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Major differences in hospitals today and 100 years ago

Three types of dental care are normally carried out in the hospital environment: The temples of Saturnand later of Asclepius in Asia Minorwere recognized as healing centres. Brahmanic hospitals were established in Sri Lanka as early as 431 bce, and King Ashoka established a chain of hospitals in Hindustan about 230 bce.

Around 100 bce the Romans established hospitals valetudinaria for the treatment of their sick and injured soldiers; their care was important because it was upon the integrity of the legions that the power of ancient Rome was based.

Ruins of the sanctuary of Asclepius at Cos, Greece Charles Walker It can be said, however, that the modern concept of a hospital dates from 331 ce when Roman emperor Constantine I Constantine the Greathaving been converted to Christianityabolished all pagan hospitals and thus created the opportunity for a new start.

  • John in 1099 established in the Holy Land a hospital that could care for some 2,000 patients;
  • Military hospitals came into being along the traveled routes; the Knights Hospitallers of the Order of St.

Until that time disease had isolated the sufferer from the community. The Christian tradition emphasized the close relationship of the sufferer to the members of the community, upon whom rested the obligation for care. Illness thus became a matter for the Christian church. About 370 ce St. Basil the Great established a religious foundation in Cappadocia that included a hospital, an isolation unit for those suffering from leprosyand buildings to house the poor, the elderly, and the sick.

Following this example, similar hospitals were later built in the eastern part of the Roman Empire. Another notable foundation was that of St. Benedict of Nursia at Montecassino, founded early in the 6th century, where the care of the sick was placed above and before every other Christian duty.

It was from this beginning that one of the first medical schools in Europe ultimately grew at Salerno and was of high repute by the 11th century.

This example led to the establishment of similar monastic infirmaries in the western part of the empire.

The manner in which monks cared for their own sick became a model for the laity. The monasteries had an infirmitorium, a place to which their sick were taken for treatment. The monasteries had a pharmacy and frequently a garden with medicinal plants.

In addition to caring for sick monks, the monasteries opened their doors to pilgrims and to other travelers. The growth of hospitals accelerated during the Crusadeswhich began at the end of the 11th century. Pestilence and disease were more potent enemies than the Saracens in defeating the crusaders.

Military hospitals came into being along the traveled routes; the Knights Hospitallers of the Order of St. John in 1099 established in the Holy Land a hospital that could care for some 2,000 patients. It is said to have been especially concerned with eye diseaseand it may have been the first of the specialized hospitals.

This order has survived through the centuries as the St. Throughout the Middle Ages, but notably in the 12th century, the number of hospitals grew rapidly in Europe.

  • The temples of Saturn , and later of Asclepius in Asia Minor , were recognized as healing centres;
  • The Hospital of the Holy Ghost , founded in 1145 at Montpellier in France, established a high reputation and later became one of the most important centres in Europe for the training of doctors.

The Hospital of the Holy Ghostfounded in 1145 at Montpellier in France, established a high reputation and later became one of the most important centres in Europe for the training of doctors.

By far the greater number of hospitals established during the Middle Ages, however, were monastic institutions under the Benedictineswho are credited with having founded more than 2,000. The Middle Ages also saw the beginnings of support for hospital-like institutions by secular authorities.

Toward the end of the 15th century, many cities and towns supported some kind of institutional health care: This gradual transfer of responsibility for institutional health care from the church to civil authorities continued in Europe after the dissolution of the monasteries in 1540 by Henry VIIIwhich put an end to hospital building in England for some 200 years. The loss of monastic hospitals in England caused the secular authorities to provide for the sick, the injured, and the handicapped, thus laying the foundation for the voluntary hospital movement.

Between 1736 and 1787, hospitals were established outside London in at least 18 cities. The initiative spread to Scotland, where the first voluntary hospital, the Little Hospital, was opened in Edinburgh in 1729. Joseph, out of which grew the order of the Sisters of St. Joseph, now considered to be the oldest nursing group organized in North America. The first hospital in the territory of the present-day United States is said to have been a hospital for soldiers on Manhattan Island, established in 1663.

The early hospitals were primarily almshouses, one of the first of which was established by English Quaker leader and colonist William Penn in Philadelphia in 1713. The first incorporated hospital in America was the Pennsylvania Hospital, in Philadelphia, which obtained a charter from the crown in 1751.

The modern hospital Hospitals may be compared and classified in various ways: Examples include the general hospital, the specialized hospital, the short-stay hospital, and the long-term-care facility. Bed number and length of stay Hospitals may be compared by the number of beds they contain.

Modern hospitals tend to rarely exceed 800 beds, and though some integrated health facilities may have more beds, they often comprise multiple geographic locations, each with several hundred beds. In the early 21st century, it was thought that a facility of 800 beds was the largest unit that could be governed satisfactorily from a single administrative unit while maintaining a corporate unity.

Another index is the average bed-occupancy rate—that is, the percentage of available beds actually occupied per day or per month. Bed-occupancy rates may be higher in the cold winter months, which bring more respiratory disease. In developing countries the bed-occupancy rate is often more than 100 percent—there are more patients in the hospital than there are beds for them.

