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Public general hospitals originated in the almshouse

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Senior Manager
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Public general hospitals originated in the almshouse [#permalink] New post 25 Jul 2008, 07:02
Public general hospitals originated in the almshouse infirmaries established as early as colonial times by local governments to care for the poor. Later, in the late eighteenth and early nineteenth centuries, the infirmary separated from the almshouse and became an independent institution supported by local tax money. At the same time, private charity hospitals began to develop. Both private and public hospitals provided mainly food and shelter for the impoverished sick, since there was little that medicine could actually do to cure illness, and the middle class was treated at home by private physicians.

Late in the nineteenth century, the private charity hospital began trying to attract middle-class patients. Although the depression of 1890 stimulated the growth of charitable institutions and an expanding urban population became dependent on assistance, there was a decline in private contributions to these organizations which forced them to look to local government for financial support. Since private institutions had also lost benefactors; they began to charge patients. In order to attract middle-class patients, private institutions provided services and amenities that distinguished between paying and non-paying patients and made the hospital a desirable place for private physicians to treat their own patients. As paying patients became more necessary to the survival of the private hospital, the public hospitals slowly became the only place for the poor to get treatment. By the end of the nineteenth century, cities were reimbursing private hospitals for their care of indigent patients and the public hospitals remained dependent on the tax dollars.

The advent of private hospital health insurance, which provided middle-class patients with the purchasing power to pay for private hospital services, guaranteed the private hospital a regular source of income. Private hospitals restricted themselves to revenue-generating patients, leaving the public hospitals to care for the poor. Although public hospitals continued to provide services for patients with communicable diseases and outpatient and emergency services, the Blue Cross plans developed around the needs of the private hospitals and the inpatients they served. Thus, reimbursement for ambulatory care has been minimal under most Blue Cross plans, and provision of outpatient care has not been a major function of the private hospital, in part because private patients can afford to pay for the services of private physicians. Additionally, since World War II, there has been a tremendous influx of federal money into private medical schools and the hospitals associated with them. Further, large private medical centers with expensive research equipment and programs have attracted the best administrators, physicians, and researchers. As a result of the greater resources available to the private medical centers, public hospitals have increasing problems attracting highly qualified research and medical personnel. With the mainstream of health care firmly established in the private medical sector, the public hospital has become a “dumping ground





The author cites all of the following as factors contributing to the decline of public hospitals EXCEPT.

(A) Government money was used to subsidize private medical schools and hospitals to the detriment of public hospitals.

(B) Public hospitals are not able to compete with private institutions for top flight managers and doctors.

(C) Large private medical centers have better research facilities and more extensive research programs than public hospitals.

(D) Public hospitals accepted the responsibility for treating patients with certain diseases.

(E) Blue Cross insurance coverage does not reimburse subscribers for medical expenses incurred in a public hospital.

The author implies that any outpatient care provided by a hospital is

(A) paid for by private insurance

(B) provided treatment by a private physician

(C) supplied primarily by private hospitals

(D) a source of revenue for public hospitals

(E) no longer provided by hospitals, public or private
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Re: RC: Public general hospitals [#permalink] New post 25 Jul 2008, 18:36
1) Between A and E. More towards A. However passage does say pvt. hospitals do receive moeny but does not say if it is subsidy or not. Similarly Blue cross patient is reimbursed or not in public hospital is not mentioned.
2) D (provision of outpatient care has not been a major function of the private hospital)
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Re: RC: Public general hospitals [#permalink] New post 25 Jul 2008, 18:39
IMO E and D

The author cites all of the following as factors contributing to the decline of public hospitals EXCEPT.

(A) Government money was used to subsidize private medical schools and hospitals to the detriment of public hospitals. (mentioned that government money flowed into private hospitals ................)

(B) Public hospitals are not able to compete with private institutions for top flight managers and doctors. (mentioned)

(C) Large private medical centers have better research facilities and more extensive research programs than public hospitals. (mentioned in the last paragraph)

(D) Public hospitals accepted the responsibility for treating patients with certain diseases. (attracted patients with communicable diseases)

(E) Blue Cross insurance coverage does not reimburse subscribers for medical expenses incurred in a public hospital. (says bluye corss was built around the need of private hospitals but does not mention that they would not pay subscribers (ones who buy the insurance) if the receive treatment in public hospitals.
The author implies that any outpatient care provided by a hospital is

(A) paid for by private insurance

(B) provided treatment by a private physician

(C) supplied primarily by private hospitals

(D) a source of revenue for public hospitals (Private hospitals restricted themselves to revenue-generating patients, leaving the public hospitals to care for the poor. Although public hospitals continued to provide services for patients with communicable diseases and outpatient and emergency services, the Blue Cross plans developed around the needs of the private hospitals and the inpatients they served.)

(E) no longer provided by hospitals, public or private
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Re: RC: Public general hospitals [#permalink] New post 26 Jul 2008, 03:49
OA = E/D
Re: RC: Public general hospitals   [#permalink] 26 Jul 2008, 03:49
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Public general hospitals originated in the almshouse

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