 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Barbara Bridgman Perkins, PhD, independent scholar, 1806 24th Ave NW, Olympia, WA 98502, (360) 570-8786, bbridgperk@aol.com
This paper analyzes the development and policy implications of niche hospitals, an emerging type of medical facility. With antecedents in specialty hospitals of the early 20th century, specialty departments at mid-century, and "centers of excellence" more recently, niche hospitals further segment the healthcare market by selecting the more remunerative specialty areas like cardiology, cardiovascular surgery, urology, and orthopedic surgery. In so doing, they inflate the use of the high-tech, high revenue-generating surgical and technologic procedures of these specialties. Policy concerns include the impact of niche facilities on the viability of full-service institutions, on competitive growth of hospital-based specialty units, on the quality of care, on interventional appropriateness and other aspects of evidence-based medicine, and on total healthcare costs. Should niche facilities receive licensure as actute care hospitals, or should new licensing categories be developed? Should there be different certificate of need criteria or new mechanisms for regulating them? Since many niche facilities are joint physician-hospital, for-profit ventures, they spark the conflict of interest issue of physicians' financial interest in the facilities in which they practice. Currently, community health planning may not have sufficient tools to ensure the public's health under such a health care restructuring--and its potential to make vast changes in healthcare delivery.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.