All hospitals are not the same.

You may not have a choice about what hospital to enter because of your insurance or because you want to use a particular doctor who in turn decides what hospital to use.

When you do have a choice about hospitals, the key is to choose the one that is best for your current needs rather than just because a hospital is close to your home or looks nice or modern or because a friend had a good experience there. It is advisable to consider the following steps, each of which are discussed in detail in the other sections of this article:

Step 1. Determine your needs.

Step 2. Decide what type of hospital is best for you.

Step 3. Identify the hospitals that provide the services you need.

Step 4. Consider the hospital's expertise with the particular procedures you may need 

Step 5. If there are accreditations for hospitals specializing in your condition, check to be sure the hospital is accredited.

Step 6. Look at the differences in quality among the hospitals you are considering.

Step 7. Check to determine whether the hospital fits your financial/insurance situation.

Step 8. Determine whether the hospital meet your practical needs.

NOTE:

• Do not take a hospital off your list just because it is a public hospital. Public hospitals can be very good choices. Many public hospitals have been recognized as centers of excellence in various areas of medicine. If the hospital is a teaching hospital, it will almost certainly be equipped with better doctors and equipment than even private hospitals. Teaching hospitals are also on top of the latest developments. 
• You may be able to travel to a distant cancer center for free. For information about free travel, click here.

Written with:
Herbert Spiers, Ph.D. New York, NY

Your current condition in addition to any relevant medical history will have a direct bearing on your choice of hospital. It is important that the hospital be capable of meeting your specific needs.

With the assistance of your doctor, determine your medical needs and requirements. Does your medical condition and treatment require specialized care?

Also think about your personal needs. For instance, how many hours a day you want people to be able to visit, whether family members and/or caregivers can stay in the room with you, and whether you are permitted to add personal touches to your area if you will be sharing space with one or more patients.

Hospital services are provided in the following public and private facilities:

Community/Rural Hospitals

• 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

• 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.

Services that the best equipped hospitals provide include the following:

• Round-the-clock doctor staffing.
• Social work and navigation services.
• Respiratory therapies, physical therapists, and rehabilitation services.
• Advanced diagnostic and therapeutic equipment (CT scans, radiation therapy, etc.)
• An intensive care unit.
• Licensed anesthesiologists.
• An accredited pathology lab, diagnostic lab, and blood bank.
• A tumor board for people with cancer

You can learn a lot about a hospital and how patients fare after they received care there through the federal government website Data.Medicare.gov . Different sections compare hospitals and tell you how patients with certain conditions fared after they received hospital care as well as results of patient surveys about the quality of care they received.

You can also call the hospitals you are considering and ask about out their track record with the particular procedure you need. For instance, consider asking:

• How many of the procedures have been performed in your facility in the past three years?
• What is their success rate with that procedure?
• Are the same personnel still at the hospital?

ACCREDITATION IN GENERAL

The Joint Commission is an independent, not-for-profit organization, which accredits and certifies more than 20,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. 

To learn if an organization is accredited by The Joint Commission, click here.  

ACCREDITATION FOR CANCER TREATMENT

The National Cancer Institute and Commission on Cancer accredit cancer treatment facilities.

• National Cancer Institute (NCI) Center Program
  • NCI facilities which are called "clinical cancer centers" and "comprehensive cancer centers" provide clinical care and services for cancer patients. They are up-to-date on the latest treatments because they also focus on cancer research, including areas such as experimental treatments, drug studies and clinical trials. 
  • You can find NCI comprehensive cancer centers at www.nci.nih.gov/cancercenters/ .

