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Copyright 2012 by Pearson Education, Inc. All rights reserved.
Chapter 14
The Hospital in Society
Medical Sociology Twelfth Edition
William C. Cockerham
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Development of the Hospital as a Social Institution
Formal institution in modern society to meet complex health needs
Gives the patient access to centralized medical knowledge and advanced technology
Protects both families and society from the disruptive effects of illness by placing the sick within the institution for medical care
Hospitals have passed through four distinct stages in the history of their development
Copyright 2012 by Pearson Education, Inc. All rights reserved.
As Centers of Religious Practice
Originally established for religious purposes
Medical care was supervised and largely performed by clergy and nuns
Consisted primarily of a rudimentary form of nursing
Primary functions of the medieval hospital were the exercise of religious practices and the extension of charity and welfare services to the poor, including both the able-bodied and the sick
Copyright 2012 by Pearson Education, Inc. All rights reserved.
As Poorhouses
Secularized during the Renaissance and the Reformation
Led to a decline of the hospital system
Hospitals during this period acquired the characteristics of boarding houses
Offered food and shelter to the poor, regardless of whether they were sick or healthy
Copyright 2012 by Pearson Education, Inc. All rights reserved.
As Deathhouses
Physicians had little influence or involvement in early hospitals
Changed around the 17th century as medical knowledge and techniques advanced
By the 19th century hospitals had taken on their present-day role as institutions for medical care
Hospitals during this period were crowded and unsanitary, and the low success rate of medical intervention often meant that hospitals were viewed as places where the poor went to die
Copyright 2012 by Pearson Education, Inc. All rights reserved.
As Centers of Medical Technology
By the end of the 19th century, hospitals were places where patients of all social classes could generally expect to find high-quality medical care and to be cured of their disorders
This development fostered by:
Improvements in medical knowledge and techniques
Implementation of sanitary measures
Better training of hospital personnel (especially nurses)
Copyright 2012 by Pearson Education, Inc. All rights reserved.
Hospitals in the United States
First hospitals founded in the U.S. more than 250 years ago
Development paralleled that of Western European institutions in the 1700s
Early hospitals were founded mostly by private citizens who wanted care available on a nonprofit basis
Federal government not involved in health care until 1798
Copyright 2012 by Pearson Education, Inc. All rights reserved.
Hospital Ownership
May be classified into three major types: Nonprofit
Most common type of hospital, approx. 51% in 2007
Controlled by a board of trustees, exempt from federal income taxes
Characterized as emphasizing high-quality care for all classes
For-profit Growing trend, often part of a multihospital chain
Government (local, state, or federal) Generally lack prestige compared to other hospitals
Major source of care for low-income populations
Copyright 2012 by Pearson Education, Inc. All rights reserved.
Organization of the Nonprofit Community Hospital
Hospitals as multipurpose institutions
Satellite outpatient clinics
Affiliated group practices
Smaller hospitals
Management organizations providing administrative services to physicians
Employ primary care doctors as part of their physician network
Copyright 2012 by Pearson Education, Inc. All rights reserved.
Organization of the Nonprofit Community Hospital
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Hospital: Dual Authority
Nominally supervised by a governing body Board of trustees
Actually exhibit a dual system of authority Administrative and medical
System emerged as: Trustee control of hospitals gave way to medical
dominance
The medical profession was balanced by the growing influence of the hospital administrator, who served to place checks on the medical exercise of power
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Hospital: Dual Authority
Organization consists of a varied group of professionals and allied health workers with different functions, training, and occupational values
Effective functioning needed a decentralized system of authority organized around the central objective of service to the patient
Administrators direct and supervise hospital policy
Medical staff retains control over medical decisions
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Hospital: Dual Authority
System can cause stress, inconsistency, overlapping of responsibility, and inadequate coordination
But also results in a process of negotiation that results in efficient and standardized forms of behavior not dependent on special instructions for all situations
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Hospital-Patient Role
Prominent theme of research on the hospitalization experience is that of depersonalization
The treatment of others as devalued and nonpersons
May also include the experience of ones self as a physical object or thing, or the feeling of being isolated from others
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Hospital-Patient Role
The structure of the hospitals work
Emphasizes organizational efficiency
Favors rules and regulations that reduce patient autonomy and encourage patient receptivity of the hospital routine
Depersonalization of patients not an intended goal of hospital organization
Depersonalization also results from the patients subjective experience of being sick
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Hospital-Patient Role
Three basic mechanisms of hospital processing reduce patients to an impersonal status:
1) Stripping of personal belongings and control over visitors and daily routines
2) Control of resources, including diagnostic information by staff
3) Restriction of patient mobility
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Hospital-Patient Role
Some patients willingly conform to hospital expectations
More true of older and less educated patients
Doctors and staff define patients according to how time they demanded
Good patients require less time and attention from the staff
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Hospital-Patient Role
Similarities between Parsons sick role and the role of the hospital patient
Both are universalistic, affectively neutral, functionally specific, and collectivity oriented
Inpatient care adds a role additionally characterized by submission to authority, enforced cooperation, and depersonalized status
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Rising Cost of Hospitalization
Over the course of the 20th century, the cost of hospitalization has increased sharply
1925: $3.00 for one days stay, paid entirely by patient
2005: $1,696 for one day, paid mostly by health insurance
Manner of payment also changed
Majority of costs are now paid by third-party sources
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Rising Cost of Hospitalization
Costs may be divided into
Routine costs, which include room and board of patients, employee salaries, and the cost of nonmedical supplies
Ancillary costs, comprised of laboratory, surgical, diagnostic, and medical supply costs
Copyright 2012 by Pearson Education, Inc. All rights reserved.
The Rising Cost of Hospitalization
Factors influencing hospital expenses: Regional cost of living
Occupancy rate
Burdensome paperwork loads for insurance claims
Technological innovations
Maintaining up-to-date facilities
Costs can be controlled through: Reducing paperwork loads
National health insurance coverage
Fee schedules