
We should welcome the advances that are making hospitals less important - dr_
https://www.nytimes.com/2018/02/25/opinion/hospitals-becoming-obsolete.html
======
cperciva
Hospitals aren't becoming obsolete, but their role is changing. Hospitals were
once a place where patients were kept for extended periods of time; now for
reasons of cost, sanitation, improved surgical techniques, and patient
preference they're increasingly places where patients go for medical treatment
but unless they're on the verge of death (and thus may need further treatment
in very short order) patients then return to the community.

More surgeries; less meals and laundry. Rather than becoming obsolete, I'd say
that hospitals are gaining an increased focus.

~~~
xaldir
>patient preference

As a patient, I'm always suspicious when I see this. When I'm in a bad enough
shape to go to the hospital, going home is not my priority, getting better is.

As someone who also work in an hospital, pushing patients out as quickly as
possible has more to do with financial objectives than anything else. (e.g. we
were told that our hospital should have 25% less beds by 2020)

~~~
apatters
In Thailand, where medical care is both cheap and good, most of it takes place
in hospitals. You can still find clinics, but people usually go to a full-
blown hospital when they have health-related issues.

Inpatient treatment is much more common here than in the US, in fact from my
American perspective it sometimes feels like they overtreat (lots of tests,
prescriptions, IVs, and overnight stays for minor ailments).

I would have thought that treatment at a hospital would generally be better--
they're larger than clinics, they have more equipment and more specialists.
Though I wouldn't be surprised if clinics had certain advantages like a more
personal relationship with your doctor.

All this is to say that in a market where health care is both cheap and good,
hospitals aren't going away and people are spending more time in them. I
wouldn't be surprised if the decline of hospitals in the US was about costs
like you say.

~~~
xamuel
Most simple things can be dealt with at a clinic in less time (in-the-door to
out-the-door) than you'd spend merely filling out the initial hospital
paperwork.

------
joshgel
As a physician, one of the things not touched on in this discussion and only
briefly mentioned in this article is the harm associated with hospitalization.
For many of my patients discharge planning is one of the toughest
conversations to have. Patients are often reluctant to leave the hospital and
I have to tell them why its better that they continue care at home. The
reasons they want to stay are many and varied, but include the long emergency
department wait times (if they get sick again and have to come back they don't
want to deal with that again), clean sheets on a comfortable bed with 3 meals
a day for my poorest patients, staff to take care of their needs and that they
probably feel safer in the hospital because of all the beeps and bops and
scurrying about of the staff. But, they can't see all the patients who had bad
outcomes from staying in the hospital too long: they get confused or
delirious, there is a medication error, they fall getting out of bed in the
middle of the night, they get a new infection, etc.

Trying to get people to see those risks is hard, especially since they
shouldn't happen, so no one expects them to happen.

------
aaavl2821
For those in the industry, the continued consolidation and increasing power of
hospital systems seems a given, despite the problems that entails. It is
refreshing to see this perspective voiced

As I said in another thread, hospitals are the largest component of US
healthcare cost. They make money by increasing the number of hospital visits,
especially for surgeries. Even non profits have been consolidating and seeking
profit, and the largest non profit systems have dramatically increased their
incomes over the last few decades

Hospitals are devouring outpatient clinics to get their patient volume into
the hospital system. These practices are loss leaders for the hospital profit
centers in many cases

Sadly, many hospital systems fight improvements in care that decrease
inpatient admissions by making people healthier, because fewer admissions
means less hospital revenue.

Having hospitals in charge of US healthcare is like having the fox in charge
of the henhouse

~~~
Eridrus
What is the thing about hospitals that distinguishes them from other
facilities?

Is it just that they have beds and everything else is a clinic?

Why is having beds such a big factor? Is it just that they are a large fixed
cost which makes it hard to turn a profit?

I don't particularly like hospitals, but the healthcare system in the US is
hugely fragmented and piecing together all the providers you need is a pain in
the ass, why are hospitals unable to capitalize on their broad experience and
expertise to help?

~~~
hkmurakami
ER. In most areas hospitals are the only facilities providing emergency care.
(And boy is it expensive)

~~~
jiggunjer
Given how many people go there with a minor fever or stomach ache, it isn't
expensive enough.

~~~
maxerickson
Some hospital systems triage those people into an urgent care style pipeline
and charge them _less_.

The horror.

------
thedailymail
Bad headline, but the article itself gives some nice insights into the current
trajectory of medical care in the US. Important to note that the trend is not
the same in all countries though. In Japan, where hospital stays are
frequently used as a stopgap measure in cases where elderly patients can't
afford or can't find a long term assisted living facility, hospitalization
shows only moderate declines from historic highs in the 90s.

------
zaroth
"Hospitals are no longer seen as therapeutic." That's putting it mildly! I
think we generally do a piss poor job of providing truly therapeutic
environments as a service.

------
setgree
"Hospitals will also continue consolidating into huge, multihospital systems.
They say that this will generate cost savings that can be passed along to
patients, but in fact, the opposite happens. The mergers create local
monopolies that raise prices to counter the decreased revenue from fewer
occupied beds. Federal antitrust regulators must be more vigorous in opposing
such mergers."

This interrupted the flow of the piece for me...it has nothing to do with
hospital visits diminishing overall and it's an empirical claim that would
have benefited from a citation. It seems that Times op-eds often go for these
sorts of flourishes at the end.

I learned some interesting facts/stats from this piece and enjoyed it overall.

