HOSPITAL LOCATOR
Choosing a health care provider in the U.S.A.
International patients seeking medical treatment
in the United States of America may use the following resources to find
American Hospitals & Physicians.
Types of Hospitals, Questions to Ask, Your Needs, Staff, Facilities, Bills, Hospital Accreditation
All Hospitals Are NOT Created Equal
The biggest mistake you can make when choosing a hospital is to simply
go to the closest facility or the "biggest and best" one in a certain
area. Selecting a hospital that's best suited to your particular needs
may mean the difference in how quickly you recover. Find out what questions
you should ask to get the most effective treatment possible.
Many people realize that hospitals are not all alike, but most believe
the differences are a matter of size and overall quality. In fact, a hospital
that excels in coronary bypass surgery may not be the best choice for
cancer treatment. Most hospitals are not staffed or equipped to perform
all procedures equally well. As with everything else in life, practice
makes perfect, and skills in medical procedures and surgery improve when
they are done by experts who perform them frequently.
In order to choose a hospital that's best for you, it is important to discuss your concerns and alternatives with the doctor who is treating you. But you should do research on your own too. This guide will help you decide what your priorities are and it will describe various hospital services and many other factors that you need to keep in mind.
Types of Hospitals
According to the American Hospital Association (AHA), finding out if a
hospital offers general or specialized care and if it is a teaching hospital
are two major criteria. Consumer advocates add another guideline: They
advise you to question whether the hospital is nonprofit or for-profit.
Below we discuss all of these considerations.
General or Specialized Hospitals. There are over 6,500 hospitals
in the United States. The majority of them are "general" hospitals set
up to deal with the full range of medical conditions for which most people
require treatment. But more than 1,000 hospitals specialize in a particular
disease or condition (cancer, rehabilitation, psychiatric illness, etc.),
or in one type of patient (children, elderly, etc.).
A general hospital may not be able to offer the very latest specialized
treatments for every disorder. So if you have a serious or highly unusual
medical problem, you may need a hospital devoted to the care of people
with similar conditions. But it is also important to consider that such
a hospital may be far from your home and may lack the facilities and staff
necessary to treat an unrelated medical complication. When weighing the
possibilities with your doctor, discuss what would be best for your condition
and if any general hospitals in the area may be able to accommodate you.
Teaching or Community Hospitals. Large teaching/research hospitals
have a variety of goals. In addition to treating patients, they are training
sites for physicians and other health professionals. Teaching institutions
are almost always affiliated with a medical school, which means patients
have access to highly skilled specialists who teach at the school and
are familiar with up-to-the-minute technology.
You shouldn't, however, automatically select a prestigious teaching hospital
as the primary source of hospital care for you and your family. The quality
of smaller community hospitals often compares to that found at large teaching
facilities, particularly for routine illnesses and surgeries. The sophisticated
equipment and specialized treatment at teaching hospitals can be very
expensive, and it is not cost-effective to pay for such services unless
you can benefit from them. Check with your physician about the appropriateness
of a teaching hospital.
Nonprofit or For-Profit Hospitals. The important question here
is, Who owns the hospital? Is it a voluntary, proprietary or government-supported
facility? Even though the quality of care varies widely within each of
these categories, knowing who owns the hospital may give you some insight
into other questions to ask.
A voluntary hospital is a nonprofit community facility operating
under religious or other voluntary auspices. Ultimate responsibility for
all that takes place at the hospital rests with its board of trustees,
generally selected from the community's business and professional people,
who serve without pay. To manage the hospital, the trustees appoint a
paid administrator.
Proprietary hospitals are commercial establishments. They are
profit-making institutions. Of course, working for profit does not necessarily
make a hospital bad, any more than being nonprofit ensures quality care.
Proprietary hospitals are owned by corporations or, less often, by individuals
such as doctors who practice at the hospital. Hospital corporations usually
own a chain of institutions located in several states, and they often
own nursing homes or other types of health care facilities as well.
Government-supported hospitals, like all tax-supported institutions,
sometimes have to curtail services when budgets are cut. Also, they may
not measure up to other hospitals in terms of comfortable accommodations
and the availability of private rooms.
Consumer advocates claim for-profit hospitals are more likely to discharge
patients before they are ready, or fail to perform necessary tests or
procedures if a patient is not insured or if their insurance won't cover
more time in the hospital. A study published in the Journal of the American
Medical Association looked at over half a million discharge records of
patients hospitalized in the United States in 1987. The researchers found
that although uninsured patients were in worse condition than privately
insured patients when they entered the hospital, they were discharged
sooner. Although the study did not distinguish between for-profit and
nonprofit hospitals, it does demonstrate that the problem does exist.
Questions to Keep in Mind
The following list of questions was compiled from suggestions from the
AHA and the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO). Decide which are most important to you and discuss your priorities
with your physician.
Does the Hospital Meet Your Needs?
- Is your doctor affiliated with the hospital? If the doctor
who is treating you will be performing the procedure, he or she must be
affiliated with the hospital you choose. Physicians are usually affiliated
with several hospitals, meaning they have met those hospitals' requirements
and are allowed to treat patients in them.
- Does the hospital offer services that meet your particular needs?
For example, do they have childbirth services, care for cancer or heart
disease?
