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Health Affairs, 25, no. 1 (2006):
8-9
doi: 10.1377/hlthaff.25.1.8 © 2006 by Project HOPE |
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From the Editor |
U.S. Hospitals: Examining Their Fraying Social Contract
AMERICA'S HOSPITALS, the employers of 4.7 million people (full-time-equivalent) in 2003 with revenues approaching a half-trillion dollars, are a bulwark of the health care system and a mainstay in the overall economy as well. In 2003, the latest year of data available, there were 5,764 hospitals in the United States, which generated revenues of $498.1 billion. These facilities operated some 965,000 beds and cared for 36.6 million inpatients, with an average daily census of 657,000. With advances in medical technology, greater patient demand when baby boomers reach retirement, and rising prices, it seems likely that hospital spending will continue to increase. Total hospital spending has grown continuously since 1960, and in the latest data available, it increased 8.6 percent in 2004 and accounted for 34 percent of the overall spending rise in that year. (See the paper by Cynthia Smith and colleagues, "National Health Spending in 2004: Recent Slowdown Led by Prescription Drug Spending," p. 186.) Although hospitals have been remarkably successful in navigating the shoals of the ever-changing U.S. health care system, new pressures lie ahead. Two of the most formidable are multiple forces that seek to eliminate the cross-subsidies sustaining hospitals’ less profitable services and an increasing number of physicians who are shifting their patients to freestanding ambulatory care centers and specialty hospitals in which they often have an investment. The first seven papers in this thematic issue on hospitals are a primer on the issues surrounding cross-subsidization and the way hospitals price their services.
A number of the papers contained in this issue were presented initially at a national conference sponsored by organizations with a large stake in the future of the medical economy. These organizations also gave support that enabled Health Affairs to develop this issue, and we hereby acknowledge their contributions. The principal supporter was the Federation of American Hospitals and its president, Charles N. Kahn III. Other provider and payer organizations also contributed to the project: AdvaMed, America’s Health Insurance Plans (AHIP), the Council on Health Care Economics and Policy, GE Healthcare, Johnson Controls, Johnson and Johnson, and MEDLINE. Needless to stay, all of the papers in this volume were subjected to rigorous external peer review—the gold standard upon which Health Affairs decides whether to publish a manuscript. Gerard Anderson, a professor of health economics at the Johns Hopkins University, served as our editorial adviser on the project.
No issue has the U.S. hospital community more exercised than the increase in the number of specialty hospitals. These are the latest in a wave of accelerating efforts by physicians to break out of the traditional hospital setting in search of more income and greater autonomy. Four papers here address the issues surrounding for-profit specialty hospitals, which are proliferating particularly in states without certificate-of-need laws. Although these new facilities are causing upset among community and teaching hospitals, it is well to remember the conclusion reached by Rosemary Stevens in her landmark study: Through thick and thin, she wrote, hospitals have always found a way to successfully bridge their twin roles as charities and businesses.
We are pleased to report that online readership of Health Affairs continues to grow, reaching nearly nine million pageviews in 2005; hits topped thirty-one million. These online readers stretch far beyond the journal’s core 11,000 subscribers. Health Affairs’ Web-Exclusive papers have been a major factor in this growth. We began publishing these peer-reviewed, fast-track papers in 2001. Today they constitute more than 25 percent of all papers that we publish. Beginning in 2006 we are incorporating into each journal’s table of contents all Web Exclusives published online in the two months prior to release of the bimonthly journal. The goal is to incorporate this important segment of the journal into one table of contents for easy reference. We also are revising our Web-Exclusive citation style to meet newly emerging online standards. The citation includes a volume number, year published, unique page numbers, the date of online publication, and a unique digital object identifier (DOI) number, so that the paper can always be located on the Web. An example is U.E. Reinhardt, "Variations in California Hospital Regions: Another Wake-Up Call for Sleeping Policymakers," Health Affairs 24 (2005): w549–w551 (published online 16 November 2005; 10.1377/hlthaff.w5.549)
As we enter our twenty-fifth volume, Health Affairs continues to add new tools to assist the research process, including delivery of our headlines via RSS feed, improved links to Google Scholar, and a new online system for handling reprints and permissions. We encourage readers to get the most out of the journal by activating their online subscriptions at http://www.healthaffairs.org.
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HOPE–The People-to-People Organization |
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