Commission on Cancer (of the American College of Surgeons)

• To locate an accredited facility visit:
  • The American College of Surgeons website at facs.org/search/cancer-programs
  • The American Cancer Society at www.cancer.org/medical_resources/Find
• The Commission on Cancer sets guidelines for cancer diagnosis and treatment with the goal of reducing the morbidity and mortality caused by cancer through prevention, monitoring and reporting of care, standard-setting, and education.
• All of the approved cancer programs are required to provide state-of-the-art diagnostic and treatment services consisting of a multidisciplinary approach.
• Each facility includes a tumor board consisting of different kinds of cancer specialists who meet regularly to discuss individual cases. For example, a tumor board may include a pathologist, diagnostic radiologist, surgeon, medical oncologist, and radiation oncology. Board members discuss the form of cancer, its location, the state, and all of the possible treatments most likely to successfully treat a specific patient.
• Commission members include surgeons and representatives from thirty-seven professional organizations including the American Cancer Society, Cancer Care, the National Cancer Institute, and the U.S. Centers for Disease Control and Prevention.
• Even at a Commission on Cancer approved facility, the experience and volume of performed treatments and procedures will vary. If you have a rare or advanced form of cancer or are considering under going a complicated procedure, consider going to a national comprehensive cancer center or a facility that has performed the greatest numbers of these procedures.

As Consumer Reports stated: "Bad things happen in all hospitals, but they happen a lot in some."  

This section first lists various rating organizations. It then provides information about particular areas which are included in the ratings.

To help compare hospital performance, there are report cards/ratings issued by various organizations, Before you look at the ratings, be aware when reviewing information that unique conditions can skew the results. For example, a really great hospital may have a high mortality rate because it gets the most difficult cases.

Some of the more popular report cards/ratings are the following:

• Medicare: www.medicare.gov/hospitalcompare/search.html  compares hospitals with respect to treatment of heart attacks, heart failure, pneumonia and surgical infections. Results are based on information voluntarily submitted by hospitals.
• Hospital Safety Score (www.HospitalSafetyScore.org ) assigns letter based grades based on 26 safety measures and standards. The site was created by the employer based, nonprofit, Leapfrog Group which has a goal of reducing preventable medical mistakes..
• Joint Commission on Accreditation of Health Care Organizations issues reports on quality at: www.qualitycheck.org
• U.S. News. Hospital rankings are specifically designed for people with critical health concerns. According to U.S. News, their mission is to identify the hospitals with the greatest expertise and experience in treating medical conditions that greatly compromise quality of life, or life itself.http://health.usnews.com/best-hospitals
• www.healthgrades.com , is a report service that offers minimal basic information for free. Click on "hospitals."
• Consumers' Checkbook, provides ratings of 4,500 acute care hospitals for a fee. The guide provides a comparison of death and "adverse outcome" rates for major types of cases; doctors' ratings of hospitals in areas such as high-risk adult surgery; patients' ratings and ratings of hospitals on key patient safety measures. See: www.checkbook.org
• Hospital Safety Score assigns easy to understand grades to more than 2,600 hospitals based on a variety of safety measures and standards. To check a hospital, go to www.HospitalSafetyScore.org

You can also check with your state's health department to determine whether there are complaints against a particular hospital. To locate the health department in the state of interest, go to http://www.cdc.gov/mmwr/international/relres.html . In the pull down box, find the state. Then click "go."

Accreditation

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the nationwide authority that surveys hospitals. JCAHO determines whether a hospital keeps or loses accreditation based on its meeting certain health and safety requirements.

Although accreditation is voluntary, most hospitals go through the process.

Surprisingly, 1 out of 4 hospitals fail to win accreditation.

To locate hospitals that meet the patient safety and quality standards set by the organization, go to: www.qualitycheck.org . To learn more about JCAHO, see: www.jcaho.org

The National Cancer Institute designates certain facilities as comprehensive cancer centers .

Experience

The old adage "practice makes perfect" certainly seems to be true when it comes to medical care. Repeated studies confirm that in the case of specialized medical care and surgical care for a complex problem, the more experience a hospital has with the necessary procedures, the better the results will be.

Infection Control

The rate of infections acquired in a hospital are ttechnically called the hospital's rate of "nosocomial infections".

About one in twenty patients gets sick from their stay in the hospital. Hospital-acquired illnesses are a major concern, especially since one-third to one-half of acquired infections are preventable and some infections acquired in hospitals are becoming resistant to treatment.

