HOSPITAL

an institution staffed and equipped for the diagnosis and treatment of the sick or injured, for their housing during treatment, for health examinations, and for the management of childbirth. Hospitals are known to have existed in the Middle East and South Asia in the 1st millennium BC and among ancient Romans as early as 100 BC. They became common in the late Roman Empire, first, for the treatment of sick and wounded soldiers and, later, especially in the Eastern Empire, for a general public of Christian persuasion. In the Middle Ages many monasteries set aside areas for the sick as part of the Christian tradition of fellowship. General hospitals offer a variety of services to the community by means of specialized departments, a trained staff, and various types of sophisticated equipment. Many hospitals also offer outpatient facilities to provide for the short-term physical and emotional needs of ambulatory patients. The two major ways of classifying hospitals are by type of ownership and by type of service. As to ownership, hospitals are either governmental (national, provincial, or local) or nongovernmental. The nongovernmental include the proprietary hospital conducted for private gain and the voluntary hospital conducted on a nonprofit basis by churches, fraternal orders, or independent associations. Most hospitals in the world, except in the United States, are government-owned. But every country contains a number of small proprietary institutions, usually with a capacity of fewer than 50 beds, owned by one or two physicians for the care of well-to-do patients. They provide less than 5 percent of the total bed capacity of the world. In the United States the term voluntary is applied to any hospital conducted by a church or religious order, a fraternal society, or an independent nonprofit association for use by the entire population. The affairs of voluntary hospitals are controlled by trustees who serve without pay in these capacities and who are responsible for designating the administrative and medical staffs and for deciding the professional and financial policies of the institution. Hospitals may be classified as general or special. A general hospital accepts all types of medical or surgical cases, usually concentrating upon acute conditions requiring short-term care, including maternity service and the care of children. A special hospital is one that limits service primarily to single classes of patients or types of illnesses, such as mental cases. Special hospitals for short-term cases are less common than they were formerly, with a tendency for hospitals for children, maternity cases, cancer patients, the physically disabled, and the like to become affiliated with general hospitals in order to improve quality of service and economy of administration. Special sections for mental and contagious cases have been established in many general hospitals. Another type of hospital is the military hospital, in which sick or wounded soldiers are grouped together and treated by military physicians and their assistants. In the mobile field hospital, physicians, nurses, and supplies follow the movement of troops and provide emergency treatment to the wounded. Hospitals have made their services increasingly available to people who do not require admission as bed patients. These outpatients, or ambulatory patients, generally outnumber bed patients by at least five to one. The majority of the outpatients are persons who come to the hospital for emergency care or who are referred by private physicians for diagnostic and therapeutic services not available in their personal offices. Many physicians use hospital examination and treatment rooms in the care of their private patients. Some of the doctors also maintain private-practice offices in facilities owned by hospitals. an institution that is built, staffed, and equipped for the diagnosis of disease; for the treatment, both medical and surgical, of the sick and the injured; and for their housing during this process. The modern hospital also often serves as a centre for investigation and for teaching. To better serve the wide-ranging needs of the community, the modern hospital has often developed outpatient facilities, as well as emergency, psychiatric, and rehabilitation services. Hospitals have long existed in every civilized country. The developing countries, which contain a large proportion of the world's population, do not have enough hospitals, equipment, and trained staff, and, by the standards of the industrialized countries, the hospitals that do exist are poorly equipped to handle the volume of persons who need care. These persons, then, do not always receive the benefits of modern medicine, public health measures, or hospital care, and they generally have lower life expectancies. In the developed countries the hospital as an institution is becoming more complex as modern technology increases the range of diagnostic capabilities and expands the possibilities for treatment. As a result of the greater range of services and the more involved treatment and surgery available, the ratio of staff to patient has increased and a more highly trained staff is required. During recent years a combination of medicine and engineering has produced a vast array of new instrumentation, much of which requires a hospital setting for its use. Hospitals thus are becoming more expensive to run, and health service administrators are increasingly concerned with the question of cost-effectiveness. Additional reading For historical discussions of hospitals, see Timothy S. Miller, The Birth of the Hospital in the Byzantine Empire (1985); Guenter B. Risse, Hospital Life in Enlightenment Scotland: Care and Teaching at the Royal Infirmary of Edinburgh (1986); and Richard H. Thurm, For the Relief of the Sick and Disabled: The U.S. Public Health Service Hospital in Boston, 17991969 (1972). Organization and administration of modern hospitals are discussed in I. Donald Snook, Jr., Hospitals: What They Are and How They Work (1981); Jonathon S. Rakich and Kurt Darr (eds.), Hospital Organization and Management, 3rd ed. (1983); Thomas Choi, Robert F. Allison, and Fred Munson, Governing University Hospitals in a Changing Environment (1986); Howard J. Berman, Lewis E. Weeks, and Steven F. Kukla, The Financial Management of Hospitals, 6th ed. (1986); Bradford H. Gray (ed.), The New Health Care for Profit: Doctors and Hospitals in a Competitive Environment (1983); and Everett A. Johnson and Richard L. Johnson, Hospitals Under Fire: Strategies for Survival (1986).For developments in the field of hospitals, see the periodical Hospitals (semimonthly), published by the American Hospital Association. Social and psychological aspects of hospital life are the subject of Geoffrey C. Robinson and Heather F. Clarke, The Hospital Care of Children: A Review of Contemporary Issues (1980); and Judith Wilson Ross, Handbook for Hospital Ethics Committees (1986). Hospital building is analyzed in W. Paul James and William Tatton-Brown, Hospitals: Design and Development (1986); Owen B. Hardy and Lawrence P. Lammers, Hospitals, the Planning and Design Process, 2nd ed. (1986); and I. Donald Snook, Jr., and Kathryn M. Ruck (eds.), Using Hospital Space Profitably (1987).