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.
