make it easier
to access and engage seasoned 0acult' members and resident ph'sicians.
10. Public(private partnerships can create governance !odels that are !ore agile
and infor!ed than boards co!posed of elected officials. Partnering &ith the private
sector can result in an advisor' board or actual decision@making board that has a broader
perspective on business and communit' issues- potentiall' includes members &ith
healthcare e6perience- and is more in0ormed on current healthcare matters and trends.
ome public hospitals- such as #ook #ount' in $llinois and .ontere' #ount' in
#ali0ornia- have bene0ited 0rom 0orming non@elected advisor' boards &ithout changing
o&nership o0 their core services
@ ee more at1 http1HH&&&.thecamdengroup.comHthought@leadershipHtop@tenH10@reasons@
public@and@private@hospitals@should@consider@a@partnership@be0ore@
*01/HIsthash.$h7n;'a*.dpu0
@ ee more at1 http1HH&&&.thecamdengroup.comHthought@leadershipHtop@tenH10@reasons@
public@and@private@hospitals@should@consider@a@partnership@be0ore@
*01/HIsthash.$h7n;'a*.dpu0
Public hospital
5rom Wikipedia- the 0ree enc'clopedia
! public hospital or govern!ent hospital is a hospital &hich is o&ned b' a government
and receives government 0unding. $n some countries- this t'pe o0 hospital provides
medical care 0ree o0 charge- the cost o0 &hich is covered b' the 0unding the hospital
receives.
Contents
1 !ustralia
* (raEil
3 #anada
/ %or&a'
B outh !0rica
6 "nited Aingdom
> "nited tates
8 $ndia
; ee also
10 ,e0erences
Australia
$n !ustralia- public hospitals are operated and 0unded b' each individual state9s health
department. The 0ederal government also contributes 0unding. ervices in public hospitals
0or all !ustralian citiEens and permanent residents are 0ull' subsidiEed b' the 0ederal
government9s .edicare "niversal 7ealthcare program. 7ospitals in !ustralia treat all
!ustralian citiEens and permanent residents regardless o0 their age- income- or social
status.
Jmergenc' )epartments are almost e6clusivel' 0ound in public hospitals. Private
hospitals rarel' operate emergenc' departments- and patients treated at these private
0acilities are billed 0or care. ome costs- ho&ever <patholog'- K@ra'2 ma' 8uali0' 0or
billing under .edicare.
Where patients hold private health insurance- a0ter initial treatment b' a public hospital9s
emergenc' department- the patient has the option o0 being trans0erred to a private
hospital.
Brazil
The braEilian health s'stem is a mi6 composed b' public hospitals- non@pro0it
philanthropic hospitals- and private hospitals. The ma?orit' o0 lo& and medium income
population uses services provided b' a public hospitals run b' either tate or b' the
municipalit'. ince the inception o0 1;88 5ederal #onstitution- health care is an universal
right 0or ever'one living in (raEil1 citiEens- permanent residents- and 0oreigner. 5or that
reason- braEilian government created a national public health insurance s'stem called
" <istema "nico de aude- "ni0ied 7ealth 'stem2 &here all public 0unded hospitals
<public and philanthropic entities2receive pa'ments based on number o0 patients and
procedures per0ormed. !lso- hospitals and health clinics are built b' government in all
three levels.
$n general- all patients are supposed to have a global coverage including emergenc' care-
preventive medicine- comple6 procedures- diagnostic procedures <blood e6ams- 6@ra's-
#T@scan- etc2- surgeries <e6cluding cosmetic procedures2- and medicines need to treat
their condition. (ecause the limitation in the budget- those services are o0ten unavailable
in most part o0 the countr'- in e6ception in large metropolis like ao Paulo- ,io de
:aneiro- and (elo 7oriEonte. Jven in those metropolis- the access to some comple6 health
care ma' take months i0 not completel' ignored. 7o&ever- patients that sued the
government &ere able to get their treatment covered b' the "- even &ith e6perimental
therapeutics.
,ecentl'- ne& legislation mandate that no private hospitals should re0use accept poor or
uninsured patients in case o0 li0e threat emergencies. #ost o0 emergenc' care in this case
is also paid b' ".
Canada
$n #anada all hospitals are 0unded through .edicare- #anada9s publicl' 0unded universal
health insurance s'stem.
L1M
7ospitals in #anada treat all #anadian citiEens and permanent
residents regardless o0 their age- income- or social status.
Norway
$n %or&a'- all public hospitals are 0unded 0rom the national budget
L*M
and run b' 0our
,egional 7ealth !uthorities <,7!2 o&ned b' the .inistr' o0 7ealth and #are ervices.
$n addition to the public hospitals- a 0e& privatel' o&ned health clinics are operating. The
0our ,egional 7ealth !uthorities are1 %orthern %or&a' ,egional 7ealth !uthorit'-
#entral %or&a' ,egional 7ealth !uthorit'- Western %or&a' ,egional 7ealth !uthorit'-
and outh@eastern %or&a' ,egional 7ealth !uthorit'.
L3ML/M
!ll citiEens are eligible 0or
treatment 0ree o0 charge in the public hospital s'stem. !ccording to The Patients9 ,ights
!ct-
LBM
all citiEens have the right to 5ree 7ospital #hoices.
L6M
South Africa
outh !0rica has private and public hospitals. Public hospitals are 0unded b' the
)epartment o0 7ealth. The ma?orit' o0 the patients use public hospitals in &hich patients
pa' a nominal 0ee- roughl' C3@B. The patients point o0 entr' usuall' is through primar'
health care <#linics2 usuall' run b' nurses. The ne6t level o0 care &ould be district
hospitals &hich have 3eneral Practitioners and basic radiographs. The ne6t level o0 care
&ould be ,egional hospitals &hich have general practitioners- specialists and $#"9s- and
#T #!%. The highest level o0 care is Tertiar' &hich includes super specialists- .,$
scans- and nuclear medicine scans.
Private patients either have healthcare insurance- kno&n as medical aid- or have to pa'
the 0ull amount privatel' i0 uninsured.
United Kingdom
$n the "A public hospitals provide health care 0ree at the point o0 use 0or the patient.
Private health care is used b' less than 8 percent o0 the population. The "A s'stem is
kno&n as the %ational 7ealth ervice <%72 and has been 0unded 0rom general ta6ation
since 1;/8.
United States
(en Taub 3eneral 7ospital in 7ouston- Te6as
$n the "nited tates- t&o thirds o0 all urban hospitals are non@pro0it. The remaining third
is split bet&een 0or@pro0it and public. The urban public hospitals are o0ten associated &ith
medical schools.
L>M
The largest public hospital s'stem in !merica is the %e& Nork #it'
7ealth and 7ospitals #orporation- &hich is associated &ith the %e& Nork "niversit'
chool o0 .edicine.
$n the "..- public hospitals receive signi0icant 0unding 0rom local- state- andHor 0ederal
governments. $n addition- the' ma' charge .edicaid- .edicare- and private insurers 0or
the care o0 patients. Public hospitals- especiall' in urban areas- have a high concentration
o0 uncompensated care and graduate medical education as compared to all other
!merican hospitals. Public hospitals in !merica are closing at a much 0aster rate than
hospitals overall. The number o0 public hospitals in ma?or suburbs declined *>O <13/ to
;82 0rom 1;;6 to *00*. $t is thought that the increase in uninsured has drained public
hospitals to near bankruptc'.
L8M
%on@pro0it rural hospitals &ere disproportionatel'
represented &ith high numbers o0 patients &ith uncompensated care. Public and non@
pro0it rural hospitals 0orm a large part o0 the health care sa0et' net 0or the uninsured and
poor underinsured in the "..
L;M
5or@pro0it hospitals &ere more likel' to provide pro0itable medical services and less
likel' to provide medical services that &ere relativel' unpro0itable. 3overnment or public
hospitals &ere more likel' to o00er relativel' unpro0itable medical services. %ot@0or@pro0it
hospitals o0ten 0ell in the middle bet&een public and 0or@pro0it hospitals in the t'pes o0
medical services the' provided. 5or@pro0it hospitals &ere 8uicker to respond to changes
in pro0itabilit' o0 medical services than the other t&o t'pes o0 hospitals.
L10M
$n *00;- at non@pro0it hospitals- the average #JO made C600-000 annuall'. The range
&as 0rom C100-000 to C3 million.
L11M
India
$n $ndia- public hospitals <called 3overnment 7ospitals2 provide health care 0ree at the
point o0 use 0or an' $ndian citiEen. These are usuall' individual state 0unded. 7o&ever-
