Understanding Hospitals in Changing Health Systems

258 Pages·2020·2.919 MB·English

by  Antonio Durán, Stephen Wright

Understanding
Hospitals in Changing
Health Systems
Edited by
Antonio Durán · Stephen Wright
Understanding Hospitals in Changing Health
Systems
Antonio Durán • Stephen Wright
Editors
Understanding
Hospitals in Changing
Health Systems
Editors
Antonio Durán Stephen Wright
ALLDMHEALTH Independent Consultant
Seville, Spain Ingleton, UK
ISBN 978-3-030-28171-7 ISBN 978-3-030-28172-4 (eBook)
https://doi.org/10.1007/978-3-030-28172-4
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F
oreword
In this work, the authors have treated the hospital as a concept, an institu-
tion and a facility. They plot the irregular path of hospitals from alms-
houses, where the inhabitants expected (with good reason) to die, to their
current status as reliable producers of safe and sophisticated healthcare.
The revolutions came about because of scientific and technical advances
in, amongst other areas, surgery (anaesthesia and sepsis control), imaging
(radiology) and laboratory medicine (biochemistry, haematology and bac-
teriology). But these advances have not come cheaply, and it sometimes
seems as though hospitals as repair shops dominate the public’s awareness
of the health and healthcare sectors, overshadowing the needs for preven-
tion via public health, and the less glamorous primary care.
The organisation which I lead—the European Observatory on Health
Systems and Policies—has published a number of studies and reports on
the role of hospitals, as well as the other care settings. The authors of this
volume have often been contributors to the Observatory’s output across
the health sector.
The authors offer an update on the role of hospitals, in a variety of
geographic and historical contexts. They therefore capture the path depen-
dency of real-life situations, recognising that this generates a lot of noise
and sometimes hides the signal. More important, however, they suggest
that the role of modern hospitals can be properly understood by reframing
the question. It should not be (just) about how expensive they are, or
whether other settings can deliver some or even most of the care—which,
evidently, they cannot, or at least not entirely. Instead, they ask how
hospitals function within their health and healthcare systems: can we
v
vi FOREWORD
substantiate a rationale for hospitals being the better place to carry out
certain things—and correspondingly, of course, the wrong places for other
things? This leads them to a three-dimensional characterisation of the role
of hospitals. Without adequate governance, hospitals or any other power-
ful institutions will not deliver happy results to users or payers. In using
expensive physical and human resources, hospitals always do operate with
a business model, irrespective of whether they are in a public or private-
for-profit setting; but their business model may be confused or inefficient.
And, finally, any business model necessarily entails a model of care, inside
and outside the walls. Throughout all of this, hospitals should be seen as
just cogs, albeit large ones, in the wider health system machine.
Evidently, other contingencies come into play, concerning the owner-
ship spectrum—public, private and various colours in-between. And the
mechanisms through which hospitals are paid are also important.
This reframing of the discussion about how hospitals function within
their contexts is a valuable contribution to policy thinking in health. The
authors complement this with an explanation of how to use the framework
to make decisions: what sort of hospitals do we want, at what scale, and
absorbing what resources?
The issues and analysis addressed in this book do not stop with the
above, though my summary of them does! Please read the book to see
whether or not the framework sheds some light for you, the reader, on
these vital institutions.
Brussels, Belgium Josep Figueras
A
cknowledgements
This work is the result of a collaboration amongst a diverse group of health
professionals, from government, academia, finance and consultancy. As
editors, we are grateful to our authors individually and collectively for
their hard work and motivation—and good humour.
The book was conceived from a collective bemusement. Why are hos-
pitals so popular with some (their users, by and large) and so unpopular
with others (health policy experts)? Why do they attract so much resource,
in terms of cash and skills, yet are seen professionally as over-sized and
wasteful? We hope as authors that we have a better grasp of the issues now.
This is largely as a result of wide-ranging discussions with many interlocu-
tors, including attendees at a seminar in London in late 2017, organised
by Oxford Policy Management, and with participation from the UK’s
Department for International Development (DfID) and other organisa-
tions and backgrounds. We have also in our various day jobs played out
the arguments to many professionals. Thank you to all who have contrib-
uted to our thinking, even if you did not realise you were doing so.
We are very grateful to the team at Palgrave Macmillan—particularly
Jemima Warren and Oliver Foster—for showing interest in the work, not
losing that interest even when we made a regular practice of missing the
deadlines, and supporting us through to a conclusion. An anonymous
reviewer also helped us with some important pointers. Antonio Moreno of
ALLDMHEALTH Consulting provided invaluable assistance in cleaning
up the text.
Finally, as editors we would like to express our thanks to our families
and friends, who bore the brunt of the stress in producing the book. You
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viii ACKNOWLEDGEMENTS
didn’t deserve the anguish but definitely deserve the credit for helping us
over the line. We’ve retained you in our wills, and perhaps this book is a
small testament to you as well.
May 2019 Antonio Duràn and Stephen Wright
d
isclAimer
The findings, interpretations and conclusions expressed in this volume do
not necessarily reflect the views of the institutions with which the authors
are affiliated.
ix
c
ontents
1 Introduction: Why This Book? 1
Antonio Durán, Stephen Wright, Paolo Belli, Tata
Chanturidze, Patrick Jeurissen, and Richard B. Saltman
2 Hospital Governance 25
Antonio Durán and Richard B. Saltman
3 Models of Care and Hospitals 49
Antonio Durán and Stephen Wright
4 Business Models and Hospitals 75
Stephen Wright and Antonio Durán
5 Hospital Care: Private Assets for-a-Profit? 103
Patrick Jeurissen and Hans Maarse
6 Hospital Payment Systems 121
Paolo Belli and Patrick Jeurissen
7 Hospitals in Different Environments: A Messy Reality 139
Tata Chanturidze and Richard B. Saltman
xi