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This book explores the contradictions between the mission of hospital care and the market for it. It shows how market forces and market actors have become increasingly important to contemporary hospital practice, and yet the commodification of hospital care in the United States remains uneven and incomplete. While they compete in a competitive marketplace, many hospitals—and the people within them—work to sustain social values that sit in uneasy tension with this market. In order to understand these contradictions, the book examines not only the broad sets of rules and regulations through which the market for hospital care is structured, but also the meanings, practices, and people that make up the hospital itself. The focus is on three hospitals located in Las Lomas, California—PubliCare Hospital, HolyCare Hospital, and GroupCare Hospital—and their ongoing struggle with the contradictory nature of the commodification of hospital care.

This chapter examines the role played by chaplains at HolyCare Hospital's Department of Mission Integration and Spiritual Care. The Department of Mission Integration and Spiritual Care was responsible for maintaining the “emotional and spiritual well-being” of patients as well as for elevating the spiritual dimensions of the hospital as a whole. In the face of market pressures, Amanda Roberts, a chaplain at HolyCare Hospital, admitted that “it can feel as though the spirit or the heart of the place is getting dried out.” The market jeopardized those parts of hospital care that, in her mind, were most central to healing. The chapter considers how HolyCare Hospital wrestled with the relationship between the market for care and the meaning of care. It shows that the Catholic values at HolyCare Hospital had economic value, and that the hospital's marketing strategy merged seamlessly with its religious identity.

This book has examined the commodification of hospital care in the United States. It has looked at PubliCare Hospital, HolyCare Hospital, and GroupCare Hospital to highlight the contradictions between the mission of hospital care and the market for it. If PubliCare is reminiscent of the hospital's past, and HolyCare is indicative of health care's present, then GroupCare seems to anticipate health care's future. This concluding chapter considers some of the changes in the U.S. health care market and cites the impact of the Patient Protection and Affordable Care Act (PPACA, 2010). For example, the law imposes important new regulations on the insurance industry and promotes and incentivizes “evidence-based” medicine. The chapter argues that while PPACA certainly changes the market for hospital care, it does not resolve the market's contradictions. It also reflects on future prospects for hospitals and hospital care.

This chapter focuses on consumer preference for, and satisfaction with, the different types of palliative care. The term ‘consumer’ in palliative care refers to the patients, families, friends, and informal carers. The focus of the chapter is confined to the views of patients and ‘informal care-givers’, which may include families, friends, and relatives. The topics discussed are the concept and methods of measuring satisfaction, satisfaction and opinions in in-patient hospice care in the UK and US, satisfaction and opinions in the hospice home care services in the UK and US, and satisfaction and opinions in the specialist outreach services in the community. The chapter also provides a comparative study of consumer views on hospital and community care.

This chapter examines a paradox of GroupCare Hospital's palliative care program. On the one hand, GroupCare created a space for intimacy, honesty, and personal connection that has become exceedingly rare in the U.S. medical system. On the other hand, GroupCare considered the palliative care program to be consistent with its goal of “appropriate utilization” and likely would not have invested such resources in the program had it not been seen as economically efficient. This chapter shows that the staff at GroupCare tended to believe that through evidence-based medicine, technical savvy, and systems integration, it could make the mission of health care and the market for health care consistent with and supportive of one another. It also considers how GroupCare seemed to have succeeded in taming the market for hospital care and aligning the health of its membership with the economic interests of the organization and the practitioners within it.

This chapter discusses hospital-based palliative care programmes. There are rapid advances in medical therapies and, partly as a result, meeting the care needs of patients in palliative care is becoming increasingly complex and technical. Palliative care (or palliative medicine) is increasingly becoming a medical specialty and hospital-based palliative care programmes have, as a result, become more important. The organization of palliative care services in hospitals, with a particular focus on the USA, and its impact on patient outcomes and health care costs, is discussed, as are the challenges hospital palliative care programmes may face in the future.

This chapter examines the link between Emergency Medical Incorporated's financial success and the quality of hospital care it ultimately was able to provide. Emergency Medical Incorporated, one of the nation's largest contract management groups, held the contract for the emergency department at HolyCare Hospital. The company managed the scheduling, billing, and workflow of the emergency medicine physicians, who were technically “independent contractors” with the company. It also provided them with medical malpractice insurance and helped them minimize legal risk. The chapter considers the billing practices of HolyCare doctors and the effects of physicians' individualism on the quality of care at HolyCare. It shows that entrepreneurship was structured within larger organizations (from the physicians' group to the hospital itself) that also profited from doctors' profiteering.