hospitals 0unded b' the central <0ederal2 government also e6ist. tate hospitals are run b'
the state <local2 government and ma' be dispensaries- peripheral health centers- rural
hospital- district hospitals or medical college hospitals <hospitals &ith a00iliated medical
college2. $n man' states <like Tamil %adu2 the hospital bill is entirel' 0unded b' the state
government &ith patient not having to pa' an'thing 0or treatment. 7o&ever- other
hospitals &ill charge nominal amounts 0or admission to special rooms and 0or medical
and surgical consumables.
! hospital is a health care institution providing patient treatment &ith specialised sta00
and e8uipment. The best@kno&n t'pe o0 hospital is the general hospital- &hich has an
emergenc' department. ! district hospital t'picall' is the ma?or health care 0acilit' in its
region- &ith large numbers o0 beds 0or intensive care and long@term care. pecialised
hospitals include trauma centres- rehabilitation hospitals- children9s hospitals- seniors9
<geriatric2 hospitals- and hospitals 0or dealing &ith speci0ic medical needs such as
ps'chiatric problems <see ps'chiatric hospital2- certain disease categories. pecialised
hospitals can help reduce health care costs compared to general hospitals. ! teaching
hospital combines assistance to people &ith teaching to medical students and nurses. The
medical 0acilit' smaller than a hospital is generall' called a clinic. 7ospitals have a range
o0 departments <e.g.- surger'- and urgent care2 and specialist units such as cardiolog'.
ome hospitals &ill have outpatient departments and some &ill have chronic treatment
units. #ommon support units include a pharmac'- patholog'- and radiolog'.
7ospitals are usuall' 0unded b' the public sector- b' health organisations <0or pro0it or
nonpro0it2- health insurance companies- or charities- including direct charitable donations.
7istoricall'- hospitals &ere o0ten 0ounded and 0unded b' religious orders or charitable
individuals and leaders.
L1M
Toda'- hospitals are largel' sta00ed b' pro0essional ph'sicians-
surgeons- and nurses- &hereas in the past- this &ork &as usuall' per0ormed b' the
0ounding religious orders or b' volunteers. 7o&ever- there are various #atholic religious
orders- such as the !le6ians and the (on ecours isters- &hich still 0ocus on hospital
ministr' toda'- as &ell as several #hristian denominations- including the .ethodists and
Lutherans- &hich run hospitals.
L*M
$n accord &ith the original meaning o0 the &ord-
hospitals &ere originall' =places o0 hospitalit'=- and this meaning is still preserved in the
names o0 some institutions such as the ,o'al 7ospital #helsea- established in 1681 as a
retirement and nursing home 0or veteran soldiers.
Contents
1 Jt'molog'
* T'pes
o *.1 3eneral
o *.* )istrict
o *.3 pecialiEed
o *./ Teaching
o *.B #linics
3 )epartments
/ 7istor'
o /.1 Jarl' e6amples
o /.* ,oman Jmpire
o /.3 .edieval $slamic &orld
o /./ .edieval Jurope
o /.B Jarl' modern and Jnlightenment Jurope
o /.6 1;th centur'
B #riticism
6 5unding
> (uildings
o >.1 !rchitecture
8 ee also
; ,e0erences
10 (ibliograph'
o 10.1 7istor' o0 hospitals
11 J6ternal links
Etymology
)uring the .iddle !ges hospitals served di00erent 0unctions to modern institutions- being
almshouses 0or the poor- hostels 0or pilgrims- or hospital schools. The &ord hospital
comes 0rom the Latin hospes- signi0'ing a stranger or 0oreigner- hence a guest. !nother
noun derived 0rom this- hospitium came to signi0' hospitalit'- that is the relation bet&een
guest and shelterer- hospitalit'- 0riendliness- hospitable reception. (' meton'm' the Latin
&ord then came to mean a guest@chamber- guest9s lodging- an inn.
L3M
Hospes is thus the
root 0or the Jnglish &ords host <&here the p &as dropped 0or convenience o0
pronunciation2 hospitalit- hospice- hostel and hotel. The latter modern &ord derives
0rom Latin via the ancient 5rench romance &ord hostel- &hich developed a silent s-
&hich letter &as eventuall' removed 0rom the &ord- the loss o0 &hich is signi0ied b' a
circum0le6 in the modern 5rench &ord h!tel. The 3erman &ord 9pital9 shares similar
roots.
3rammar o0 the &ord di00ers slightl' depending on the dialect. $n the "..- hospital
usuall' re8uires an article4 in (ritain and else&here- the &ord normall' is used &ithout an
article &hen it is the ob?ect o0 a preposition and &hen re0erring to a patient <=inHto the
hospital= vs. =inHto hospital=24 in #anada- both uses are 0ound.
Lcitation neededM
Types
Lehigh Dalle' 7ospital in !llento&n- Penns'lvania
ome patients go to a hospital ?ust 0or diagnosis- treatment- or therap' and then leave
<9outpatients92 &ithout sta'ing overnight4 &hile others are 9admitted9 and sta' overnight or
0or several da's or &eeks or months <9inpatients92. 7ospitals usuall' are distinguished
0rom other t'pes o0 medical 0acilities b' their abilit' to admit and care 0or inpatients
&hilst the others o0ten are described as clinics.
General
The best@kno&n t'pe o0 hospital is the general hospital- &hich is set up to deal &ith man'
kinds o0 disease and in?ur'- and normall' has an emergenc' department to deal &ith
immediate and urgent threats to health. Larger cities ma' have several hospitals o0
var'ing siEes and 0acilities. ome hospitals- especiall' in the "nited tates- have their
o&n ambulance service.
District
! district hospital t'picall' is the ma?or health care 0acilit' in its region- &ith large
numbers o0 beds 0or intensive care and long@term care.
$n #ali0ornia- =)istrict hospital= re0ers speci0icall' to a class o0 healthcare 0acilit' created
shortl' a0ter World War $$ to address a shortage o0 hospital beds in man' local
communities.
L/MLBM
Jven toda'- )istrict hospitals are the sole public hospitals in 1; o0
#ali0ornia9s counties-
L/M
and are the sole locall'@accessible hospital &ithin ; additional
counties in &hich one or more other hospitals are present at substantial distance 0rom a
local communit'.
L/M
T&ent'@eight o0 #ali0ornia9s rural hospitals and *0 o0 its critical@
access hospitals are )istrict hospitals.
LBM
#ali0ornia9s )istrict hospitals are 0ormed b' local municipalities- have (oards that are
individuall' elected b' their local communities- and e6ist to serve local needs.
L/MLBM
The'
are a particularl' important provider o0 healthcare to uninsured patients and patients &ith
.edi@#al <&hich is #ali0ornia9s .edicaid program- serving lo&@income persons- some
senior citiEens- persons &ith disabilities- children in 0oster care- and pregnant &omen2.
L/MLBM
$n *01*- )istrict hospitals provided CB/ million in uncompensated care in #ali0ornia.
LBM
Specialized
.c.aster "niversit' .edical #entre- a teaching hospital in #anada
T'pes o0 specialised hospitals include trauma centres- rehabilitation hospitals- children9s
hospitals- seniors9 <geriatric2 hospitals- and hospitals 0or dealing &ith speci0ic medical
needs such as ps'chiatric problems <see ps'chiatric hospital2- certain disease categories
such as cardiac- oncolog'- or orthopedic problems- and so 0orth. $n 3erman' specialised
hospitals are called Fach"ran"enhaus4 an e6ample is 5achkrankenhaus #os&ig <thoracic
surger'2.
! hospital ma' be a single building or a number o0 buildings on a campus. .an'
hospitals &ith pre@t&entieth@centur' origins began as one building and evolved into
campuses. ome hospitals are a00iliated &ith universities 0or medical research and the
training o0 medical personnel such as ph'sicians and nurses- o0ten called teaching
hospitals. World&ide- most hospitals are run on a nonpro0it basis b' governments or
charities. There are ho&ever a 0e& e6ceptions- e.g. #hina- &here government 0unding
onl' constitutes 10O o0 income o0 hospitals. #need citation here. $hinese sources seem
conflicted about the for%profit&non%profit ratio of hospitals in $hina'
pecialised hospitals can help reduce health care costs compared to general hospitals. 5or
e6ample- %ara'ana 7ruda'ala'a9s (angalore cardiac unit- &hich is specialised in cardiac
surger'- allo&s 0or signi0icantl' greater number o0 patients. $t has 3000 beds <more than
*0 times the average !merican hospital2 and in pediatric heart surger' alone- it per0orms
3000 heart operations annuall'- making it b' 0ar the largest such 0acilit' in the &orld.
L6ML>M

