In spite of the phenomenal growth in the number of hospitals and medical manpower, it is a paradox that medical services have remained inaccessible to many.
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Geographical barriers, climatic features, insufficiency of resources and inability to provide finances, the conditional nature of the right to services under social security institutions, poverty and illiteracy are some of the causes that make medical services inaccessible to a great proportion of the population.
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In a society well-protected against epidemics, each individual seeks medical advice 3 to 4 times a year either for protection of his or her health or because of illness or injury.
In the 50s and 60s, the frequency of hospital admissions in such a society was between 150 and 200 per 1000 population per year, with each admitted patient spending as an average of 1.5 to 2 days a year in the hospital.
The cost of an average hospitalization episode was about four to five times the average per capita daily income, the overall expenditure on hospitals being 2 to 3 per cent of the GNP.
Although health promotion and disease prevention have the greatest impact on health, diagnostic and therapeutic factors, i.e. physician and hospital services receive primary attention only when health problems are encountered.
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Many authorities point an accusing finger at the complacency of hospitals which have developed as highly sectionalised segments of medical care and which have drifted further away from their true role as community institutions that should assume a larger role than just “caring for the sick and relieving often.”
To fulfill its role a hospital need not be content with bidding goodbye to cured patients at its gates and expressing sympathies for the dead and noncore.
It is useful only if it is in tune with the economic limits of the people it has to serve, and patients and family members coming to the hospitals should be able to go back home after being educated on the present disease, its prevention and their personal role in prevention of disease and promotion of health in general.
Informed nonmedical opinion considers that medical and hospital services are “crisis care” concerned with illness, not health. Sociologists believe the reason for this is that it is concerned with personal attitudes people respond only when they have to.
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A shift in the emphasis of medicine is therefore needed, that from “cure” to “care”. Although medicine can claim many effective cures, it must confront the task of caring for the sick with greater zeal and effectiveness. Caring necessitates concern with the quality of life of the ill and reduction in any handicap consequent to disease.
The important factors which have led to the changing role and functions of the hospital are as follows:
1. Expansion of the clientele from the dying, the destitute, the poor and needy to all classes of people.
2. Improved economic and social status of the community.
3. Control of communicable disease and increase in chronic degenerative diseases.
4. Progress in the means of communications and transportation.
5. Political obligation of the government to provide comprehensive health care.
6. Increasing health awareness.
7. Rising standard of living (especially in urban areas) and sociopolitical awareness (especially in semi urban and rural areas) with the result that people expect better services and facilities in health care institutions.
8. Control and promotion of quality of care by statutory and professional associations.
9. Increase in specialisation where need for team approach to health and disease is now required.
10. Rapid advances in medical science and technology.
11. Increase in population requiring more number of hospital beds.
12. Sophisticated instrumentation, equipment and better diagnostic and therapeutic tools.
13. Advances in administrative procedures and management techniques.
14. Reorientation of the health care delivery system with emphasis on delivery of primary health care.
15. Awareness of the community.
If the task of the hospital is to restore health and not merely to cure a disease entity, the role and responsibility of hospitals assume great significance. It goes far beyond the diseased organ or individual. The modern hospital is a social universe with a multiplicity of goals, profusion of personnel and extremely fine division of labour.