The modern hospital

Bed number and length of stay

Hospitals may be compared by the number of beds they contain. Modern hospitals tend to rarely exceed 800 beds, and though some integrated health facilities may have more beds, they often comprise multiple geographic locations, each with several hundred beds. In the early 21st century, it was thought that a facility of 800 beds was the largest unit that could be governed satisfactorily from a single administrative unit while maintaining a corporate unity.

Another index is the average bed-occupancy rate—that is, the percentage of available beds actually occupied per day or per month. Bed-occupancy rates may be higher in the cold winter months, which bring more respiratory disease. In developing countries the bed-occupancy rate is often more than 100 percent—there are more patients in the hospital than there are beds for them. This situation has also emerged in some developed countries where demand for services has outstripped supply.

The amount of time that a patient spends in a hospital bed, or the average length of stay (ALOS), is another important index and depends on the nature of the hospital. In an acute-care hospital the ALOS will be relatively short. In hospitals catering to the chronically ill, the ALOS will, for the most part, be higher. There may be significant variations between units in the same hospital, depending on the acuity and comorbidities of the patients (comorbidity is the presence of two or more unrelated diseases or disease processes in a single patient). In hospitals in developing countries, the ALOS is much shorter than in developed countries.

Ownership and control

The issues of hospital ownership and control underwent significant analysis and change in the late 20th and early 21st centuries. Such transformation was prevalent in developed countries, particularly those in which fiscal sustainability was problematic.

In many countries nearly all hospitals are owned and operated by the government. In Great Britain, except for a small number run by religious orders or serving special groups, most hospitals are within the National Health Service. The local hospital management committee answers directly to the regional hospital board and ultimately to the Department of Health and Social Security. In the United States most hospitals are neither owned nor operated by governmental agencies. In some instances hospitals that are part of a regional health authority are governed by the board of the regional authority, and hence these hospitals no longer have their own boards.

In Canada some hospitals are owned by religious orders and are contracted to deliver publicly funded services. Other hospitals may be owned by municipalities or provincial or territorial governments.

Worldwide, many hospitals are associated with universities; others were founded by religious groups or by public-spirited individuals. Mental health facilities traditionally have been the responsibility of state or provincial governments, while military and veterans hospitals have been provided by the federal government. In addition, there are a number of municipal and county general hospitals.

Financing

Because hospitals may serve specific populations and because they may be not-for-profit or for-profit, there exist a variety of mechanisms for hospital financing. Almost universally, hospital-construction costs are met at least in some part by governmental contributions. Operating costs, however, are taken care of in different ways. For example, funds may come from private endowments or gifts, general funds of some unit of government, funds collected by insurance carriers from subscribers, or some combination thereof. In some countries, operating costs may be supplemented in part by public or private sources that pay charges on uninsured or inadequately insured patients or by out-of-pocket payment by these individuals.

In many countries, and in Europe in particular, the financial support of services in hospitals tends to be collectivized, with funding provided through public revenues, social insurance, or a combination of the two. Thus, the costs of hospital operation are covered infrequently by payments made directly by patients. Details vary somewhat from country to country. In Sweden, for example, most hospital operating costs are financed by public revenues collected by regional governments. Many other European countries follow a similar model, with operating costs for hospitals paid out of national insurance funds; such is the case in the Netherlands, Finland, Norway, and elsewhere. In contrast, other countries, such as the United States, rely heavily on private insurance funds.

Private health insurance corporations or agencies exist in many countries. These entities may offer different or more services relative to national health insurance, although generally at additional cost as well. Private insurance funds offer an alternative mechanism of hospital financing.