urgeons are paid on a 0i6ed salar' instead o0 per operation- thus the costs to the hospital
drops &hen the number o0 procedures increases- taking advantage o0 economies o0 scale.
L6M
!dditionall'- it is argued that costs go do&n as all its specialists become e00icient b'
&orking on one =production line= procedure.
L>M
Teaching
! teaching hospital combines assistance to people &ith teaching to medical students and
nurses and o0ten is linked to a medical school- nursing school or universit'.
Clinics
.ain article1 #linic
The medical 0acilit' smaller than a hospital is generall' called a clinic- and o0ten is run
b' a government agenc' 0or health services or a private partnership o0 ph'sicians <in
nations &here private practise is allo&ed2. #linics generall' provide onl' outpatient
services.
epartments
,esuscitation room bed a0ter a trauma intervention- sho&ing the highl' technical
e8uipment o0 modern hospitals
7ospitals var' &idel' in the services the' o00er and there0ore- in the departments <or
=&ards=2 the' have. Jach is usuall' headed b' a #hie0 Ph'sician. The' ma' have acute
services such as an emergenc' department or specialist trauma centre- burn unit- surger'-
or urgent care. These ma' then be backed up b' more specialist units such as1
Jmergenc' department
#ardiolog'
$ntensive care unit
o Paediatric intensive care unit
o %eonatal intensive care unit
o #ardiovascular intensive care unit
%eurolog'
Oncolog'
Obstetrics and g'naecolog'
ome hospitals &ill have outpatient departments and some &ill have chronic treatment
units such as behavioral health services- dentistr'- dermatolog'- ps'chiatric &ard-
rehabilitation services- and ph'sical therap'.
#ommon support units include a dispensar' or pharmac'- patholog'- and radiolog'- and
on the non@medical side- there o0ten are medical records departments- release o0
in0ormation departments- $n0ormation .anagement <aka $.- $T or $2- #linical
Jngineering <aka (iomed2- 5acilities .anagement- Plant Ops <aka .aintenance2- )ining
ervices- and ecurit' departments.
!istory
.ain article1 7istor' o0 hospitals
Early examples
Die& o0 the (s"leipion o0 Aos- the best preserved instance o0 an !sklepieion.
The earliest documented institutions aiming to provide cures &ere ancient Jg'ptian
temples. $n ancient 3reece- temples dedicated to the healer@god !sclepius- kno&n as
(sclepieia 0unctioned as centres o0 medical advice- prognosis- and healing.
L8M
!sclepeia
provided care0ull' controlled spaces conducive to healing and 0ul0illed several o0 the
re8uirements o0 institutions created 0or healing.
L;M
"nder his ,oman name Psculapius- he
&as provided &ith a temple <*;1 (#2 on an island in the Tiber in ,ome- &here similar
rites &ere per0ormed.
L10M
$nstitutions created speci0icall' to care 0or the ill also appeared earl' in $ndia. 5a Kian- a
#hinese (uddhist monk &ho travelled across $ndia ca. /00 #J- recorded in his travelogue
that1 The heads o0 the Dais'a LmerchantM 0amilies in them Lall the kingdoms o0 north
$ndiaM establish in the cities houses 0or dispensing charit' and medicine. !ll the poor and
destitute in the countr'- orphans- &ido&ers- and childless men- maimed people and
cripples- and all &ho are diseased- go to those houses- and are provided &ith ever' kind
o0 help- and doctors e6amine their diseases. The' get the 0ood and medicines &hich their
cases re8uire- and are made to 0eel at ease4 and &hen the' are better- the' go a&a' o0
themselves.
L11M
The earliest surviving enc'clopaedia o0 medicine in anskrit is the $ara"asamhita
<#ompendium o0 #araka2. This te6t- &hich describes the building o0 a hospital is dated
b' )ominik Wu?ast'k o0 the "niversit' #ollege London 0rom the period bet&een 100
(#J and #J1B0.
L1*M
!ccording to )r.Wu?ast'k- the description b' 5a Kian is one o0 the
earliest accounts o0 a civic hospital s'stem an'&here in the &orld and- coupled &ith
#arakaQs description o0 ho& a clinic should be e8uipped- suggests that $ndia ma' have
been the 0irst part o0 the &orld to have evolved an organised cosmopolitan s'stem o0
institutionall'@based medical provision.
L1*M
!ccording to the )aha*amsa- the ancient chronicle o0 inhalese ro'alt'- &ritten in the
si6th centur' !.).- Aing Pandukabha'a o0 ri Lanka <reigned /3> (# to 36> (#2 had
l'ing@in@homes and hospitals <ivikasotthi@ala2 built in various parts o0 the countr'. This
is the earliest documentar' evidence &e have o0 institutions speci0icall' dedicated to the
care o0 the sick an'&here in the &orld.
L13ML1/M
.ihintale 7ospital is the oldest in the &orld.
L1BM
,uins o0 ancient hospitals in ri Lanka are still in e6istence in .ihintale-
!nuradhapura- and .edirigiri'a.
L16M
Roman Empire
5urther in0ormation1 ('Eantine medicine
The ,omans constructed buildings called *aletudinaria 0or the care o0 sick slaves-
gladiators- and soldiers around 100 (.#.- and man' &ere identi0ied b' later archaeolog'.
While their e6istence is considered proven- there is some doubt as to &hether the' &ere
as &idespread as &as once thought- as man' &ere identi0ied onl' according to the la'out
o0 building remains- and not b' means o0 surviving records or 0inds o0 medical tools.
L1>M
aint ampson the 7ospitable built some o0 the earliest hospitals in the ,oman Jmpire.
The declaration o0 #hristianit' as accepted religion in the ,oman Jmpire drove an
e6pansion o0 the provision o0 care. 5ollo&ing the 5irst #ouncil o0 %icaea in 3*B !.).
construction o0 a hospital in ever' cathedral to&n &as begun. !mong the earliest &ere
those built b' the ph'sician aint ampson in #onstantinople and b' (asil- bishop o0
#aesarea in modern@da' Turke'. #alled the =(asilias=- the latter resembled a cit' and
included housing 0or doctors and nurses and separate buildings 0or various classes o0
patients.
L18M
There &as a separate section 0or lepers.
L1;M
ome hospitals maintained libraries
and training programmes- and doctors compiled their medical and pharmacological
studies in manuscripts. Thus in@patient medical care in the sense o0 &hat &e toda'
consider a hospital- &as an invention driven b' #hristian merc' and ('Eantine
innovation.
L*0M
('Eantine hospital sta00 included the #hie0 Ph'sician <archiatroi2-
pro0essional nurses <h'pourgoi2 and the orderlies <h'peretai2. (' the t&el0th centur'-
#onstantinople had t&o &ell@organised hospitals- sta00ed b' doctors &ho &ere both male
and 0emale. 5acilities included s'stematic treatment procedures and specialised &ards 0or
various diseases.
L*1M
! hospital and medical training centre also e6isted at 3undeshapur. The cit' o0
3undeshapur &as 0ounded in *>1 #J b' the asanian king hapur $. $t &as one o0 the
ma?or cities in AhuEestan province o0 the Persian empire in &hat is toda' $ran. ! large
percentage o0 the population &ere 'riacs- most o0 &hom &ere #hristians. "nder the rule
o0 Ahusra& $- re0uge &as granted to 3reek %estorian #hristian philosophers including
the scholars o0 the Persian chool o0 Jdessa <"r0a2<also called the !cadem' o0 !thens2- a
#hristian theological and medical universit'. These scholars made their &a' to
3undeshapur in B*; 0ollo&ing the closing o0 the academ' b' Jmperor :ustinian. The'
&ere engaged in medical sciences and initiated the 0irst translation pro?ects o0 medical
te6ts.
L**M
The arrival o0 these medical practitioners 0rom Jdessa marks the beginning o0 the
hospital and medical centre at 3undeshapur.
L*3M
$t included a medical school and hospital
