Types of Hospitals
Hospital services are provided in the following public and private facilities:
- Most hospitals in the United States fall under this category, also referred to as "general" hospitals. They are equipped to provide care for a broad range of medical conditions and treatments that the general population may require.
- The quality of care can be very good but they may not be as experienced or well equipped for treating some serious or special conditions. They may also not be capable of providing a complete range of medical services on a 24 hour basis.
- The benefit of a community hospital is that they tend to be smaller, may provide more personalized care, are usually less expensive and may be more conveniently located. A small number of community hospitals are affiliated with teaching institutions and may provide a greater number of specialized services than those who have no teaching affiliation.
- If something goes wrong, a community hospital will not have the breadth of specialties available in a larger, teaching hospital.
Major Medical Centers, Research and Teaching Hospitals
Major medical centers, research and teaching hospitals:
- Are usually located in large urban centers.
- Are affiliated with a medical school and provide training to doctors and other health care professionals.
- Are complex institutions with many departments of treatment and research.
- Provide a wide range of services, including emergency services, for all medical problems, including diagnostic procedures, on a 24/7 basis.
- Generally do important research into serious diseases and injuries.
- Are staffed with all types of medical personnel, from staff that are trained in nutrition and food preparation, to nurses, interns, resident doctors, nurse practitioners and specialists such as surgeons.
- Often use teams of doctors with different expertise (known as a multi-disciplinary team) and nurses to treat patients.
- Often have satellite locations which specialize in particular areas of medicine, or serve a particular community.
- Have been certified as "Centers of Excellence" in various types of health care; for example, cardiology, oncology, burn treatment, etc.
Generally, people with a life-threatening or chronic illness will be treated at a medical center because of the expertise of the doctors and medical staff. Studies from Yale and Duke Universities, among others, indicate that when being treated for some serious medical problems, teaching hospitals may offer higher quality of care and are more likely to adhere to conventional treatment recommendations.
Teaching hospitals also tend to have access to the latest technologies and research combined with the highly skilled specialists who teach at their affiliated medical school. These benefits can be tremendous for patients with serious illness. For example, the Duke University study reviewed medical records of a total of 2,674 Medicare patients admitted to a total of 1,378 hospitals during 1994. The patients were treated for hip fractures, heart disease, stroke and congestive heart failure. The study concluded that death rates were 25% lower for those patients who were admitted to major teaching hospitals.
One of the most common complaints about teaching hospitals is that they can be large and impersonal, making it difficult for patients to develop personal relationships with their caregivers.
Another complaint is that a portion of hospital patient care may involve medical students and doctors-in-training. As one patient put it, "I always feel like a guinea pig with four medical students standing in my room." It is worth mentioning that you do have the right to refuse the care of any doctor, including medical students.
The cost of hospital care also tends to be more expensive at a teaching hospital. However, if you have been diagnosed with a serious illness that requires specialized care, the tradeoff may be well worth the additional expense, or the possibility of receiving impersonal care. It is important to note that in the annual U.S. News selection for "Best Hospitals" providing the highest level of specialized quality care, virtually every listing is a teaching hospital.
Specialty Care Hospitals
- Specialty care hospitals are owned by a group of doctors specializing in a particular type of medical treatment. They focus on a limited number of procedures and sometimes only on one specialty such as heart surgery.
- Specialty Care Hospitals do not generally offer emergency services or the full range of specialties or procedures offered by major medical centers.
- Since they are privately owned institutions, a specialty care hospital may not take medical insurance.
- Admission to a specialty hospital is usually by referral from a doctor, usually one who has a financial interest in the hospital.
- Some states do not permit or severely limit specialty care hospitals.
- Clinics are usually a small facility that may be associated with a major medical center. Often they are government run centers that treat patients of low income with no insurance.
- Doctors at clinics treat a wide range of medical problems. They refer emergencies or severe problems to a medical center for treatment.
Urgent Care Centers
- Urgent care centers are not hospitals. They are equipped to treat minor illnesses that are temporary in nature, such as nausea, diarrhea and flu. They are not equipped to treat a life-threatening emergency.
- Usually the patient is treated and sent home or, if necessary, referred to a larger hospital.
- Urgent care centers are generally privately owned and are not affiliated with a major medical center.
- Most urgent care centers accept insurance. Some require payment in advance for treatment.
Herbert Spiers, Ph.D.
New York, NY