Types of Hospitals

• General or Specialized Hospitals. There are over 6,500 hospitals in the United States. The majority of them are “general” hospitals set up to deal with the full range of medical conditions most people require treatment for. But more than 1,000 hospitals specialize in a particular disease or condition (cancer, rehabilitation, psychiatric illness, etc.) or in one type of patient (children, the elderly, etc.).

A general hospital may not be able to offer the very latest specialized treatments for every disorder. So if you have a serious or highly unusual medical problem, you may need a hospital devoted to the care of people with similar conditions. But it is also important to consider that such a hospital may be far from your home and may lack the facilities and staff necessary to treat an unrelated medical complication. When weighing the possibilities with your doctor, discuss what would be best for your condition and if any general hospitals in the area may be able to accommodate you.

• Teaching or Community Hospitals. Large teaching/research hospitals have a variety of goals. In addition to treating patients, they are training sites for physicians and other health professionals. Teaching institutions are almost always affiliated with a medical school, which means patients have access to highly skilled specialists who teach at the school and are familiar with up-to-the-minute technology.

You shouldn’t, however, automatically select a prestigious teaching hospital as the primary source of hospital care for you and your family. The quality of smaller community hospitals often compares to that found at large teaching facilities, particularly for routine illnesses and surgeries. The sophisticated equipment and specialized treatment at teaching hospitals can be very expensive, and it is not cost-effective to pay for such services unless you can benefit from them. Check with your physician about the appropriateness of a teaching hospital.

• Nonprofit or For-Profit Hospitals. The important question here is, who owns the hospital? Is it a voluntary, proprietary or government-supported facility? Even though the quality of care varies widely within each of these categories, knowing who owns the hospital may give you some insight into other questions to ask.

A voluntary hospital is a nonprofit community facility operating under religious or other voluntary auspices. Ultimate responsibility for all that takes place at the hospital rests with its board of trustees, generally selected from the community’s business and professional people, who serve without pay. To manage the hospital the trustees appoint a paid administrator.

Proprietary hospitals are commercial establishments. They are profit-making institutions. Of course, working for profit does not necessarily make a hospital bad, any more than being nonprofit ensures quality care. Proprietary hospitals are owned by corporation or, less often, by individuals such as doctors who practice at the hospital. Hospital corporations usually own a chain of institutions located in several states, and they often own nursing homes or other types of health care facilities as well.

Government-supported hospitals, like all tax-supported institution, sometimes have to curtail service when budget are cut. Also, they may not measure up to other hospitals in terms of comfortable accommodations and the availability of private rooms.

Consumer advocates claim for-profit hospitals are more likely to discharge patients before they are ready or fail to perform necessary test or procedures if a patient is not insured or if their insurance won’t cover more time in the hospital. In a study published in the Journal of the American Medical Association, researchers looked at over half a million discharge records of patients hospitalized in the United States in 1987. They found that while uninsured patients were in wore condition than privately insured patients when they entered the hospital, they were discharged sooner. Although the study did not distinguish between for-profit and nonprofit hospitals, it does indicate that the problem does exist. Additionally, in the spring of 2000, a study in the Journal of General Internal Medicine found that patients at for-profit hospitals are two to four times more likely than patients at not-for-profit hospital to complications from surgery or delays in diagnosing and treating an illness. Previous research found death rates 25 percent higher at for-profit hospitals than at teaching hospitals and six to seven percent higher than at non-profit, non-teaching hospitals.

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