The earliest hospitals were more like hospices, where poor people could die in peace. The first hospital in the U.S., founded in 1751 by Benjamin Franklin and Dr. Thomas Bond. served the mentally ill and the poor. People who could afford it had the doctor come to their home for care and procedures.
The role of the hospital was to provide care for poor people. Today hospitals care for the poor and the rich. But there is a movement today, started by the Centers for Medicare and Medicaid Services (CMS), to encourage hospitals, through reimbursement rates, to reach into the community to keep patients from returning to the hospital within 30 days of discharge.
What will be the role of the hospital in the future? Will hospitals be required by CMS and other insurers to have greater roles in the community, to measurably improve the health status of the people, rich or poor?
The idea may be to reduce the number of people who need, for example, heart surgery. In many countries where there is universal health care, hospitals are rewarded by having shorter length of stay and doctors are rewarded by providing care that keeps their patients out of the hospital. Preventing health problems is the emphasis.
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