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Improving Community Health

Hospitals have long been places people go when they are ill, going to have a baby, or to get a test.   

Not-for-profit hospitals, in order to keep that IRS status, have been required for the past few years to file a Community Health Needs Assessment (CHNA) every three years, along with a plan to address health needs, such as diabetes, high blood pressure, and obesity. 

Hospital's Role in the Community

The first hospital in America was Pennsylvania Hospital, founded in 1751 by Benjamin Franklin and Dr Thomas Bond in Philadelphia. The hospital was for the poor and the insane. Well to do people did not go to a hospital. The doctor came to them. Pennsylvania Hospital still exists as a Penn Medicine facility.

While there is a question as to what and where the first hospital outside the US was created, some of the earliest hospitals were run by religious organizations, including the Roman Catholic Church. Like the more modern Pennsylvania Hospital, these hospitals cared for the poor and were more like a hospice than anything else. Hospitals were places where poor people could die in relative comfort.

Today's hospitals are places where people who have money or insurance can go and be cared for. People who do not have money, by an Act of Congress in 1984, called the Emergency Medical Treatment and Active Labor Act (EMTALA), can go to the Emergency Room and be stabilized. The role of the hospital has been reversed from Ben Franklin's time.

Now, under the Patient Protection and Affordable Care Act (PPACA) of 2010, nearly all people, rich or poor, will be able to get insurance and care at any hospital. The role of the hospital will be not only to care for the sick, but to work on preventive care and assurance of quality outcomes. Physician extenders, nurse practitioners and physician assistants, will be more important than ever before since the demand for primary care will exceed the availability of internal medicine and family practice physicians.

Preventive care, such as providing prenatal care for all women who become pregnant, will be paramount in health care. Preventive care will include reducing obesity in children and adults, since obesity is related to diabetes, hypertension, high blood pressure, heart disease, joint problems, and other chronic medical conditions.

The future of healthcare will have less reliance on medication and surgery and more reliance of exercise, nutrition, and stress management. Many of the drugs we use today, many surgical procedures, and treatments, such as chemotherapy and radiation for cancer, will be looked upon just as we look upon the very earliest medical treatments and procedures. The community, including schools, churches, banks, restaurants, and other services, will be much more involved than they are now.

Medicaid Expansion

Every state in the US has had to deal with the decision as to whether or not to participate in the Medicaid expansion as a part of the implementation of the Affordable Care Act (ACA). The Medicaid expansion was an integral and automatic part of the ACA until the Supreme Court ruled that the expansion is a state option. The purpose, under the ACA, was to assure nearly universal health coverage in the US.

Many analysts see those states that have initially said they will not participate in the expansion as responding to political pressures to halt the successful implementation of the ACA. The opposition is to universal health care coverage as passed under a Democratic majority in Congress.

Those opposing the expansion of Medicaid say that the focus should be on prevention of illness and disease. Few will dispute the need for prevention and encouraging people to lose weight, control their diet, and have a regular exercise program. The problem now, however, is to care for those with chronic diseases, including chronic obstructive pulmonary disease and congestive heart failure, and those who will not have access to any preventive programs in the near future.

Once the political posturing has been done, it is expected that nearly all states will join the Medicaid expansion.