<bimaristan2- a pharmacolog' laborator'- a translation house- a librar' and an observator'.
L*/M
$ndian doctors also contributed to the school at 3undeshapur- most notabl' the
medical researcher .ankah. Later a0ter $slamic invasion- the &ritings o0 .ankah and o0
the $ndian doctor ustura &ere translated into !rabic at (aghdad.
L*BM
Medieval Islamic world
.ain article1 .edicine in medieval $slam
The 0irst prominent $slamic hospital &as 0ounded in )amascus- 'ria in around >0> &ith
assistance 0rom #hristians.
L*6M
7o&ever most agree that the establishment at (aghdad &as
the most in0luential4 it opened during the !bbasid #aliphate o0 7arun al@,ashid in the 8th
centur'.
L*>M
The bimaristan <medical school2 and ba't al@hikmah <house o0 &isdom2 &ere
established b' pro0essors and graduates 0rom 3undeshapur and &as 0irst headed b' the
#hristian ph'sician :ibrael ibn (ukhtishu 0rom 3undeshapur and later b' $slamic
ph'sicians.
L*8M
$n the ninth and tenth centuries the hospital in (aghdad emplo'ed t&ent'@0ive sta00
ph'sicians and had separate &ards 0or di00erent conditions.
L*;M
The !l@Raira&an hospital
and mos8ue- in Tunisia- &ere built under the !ghlabid rule in 830 and &as simple- but
ade8uatel' e8uipped &ith halls organised into &aiting rooms- a mos8ue- and a special
bath. The 0irst hospital in Jg'pt &as opened in 8>* and therea0ter public hospitals sprang
up all over the empire 0rom $slamic pain and the .aghrib to Persia. The 0irst $slamic
ps'chiatric hospital opened in (aghdad in >0B. .an' other $slamic hospitals also o0ten
had their o&n &ards dedicated to mental health.
L30M
$n contrast to medieval Jurope- medical school under $slam did not have 0aculties and did
not develop a s'stem o0 academic evaluation and certi0ication
L31M
Medieval Europe
The church at Les $nvalides in 5rance sho&ing the o0ten close connection bet&een
historical hospitals and churches
.edieval hospitals in Jurope 0ollo&ed a similar pattern to the ('Eantine. The' &ere
religious communities- &ith care provided b' monks and nuns. <!n old 5rench term 0or
hospital is h!tel%+ieu- =hostel o0 3od.=2 ome &ere attached to monasteries4 others &ere
independent and had their o&n endo&ments- usuall' o0 propert'- &hich provided income
0or their support. ome hospitals &ere multi@0unctional &hile others &ere 0ounded 0or
speci0ic purposes such as leper hospitals- or as re0uges 0or the poor- or 0or pilgrims1 not
all cared 0or the sick. The 0irst panish hospital- 0ounded b' the #atholic Disigoth bishop
.asona in B80!) at .Srida- &as a ,enodochium designed as an inn 0or travellers
<mostl' pilgrims to the shrine o0 Julalia o0 .Srida2 as &ell as a hospital 0or citiEens and
local 0armers. The hospital9s endo&ment consisted o0 0arms to 0eed its patients and
guests.
7Ttel@)ieu de Paris circa 1B00. The comparativel' &ell patients <on the right2 &ere
separated 0rom the ver' ill <on the le0t2.
The Ospedale .aggiore- traditionall' named #a9 3randa <i.e. (ig 7ouse2- in .ilan-
northern $tal'- &as constructed to house one o0 the 0irst communit' hospitals- the largest
such undertaking o0 the 0i0teenth centur'. #ommissioned b' 5rancesco 0orEa in 1/B6
and designed b' !ntonio 5ilarete it is among the 0irst e6amples o0 ,enaissance
architecture in Lombard'.
The %ormans brought their hospital s'stem along &hen the' con8uered Jngland in 1066.
(' merging &ith traditional land@tenure and customs- the ne& charitable houses became
popular and &ere distinct 0rom both Jnglish monasteries and 5rench hospitals. The'
dispensed alms and some medicine- and &ere generousl' endo&ed b' the nobilit' and
gentr' &ho counted on them 0or spiritual re&ards a0ter death.
L3*M
Early modern and Enlightenment Europe
$n Jurope the medieval concept o0 #hristian care evolved during the si6teenth and
seventeenth centuries into a secular one. !0ter the dissolution o0 the monasteries in 1B/0
b' Aing 7enr' D$$$ the church abruptl' ceased to be the supporter o0 hospitals- and onl'
b' direct petition 0rom the citiEens o0 London- &ere the hospitals t (artholome&9s- t
Thomas9s and t .ar' o0 (ethlehem9s <(edlam2 endo&ed directl' b' the cro&n4 this &as
the 0irst instance o0 secular support being provided 0or medical institutions.
18*0 Jngraving o0 3u'9s 7ospital in London one o0 the 0irst voluntar' hospitals to be
established in 1>*/.
The voluntar' hospital movement began in the earl' 18th centur'- &ith hospitals being
0ounded in London b' the 1>10s and *0s- including Westminster 7ospital <1>1;2
promoted b' the private bank #. 7oare U #o and 3u'9s 7ospital <1>*/2 0unded 0rom the
be8uest o0 the &ealth' merchant- Thomas 3u'. Other hospitals sprang up in London and
other (ritish cities over the centur'- man' paid 0or b' private subscriptions. t.
(artholome&9s opened in London in 1>30- and the London 7ospital in 1>B*.
These hospitals represented a turning point in the 0unction o0 the institution4 the' began
to evolve 0rom being basic places o0 care 0or the sick to becoming centres o0 medical
innovation and discover' and the principle place 0or the education and training o0
prospective practitioners. ome o0 the era9s greatest surgeons and doctors &orked and
passed on their kno&ledge at the hospitals.
L33M
The' also changed 0rom being mere homes
o0 re0uge to being comple6 institutions 0or the provision o0 medicine and care 0or sick.
The #haritS &as 0ounded in (erlin in 1>10 b' Aing 5rederick $ o0 Prussia as a response
to an outbreak o0 plague.
The concept o0 voluntar' hospitals also spread to #olonial !merica4 the Penns'lvania
7ospital opened in 1>B*- %e& Nork 7ospital in 1>>1- and .assachusetts 3eneral
7ospital in 1811. When the Dienna 3eneral 7ospital opened in 1>8/ <instantl' becoming
the &orld9s largest hospital2- ph'sicians ac8uired a ne& 0acilit' that graduall' developed
into one o0 the most important research centres.
L3/M
!nother Jnlightenment era charitable innovation &as the dispensar'4 these &ould issue
the poor &ith medicines 0ree o0 charge. The London )ispensar' opened its doors in 16;6
as the 0irst such clinic in the (ritish Jmpire. The idea &as slo& to catch on until the
1>>0s- &hen man' such organisations began to appear- including the Public )ispensar'
o0 Jdinburgh <1>>62- the .etropolitan )ispensar' and #haritable 5und <1>>;2 and the
5insbur' )ispensar' <1>802. )ispensaries &ere also opened in %e& Nork 1>>1-
Philadelphia 1>86- and (oston 1>;6.
L3BM
!th century
Jnglish ph'sician Thomas Percival <1>/0@180/2 &rote a comprehensive s'stem o0
medical conduct- -)edical .thics, or a $ode of /nstitutes and 0recepts, (dapted to the
0rofessional $onduct of 0hsicians and 1urgeons <18032 that set the standard 0or man'
te6tbooks.
L36M
! &ard o0 the hospital at cutari &here 5lorence %ightingale &orked and helped to
restructure the modern hospital.
$n the mid 1;th centur'- hospitals and the medical pro0ession became more
pro0essionalised- &ith a reorganisation o0 hospital management along more bureaucratic
and administrative lines. The !pothecaries !ct 181B made it compulsor' 0or medical
students to practise 0or at least hal0 a 'ear at a hospital as part o0 their training.
L3>M
5lorence %ightingale pioneered the modern pro0ession o0 nursing during the #rimean
War &hen she set an e6ample o0 compassion- commitment to patient care and diligent
and thought0ul hospital administration. The 0irst o00icial nursesQ training programme- the
%ightingale chool 0or %urses- &as opened in 1860- &ith the mission o0 training nurses