~~~
Spooky23
It is absolutely relevant as these hospital networks are gobbling up medical
practcies, nursing facilities, and other providers (acute rehab, pt, hospice,
etc).

The results are predictable. Prices are going up and medical providers are
marketing funnels.

In my little area (Albany-Schenectady-Troy NY), 90% of the providers are now
affiliated with two medical systems. One is a former Catholic medical system
that was absorbed by a national system and the other is a federation of joint
ventures headlined by the local trauma/teaching hospital. 10 years ago, we had
5 networks in the region. Even as an outsider looking in, you can see the
monopolist behaviors. Nursing and other medical staff are taking 20% salary
haircuts, doctors are forced to sell practices or lose referrals and go out of
business, and the quality and costs are not moving the right way.

------
chime
Seeing as how the infant/mother mortality rate is so high in the US compared
to other developed nations, I don't think home births should be encouraged as
much in non-rural areas. Birthing Centers are better than home births though
not suitable for high-risk cases.

~~~
vonmoltke
> Seeing as how the infant/mother mortality rate is so high in the US compared
> to other developed nations

6.2 in the US versus 5.7 in the EU doesn't really back that statement up.

[https://www.infoplease.com/world/health-and-social-
statistic...](https://www.infoplease.com/world/health-and-social-
statistics/infant-mortality-rates-countries)

------
Izkata
> Through the 19th century, most Americans were treated in their homes.
> Hospitals were a last resort, places only the very poor or those with no
> family went. And they went mainly to die.

Sort-of related: Why would anyone ever think putting "memorial" in a hospital
name was a good idea? "A place to go to die" is the first thing that has
always popped into mind when I see that.

~~~
mattkrause
If 'memorial' bothers you, you are going to love the an archaic French term:
'Hôtel-Dieu', or hotel of God.

------
vermontdevil
And yet a hospital chain is in the works to build a $1 billion facility mere 3
miles from their current one. [1]

Carmel (pop 90,000) has 2 hospitals already pluz a gazillion medical centers.

[1] [https://www.indystar.com/story/news/local/hamilton-
county/20...](https://www.indystar.com/story/news/local/hamilton-
county/2018/02/19/developers-propose-1-billion-hospital-development-
carmel/351119002/)

------
Steven_Evans
Here's all you need to know at the bottom of the article:

"Ezekiel J. Emanuel is ....a partner at Oak HC/FT, a health care investment
company."

Shabby nonsense from the Times.

~~~
maxerickson
So someone with enough expertise to manage investments in the area is
automatically disqualified from having and sharing an opinion about it?

Ezekiel Emanuel was also one of the architects of Obamacare, which hey, lots
of people will hold that as an even bigger point against him. But he may have
an interesting opinion about health care policy.

------
majidazimi
The title should be: We should welcome the advances that are making hospitals
less important in US.

There is nothing wrong with hospitals in EU.

~~~
24gttghh
I'm sure there is _something_ wrong with hospitals in the EU. They're run by
humans, after all.

------
iamdave
I came here prepared to walk away from this article being reminded once again
of Betteridge's Law[1], but then I got to thinking once I _did_ finish it...

...decoupling certain aspects of healthcare from gigantic, expensive hospital
systems may actually work for patients _and_ medical care providers couldn't
it? Article points out how we do to an extent already, and paints an
interesting argument for why we could see more of it. I think I'm on the "want
to see more of it", but unsure what the drawbacks would be aside how the
expected parties would like to see those traditionally centralized services
remain so.

I am not a medical professional, the article just got me thinking on the
topic...which means, Betteridge be damned-if a piece of writing gets you
thinking about something you wouldn't ordinarily think about, article
succeeded.

\---

[1]
[https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...](https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines)

~~~
ZeroGravitas
For those, like me, confused by this comment, the article's real title, which
I guess was changed on HN after this comment is "Are Hospitals Becoming
Obsolete?".

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drivingmenuts
As opposed to?

------
themodelplumber
Is there a framework that could communicate the most appropriate role of a
given hospital for those trying to evaluate their care options? For example,
"given the individual's parameters X and Y and Z, the hospital in question is
in quadrant N of the individual's sphere of care options. This implies a role
of [e.g. emergency use only, etc]."

It just seems like we need a more objective idea of _what a given hospital
really is and can be_ for a given individual. Such a model would naturally
expose economic opportunities for providers who have the resources to open
small competitor clinics, while conserving resources like money, energy, etc.
for care seekers who can only be excused for thinking "sick = hospital".

If we can't get needed anti-monopoly regulators to do their job, we can at
least start to find points of leverage with which to educate the public on the
cost-benefit and alternatives in a more straightforward way.

