Hospitals in the United States are mostly private corporations. Though the urgent-health market is a unique one, where demand always heavily outweighs supply, hospitals are nevertheless competing businesses. Sometimes this competition can fuel administrative ingenuity and hard work. It can allow practices to flex with economic shifts, adapt to the local environment, and gain all of the other benefits of the capitalist struggle. However, there are plenty of downsides, including many unique to the healthcare profession.
The privatization of hospitals can make it hard for smaller practices to keep afloat. Medical equipment and providers’ salaries are expensive, and some practices just don’t have enough income to pay for certain equipment or more staff. This leads to understaffed smaller practices, and over-referral to other larger practices, creating more paperwork and flooding the specialty offices. Some patients end up being juggled between hospitals and insurance policies, and people and nuanced diagnosis can slip through the cracks.
The common solution for this is hospital combination. Combined systems of hospitals can refer to each other easier, coordinate EMR systems, and of course have much more disposable income. This extra monetary padding can be invested into biomedical research, digital health systems, and engineering, as well as towards staff benefits. Combined systems can also share best practices between doctors, which has shown to improve the effectiveness and decrease the cost of surgery.
Other times, hospitals collaborate without being entirely combined. Practice-sharing, health studies, and provider unions tend to operate across multiple hospital systems, regardless of whether they’re combined or not. And while it’s easier to refer patients to other centers within the same system, it’s not required, and patients are usually referred to wherever they’ll be served best, regardless of hospital affiliation. For more information on the specific forms and economics of hospital collaboration, see here.
The COVID-19 pandemic has forced hospitals to work together more than ever before, though. Hospitals have had to coordinate closely with each other, to make sure that every patient gets a bed and ventilator if they need one. They’ve traded equipment, patients, even staff sometimes. In the words of Dr. Kevin Tabb, the president of Beth Israel Lahey Health, one of the biggest hospital systems in Massachusetts, “At this point, I think of us all as one big hospital system...We’re all in this together. That’s the only way we’re going to get through it”.
Will this unification continue on after the pandemic ends? Some of us hope so, but there’s really only one way to find out.