Managing the Metropolitan Public Hospital
Many of the nation's public hospitals, especially those in urban areas, are in a state of crisis. Some have been or will be privatized, some are being sold to for-profit companies, and others have simply been closed as funds disappear and staff exits for more lucrative positions elsewhere (Waters & Young, 1997). In the health care industry of today, numerous threats exist that can negatively impact upon the viability of public hospitals in metropolitan areas where they often represent the primary source of service for un- and underinsured individuals, the poor, the elderly, and the disabled. Consequently, management and administration issues in the context of these vital institutions are of new and special significance.
The Joint Center for Political and Economic Studies (2000) examined the status and future of urban public hospitals, noting that these institutions serve America's most vulnerable populations and provide essential services such a trauma care and burn units to the entire population of major metropolitan areas. Such institutions depend heavily upon Medicaid and Medicare populations, and upon these federal programs as well as state and local governments for financial solvency. Driven by the quality improvement movement and constrained by competition and limited funding, such institutions face myriad challenges related to workforce issues as well as service issues.
Several factors impact upon management and administration in public hospitals. Many American public hospitals are closely tied to academic medicine, and as such, have a complex mission that extends beyond patient care to include teaching, research and serving the poor. Sustaining this mission in light of declining funds and strict regulatory oversight of reimbursement policies and practices has become difficult (Waters & Young, 1997). Additionally, many public hospitals in metropolitan areas find i...