Tuesday, July 30, 2013

The Demise of Hospital Charity 

Among the many unremarked implications of Obamacare is its contribution to the demise of the hospital as a charitable institution. 

The modern hospital in its original form was created to provide care for people who were economically unable to be sick decently at home.  In northern climes, there was nothing humane about being ill in December in a third floor unheated walkup when everyone else in the family had to go to work.  Hospitals were developed as a remedy for that.  They were also a way to get the bothersome mentally ill off the streets. 

As the years went by, hospitals began to provide treatment as well as care and so people of means had to use them too.  They occupied private rooms (charity cases were cared for in open wards) and were expected to pay for the services they received.  Then insurance came along, creating a category of paying patients in between those occupying private rooms and those housed in wards.  They were admitted to semi-private (two bed) rooms, for which the charges were lower. 

As both the nature and the economics of what they did changed, so did the charitable orientation of hospitals.  From an initial dependence on donations, they became increasingly dependent on revenues from paying patients.   Charity patients, once the purpose for which the hospital existed, came to be seen as a burden.  In the large cities, publicly supported hospitals were built to provide care to the poor. 

With the exception of Catholic institutions, hospitals gradually lost their sense of obligation to serve the poor – to the extent that most states now have laws that prohibit them from denying care because of inability to pay. 

Obamacare promises to move that trend some distance towards its final conclusion.  By requiring everyone to have insurance, it will greatly reduce the number of non-paying patients.  Legal proscription against denying care to those who remain will no doubt continue, but for most hospitals providing services to the indigent will become a minor burden and any remnant of their identity as charitable institutions will pretty much disappear.

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