Classification of Hospitals

There are different types of hospitals and each type has its own characteristics, strengths and limitations. Due to variation in types it is importance to classify a hospital to understand its type. (Click here to read definition and roles of hospitals)

Hospitals can be classified on following basis

·         Size

·         Level of care

·         Clinical specialities

·         Ownership

·         System of medicine

·         Length of stay

       

We will understand each of this type with its features

1.1.  Size – 

      Size of a hospital is usually measured by the number of in-patient beds it offers. An in-patient bed is a bed in which a patient can be admitted for overnight. On the basis of size, a hospital can be classified as, small hospital, mid-sized hospital or a large hospital

1.1.1.      Small hospital – The hospital with approximately 30 or less beds are generally considered as small hospital. A small hospital, typically has limited resources and do not offer high end-care. Majority of the hospitals in India are small hospitals, especially in sub-urban and rural areas. Since small hospitals cost less to establish and run, most doctors prefer to open a small hospital either individually or in partnership. Usually patients will find it convenient to approach a small hospital as they are more likely to be nearby, take less time for offering services, are less costly and are easy to navigate by. However, there can be capacity issue in several small hospitals in handling large number of patients or handling complex cases due to its limited resources. It is a common practice in small hospitals to outsource various services such as laboratory, radiology and pharmacy. Emergency care, intensive care and surgical care facilities are usually at a very basic level in small hospitals.

 

Some specific specialities that often do not require hospitalization also gets categorized as small hospitals, although they may have adequate resources to cater to all kinds of health issue within that speciality. For example, eye hospitals generally have fewer beds, but can be very well geared to provide all kinds of treatment required for eye related issue. Hence, while categorizing hospital on the basis of size, one must also look its speciality to understand the features of the hospital.

 

1.1.2.      Mid-sized hospitals – Mid-sized hospitals, typically having 30 to 100 beds are also very popular in India. They have more resources and are better geared to provide complex services; however, they are less comprehensive compared to large hospitals. They generally offer reasonable level of emergency and intensive care and will have most of the clinical support services such as diagnostics as in-house services. Non-clinical services such as food services, laundry, housekeeping etc. are usually outsourced in a mid-sized hospital

 

1.1.3.      Large hospitals – Hospitals with more than 100 beds are considered as large hospitals. Very often these hospitals offer multiple speciality and super speciality services. Large hospitals have ample resources to handle large number of patients and complex health issues. They will typically have full-fledged ICU, operation theatre complex, emergency care units and all other clinical support units such as laboratory and radiology. Depending upon speciality, large hospitals can have additional units such as radiation therapy or burns care units. High end and complex cases are usually treated best at a large hospital.

 

Large hospitals are very costly to establish and operate and hence are few in the country. They are typically located in cities and can be less accessible to people from far off places.

 

In addition, some hospitals can be very large (1000+ beds). They are generally most comprehensive and will house the most sophisticated equipment for offering medical care. Operationally, the complexity of managing a hospital increases with increase in its size

 

1.2.  Level of care – 

    Another basis of classifying hospitals is the level of care, which are basically three; Primary care, secondary care and tertiary care

1.2.1.      Primary care – The hospitals that provide basic medical care such as out-patient consultation, vaccination, medicines for simple ailment or seasonal infections, normal deliveries etc. are called primary care hospitals. In government system, primary health centre (PHC) are the hospitals that provides primary care. Primary care hospitals are simple organizations with limited resources. However, primary care hospitals serve an important purpose of handling a large number of patients with simple medical issues and avoiding them to crowd at hospitals offering higher level of care. Primary care can be considered as the level of care that can be offered by a doctor with basic MBBS qualification

 

1.2.2.      Secondary care – These are hospitals that offer medical care which is one level higher than primary care. Such hospitals will offer treatments such as general surgery, non-complex speciality surgeries, basic intensive care, clinical procedures, caesarean delivery etc. In government system, Community Health Centres (CHC) and Divisional & District hospitals are considered as secondary care level hospital. Secondary care hospitals are better resourced than primary hospitals and can handle reasonable number of emergency cases

Most of the small and mid-sized private hospitals described in earlier section generally offer secondary care. Secondary care level can be considered as a level of care that can be offered by a specialist, such as MS or MD or equivalent qualifications.