to &ork in hospitals- to &ork &ith the poor and to teach.
L38M
%ightingale &as instrumental in re0orming the nature o0 the hospital- b' improving
sanitation standards and changing the image o0 the hospital 0rom a place the sick &ould
go to die- to an institution devoted to recuperation and healing. he also emphasised the
importance o0 statistical measurement 0or determining the success rate o0 a given
intervention and pushed 0or administrative re0orm at hospitals.
L3;M
(' the late 1;th centur'- the modern hospital &as beginning to take shape &ith a
proli0eration o0 a variet' o0 public and private hospital s'stems. (' the 18>0s- hospitals
had more than trebled their original average intake o0 3-000 patients. $n continental
Jurope the ne& hospitals generall' &ere built and run 0rom public 0unds. The %ational
7ealth ervice- the principle provider o0 health care in the "nited Aingdom- &as 0ounded
in 1;/8.
)uring the nineteenth centur'- the econd Diennese .edical chool emerged &ith the
contributions o0 ph'sicians such as #arl 5reiherr von ,okitansk'- :ose0 Vkoda- 5erdinand
,itter von 7ebra- and $gnaE Philipp emmel&eis. (asic medical science e6panded and
specialisation advanced. 5urthermore- the 0irst dermatolog'- e'e- as &ell as ear- nose- and
throat clinics in the &orld &ere 0ounded in Dienna- being considered as the birth o0
specialised medicine.
L/0M
Criticism
While hospitals- b' concentrating e8uipment- skilled sta00 and other resources in one
place- clearl' provide important help to patients &ith serious or rare health problems-
hospitals also are criticised 0or a number o0 0aults- some o0 &hich are endemic to the
s'stem- others &hich develop 0rom &hat some consider &rong approaches to health care.
One criticism o0ten voiced is the 9industrialised9 nature o0 care- &ith constantl' shi0ting
treatment sta00- &hich dehumanises the patient and prevents more e00ective care as
doctors and nurses rarel' are intimatel' 0amiliar &ith the patient. The high &orking
pressures o0ten put on the sta00 can sometimes e6acerbate such rushed and impersonal
treatment. The architecture and setup o0 modern hospitals o0ten is voiced as a
contributing 0actor to the 0eelings o0 0aceless treatment man' people complain about.
L/1M
"unding
#linical 7ospital )ubrava .odern .edical centre in Wagreb- #roatia.
$n the modern era- hospitals are- broadl'- either 0unded b' the government o0 the countr'
in &hich the' are situated- or survive 0inanciall' b' competing in the private sector <a
number o0 hospitals also are still supported b' the historical t'pe o0 charitable or religious
associations2.
$n the "nited Aingdom 0or e6ample- a relativel' comprehensive- =0ree at the point o0
deliver'= health care s'stem e6ists- 0unded b' the state. 7ospital care is thus relativel'
easil' available to all legal residents- although 0ree emergenc' care is available to an'one-
regardless o0 nationalit' or status. !s hospitals prioritise their limited resources- there is a
tendenc' 0or 9&aiting lists9 0or non@crucial treatment in countries &ith such s'stems- as
opposed to letting higher@pa'ers get treated 0irst- so sometimes those &ho can a00ord it
take out private health care to get treatment more 8uickl'.
L/*M
On the other hand- some
countries- including the "!- have in the t&entieth centur' introduced a private@based-
0or@pro0it@approach to providing hospital care- &ith 0e& state@mone' supported 9charit'9
hospitals remaining toda'.
L/3M
Where 0or@pro0it hospitals in such countries admit uninsured
patients in emergenc' situations <such as during and a0ter 7urricane Aatrina in the "!2-
the' incur direct 0inancial losses-
L/3M
ensuring that there is a clear disincentive to admit
such patients. $n the "nited tates- la&s e6ist to ensure patients receive care in li0e@
threatening emergenc' situations regardless o0 the patient9s abilit' to pa'.
L//M
!s the 8ualit' o0 health care has increasingl' become an issue around the &orld- hospitals
have increasingl' had to pa' serious attention to this matter. $ndependent e6ternal
assessment o0 8ualit' is one o0 the most po&er0ul &a's to assess this aspect o0 health
care- and hospital accreditation is one means b' &hich this is achieved. $n man' parts o0
the &orld such accreditation is sourced 0rom other countries- a phenomenon kno&n as
international healthcare accreditation- b' groups such as !ccreditation #anada 0rom
#anada- the :oint #ommission 0rom the "!- the Trent !ccreditation cheme 0rom 3reat
(ritain- and 7aute !uthoritS de santS <7!2 0rom 5rance.
Buildings
"rchitecture
The %ational 7ealth ervice %or0olk and %or&ich "niversit' 7ospital in the "A-
sho&ing the utilitarian architecture o0 man' modern hospitals.
7ospital chapel at 5a&cett .emorial 7ospital <Port #harlotte- 5lorida2
.odern hospital buildings are designed to minimise the e00ort o0 medical personnel and
the possibilit' o0 contamination &hile ma6imising the e00icienc' o0 the &hole s'stem.
Travel time 0or personnel &ithin the hospital and the transportation o0 patients bet&een
units is 0acilitated and minimised. The building also should be built to accommodate
heav' departments such as radiolog' and operating rooms &hile space 0or special &iring-
plumbing- and &aste disposal must be allo&ed 0or in the design.
L/BM
7o&ever- the realit' is that man' hospitals- even those considered 9modern9- are the
product o0 continual and o0ten badl' managed gro&th over decades or even centuries-
&ith utilitarian ne& sections added on as needs and 0inances dictate. !s a result- )utch
architectural historian #or Wagenaar has called man' hospitals1
2... built catastrophes, anonmous institutional comple,es run b *ast
bureaucracies, and totall unfit for the purpose the ha*e been designed for ...
3he are hardl e*er functional, and instead of ma"ing patients feel at home, the
produce stress and an,iet.2
4567
ome ne&er hospitals no& tr' to re@establish design that takes the patient9s ps'chological
needs into account- such as providing more 0resh air- better vie&s and more pleasant
colour schemes. These ideas harken back to the late eighteenth centur'- &hen the concept
o0 providing 0resh air and access to the 9healing po&ers o0 nature9 &ere 0irst emplo'ed b'
hospital architects in improving their buildings.
L/6M
The research o0 (ritish .edical !ssociation is sho&ing that good hospital design can
reduce patient9s recover' time. J6posure to da'light is e00ective in reducing depression.
ingle se6 accommodation help ensure that patients are treated in privac' and &ith
dignit'. J6posure to nature and hospital gardens is also important G looking out &indo&s
improves patients9 moods and reduces blood pressure and stress level. Jliminating long
corridors can reduce nurses9 0atigue and stress.
L/>M
!nother ongoing ma?or development is the change 0rom a &ard@based s'stem <&here
patients are accommodated in communal rooms- separated b' movable partitions2 to one
in &hich the' are accommodated in individual rooms. The &ard@based s'stem has been
described as ver' e00icient- especiall' 0or the medical sta00- but is considered to be more
stress0ul 0or patients and detrimental to their privac'. ! ma?or constraint on providing all
patients &ith their o&n rooms is ho&ever 0ound in the higher cost o0 building and
operating such a hospital4 this causes some hospitals to charge 0or private rooms.
L/8M
Hospital .uthorit#
5rom Wikipedia- the 0ree enc'clopedia
7ospital !uthorit'

