Changing Role of Hospitals in New Millennium

An Overview

From us gradual evolution through the 18th and 19th centuries, the hospital both in the eastern and the western world—has come of age only recently during the past 50 years or w. the concept of today’s hospital contrasting fundamentally from the old idea of a hospital as no more than a place for the treatment of the sick. With the wide coverage of every aspect of human welfare as part of health care—viz physical. mental and social wellbeing, a reach out to the community, training of health workers, biosocial research, etc.—the health care services have undergone a steady metamorphosis, and the role of hospital has changed, with the emphasis shifting from:

1. acute to chronic illness

2. curative to preventive medicine

3. restorative to comprehensive medicine

4. inpatient care to outpatient and home care

5. individual orientation to community orientation

6. isolated function to area-wise or regional function

7. tertiary and secondary to primary health care

8. episodic care to total care.

The important factors which have led to the changing role and functions of the hospital are as follows.

1. Expansion of the clientele from the dying, the destitute, the poor and needy to all classes of people

2. Improved economic and social status of the community

3. Control of communicable disease and increase in chronic degenerative diseases

4. Progress in the means of communications and transportation

5. Political obligation of the government to provide comprehensive health care

6. Increasing health awareness

7. Rising standard of living (especially in urban areas) and sociopolitical awareness (especially in semi urban and rural areas) with the result that people expect better services and facilities in health care institutions

8. Control and promotion of quality of care by statutory and professional associations

9. Increase in specialization where need for team approach to health and disease is now required

10. Rapid advances in medical science and technology

11. Increase in population requiring more number of hospital beds.

12. Sophisticated instrumentation, equipment and better diagnostic and therapeutic tools.

13. Advances in administrative procedures and management techniques.

14. Reorientation of the health care delivery system with emphasis on delivery of primary health care.

15. Awareness of the community.

The Changing Scene in The Hospital Field

Our technical abilities have outstripped our social, economic and political policies. The technological advances in the field of medical sciences have provided clinicians with more esoteric aids to diagnose and treat illnesses. Clinics and communities will continue to pressure hospital management to provide such advances even though they will be very costly. Not only pressures will increase for providing newer technological capabilities, but there will be growing demands for such care. There are growing indications that this has started happening in our Indian situation.

Since treatment is provided free of charge in government hospitals, it has in many cases resulted in abuse, particularly in the outpatient department. This has led to the patient being made to pay a small charge, varying between 10 to 20 per cent of the cost of medical attention, which, though modest is a useful contribution to hospital running costs. The model of the nationalized health system that took shape in Great Britain and some other countries has not found true acceptance in India, because health and medical care is not a central but state subject. Allocation of funds for the health sector both in the central and state budgets has also declined gradually. Perhaps this is the reason, among others, that private institution, commercial firms and corporate bodies are jumping into the medical care field to form investor-owned, for-profit hospitals.

One-third of the last decade’s increase in medical costs is attributed to increase use of high technology medicine, particularly surgical and diagnostic procedures. Even then, successful launching of state-of.-the-art investor owned hospitals has proved that hospitals can benefit from corporate management principles and can function profitably and efficiently without sacrificing quality and affordability.

At the turn of the century most people died at home cheaply. Today, more than 20 per cent the in expensively equipped hospitals, and it is estimated that up to half of an average person’s lifetime medical expenses will occur during his last six months.

The changing trends are indicating the following—

1. In determining the extent and coverage, there will be more and more dominance by consumers rather than providers or producers.

2. Hospitals and health care institutions will become akin to industries.

3. Not all services under one roof Hospitals will be catering more and more to the needs of patients in fragments, which:

a. will lead to more and more specialized hospitals in place of general hospitals which provided medical, surgical, obstetric and gynecological, ENT, pediatrics, etc. under one roof

b. people will medical care

c. hospitals will require more and more management skills as administrators at each level

d. will lead to growth of corporate hospitals and modern management concepts

e. will be capital intensive

f. will be technology intensive

g. ascendancy of technical expectations over human values.