To obtaininformation about infection control, ask the hospital, your doctor, and/or contact your local department of health. Every accredited hospital has an infection control committee which generally includes doctors and nurses, and often a hospital administrator. Their reports are usually available upon request.

Nursing Staff

The number of nurses on staff in relation to the number of patients can directly impact patient care, for example with regard to medication error, and post-surgical complications such as pneumonia, blood clots, and infection.

Specialty Departments

Medical conditions do not always exist in isolation. Related and/or unrelated complications may occur in the hospital. Managing these problems requires a multidisciplinary team approach with doctors from several specialties.

Quality of care is generally higher in hospitals that use a multidisciplinary team approach to treating serious illness.

Range of Diagnostic and Treatment Options

There may be more than one way to treat your medical condition. The hospital should be equipped for the treatment option agreed to by you and your doctor.

If your condition is the least bit out of the ordinary, or lacking viable treatment options, check to see whether the hospital conducts research into the cause and treatment of your illness through clinical trials . Clinical trials provide access to the most up-to-date treatments which are not yet approved for general use.

Referral Network

If a hospital does not have the staff and/or services necessary to treat a complication or problem that occurs while you are in the hospital, it will have to transfer you to another facility. Find out what arrangements a hospital has with other hospitals.

Is your primary care doctor affiliated with the hospital?

Doctors cannot work in a particular hospital unless they are affiliated with that hospital.

Your primary care doctor is important to your care in a hospital because he or she knows you and your history. Specialists tend to focus on their particular area instead of the whole patient.

If your doctor is not affiliated with a hospital, ask the specialist who will be in charge of your care to keep your primary care physician updated on a daily basis. If he or she is not willing to do so, ask a friend or family member to do it for you.

Word of mouth/Social Media

Word of mouth and social media can give you an idea about what actually goes on in a hospital on a day-to-day basis. Of course this type of information is anecdotal (what happen to one or a few people) and is not necessarily representative of reality.

In addition to social media such as Facebook and Twitter, try to speak with people in health care. Also ask people in your support group or others with your condition about their experiences with the different hospitals in your area.

• Were they treated as numbers or individuals?
• Were they treated as partners in their care?
• Were all tests and procedures discussed ahead of time or did doctors just show up for them?
• How about the cleanliness of the place? The noise level?
• Which emergency room worked best for them?

Hospital charges can vary greatly.  If you are likely to pay a percentage of the charges,   you should know what your costs will be.  What is the charge for a bed in a semiprivate room?  Are private rooms available?  What do these charges include?  What will be billed separately?  If the hospital's charges exceed what your insurance company considers "reasonable and customary," can some compromise be reached on the price?  Is there a hospital payment counselor to help arrange payment installment plans for charges you will pay out of pocket. Does the hospital provide any resources to help you find financial assistance if you need it?

If you look at a hospital's web site or call the hospital you can also obtain and compare:

• Room costs. They will vary from hospital to hospital. 
• Whether the hospital will accept your form of payment.
• What the hospital charges for the procedure under discussion. Charges for the same procedure can vary widely from hospital to hospital -- even in the same geographic area.

If you are uninsured:

• Keep in mind that if a facility receives funds from the federal government, you may be eligible for free or low cost careunder the Hill-Burton program. Eligibility is based on family size and income. To learn more, call the Hill-Burton hotline at 800.638.0742. or see http://www.hrsa.gov/hillburton/default.htm .
• Companies such as North American Surgery pair patients willing to pay up front with small hospitals willing to give discounts - sometimes very large discounts. See: http://www.NorthAmericanSurgery.com

Questions to consider:

• Does the hospital provide patient navigators, social workers and other services to help you and your family through the emotional aspects of your illness or hospitalization?
• Does the hospital have programs to educate you and your family about your condition, procedure or recovery?
• If you visit the hospital, do you feel comfortable there?
• Is the hospital geographically accessible to you in case you need return visits, and to people who would visit you?
• Will the hospital honor your Living Will, your medical power of attorney, and other advance directives?