First and foremost, find this out: where is the money coming from? Put another way, who owns the hospital? The answer will probably fall into one of three categories:
• Voluntary (i.e. religious group)
• Proprietary (i.e. private ownership)
• Government-supported (i.e. city, county)
A Voluntary hospital typically functions under the auspices of a particular religion or other non-profit body. As such, the hospital will have a board of trustees on whose shoulders the final say and ultimate responsibility will lie. The board is often chosen from high-standing members of the business community and the position is not generally a paid one. The hospital itself is managed, or run, by a paid administrator.
Proprietary hospitals are for-profit; they are commercial businesses. Judgment should not be swayed too far one way or the other on the fact that they need to make a profit in order to stay in business, however, It is rare for these hospitals to be owned by a single individual; more often they are owned by hospital corporations, and it is likely the same company operates a ‘chain’ of these hospitals, and it is also likely that they also own and operate other health care facilities as well, such as a rehab clinic or a nursing home.
Government-supported hospitals are at the mercy of state and/or federal budgets, and consequently may have to cut back on the services they provide. You might find the accommodations lacking when compared to proprietary hospitals, and you may find them short on private rooms.
Profit vs. Not-for-Profit
Would a for-profit hospital discharge you, or skip out on a treatment you might need, because you were either uninsured or your insurance coverage only allows a certain amount of time in the hospital? Consumer advocates say yes, and some peer-reviewed studies in medical journals would indicate that you should think twice before going to a for-profit hospital, whether or not you have health insurance.
A 1987 study that appeared in the Journal of the American Medical Association examined half a million patient discharge records from hospitals in the US and concluded the following: uninsured patients tended to be discharged from the hospital sooner than insured patients, even when their condition was worse. Now, this study did not differentiate between nonprofit and for-profit hospitals, but it helps to suggest that a hospital’s bottom line has some say, albeit minor, in the quality of one’s treatment. A 2000 study published in the Journal of General Internal Medicine found that surgical complications and diagnostic delays were more 2 to 4 times more likely to occur to patients at for-profit hospitals than they did at not-for-profits.
Finally, some research suggests that mortality rates are highest at for-profit hospitals, higher even than those at teaching hospitals.
Asking the Right Questions:
At this point you may very well be confused and even scared, but you can make an informed decision if you are armed with the right questions. We’ve accumulated some questions to consider which we gathered from the American Hospital Association as well as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Read through them, determine which ones are a priority for you, and bring them to your doctor.
Don’t forget to request a patient’s handbook from each hospital you’re considering. These handbooks typically answer most questions you might have.
• Is your doctor affiliated with the hospital? Physicians are typically affiliated with a number of hospitals, which means that they have met the requirements of that hospital and are permitted to practice there.
• Do they offer services that meet your particular needs? In terms of why you’re going to a hospital to begin with, i.e. chemotherapy or childbirth.
• What is their experience with doing your procedure? Maybe they see 2 cases per year, maybe 200. To some degree, the more the better.
• Who manages your personal care?
In other words, how easy will it be for you or family and friends to find out how you’re doing? • How big is their referral network?
What arrangements do they have with other facilities to provide services they themselves cannot?
• How many registered nurses (RNs) are on staff? The AHA says on average in the US, this amounts to around four RNs to every licensed practical nurse (LPN).
• What is the nurse-to-patient ratio? One nurse can effectively care for 3-6 patients (in anywhere but the ICU, where it’s more like one nurse to every 1-2 patients)
• Who is their infection control practitioner? They may not have one, but someone in the hospital should be in charge of coordinating infection control, since as many as 5 percent of patients in the US pick up a hospital-acquired illness during their stay.
• Who is the ombudsman? Ombudsmen work as go-betweens for patients and their complaints, so if the hospital doesn’t have one, ask who handles patient complaints.
• How many social workers are on staff? Social workers aide patients in dealing with everything except the actual procedure, such as emotional, social, clinical, physical, and financial issues.
• Do they accept Medicare patients? A good question to ask even if you aren’t on Medicare, since if the answer is no, they may be on probation or been suspended from the program and you would like to find out why.
• Is the hospital clean? Visit it and look around. Ask to see the waiting rooms and patient care rooms. Do they look comfortable? Would you want to recuperate in the patient rooms? How much privacy would you have in these rooms?
• Can I take care of some testing on an outpatient basis? Getting X-rays etc before being admitted can save you money.
• What departments are available at all hours? Lab, x-ray, emergency, operating room?
• When are visiting hours? Where can you use your cell phone? Is there a courtyard available?
• What about diet needs? Request to see a weekly menu; if it doesn’t look too good, ask if guests can bring you food.
• Is it in a convenient location? Convenient to you, to friends and family who might want to visit. Find out if there is a public transit stop near by, and what the parking situation is.
Bills & Costs
• Do they have private and semiprivate rooms? Ask how much each costs and what is included in those charges. Ask what gets billed separately. Determine what will be covered by your insurance, and if it looks like costs will exceed what they will pay, ask whether the hospital will work with you on a compromise.
• If paying out-of-pocket, ask to speak with a finance counselor. Work out the best possible financial scenario. Do they offer any financial assistance or a way to establish payment plans? And is a deposit necessary?
In the US, hospitals can earn accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). JCAHO is an independent, nonprofit organization and they carry out quality assessments at 5,000 US hospitals and 6,000 US health care facilities every three years. Hospitals do not require JCAHO accreditation to operate, and the process is not obligatory.
However, being accredited by JCAHO says some good things about the hospital, because they use 28 areas of performance that range from infection control to patients rights to social services and surgical procedures. In all they have six scores:
• Accreditation with Recommendations for Improvement. The hospital meets most standards, but regarding at least one critical area, it does not. They are given a time frame in which to meet this standard; if they fail to do so, accreditation is withdrawn. About 90 percent of the hospitals are given this status.
• Full Accreditation The hospital meets all their standards in every area of performance. About four percent
• Accreditation with Commendation This is also earned by about four percent. In these cases, the hospital not only met all standards but proved to be outstanding overall.
• Conditional Accreditation The hospital’s performance is considered marginal at best and they are given a time frame in which to improve certain areas or risk losing this status. About one percent are given this assessment.
• Denied Accreditation The hospital failed to meet their standards. Fewer than one percent.
• Provisional Accreditation This only applies to new hospitals that have passed an initial assessment. They will be assessed twice more in the coming six months, at which time this status will change depending on the results.