To make hospital services available to a larger number of people, hospitals are accepting what is known as Hospital Service Plans. Hospital Service Plans is a means whereby persons of low-income groups, both urban and rural, are able to pay a part or all of their costs through plans adapted to their needs and resources. More than one and one-fourth million Americans pay from fifty to eighty cents each for hospital insurance each month, which provides hospitalization ranging from no cost to slight extra expense in a private room. At the present rate of increase it is believed that by 1942, ten million Americans will have hospital insurance.' There are twenty such approved plans which offer family coverage at monthly rates of from ninety cents to one dollar and a half.'
"The administrators and trustees of hospitals and service plans are joined in a program of bringing hospital care to the American people through a method consistent with the American ideal of individual initiative, combined with a sense of public responsibility." 3
The attitude of hospital leaders is expressed with respect to hospital service plans, in an editorial in the Modern Hospital:
"As rapidly as possible hospital service plans should be extended more deeply into the low-income groups, and should be broadened to include medical services for those who cannot afford such prepayment plans ; ample free services of good quality should be available without humiliation or degradation."
Hospitals today operate on a higher cost than they did at the beginning of the century. In an annual report released by the Bridgeport, Connecticut, Hospital, figures are given from the beginning of the century which showed the increase of cost per patient day. In 1899 the cost per patient day was $1.32; in 5939 it was $5.04. In a later report the same hospital gave additional information, covering a period of forty years' experience, which showed the average hospital cost per patient. In 1899 the hospital cost per patient was $44.88. In 1940 it was $54.88. The steady rise in hospital cost per patient is attributed to the great advances in medicine, hospital administration, and equipment.'
Nursing service to the patient has also undergone a change. It used to be that one nurse was responsible for a large number of patients, with different diseases. These diseases are now segregated, and the time required for the different nursing services is revealed by Blanche Pfefferkorn and Charles A. Rovetta.' Average number of bedside nursing hours per patient in every twenty-four hours :
In Ward and Semiprivate Accomodations
Medical service ............................................. 3.2 hours
Surgical ....................................................... 3.2 hours
Mixed ......................................................... 3.2 hours
Obstetrics—mothers ....................................... 4.2 hours
Obstetrics—newborn infants ............................ 2.3 hours
Pediatrics—all ages ........................................ 4.4 hours
Communicable diseases .................................. 4.7 hours
In Private Accomodations
Mixed—medical and surgical.....................
No comparative figures for identical services are available. If there were, these figures would show a large increase in time given to nursing service.
The cost of medical service involves two major problems: (a) the allocations of facilities to fit the demands of the various economic groups (for some desire better accommodations than others, and, again, some are forced to take accommodations for which they are unable to pay) ; and (b) bringing medical services within the reach of everyone.
That hospitals are being more utilized by people is revealed by the annual census of hospitals registered' by the American College of Surgeons. The total number of patient days of hospital service for the year 1940 was 375,578,586. The average number of patients was 1,026,171. The total number of patients admitted by registered hospitals was 10,087,548, not including the 1,214,492 babies born during the year. "One person for every three and one-half seconds" is the rate at which patients entered hospitals during 1940.
The hospital has changed repeatedly to meet the needs of society, though it has met with many adverse conditions. When prevention is accepted as the preferred treatment of medicine, the hospital in time may become a complete unit, and every service that bears any relation to the welfare of the individual will be incorporated in its organization. It will have its mental-hygiene department as well as its medical department; its medicosocial service as well as its surgical department; its recreational wards for teaching patients creative recreation as well as its occupational-therapy department ; its homes for the convalescent as well as its wards for the acutely ill.
The increase of mental and chronic disease is a serious problem to every community. In the annual census of registered hospitals, statistics show that in nervous and mental hospitals, there were admitted in 1940, 190,376 patients as compared with 184,936 in 1936. In 1940 the average census was 590,752 as compared with 524,993 in 1936.8 There has been a steady increase in mental and nervous diseases. These figures do not even include those patients who may be in homes, private institutions, or nonregistered hospitals. Were these all included, the number would be much greater. With respect to the chronically ill, Roche reveals these facts:
"Today seventy-five per cent of all mortality from disease is from chronic illness. Fifty years ago ninety-four per cent of all mortality from disease was from acute illness, chiefly infectious."
The prolonged hospitalization required in certain diseases, such as orthopedics, choreics, and certain neuromental diseases, is causing hospitals to realize that institutions under skilled supervision are needed where the patient can be gradually rehabilitated to normal social life.
As better relationships become established on a firmer basis between hospitals and the general public, the hospitals will come to be the great teaching centers for public-health education, for which they are well able to provide all the necessary machinery for teaching. There is no other agency in the health field which is so well organized or adapted to the newer opportunities of medical service and public health education as the hospital.
With the dissemination of the knowledge of preventive medicine, and the decrease of acute diseases, people will come to the hospital for a regular periodic checkup, and to be taught the principles of healthful living. All babies will be born in hospitals, and mothers will be taught the best methods for their care. Through the co-operation of the hospital, the home, the school, and other agencies, every member of society from early childhood will be taught the anatomy and physiology of his own body, and the principles of life, as well as the principles of the prevention of disease. Ignorance of human life and health will then be the exception rather than the rule.
Upon this unique and complex social institution—the hospital—rests the responsibility of taking the leadership in medical care and in public education individually and en masse. This is its challenge.
1 Roy L. Cleere, M. D., "Future Relations Between Hospitals and the Public Health Agencies," Hospitals, 12:45, January, 1938.
2 Rufus Rorem, "Recent Developments in Hospital Service Plans," Transactions of the American Hospital Association., 42 :213, 1940.
3 Rorem, "Hospital Plans Explained," Id., 42 :640.
4 Modern Hospital, 56 :41, January, 1941.
5 W. Morril, "A Memo : The Function of the Hospital Consultant" (Unpublished paper found in the Bacon Library), American Hospital Association, Chicago, August 1, 1939.
6 Pfefferkorn and Rovetta, Adniinistrative Cost Analyses for Nursing Service and Nursing Education, p. 89, Chicago ; American Hospital Association ; and New York: National League of Nursing Education, 1940.
7 Registration means that the hospital is included in the list of hospitals published in the Journal of the American Medical Association and the Medical Directory. "Hospital Service in the United States," J. A. M. A., 116:1057, March 15, 1941.
8"Hospital Service in the United States," J. A. M. A., 116:1064,1071, March 15, 1941.
9 Cleere, "Future Relations Between Hospitals and the Public Health Agencies," p. 45.