This chapter aims to inform readers about the health care delivery landscape, with a specific focus on inpatient hospital settings. It briefly describes older adults' use of acute care settings and the types of hospitals providing acute care, examines the payment mechanisms that older adults use to pay for this care, and outlines what special concerns older adults and their families have about acute hospital care. The chapter also includes an overview of the organization and delivery of social worker services in these hospitals.

Hospitals across countries face common pressures of changing ideology, shifting consumer demand, and financial and budgetary pressure. This chapter addresses the question of whether such common pressure also leads to similar policy directions and organizational change. It examines the experience of five industrialized countries: the United States, Canada, Germany, the Netherlands, and the United Kingdom.

This chapter begins by addressing the following questions: How common is dementia in the acute hospital? Why are people with dementia admitted to the acute hospital? It then discusses the clinical characteristics of people with dementia admitted to the acute hospital, their experience, and the impact of dementia on outcomes in the acute hospital. This is followed by a discussion on improving acute hospital care for people with dementia.

This chapter addresses the needs of patients dying from progressive non-malignant diseases and those of patients living with non-malignant diseases in the acute hospital setting, and discusses the challenges that these patients present. Three perspectives run as vertical threads through the chapter, that of the patient and the family, that of non-specialist staff, and that of specialist palliative care staff. The study is limited by the lack of formal trials of palliative care for patients with non-malignant disease in the acute hospital setting. Thus, the authors also reflect on their experiences as members of an interdisciplinary hospital palliative care team. Where necessary, they have made considered extrapolations from the literature on palliative care for cancer patients in the acute hospital and other settings.

This chapter discusses the positive and negative aspects of home care, hospice care, and hospital care. It also discusses the pros and cons of dying in one's home, in a hospital, or in a hospice. The research presented in the chapter discovered that while patients often opt for palliative care at home, few actually wanted to die in their own beds. It also showed that much as the relatives want to care for the patients at home, many of them do not want death in the home. Finally, the research also showed that the death of the patient largely did not depend on the number of professionals providing palliative care within the home setting; rather, it was dependent on the quality of care offered at home, both to patients and the carers.

The Health Care Financing Administration (HCFA), an agency of the Department of Health and Human Services, in its National Health Accounts (NHA), and the Bureau of Economic Analysis (BEA), an agency of the Department of Commerce, in its National Income and Product Accounts (NIPA), each publish national data on expenditures for health care. The NHA show the interaction between health care services and funding sources and how these relationships change over time, while the NIPA provide an up-to-date, overall view of domestic and national production, its distribution, and its use as shown by the interrelated receipts and expenditures of producers, consumers, investors, government, and the foreign suppliers and customers of the United States. In an effort to improve the consistency of these two sets of estimates, HCFA and BEA are engaged in a joint program to reconcile the health care estimates in the NHA and in the NIPA. This chapter focuses on the reconciliation of hospital care and physician services.

During the course of illness, many patients move between care settings. They may be hospitalized to receive some forms of medical treatment or to treat pain, symptoms, treatment side effects, or acute episodes of illness. They may also receive care in nonhospital settings, such as a nursing home, the home of the patient or a loved one, or a residential hospice. This section discusses guidelines for care transitions. It covers general guidelines for hand-offs between professionals and transfers across care settings; guidelines on care transitions for nursing home residents; guidelines on portable medical orders; guidelines on discharge planning and collaboration with nursing homes, home care, hospice, and outpatient care; and guidelines on care transitions for patients who will die in the hospital.

The 1904 Louisiana Purchase Exposition, held in St. Louis, Missouri, featured rich and extensive exhibits of social economy and health. Aside from exhibits found in the Education and Social Economy building, there were important related exhibits in the New York City building, the Model Town Hall, the Liberal Arts building, and various foreign buildings. This chapter examines a select group of exhibits related to health and medicine, focusing on the official exhibition theme of “life and motion.” A notable exhibit format was the “Proposed Plan of the Municipal Art and Science Exhibit” by Albert Kelsey, a Philadelphia architect and municipal reformer. There were also exhibits on urban tenements and employer-provided workers’ housing, on hygiene and public health, and on hospital care, mental health, tuberculosis, and pathology/anatomy.