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OVERVIEW AND TYPES OF HOSPITALS

The United States had 6,146 hospitals as of January 2020 (Figure 11-1). Hospitals are typically classified by the types of services they render, their average length of stay, ownership, and teaching affiliation. With regard to service, 5,198 of the 6,146 facilities are considered “community hospitals.” These provide either (1) general medical-surgical services that span lots of specialties or (2) specialty services for specific diseases and conditions (eg, rehabilitation, orthopedic, obstetrics/gynecology, ear/nose/throat, long-term acute care). Most of the beds set up and staffed in hospitals are for general medical-surgical patients; only a fraction are set up for intensive care units (ICUs) and other specialized purposes (eg, burn units). There are also more than 400 psychiatric hospitals in the private sector that treat patients with mental health illnesses (severe depression, substance abuse) requiring acute hospital care. Noncommunity (“other” in Figure 11-1) hospitals include prison hospitals and school infirmaries.

Figure 11-1

Characteristics of US Hospitals. (Source: American Hospital Association.)

With regard to length of stay, general medical-surgical hospitals are considered “short term” if they admit patients for less than 30-day stays. By contrast, long-term care hospitals (LTCHs), also known as long-term acute care (LTAC) hospitals, admit patients for stays lasting 30 or more days.

Hospitals can also be classified based on their ownership. Roughly 60% of the community hospitals (2,937) are nonprofit institutions owned by their local community; another 25% (1,296) are for-profit hospitals owned by publicly traded companies (hence the label “investor-owned”); the remaining 15% (965) are owned by state and local governments. A small number (200) and percentage of hospitals are owned and operated by the federal government for former or active military personnel (eg, Veterans Administration, Department of Defense).

Community hospitals can be further classified by their teaching status. Teaching hospitals train future physicians and other healthcare professionals, conduct research projects and clinical trials on new drugs and therapies, and care for patients with rare or complex conditions. There are various methods used to delineate gradations in the teaching status of a hospital. Some researchers define major teaching hospitals as (1) belonging to the Council of Teaching Hospitals (COTH) of the Association of American Medical Colleges; (2) offering a specified ratio of interns and residents to beds, ranging from more than 0.10 to more than 0.27; or (3) being designated as a flagship hospital or major affiliate of a medical school (ie, academic medical center [AMC]). By contrast, minor teaching status is alternatively defined as the presence of a residency program, a minor affiliation with a medical school, or simply as those not meeting the criteria for major teaching status outlined earlier. Nonteaching hospitals have professionally trained medical staff that focus on providing essential care for patients in a community rather than conducting medical training and ...

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