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Copyright 2012 by Pearson Education, Inc. All rights reserved.

Chapter 14

The Hospital in Society

Medical Sociology Twelfth Edition

William C. Cockerham


The Development of the Hospital as a Social Institution

Formal institution in modern society to meet complex health needs

Gives the patient access to centralized medical knowledge and advanced technology

Protects both families and society from the disruptive effects of illness by placing the sick within the institution for medical care

Hospitals have passed through four distinct stages in the history of their development


As Centers of Religious Practice

Originally established for religious purposes

Medical care was supervised and largely performed by clergy and nuns

Consisted primarily of a rudimentary form of nursing

Primary functions of the medieval hospital were the exercise of religious practices and the extension of charity and welfare services to the poor, including both the able-bodied and the sick


As Poorhouses

Secularized during the Renaissance and the Reformation

Led to a decline of the hospital system

Hospitals during this period acquired the characteristics of boarding houses

Offered food and shelter to the poor, regardless of whether they were sick or healthy


As Deathhouses

Physicians had little influence or involvement in early hospitals

Changed around the 17th century as medical knowledge and techniques advanced

By the 19th century hospitals had taken on their present-day role as institutions for medical care

Hospitals during this period were crowded and unsanitary, and the low success rate of medical intervention often meant that hospitals were viewed as places where the poor went to die


As Centers of Medical Technology

By the end of the 19th century, hospitals were places where patients of all social classes could generally expect to find high-quality medical care and to be cured of their disorders

This development fostered by:

Improvements in medical knowledge and techniques

Implementation of sanitary measures

Better training of hospital personnel (especially nurses)


Hospitals in the United States

First hospitals founded in the U.S. more than 250 years ago

Development paralleled that of Western European institutions in the 1700s

Early hospitals were founded mostly by private citizens who wanted care available on a nonprofit basis

Federal government not involved in health care until 1798


Hospital Ownership

May be classified into three major types: Nonprofit

Most common type of hospital, approx. 51% in 2007

Controlled by a board of trustees, exempt from federal income taxes

Characterized as emphasizing high-quality care for all classes

For-profit Growing trend, often part of a multihospital chain

Government (local, state, or federal) Generally lack prestige compared to other hospitals

Major source of care for low-income populations


Organization of the Nonprofit Community Hospital

Hospitals as multipurpose institutions

Satellite outpatient clinics

Affiliated group practices

Smaller hospitals

Management organizations providing administrative services to physicians

Employ primary care doctors as part of their physician network


Organization of the Nonprofit Community Hospital


The Hospital: Dual Authority

Nominally supervised by a governing body Board of trustees

Actually exhibit a dual system of authority Administrative and medical

System emerged as: Trustee control of hospitals gave way to medical

dominance

The medical profession was balanced by the growing influence of the hospital administrator, who served to place checks on the medical exercise of power



Organization consists of a varied group of professionals and allied health workers with different functions, training, and occupational values

Effective functioning needed a decentralized system of authority organized around the central objective of service to the patient

Administrators direct and supervise hospital policy

Medical staff retains control over medical decisions



System can cause stress, inconsistency, overlapping of responsibility, and inadequate coordination

But also results in a process of negotiation that results in efficient and standardized forms of behavior not dependent on special instructions for all situations


The Hospital-Patient Role

Prominent theme of research on the hospitalization experience is that of depersonalization

The treatment of others as devalued and nonpersons

May also include the experience of ones self as a physical object or thing, or the feeling of being isolated from others



The structure of the hospitals work

Emphasizes organizational efficiency

Favors rules and regulations that reduce patient autonomy and encourage patient receptivity of the hospital routine

Depersonalization of patients not an intended goal of hospital organization

Depersonalization also results from the patients subjective experience of being sick



Three basic mechanisms of hospital processing reduce patients to an impersonal status:

1) Stripping of personal belongings and control over visitors and daily routines

2) Control of resources, including diagnostic information by staff

3) Restriction of patient mobility



Some patients willingly conform to hospital expectations

More true of older and less educated patients

Doctors and staff define patients according to how time they demanded

Good patients require less time and attention from the staff



Similarities between Parsons sick role and the role of the hospital patient

Both are universalistic, affectively neutral, functionally specific, and collectivity oriented

Inpatient care adds a role additionally characterized by submission to authority, enforced cooperation, and depersonalized status


The Rising Cost of Hospitalization

Over the course of the 20th century, the cost of hospitalization has increased sharply

1925: $3.00 for one days stay, paid entirely by patient

2005: $1,696 for one day, paid mostly by health insurance

Manner of payment also changed

Majority of costs are now paid by third-party sources



Costs may be divided into

Routine costs, which include room and board of patients, employee salaries, and the cost of nonmedical supplies

Ancillary costs, comprised of laboratory, surgical, diagnostic, and medical supply costs



Factors influencing hospital expenses: Regional cost of living

Occupancy rate

Burdensome paperwork loads for insurance claims

Technological innovations

Maintaining up-to-date facilities

Costs can be controlled through: Reducing paperwork loads

National health insurance coverage

Fee schedules

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