Logo o0 the 7ospital !uthorit'

.bbreviation 7!
/stablished )ecember 1- 1;;0
0egal status tatutor' bod'
Head"uarters
7ospital !uthorit' (uilding- 1/>(
!rg'le treet- Ao&loon- 7ong Aong
Coordinates
**.3*//X%
11/.1833XJ #oordinates1
**.3*//X% 11/.1833XJ
Region 7ong Aong
Chair!an :ohn # N Leong
Chief
/ecutive
Leung Pak@'in
Budget
7AC/>.* billion <*013@*01/2
7AC/B.B billion <*01*@*0132
Staff 6>-000
1ebsite &&&.ha.org.hk
7ospital !uthorit' (uilding- &here the 7ospital !uthorit' 7ead O00ice is located
The Hospital .uthorit# <#hinese1 2 is a statutor' bod' managing all the
public hospitals and institutes in 7ong Aong. $t is under the governance o0 its board and
is under the monitor o0 the ecretar' 0or 5ood and 7ealth o0 the 7ong Aong 3overnment.
$ts chairman is :ohn Leong #hi@'an.
Contents
1 7istor'
* 7ospital clusters
3 #orporate governance
o 3.1 7ospital !uthorit' (oard
3.1.1 #urrent and 0ormer chairmen
3.1.* #urrent and 0ormer chie0 e6ecutives
o 3.* (oard #ommittees
o 3.3 7ospital 3overning #ommittees
o 3./ ,egional !dvisor' #ommittees
/ 5unding
B #ontroversies
o B.1 *008 milk contamination
6 ee also
> ,e0erences
8 J6ternal links
!istory
(e0ore the establishment o0 the authorit'- all health and medical issues &ere under the
management o0 the .edical and 7ealth )epartment. $n 1;;0- a ne& health administration
s'stem &as introduced. The department became the )epartment o0 7ealth and in 1;;1-
the management o0 all the public hospitals &as passed to a ne& statutor' bod'- the
7ospital !uthorit'- &hich &as established in 1;;0 under the 7ospital !uthorit'
Ordinance. $n *003- the 3eneral Outpatient #linics o0 )epartment o0 7ealth &ere
trans0erred to the authorit'.
!ospital clusters
5urther in0ormation1 List o0 hospitals in 7ong Aong Y 7ospitals and institutions managed
b' the 7ospital !uthorit'
7ospital !uthorit' has been providing services to the public under a cluster@based
structure since 1;;3.
L1M
$t currentl' manages /* public hospitals and institutions- /8
specialist outpatient clinics and >3 general outpatient clinics. These 0acilities are
organised into seven hospital clusters according to their geographical locations- as sho&n
in the table belo&. Jach hospital cluster comprises a mi6 o0 acute and convalescent or
rehabilitation hospitals to provide a 0ull range o0 healthcare services.
L*M
Hospital cluster Service area
Population of the
area in !id(2012
7ong Aong Jast
#luster
Jastern- Wanchai and $slands <apart 0rom
%orth Lantau2 areas
8*B-/00
7ong Aong West
#luster
#entral and Western- and outhern districts o0
the 7ong Aong $sland
B//-100
Ao&loon #entral
#luster
Nau .a Tei- Tsim ha Tsui and Ao&loon #it'
districts
B03-*00
Ao&loon Jast
#luster
A&un Tung- Tseung A&an O and part o0 the
ai Aung districts
1-01*-000
Ao&loon West
#luster
)istricts o0 Wong Tai in- .ong Aok- ham
hui Po- A&ai Tsing- Tsuen Wan and %orth
Lantau
1-88>-600
%e& Territories
Jast #luster
ha Tin- Tai Po- %orth and part o0 the ai Aung
districts
1-3*1-300
%e& Territories
West #luster
Tuen .un and Nuen Long districts 1-08B-300
Corporate go#ernance
#ospital "uthority $oard
!ccording to the 7ospital !uthorit' Ordinance <#ap 1132- the #hie0 J6ecutive o0 7ong
Aong appoints members o0 the 7ospital !uthorit' (oard governing the authorit'. The
present board consists o0 *> members- including the chairman. .embership o0 the
authorit' comprises *3 non@public o00icers- three public o00icers and the chie0 e6ecutive
o0 the authorit'. !part 0rom the chie0 e6ecutive o0 the authorit'- other members are not
remunerated in the capacit' as board members.
L3M
Current and for!er chair!en
ir #hung Ee@'uen- 3(.- 3(J- :P <1 )ecember 1;;0 G 31 .arch 1;;B2
Peter Woo A&ong@ching- 3(.- 3(- :P <1 !pril 1;;B G 30 eptember *0002
Lo Aa@shui- 3(- :P <1 October *000 G 30 eptember *00*2
Jd&ard Leong #he@hung- 3(.- 3(- O(J- :P <1 October *00* G 8 :ul' *00/2
!nthon' Wu Ting@'uk- 3(- :P <> October *00/ G 30 %ovember *0132
:ohn Leong #hi@'an- (- :P <1 )ecember *013 G present2
Current and for!er chief eecutives