This situation has also emerged in some developed countries where demand for services has outstripped supply. The amount of time that a patient spends in a hospital bed, or the average length of stay ALOSis another important index and depends on the nature of the hospital.

In an acute-care hospital the ALOS will be relatively short. In hospitals catering to the chronically illthe ALOS will, for the most part, be higher.

There may be significant variations between units in the same hospital, depending on the acuity and comorbidities of the patients comorbidity is the presence of two or more unrelated diseases or disease processes in a single patient. In hospitals in developing countries, the ALOS is much shorter than in developed countries. Ownership and control The issues of hospital ownership and control underwent significant analysis and change in the late 20th and early 21st centuries.

Such transformation was prevalent in developed countries, particularly those in which fiscal sustainability was problematic. In many countries nearly all hospitals are owned and operated by the government. In Great Britainexcept for a small number run by religious orders or serving special groups, most hospitals are within the National Health Service.

The local hospital management committee answers directly to the regional hospital board and ultimately to the Department of Health and Social Security. In the United States most hospitals are neither owned nor operated by governmental agencies. In some instances hospitals that are part of a regional health authority are governed by the board of the regional authority, and hence these hospitals no longer have their own boards.

Francis Tyers In Canada some hospitals are owned by religious orders and are contracted to deliver publicly funded services. Other hospitals may be owned by municipalities or provincial or territorial governments. Worldwide, many hospitals are associated with universities; others were founded by religious groups or by public-spirited individuals.

Mental health facilities traditionally have been the responsibility of state or provincial governmentswhile military and veterans hospitals have been provided by the federal government. In addition, there are a number of municipal and county general hospitals. Financing Because hospitals may serve specific populations and because they may be not-for-profit or for-profit, there exist a variety of mechanisms for hospital financing.

Almost universally, hospital-construction costs are met at least in some part by governmental contributions. Operating costs, however, are taken care of in different ways. For example, funds may come from private endowments or gifts, general funds of some unit of government, funds collected by insurance carriers from subscribers, or some combination thereof. In some countries, operating costs may be supplemented in part by public or private sources that pay charges on uninsured or inadequately insured patients or by out-of-pocket payment by these individuals.

In many countries, major differences in hospitals today and 100 years ago in Europe in particular, the financial support of services in hospitals tends to be collectivized, with funding provided through public revenues, social insuranceor a combination of the two.

Thus, the costs of hospital operation are covered infrequently by payments made directly by patients. Details vary somewhat from country to country.

In Swedenfor example, most hospital operating costs are financed by public revenues collected by major differences in hospitals today and 100 years ago governments. Many other European countries follow a similar model, with operating costs for hospitals paid out of national insurance funds; such is the case in the Netherlands, Finland, Norway, and elsewhere.

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In contrast, other countries, such as the United States, rely heavily on private insurance funds. Private health insurance corporations or agencies exist in many countries. These entities may offer different or more services relative to national health insurance, although generally at additional cost as well. Private insurance funds offer an alternative mechanism of hospital financing.

The general hospital General hospitals may be academic health facilities or community-based entities. They are general in the sense that they admit all types of medical and surgical cases, and they concentrate on patients with acute illnesses needing relatively short-term care. Community general hospitals vary in their bed numbers. Each general hospital, however, has an organized medical staff, a professional staff of other health providers such as nurses, technicians, dietitians, and physiotherapistsand basic diagnostic equipment.

In addition to the essential services relating to patient care, and depending on size and location, a community general hospital may also have a pharmacy, a laboratory, sophisticated diagnostic services such as radiology and angiographyphysical therapy departments, an obstetrical unit a nursery and a delivery roomoperating rooms, recovery rooms, an outpatient department, and an emergency department.

History of hospitals

Smaller hospitals may diagnose and stabilize patients prior to transfer to facilities with specialty services. In larger hospitals there may be additional facilities: Patient undergoing dialysis treatment. Such advances range from the 20th-century introduction of antibiotics and laboratory procedures to the continued emergence of new surgical techniques, new materials and equipment for complex therapies e.

The legally constituted governing body of the hospital, with full responsibility for the conduct and efficient management of the hospital, is usually a hospital board. The board establishes policy and, on the advice of a medical advisory board, appoints a medical staff and an administrator.

It exercises control over expenditures and has the responsibility for maintaining professional standards. The administrator is the chief executive officer of the hospital and is responsible to the board. In a large hospital there are many separate departments, each of which is controlled by a department head. The largest department in any hospital is nursing, followed by the dietary department and housekeeping.

Examples of other departments that are important to the functioning of the hospital include laundry, engineering, stores, purchasing, accounting, pharmacy, physical and occupational therapysocial service, pathologyX-ray, and medical records. The degree of departmentalization of the medical staff depends on the specialization of its members and not primarily on the size of the hospital, although there is usually some correlation between the two. The chiefs of the medical-staff departments, along with the chiefs of radiology and pathology, make major differences in hospitals today and 100 years ago the medical advisory board, which usually holds regular meetings on medical-administrative matters.

The professional work of the individual staff members is reviewed by medical-staff committees. In a large hospital the committees may report to the medical advisory board; in a smaller hospital, to the medical staff directly, at regular staff meetings.