LECTURE 5

Classification of Hospitals

WHO Expert Committee on organization of Medical Care (1957)

A hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete health care, both curative and preventive, and whose outpatient services reach out to the family and its home environment; the hospital is also a centre for the training of health workers and bio-social research.
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WHO Expert Committee in its report, Hospital and Health for all (1985).

A hospital must seek to promote the health of the whole population that it serves, including the healthy individuals who never enter it to achieve the goal of health for all.

SUMMARY OF

HISTORY OF HOSPITALS
Bunyan trees/riverside Temples of gods [cause of disease: supernatural forces] Greek hospitals [beginning of rational medicine: Hippocrates] Church hospitals [Reversion of medicine to religion, monks & nuns practicing it] Secular hospitals organized by philanthropists/private citizens [for the sick, poor, & needy] Government hospitals for masses Modern hospitals +advances in medicine increased costoutpatient service; hospital was no longer a place where people went to die
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FUNCTIONS OF A MODERN HOSPITALS Health Promotion: Special clinics (baby, asthma, diabetes) Disease Prevention: Health education, Vaccination Diagnosis Treatment Rehabilitation

Follow-up Care
Training: Doctors, Nurses & Paramedics
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A MODERN HOSPITAL

No longer a charity institution Antibiotics, asepsis, anesthesia, cleanliness, improved nursing, sophisticated equipment, etc Excellent facilities attract the rich Improved facilities rising cost Massive & compact buildings Patient- focused care
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A modern hospital (continued)

Specialization A right to health guaranteed by the state, resulting in increased government involvement in health care of masses Control of doctors increased Excellent training facilities Standardization (accreditation)

Ownership Based CLASSIFICATION

Government hospitals Federal---PIMS/JPMC Autonomous Army, Railway etc Provincial Teaching hospitals--RGH District headquarter hospital Tehsil headquarter hospital Private Not-for-profit hospitalShaukat Khanum; AlShifa Eye Trust Hospital For-profit hospitalsShifa International
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TEACHING/NON-TEACHING HOSPITALS

Teaching hospitals university hospital or university-affiliated a) Major teaching hospital = residencies in medicine, surgery, obst/gyne, pediatrics + sub-specialities of medicine & surgery+ path, anesthesia, family practice + others

b) Minor teaching hospital = only 2 or 3 programs: medicine, surgery, pediatrics, obs/gyne, or any other

Non-teaching hospitals
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General & Specialty hospitals

General hospitals see a wide variety of medical problems. Specialty hospitals (e.g., childrens hospital or a psychiatric hospital) limit their care to specific illnesses or patients.

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CLASSIFICATION

BASED ON VERTICAL INTEGRATION

Primary care institution=operated as an integral part of a comprehensive health system. Outpatient basis. Example--BHUs Secondary care institution=render care that requires a degree of sophistication; indoor treatment for a definite period of time. general acute hospitals or specialized outpatient facilities, such as ambulatory surgical centersdistrict hospitals Tertiary care institution=highly specialized services, available in teaching hospitals or specialty hospitals, such as burn centers
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CLASSIFICATION

BASED ON LENGTH OF PATIENT STAY

Short-term stay hospital= averages less than 30 days; with a national average under 7 days Long-term stay hospital= average stay of over 30 days

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CLASSIFICATION

BASED ON NUMBER Of BEDS

Under 25 beds; 25 to 49; 50 to 99; 100 to 199; 200 to 299; 300 to 399; 400 to 499; & 500 or more This classification is usually combined with other classifications, such as regional & teaching & non-teaching hospitals

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