- How extensive is the hospital's experience with the type of procedure
you need? Exactly how many of them have they done?
- Who is responsible for maintaining your personal care plan?
How is your health team kept informed about your needs? Can you or your
family easily be kept up-to-date on your care?
- How extensive is the hospital's referral network? What arrangements
do they have with other facilities to provide services they themselves
cannot?
How Good is the Hospital Staff?
- What is the training of the specific surgeon or surgical team who
will perform the procedure?
- What percentage of the staff is board certified in their specialty?
- How many registered nurses (RNs) are there on staff? According
to the AHA, the national average is little more than four RNs to every
licensed practical nurse (LPN) who is qualified to perform a limited range
of duties.
- How many nurses are there for each patient? One nurse can usually
care for three to six patients, except in intensive care units (ICU) where
the ratio is more likely to be one nurse for every one or two patients.
- Is there an infection control practitioner on staff? If not, how does the hospital coordinate infection control? About one in twenty American patients gets sick because of their stay in the hospital. Hospital-acquired illnesses are a major concern, especially since one-third to one-half of acquired infections are preventable.
- Is there a patient representative or ombudsman on staff? If
so, ask what services the representative can provide for you and your
family. If not, how are patient complaints handled?
- Does the hospital have social workers? These experts usually
help patients and their families find emotional, social, clinical, physical
and financial support services.
Are the Hospital's Facilities Adequate?
- Is the hospital accredited by a nationally recognized accrediting
body, such as the JCAHO?
- Does the hospital accept Medicare patients? If not, check with
your state health department to see if the hospital has been suspended
from participation in this government program or if it is on probation.
- Is the hospital clean? Visit it and look around. Ask to see
the waiting rooms and patient care rooms. Do they look comfortable? Would
you want to recuperate in the patient rooms? How much privacy would you
have in these rooms?
- Does the hospital offer pre-admission testing services (lab
tests, x-rays, etc.) on an outpatient basis? If so, it could save you
money not to be hospitalized for these tests.
- Proper management of pain has been shown to speed healing after
surgery. If prescribed, is the hospital prepared to provide such measures
as patient-administered pain medication through intravenous infusion pump?
- Are operating room services available at all hours? How about
lab and x-ray and emergency department services?
- What hours can patients make and receive phone calls?
- Where can patients sit outside of their rooms? Is there a patient
lounge or court yard?
- Can the hospital accommodate special diet requests? Are visitors
permitted to bring you food from outside? Ask to see a typical week's
menu to get an idea of what is available.
- Is the hospital conveniently located? What are the visiting
hours and are there any restrictions on visitors? Is it near public transportation?
Is affordable parking available?
- Does the hospital offer education programs for patients and members
of the community? If so, you may want to attend one to see how the
hospital is represented.
- Does the hospital provide you with the necessary training to continue
your care at home after discharge? Does the hospital provide you with
easy to understand written instructions?
- What kind of follow-up services does the hospital provide after
discharge (i.e. home care, a nursing home)?
Paying the Bills
- What is the charge for a bed in a semiprivate room? Are private
rooms available? How much are they? What do these charges include? What
is billed separately? Find out what and how much your insurance will cover.
If the hospital's charges exceed what your insurance company considers
"reasonable and customary", can some compromise be reached on the price?
- If you are paying your bills out-of-pocket, does the hospital have
a payment counselor to help arrange such things as installment payments?
What resources does the hospital provide to help you find financial
assistance if you need it? Does it require a deposit?
- If a procedure can be done on an inpatient or an outpatient basis,
what is the cost difference?
Is the Hospital Accredited?
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO),
an independent, nonprofit organization, conducts a quality assessment
of about 80 percent of all hospitals in the United States every three
years. The Joint Commission accredits more than 5,000 hospitals and over
6,000 other health care facilities, including outpatient surgery, home
care, long term care and mental health care organizations. Hospitals do
not have to be accredited by JCAHO to operate-the accreditation process
is entirely voluntary. Accreditation by the Joint Commission means that
a hospital meets at least minimum standards of quality. JCAHO rates hospitals
in 28 different performance areas, including assessment of patients, medication
use, operative procedures, patient rights, staff, laboratory and emergency
services, infection control and social services.
Of the hospitals accredited by JCAHO, 90 percent have Accreditation
with Recommendations for Improvement, meaning the hospital generally
meets the standards, but does not meet certain important standards in
at least one important area. In order to remain accredited they must meet
the identified standards within a specified period of time. Four percent
have Full Accreditation, which indicates that the hospital meets
the Joint Commission's standards in all performance areas. Another four
percent receive JCHAO's highest level, Accreditation with Commendation,
awarded to hospitals that demonstrate exemplary performance overall. Conditional
Accreditation, which means the hospital is performing only marginally
and must correct the problem areas within a specified period of time,
is given to one percent of the hospitals. Less than one percent of the
hospitals are Denied Accreditation because they do not meet the
Joint Commission's standards. In addition, Provisional Accreditation
may be granted to a new hospital if it demonstrates satisfactory compliance
with the Early JCAHO Survey. Two more surveys must be performed within
six months of opening to determine final status.
You have the right to know a hospital's accreditation status. To find
out, you can call JCAHO at 630-792-5000 or visit their website at www.jcaho.org.
Article reprinted with permission of Health
Pages.
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