Neoh Jng@kiong- O(J- :P <:anuar' 1;;/ G eptember 1;;;2

L/M

William 7o hiu@&ei- :P <*0 eptember 1;;; G 1; eptember *00B2

LBM

Ao Wing@man- :P <acting- */ .arch *003 G Z2

L6M

Divian Wong Taam #hi@&oon- :P <acting- *0 eptember *00B G *8 5ebruar'

*0062
L>M

hane olomon <1 .arch *006 G *3 :ul' *0102

L8ML;M

Leung Pak@'in- :P <8 %ovember *010 G present2

L10M
$oard Committees
To per0orm its roles and e6ercise its po&ers- the board has established 11 0unctional
committees1

!udit and ,isk #ommittee

Jmergenc' J6ecutive #ommittee

J6ecutive #ommittee

5inance #ommittee

7uman ,esources #ommittee

$n0ormation Technolog' ervices 3overning #ommittee

.ain Tender (oard

.edical ervices )evelopment #ommittee

Public #omplaints #ommittee

ta00 !ppeals #ommittee- and

upporting ervices )evelopment #ommittee.

L3M
#ospital Governing Committees
To enhance communit' participation and governance o0 public hospitals- the authorit'
has established 31 7ospital 3overning #ommittees in 38 hospitals and institutions. These
committees received regular management reports 0rom the hospital chie0 e6ecutives-
monitored operational and 0inancial per0ormance o0 the hospitals- participated in human
resources and procurement 0unctions- as &ell as hospital and communit' partnership
activities.
L3M
Regional "dvisory Committees
To provide the authorit' &ith advice on the healthcare needs 0or speci0ic regions o0 7ong
Aong- the authorit' has established three ,egional !dvisor' #ommittees. Jach o0 the
committees meets 0our times a 'ear.
L3M
"unding
The authorit' is 0unded primaril' b' 7ong Aong 3overnment subvention- &hich
amounted to 7AC/*.B billion 0or *01*G*013- e8uating to over ;0O o0 the authorit'9s
total income. $ts other incomes include hospital and clinic 0ees and charges- donations-
and investment.
L3M
The authorit'9s total e6penditure &as 7AC/6.1 billion 0or *01*G*013- &ith >0O used to
pa' sta00- and 1/O to pa' 0or drugs and other supplies.
L3M
Contro#ersies
%&&' mil( contamination
On the da' &hen a 7ong Aong girl &as diagnosed as the territor'9s 0irst victim o0 the
*008 #hinese milk scandal- an6ious parents &ere 0rustrated to discover that doctors at the
special unit set up at the Princess .argaret 7ospital &ere taking the da' o00. )eput'
)irector o0 7ealth 3loria Tam said that it &as =not something so urgent that it needs to be
dealt &ith in */ hours... The' can go during o00ice hours tomorro&=. .edical sector
legislator Leung Aa@lau said the lack o0 dail' cover during the crisis &as =insensitive=.
L11M

