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.”
1. According to the passage, the very first private hospitals
(A) developed from almshouse infirmaries
(B) provided better care than public infirmaries
(C) were established mainly to service the poor
(D) were supported by government revenues
(E) catered primarily to the middle-class patients
2. It can be inferred that the author believes the differences that currently exist between public and private hospitals are primarily the result of
(A) political considerations
(B) economic factors
(C) ethical concerns
(D) legislative requirements
(E) technological developments
3. It can be inferred that the growth of private health insurance
(A) relieved local governments of the need to fund public hospitals
(B) guaranteed that the poor would have access to medical care
(C) forced middle-class patients to use public hospitals
(D) prompted the closing of many charitable institutions
(E) reinforced the distinction between public and private hospitals
4. Which of the following would be the most logical topic for the author to introduce in the next paragraph?
(A) A plan to improve the quality of public hospitals
(B) An analysis of the profit structure of health insurance companies
(C) A proposal to raise taxes on the middle class
(D) A discussion of recent developments in medical technology
(E) A list of the subjects studied by students in medical school
5. The author’s primary concern is to
(A) describe the financial structure of the healthcare industry
(B) demonstrate the importance of government support for health-care institutions
(C) criticize wealthy institutions for refusing to provide services to the poor
(D) identify the historical causes of the division between private and public hospitals
(E) praise public hospitals for their willingness to provide health care for the poor
6. 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.
7. The author’s attitude toward public hospitals can best be described as
(A) contemptuous and prejudiced
(B) apprehensive and distrustful
(C) concerned and understanding
(D) enthusiastic and supportive
(E) unsympathetic and annoyed
8. The author implies that any outpatient care provided by a hospital is
(A) paid for by private insurance
(B) provided in lieu of 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
9. Which of the following titles best describes the content of the passage?
(A) Public versus Private Hospitals: A Competitive Mismatch
(B) Historical and Economic Factors in the Decline of the Public Hospital
(C) A Comparison of the Quality of Care Provided in Public and Private Hospitals
(D) A Proposal for Revamping the Health Delivery Services Sector of the Economy
(E) Economic Factors That Contribute to the Inability of the Poor to Get Adequate Care