HOSPITALS AND HEALTH CARE FOR ALL

Historically charity and the community’s health care had been a local affair. This concept was exceptionally strong in the Northeast. Many municipalities, such as Plainfield, had well organized Welfare and Health Departments.

Hospitals were mostly non-profit, owned by a self perpetuating board of trustees. These institutions were formed by concerned individuals often stimulated by some loc al catastrophe. In Plainfield, Muhlenberg was conceived after a local train accident.

They provided for all, irrespective of ability to pay, a contemporary standard of hospital care. Those who could not afford private care patients were admitted to “ward services”. Services rendered were equal to all.

For ambulatory patients there were also outpatient clinics of all the major specialties. All staffing except for the physicians was the hospital’s responsibility. Funding for these services came from charitable gifts plus grants from the municipalities served by the institution. No one was turned away

Professional services were provided on a “Pro Bono” basis by the doctors as part of their obligation for the right to treat their patients in that hospital. This usually amounted to the equivalent of 3 months or more a year depending on the specialty. The younger physicians manned the outpatient clinics. The older ones treated those patients that were hospitalized. Prior to the 60s most physicians were also general practitioners who practiced all phases of medicine but some became more proficient in various specialties.

On busy "in hospital" services such as Surgery, Medicine, and Pediatrics there were customarily four senior along with at least four junior attending physicians who shared at designated intervals the year round patient care responsibilities.

Where the hospital had an internship program, the physicians on service were their supervisors and teachers. All this was done without compensation. The doctor’s payback came from referrals which routinely went to the senior service member.

All staff members were responsible for emergency room service in their specialty. The emergency room was not used as a walk in medical clinic. The ER was not a substitute for a physician’s office. A doctor or his substitute was expected to be available 24/*7 in an emergency. It was inconceivable to ask a patient to call 911 (which did not exist) or go directly to the ER.

Except for the “interns” who in community hospitals served for one or two years with only being compensated with room and board, there were no paid hospital based doctors.

Under this setup, the costs of providing patient care were shared by professionals, municipalities and the public in general through philanthropic giving. The quality of care was good for all and the institutions could survive.

In other parts of the country, the voluntary health services were not as well established. Therefore well meaning social planners sought an alternate mechanism to assure adequate medical to the under privileged.

Lyndon B Johnson’s administration was one of great social reformation. Their solution resulted in Medicaid, which was created on July 30, 1965 through Title XIX of the Social Security Act. Each state administers its own Medicaid program while the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.

State participation in Medicaid is voluntary; however, all states have participated since 1982

Perhaps this well meaning legislation was the one factor that has led to the health care financial crisis that has (1) reduced the quality of care, and (2) led to the demise of many hospitals.

I shall amplify on that statement in a subsequent posting.

Your comments are desired and most welcomed. I do not wish to post anything that is not of interest. Thank you.