HOSPITAL MEDICAL SURGICAL SERVICES

Hospital services is a term that refers to medical and surgical services and the supporting laboratories, equipment and personnel that make up the medical and surgical mission of a hospital or hospital system. Purpose
Hospital services make up the core of a hospitals offerings. They are often shaped by the needs or wishes of its major users to make the hospital a one-stop or core institution of its local commun ity or medical network. Hospitals are institutions comprising basic services and personnel usually departments of medicine and surgery that administer clinical and other services for specific diseases and conditions, as well as emergency services. Hospital services cover a range of medical offerings from basic health care necessities or training and research for major medical school centers to services designed by an industry-owned network of such institutions as health maintenance organizations (HMOs). The mix of services that a hospital may offer depends almost entirely upon its basic mission(s) or objective( s).

There are three basic types of hospitals in the United States: proprietary (for-profit) hospitals; nonprofit hospitals; and charity- or government-supported hospitals.

The services within these institutions vary considerably, but are usually organized around the basic mission(s) or objective (s) of the institution:
• Proprietary hospitals. For-profit hospitals include both general and specialized hospitals, usually as part of a healthcare network like Humana or HCA, which may be corporately owned. The main objective of proprietary hospitals is to make a profit from the services provided.

• Teaching or community hospitals. These are hospitals that serve several purposes: they provide patients for the training or research of interns and residents; they also offer services to patients who are unable to pay for services, while attempting to maintain profitability. Nonprofit centers like the University of California at San Francisco (UCSF) or the
Mayo Clinics combine service, teaching, and profitability without being owned by a corporation or private owner.

• Government-supported hospitals. This group includes tax-supported hospitals for counties, communities and cities with voluntary hospitals (community or charity hospitals) run by a board of citizen administrators who serve without pay. The main objective of this type of hospital is to provide health care for a community or geographic region.

Demographics
The total number of hospitals in the United States, including military and prison hospitals, is over 6,500. Of this total, approximately 3,000 are non-government-related nonprofit hospitals; almost 800 are investor-owned; and 1,156 are government (state, county, or local) hospitals.Description Over the past two decades, hospital services in the United States have declined markedly as a percentage of health care costs, from 43.5% in 1980 to 32.8% in 2000.

This decline was due to shortened lengths of hospital stay, the move from inpatient to outpatient facilities for surgery, and a wave of hospital mergers in the 1990s that consolidated services and staff. Since 2001, however, spending on hospital care in the United States has been growing faster than other sectors of the economy as a result of increasing demand for hospital services. Forty percent of the rise in spending on hospital care is due to escalating costs for hospital services attributed to population growth, the aging of the general population, and growing discontent with the limitations imposed by managed care. In addition, new medical technologies have allowed hospitals to provide life-saving diagnostic and therapeutic alternatives that were unavailable in the 1990s.

At the same time that the use of hospital services is increasing nationwide, government support of hospital services with Medicaid and Medicare has been decreasing, putting pressure upon hospitals to treat the uninsured and make up for $21.6 billion in uncompensated care (year 2002). This trend has put pressure on for-profit, not-for-profit and teaching hospitals to provide a broader range of community services or such low-end services as mental health care, preventive health services, and general pediatric care. In addition, very recent changes in Federal laws governing the entry of hospitals into new markets Certificate of Need laws allow health care providers to offer new hospital services, resulting in the growth of ambulatory surgical centers, special tertiary surgery centers and specialty hospitals that treat a single major disease category. These legislative changes encourage the offering of high-end services that are increasingly demanded by consumers.

Hospital services define the core features of a hospitals organization. The range of services may be limited in such specialty hospitals as cardiovascular centers or cancer treatment centers, or very broad to meet the needs of the community or patient base, as in full service health maintenance organizations (HMOs), rural charity centers, urban health centers, or medical research centers. Hospital services are usually the most general in large urban areas or underserved rural areas, broadly encompassing many services ordinarily offered by other medical providers. The basic services that hospitals offer include:
• short-term hospitalization
• emergency room services
• general and specialty surgical services
• x ray/radiology services
• laboratory services
• blood services

HMO hospitals add a number of special and auxiliary services to the basic list, including:
• pediatric specialty care
• greater access to surgical specialists
• physical therapy and rehabilitation services
• prescription services
• home nursing services
• nutritional counseling
• mental health care
• family support services
• genetic counseling and testing
• social work or case management services
• financial services

Hospitals funded by state, regional, or local government, as well as charity hospitals and hospitals within research and teaching centers, are pressed by community needs to provide for the uninsured or underinsured with more basic services:
• primary care services
• mental health and drug treatment
• infectious disease clinics
• hospice care
• dental services
• translation and interpreter services