Going to the hospital… it sounds almost quaint to the modern ear, when we can now choose among so many different kinds of hospitals.
There are traditional community hospitals… academic medical centers… small, upscale private hospitals (some owned by doctors)… long-term-care facilities… and specialty hospitals that focus on particular disciplines such as rehabilitation or ophthalmology.
Why so many different kinds? Is one type better than the others? Are you getting bad care if you don’t go to a specialty hospital? Is it misguided to just choose the closest, most convenient hospital? These are just some of the questions I’ve heard from readers over the past year… so I thought it would be helpful to ask medical consumer advocate Charles B. Inlander, author of Take This Book to the Hospital with You, what people need to know in order to choose the right hospital every time.
Exactly as the term implies, specialty hospitals specialize — they either treat a specific type of illness or medical condition, such as cancer, eye problems or heart disease… or deal exclusively with a specific category of patients, such as women, children or the elderly. Advantages: Specialty hospitals typically excel in treating related conditions and also offer greater access to new technology and treatment techniques. Doctors affiliated with these facilities often are at the cutting edge of their specialties. Disadvantages: Specialty hospitals may find it challenging to treat multiple medical conditions or unanticipated, unrelated problems that arise during medical treatment. Also, patients may need to travel, incurring additional costs, to get to a specialty hospital.
General hospitals are what most people associate with the word “hospital.” These broad-based facilities treat a far wider range of medical conditions than specialty hospitals. Advantages: General hospitals are better equipped to handle unexpected medical situations and multiple conditions, not to mention that almost all communities have a general hospital nearby. Disadvantages: They may or may not have specialists on staff to treat rare, unique or complex medical problems. Also, these hospitals are more likely to be overcrowded, making it difficult to provide personalized attention.
Community hospitals generally serve a local community and are relatively small, with fewer than 250 beds. But don’t let the word “small” fool you — community hospitals are fully equipped to handle most medical conditions and usually focus on giving personal attention to patients. Advantages: Studies have shown that community hospitals are good choices for routine treatments, such as dialysis or asthma management, and for uncomplicated surgeries, such as appendectomies. This is in part because of the personal attention from doctors and nurses and also because they tend to have lower infection rates. Disadvantages: Community hospitals are less likely to have highly trained specialists and are not typically affiliated with major university medical programs.
Medical centers are larger institutions with more specialized and sophisticated medical departments, as well as personnel trained to handle serious illnesses, injuries and conditions. Advantages: Usually you will get a higher level of both intensive and cardiovascular care in a medical center (for instance, the doctors at medical centers may be able to perform emergency and elective angioplasty), and most medical centers also have designated trauma units. They’re often affiliated with academic institutions (medical schools and research centers), which may mean that patients have greater access to new drugs, technology and treatments. Disadvantages: Research shows that infection rates tend to be higher in these facilities because they treat many patients who are very ill and therefore vulnerable. The environment is less personal, and medical students may be involved in your care, which some patients may find intrusive.
In addition to the above, here are some other types of hospitals that you might encounter or hear about…
Teaching hospitals. It is important to realize that a teaching hospital is first and foremost an institute of learning — it is affiliated with a medical school and provides teaching programs for medical students, interns (students still in training) and residents (doctors learning specialties). Advantages: Teaching hospitals give patients access to innovative treatments, technology and renowned expertise (that’s why students go there). Disadvantages: Students are learning on you! The risk for medical mistakes may be higher and a common patient complaint is being treated as a “condition” to learn about rather than as a person who needs care.
Long-term acute-care hospitals. This type of hospital provides care for frail, usually elderly patients who aren’t going to get better but need more focused medical care than they would get in a nursing home. Distinct from “transitional care units” within hospitals, these are freestanding hospitals usually operated by for-profit companies, which many see as a red flag. Concern about high mortality rates has put these hospitals under scrutiny of late… in March the US Senate Finance Committee launched an investigation into the quality of care that they provide. Advantages: With about 60 beds each, long-term acute-care hospitals may be more intimate and can offer warmer, more personalized care than larger hospitals. Also, very sick patients are less likely to be subject to unnecessary tests and treatments than in a conventional hospital setting. Disadvantages: Because they’re more oriented toward providing nursing care, long-term acute care hospitals rarely have full-time physicians on staff. This raises obvious concerns about patient safety and, of course, is of concern given the higher-than-expected mortality rates.
Physician-owned: A controversial type of specialty hospital. This subgroup of specialty hospitals has burgeoned in recent years, especially in lucrative specialties such as cardiology and surgery. They have been criticized for cherry-picking patients — admitting those with health insurance and/or who are relatively healthy and likely to do well with treatment, while turning away less profitable patients without the means to pay… or who have no health insurance… or who have a poor prognosis and may negatively impact the hospital’s outcome scores. Advantages: Patient satisfaction is typically high at doctor-owned hospitals. The facilities often are luxurious — private rooms, comfortable common areas and excellent food. Disadvantages: Physician-owned hospitals pose an inherent conflict of interest, since doctors have a financial incentive to refer patients to their own facilities. For the same reason, patients are more likely to undergo costly, and sometimes unnecessary, tests and procedures. Also, these facilities tend to be small and may be ill-equipped to handle emergencies, so patients who develop complications often end up being transported to full-service hospitals.
In a nutshell, your choice of hospital depends on your health overall, what’s wrong with you in this particular instance and the quality of the facility. If you want to use a particular doctor, you also need to ask where he/she has privileges.
You can learn how hospitals in your area are ranked at Web sites such as the US Department of Health & Human Services Hospital Compare (www.hospitalcompare.hhs.gov) and Consumer Reports Health.org site (www.consumerreports.org/health/doctors-hospitals/doctors-and-hospitals.htm).
