20th Century Hospitals

1
20th Century Hospitals

• 1900-1920 Flexner Report led to medical school
  /hospital affiliations
• 1920s Physician licensing and hospital
  privileges role and trainings of nurses
• 1930s Health insurance beginnings important
  drug discoveries
• 1940s IRS rulings that health benefits are tax
  deductible and tax exempt
• 1950s Advances in drugs and technology

2
20th Century Hospitals

• 1960s Medicare and Medicaid passed
• 1970s Explosive growth development of expensive
  procedures and technology double digit increases
  in HCE annually
• 1980s Hospital DRGs HCE/GDP gt 10
• 1990s New forms of managed care to control costs

3
U.S. Institutional Setting

• Hospital classification
• Community hospitals
• Teaching hospitals
• Private for profit, private not-for-profit,
  public not-for-profit
• Hospital spending
• Hospital market structure

4
Community Hospital Characteristics, 1970-2001
5
Community Hospitals, by Ownership Type
6
Pricing Practices in Medicine

• Price discrimination
• Cost shifting

7
Charges and discounts for diagnostic bilateral
mammogram
8
The Trend Toward Multi-hospital Systems

• The theory of consolidation
• Reasons for consolidation
• Empirical evidence