While the 0irst victim le0t hospital a0ter success0ul treatment one da' later- t&o more
children &ere admitted to hospital on ** eptember4 the 7ospital !uthorit' &as
reportedl' over&helmed &hen over 100 parents demanding check@ups 0or their children
at Princess .argaret amids con0usion about re0errals and registration procedures- causing
ecretar' 0or 5ood and 7ealth- Nork #ho& to grovel 0or having underestimated the
problem.
L1*M
#ho& pledged 18 additional 0acilities around 7ong Aong &ould be
operational the ne6t da'.
L13M
Private hospital
5rom Wikipedia- the 0ree enc'clopedia
! private hospital is a hospital o&ned b' a pro0it compan' or a non@pro0it organisation
and privatel' 0unded through pa'ment 0or medical services b' patients themselves- b'
insurers- 3overnments through national health insurance schemes- or b' 0oreign
embassies. This practice is ver' common in the "nited tates- #hile- 5rance- 3erman'-
and !ustralia. $n the "nited Aingdom- private hospitals are distinguished 0rom the 0ar
more prevalent %ational 7ealth ervice institutions.
2or(profit hospital
5rom Wikipedia- the 0ree enc'clopedia
The e6amples and perspective in this article !a# not represent a $orld$ide
vie$ of the sub3ect. Please improve this article and discuss the issue on the talk
page. #+ecember 2010'
2or(profit hospitals- or alternativel' investor@o&ned hospitals- are investor@o&ned
chains o0 hospitals &hich have been established particularl' in the "nited tates during
the late t&entieth centur'. $n contrast to the traditional and more common non@pro0it
hospitals- the' attempt to garner a pro0it 0or their shareholders.
$n the "nited tates. the three largest such 0irms are 7ospital #orporation o0 !merica-
Tenet <0ormerl' %.J2- and 7ealthouth.
Lcitation neededM
7ealthouth- as the third@largest "..
national chain- is also the leading provider o0 rehabilitation services. 5or pro0it
Ps'chiatric olutions is the largest provider o0 ps'chiatric services in the nation.
! conceptuall' related institution is the 0or@pro0it 7.O- &hich no& comprises the
predominant means o0 delivering medical services in the "nited tates.
!dvocates o0 such institutions claim the' are able to provide better care at lo&er cost due
to higher e00icienc'. $t is also said that- in the 0ree market- hospitals have an incentive to
do better due to competition.
)etractors- ho&ever- claim that the relative success o0 0or@pro0it medical providers arises
0rom their positioning themselves in the medical marketplace in such a manner as to o00er
mainl' pro0itable care services 0or a largel' a00luent and insured clientele &hilst avoiding
unpro0itable care areas. #ritics thus claim- 0or e6ample- that 0or@pro0it hospitals specialiEe
in such highl' lucrative 0ields as medical rehabilitation- electiveHplastic surger'- and
cardiolog' &hile avoiding provision o0 loss@making services such as emergenc' medicine
&hich in turn caters mainl' to the indigent. !nalogousl'- critics o0 0or@pro0it 7.Os argue
that such 0irms disproportionatel' insure health' people- &hile simultaneousl' esche&ing
chronicall' ill patients- &ho must then b' de0ault be cared 0or disproportionatel' b'
public insurance schemes and non@pro0it providers[thus a so@called =dumping= o0
undesirable patients.
The' have also been criticised b' elements o0 the #anadian medical establishment as
providing in0erior care at higher cost. ee this commentar' in the #anadian .edical
!ssociation :ournal and this editorial in the %e& Jngland :ournal o0 .edicine.
What $s the )i00erence (et&een %onpro0it 7ospitals and 5or@Pro0it 7ospitalsZ
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Print
! nonpro0it hospital means the 0acilit' does not pa' either state or local propert' ta6es or
0ederal income ta6es because it is considered a charit'- and proves certain communit'
bene0its in accord &ith state and 0ederal guidelines.
! 0or@pro0it- or investor@o&ned- hospital means the 0acilit' is either o&ned b' private
investors or is o&ned publicl' b' shareholders and is part o0 a compan' that issues shares
o0 stock to raise revenue to e6pand the hospital activities. 5or@pro0it hospitals have
historicall' been based in the southern part o0 the "nited tates- particularl' in 5lorida
and Te6as. (ut in recent 'ears- investor@o&ned hospitals have e6panded nationall'-
purchasing o0ten 0inanciall' distressed 0acilities or stand@alone hospitals that are in need
o0 access to capital 0or e6pansion. )epending on economic conditions- 0or@pro0it hospitals
can have better access to capital than nonpro0its that e6pand b' issuing debt through ta6@
e6empt bonds.
The #ongressional (udget O00ice <#(O2 0ound that \on average- nonpro0it hospitals
provided higher levels o0 uncompensated care than did other&ise similar 0or@pro0it
hospitals. !mong individual hospitals- ho&ever- the provision o0 uncompensated care
varied &idel'- and the distributions 0or nonpro0it and 0or@pro0it hospitals largel'
overlapped. %onpro0it hospitals &ere more likel' than other&ise similar 0or@pro0it
hospitals to provide certain specialiEed services but &ere 0ound to provide care to 0e&er
.edicaid@covered patients as a share o0 their total patient population. On average-
nonpro0it hospitals &ere 0ound to operate in areas &ith higher average incomes- lo&er
povert' rates- and lo&er rates o0 un@insurance than 0or@pro0it hospitals.
!ospital $%&ecti#es
Jdna !dan at her 7ospital
$%&ecti#es
To make available in omaliland a modern- &ell@e8uipped and e00icient health
care 0acilit' that provides a much higher standard o0 patient care than that &hich
&as previousl' available to &omen and children
To make available a model 7ealth #are $nstitution- &hich provides not onl' good
health care- but &hich also provides Training and ,esearch opportunities to
.edical and Para@.edical personnel.
To serve as an e6ample to others and thus encourage national as &ell as
international initiatives to invest in health services in order to improve the over@all
&el0are o0 the nation.
To make available to &omen and children 6; beds 0or Obstetrical- %eonatal care
and general patient care- including $ncubators 0or premature babies.
To make available to &omen Pre@%atal and Post@%atal outpatient services- as &ell
as $mmuniEation 0or &omen and children
To make available to &omen and children- diagnostic Laborator' 0acilities as &ell
as a (lood (ank 0or emergencies.
To make available "ltrasound and visual monitoring 0acilities.
To make available treatment 0or 3'naecological problems including .anagement
o0 $n0ertilit'- as &ell as the diagnosis and treatment o0 e6uall' Transmitted
)iseases including testing 0or 7$DH!$) and providing counselling as
appropriate.
To make available 0acilities 0or carr'ing out medical research- studies and
counselling- &ith particular attention to the health problems associated &ith
5emale 3enital .utilation <53.2 - as part o0 the #omprehensive ,eproductive
7ealth services that are o00ered b' the hospital
$n collaboration &ith the .inistr' o0 7ealth- "%$#J5- and W7O- carr' out
training programs 0or health &orkers- &ith particular attention to the training o0
%urses and .id&ives.
5irst graduating class o0 mid&ives- *00/
Beneficiaries
Women o0 child bearing age- under@0ive children and adults in omaliland &ho
seek inpatient- outpatient and emergenc' care in ,eproductive 7ealth@related or
other health problems.
7ealth &orkers &ho are trained or &ho are emplo'ed b' the 0acilit'- as &ell as
those &ho practice healthcare throughout the countr'.
%e&l'@graduated nurses
leep o0 the :ust
7ospital9s 0irst born
.id&ives graduate *00;
*010 %urses graduate
*003 %urses graduate
Southern !ighlands 'ri#ate !ospital (ission) *ision +
$%&ecti#es
4he Ra!sa# 5ision
,amsa' 7ealth #are is committed to being a leading provider o0 health care services b'
delivering high 8ualit' outcomes 0or patients and ensuring long term pro0itabilit'.
4he Ra!sa# 1a#
We are caring- progressive- en?o' our &ork and use a positive spirit to succeed
We take pride in our achievements and activel' seek ne& &a's o0 doing things
better
We value integrit'- credibilit' and respect 0or the individual
We build constructive relationships to achieve positive outcomes 0or all
We believe that success comes through recognising and encouraging the value o0
people and teams
We aim to gro& our business &hile maintaining sustainable levels o0 pro0itabilit'-
providing a basis 0or stakeholder lo'alt'
$n *00B- the management team also decided upon a set o0 core values G that &ere loosel'
based on the ,amsa' Wa' but also gave an idea o0 &hat it is like to be part o0 outhern
7ighlands Private 7ospital.
outhern 7ighlands Private 7ospital aims to be the leader o0 accessible and 8ualit'
private health services to the communities o0 the outhern 7ighlands and be'ond. The
hospital embraces the ,amsa' corporate philosoph'- the ,amsa' &a' &hich underpins
our Rualit' .anagement 'stem and the &a' &e manage our business.
)$*ECTI+ES
We aim to1
$ncrease the range o0 services &herever there are opportunities to meet an area o0
customer need and demand- on 0inanciall' viable basis
Provide a sa0e and therapeutic environment 0or all patient- sta00 and visitors
$ncrease overall satis0action rates o0 patients- emplo'ees and visiting medical
o00icers
!chieve 0inancial and human resource ke' per0ormance indicators
.aintain clinical indicators belo& aggregate rate 0or peer hospitals

1. mall (usiness ]
*. 5inances U Ta6es ]
3. (usiness U 5inancials
Business 6 2inancial 7ifferences Bet$een
Profit 6 8onprofit Hospitals
b (le,is 8riting, +emand )edia
Learn the di00erences bet&een nonpro0it and 0or@pro0it hospitals.
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)i00erence (et&een 0or Pro0it U %ot 0or Pro0it .arketing
.ost people donQt think about &hether the hospital that the' are going to visit is a 0or@
pro0it or a nonpro0it medical institution. 7o&ever- there are distinct di00erences bet&een
0or@pro0it and nonpro0it hospitals- in both business and 0inancial terms. ome o0 these
di00erences ma' potentiall' a00ect the care 'ou receive and ho& much 'ou are re8uired to
pa' 0or it. Thus- 'ou should understand the di00erences bet&een a 0or@pro0it and a
nonpro0it hospital.
!ds b' 3oogle
.edical .issions
Dolunteers %eeded. OrganiEations Welcome to Post %eeds
&&&.medicalmissions.org
Accepting 'atients
%onpro0it hospitals are t'picall' considered to accept ever'one &ho comes in the doors-
regardless o0 their abilit' to pa'. There0ore- nonpro0it hospitals receive a ta6 e6emption.
$t is also possible that a nonpro0it hospital- especiall' in a large cit'- ma' be busier at an'
given time than a 0or@pro0it hospital. To get an idea o0 &hat a large cit'Qs nonpro0it
hospital is like- 'ou can recall the television sho& \J,-^ &hich &as set in a nonpro0it
hospital. (' treating ever'one regardless o0 abilit' to pa'- nonpro0its provide a needed
service.
Community Benefits
(oth t'pes o0 hospitals provide so@called communit' bene0its- &hich can include
preventative health education- smoking cessation programs- ongoing medical education
0or sta00 and college students entering the medical pro0ession- clinical services 0or lo&@
income 0amilies and others- and urgent careHemergenc' room services. ! stud' b' the
".. 3!O sho&ed that there &ere similar t'pes and levels o0 communit' bene0it services
o00ered b' both 0or@pro0it and nonpro0it hospitals in the "nited tates4 ho&ever- nonpro0it
hospitals ma' make these events available more 0re8uentl' and on a larger scale.