 

1.2.3.      Tertiary care – These are hospitals will most advanced level of care. Generally they offer super-speciality care which is required in the field of Cardiac, Neuro, Nephro, Cancer etc. Tertiary care hospitals will have most advanced equipment and doctors with highest level of qualification and expertise. The operation theatres and ICU of such hospitals will typically be state-of-the art. In government system, the medical college hospitals are tertiary care level. Tertiary care level can be considered as medical care that can be offered by doctors who are super-specialist, qualified as DM or M.Ch. or have gained sufficient experience to be called as super-specialist

 

1.3.  Clinical specialities – 

    Hospitals can also be classified on the basis of clinical speciality they offer. For example, hospitals offering cardiac care are classified as Cardiac hospital, hospital providing cancer care are classified as Onco hospital. A hospital can offer one or more speciality, in which case, they are categorized as single-speciality or multi-speciality hospital. A multi-speciality hospital is operationally more complex compared to single-speciality hospital. Also, depending upon the speciality that a hospital offer, the type of resources and its organization is determined. For example, a cardiac hospital will need Cath-lab and a cardiac ICU, while an Onco hospital will require Radiation therapy unit

 

1.4.  Ownership – 

    On the basis of ownership, a hospital can be classified as follows

                 ·         Public Hospital (Hospitals owned by government)

o   Central Government Hospital – Hospital managed by central government such as AIIMS, PGIs etc.

o   State Government Hospital – Those managed by state government, such as district hospitals

o   Municipal Hospital – Those managed by district administration

o   PSU hospital – Those managed by specific PSU like railway, Coal India Ltd etc.

·         Private Hospitals (Hospitals owned by private individual/organization)

o   For profit private hospitals (Hospitals that have the business purpose)

§  Individual/Partnership (Hospitals that are owned by individuals or in partnership)

§  Corporate hospitals (Hospitals owned by a private company)

o   Not-for-profit hospitals (Hospitals owned by NGO/charitable organization, that do not have a business purpose linked to it)

 

The features and characteristics that a hospital exhibit can vary significantly on the basis of ownership. For example, government hospitals, will typically provide free or heavily subsidized treatment to all, but generally the service quality of government hospital is considered to be poor. Within government, central government hospitals are usually large and provide high-end tertiary care. State government hospitals, may make policies for prioritizing treatment to patients from their state. Similarly, PSU hospital may give special facility/benefit to the employee of that PSU.

In private hospital category, whether the hospital is for-profit or not-for-profit can make significant difference. It is typically seen that for-profit hospitals are more focused on providing good customer services. These hospitals also generally offer services that are business friendly. Not-for-profit hospitals generally offer services as per the need of the society. Their customer service generally lies in between that of a government hospital and of a private hospital.

 

1.5.   System of Medicine – 

    In modern world allopathy as a system of medicine is pre-dominantly used, however, in India Ayurveda, Homeopathy and Unani are also recognized system of medicine and preferred by many people. Thus, hospitals do provide these systems of medicine also. Depending upon their dominant system of medicine, a hospital can be classified as Homeopathy hospital, Ayurveda hospital or Unani hospital. While such hospitals are few in numbers, there is an increasing interest of people in availing treatment of these system of medicine

 

1.6.   Length of stay – 

    On the basis of length of stay generally required for a patient in a hospital, the hospitals can be classified as long-stay hospitals and short-stay hospitals.

 

1.6.1.      Short-stay hospitals – Patients in short-stay hospitals are required to be admitted for a relatively shorter duration such as 1,2 days to up to 20 days. Most hospitals that we observe in our vicinity are short-stay hospitals

 

1.7.   Long-stay hospitals – These hospitals offer care that generally require its patients to stay for a long-term, such as months or years in the hospital. Typically such hospitals will be metal hospital, rehabilitation centres, geriatric care centres, palliative care units etc. Due to long—term residential requirements, these hospitals are built in a manner that gives it a feel of a home like environment rather than a hospital

 

2.     OTHER TERMINOLOGIES ASSOCIATED WITH HEALTHCARE ORGANIZATIONS

While the word hospital is generally used to describe a healthcare delivery organization, there are few more terminology used. They differ in their nature and role they play in healthcare organization and may not necessary be a hospital, as per the definition. Some of these terms are given below

 

2.1.   Nursing Homes: A very common term used in place of a hospital is nursing home. While in current practice, there may not be much difference between a hospital and a nursing home, conceptually they differ. Nursing home as a concept was developed to accommodate patients with primary purpose of providing them a nursing care. Nursing homes typically are not expected to employ doctors, but just nursing staff who help patients in going through the treatment advised by a doctor. For example, nursing home is geared to administer medicine, do wound care, collect sample for testing etc. In earlier times, people use to admit in nursing home so that they can take help for administering the treatment prescribed by the doctor

 

2.2.   Polyclinic – A polyclinic is a building or complex where multiple clinics of different specialities exist together. A polyclinic generally does not provide in-patient care   or any surgical procedure. The clinics only provide consultation while for treatment patient has to get admitted in a hospital or in a nursing home. In polyclinic different doctors, belonging to different specialities, can run their clinics together. Advantage of polyclinic is that for a patient various specialist are available under one roof and in case of cross reference, it can be done efficiently.

 

2.3.   Ambulatory care – The term ambulatory care is used specifically in western countries. It is basically and organization that offer OPD and emergency care only and do not provide in-patient care.

 

2.4.   Palliative care centres/Hospice centres – These are centres that provide care to those patients whose diseases are incurable or terminal in nature. In palliative care centres, the aim is to provide symptomatic relief from patients (such as relief from pain and swelling), while helping the patient to carry out his/her daily routine.