12 challenges for public, rural hospitals (USA)

Citation

(2011), "12 challenges for public, rural hospitals (USA)", Leadership in Health Services, Vol. 24 No. 1. https://doi.org/10.1108/lhs.2011.21124aab.001

12 challenges for public, rural hospitals (USA)

Article Type: News and views From: Leadership in Health Services, Volume 24, Issue 1

Edited by Jo Lamb-White

Keywords: Public healthcare, Community healthcare, Leadership challenges in healthcare

One in four community hospitals in the US are public hospitals owned by a government and as such, face unique challenges because they tend to be smaller, less technologically equipped and treat a population that receives lower income and is more likely to be uninsured or covered by Medicaid.

That is the finding in a statistical brief by the federal Agency for Healthcare Research and Quality, which compared these 1,131 hospitals to their 2,944 private, not-for-profit counterparts, and to all 5,162 community-hospitals in 2008.

Additionally, those public hospitals in rural areas, 724, tended to have more patients per nurse, a lower percentage of registered nurses among licensed nurses, and more patients diagnosed with a high severity of illness than the public hospitals in metropolitan areas.

Public hospitals “play an important role in the healthcare safety net, providing care for patients who may have limited access to care elsewhere” says the report, by researchers for the agency.

“However, these institutions face unique challenges (because they) provide care for a large proportion of patients who have low income, are uninsured, or are covered by Medicaid. They serve a critical role as teaching institutions, and are often the first choice for trauma care”.

Here are some findings from the report.

Public hospitals are:

• •

  Smaller, averaging 126 beds compared to 190 beds for private NFP hospitals.

• •

  Have lower occupancy rates, 51.9 per cent compared with 58.9 per cent.

• •

  Provide a large amount of unreimbursed or under-reimbursed care, with 32.8 per cent covered by Medicaid or uninsured, compared with 21 per cent for private NFP facilities and 23.7 per cent for all community hospitals.

• •

  Have a higher percentage of patients from the lowest income zip code, 34.5 per cent compared with 25.7 per cent for private NFP.

• •

  Likely to be in rural areas, with two out of three located in areas of low population, with even lower occupancy rates, 47.2 per cent, compared with 60.7 per cent in metropolitan areas and 59.7 per cent in what the report calls “micropolitan”, or small or medium sized towns.

• •

  Less likely to be part of large multi-hospital system compared with private NFP facilities, 26.1 per cent compared with 61.1 per cent. And only 21.5 per cent of rural public hospitals were in multi-hospital systems.

• •

  Less likely than private NFP hospitals to have an approved medical teaching residency program than private NFP facilities.

• •

  Less likely to have a hospitalist on staff, with 28.5 per cent compared with 50.3 per cent for private NFP hospitals.

• •

  Public hospital stays are longer, 4.8 days compared with 4.6 for both private NFP and all community hospitals.

• •

  More likely to require mechanical ventilation, 29 per cent compared with 2.6 and 2.7 per cent.

• •

  Offered fewer “high technology” services, such as trauma, medical surgical ICU, neonatal ICU, CT or MRI, cardiac catheterization, cardiac surgery or transplant services. For example, while 27.5 per cent of private NFP hospitals and 22.4 per cent of all community hospitals offer cardiac surgery services, only 13.9 per cent of public hospitals did.

• •

  Have fewer patients with a high severity of illness than private NFP and all community hospitals.

For more information: www.healthleadersmedia.com