Recently I read an opinion piece in the New York Times by oncologist and bioethicist Ezekiel “Zeke” Emanuel, M.D., regarding the role of hospitals in our health care system. Dr. Emanuel posited that hospitals are shrinking in number, and that trend is a good thing for patient safety and cost.

It is an interesting read. Dr. Emanuel describes the rise of hospitals in the late 19th century, particularly with the advent of safer surgical technique, the discovery of x-ray technology, and a better understanding of how to reduce the spread of infectious disease. The amount of hospitals and hospitalizations grew until reaching a zenith in 1981.

Since that time, while the population has grown, the number of hospitalizations has decreased. This in part is because much care now does not necessitate hospitalization, such as chemotherapy, joint replacement surgeries, and even births.

And this may be a good thing. Dr. Emanuel points out that in 2002, there were nearly 1.7 million hospital acquired infection causing approximately 100,000 deaths. Further, a hospitalization is better characterized as a “trial to be endured” than “rejuvenating stay at a spa”.

Certainly, hospitals will not like it if this trend continues. In the Pacific Northwest, we have already seen hospitals merge with one another, ostensibly for purposes of saving money. However, as a recent lawsuit filed by Washington’s AG against Catholic Health Initiatives d/b/a Franciscan Health System and other health care entities in Kitsap County shows, such mergers and relationships risk raising consumer prices.

You can read Dr. Emanuel’s full opinion piece here:

[Are Hospitals Becoming Obsolete?](https://www.nytimes.com/2018/02/25/opinion/hospitals-becoming-obsolete.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-right-region&region=opinion-c-col-right-region&WT.nav=opinion-c-col-right-region)