The Emergence of Modern Hospital Management and Organisation in the World 1880s-1930s

Paloma Fernández Pérez

• Publisher: Emerald Publishing Limited
• Year: 2021
• ISBN:
  9781787699915
• Topic: Business
• Subtopic: Management
• Index: Business

The Emergence of Modern Hospital Management and Organisation in the World 1880s-1930s uses a range of empirical evidences and case studies drawn from previously unpublished archival sources to offer one of the first international comparative studies on the transformation and modernization of hospital management globally, a century ago.
Focusing in the key years between the 1880s and the 1930s, when millions of people crossed the globe and created new large health care needs in the largest cities of the world, Paloma Fernández-Pérez analyzes core themes from a business history perspective, like organization, ownership and the professionalization of management, to reach a new understanding about the history of modern large scale healthcare institutions from the United States to China, with particular attention to Spain.
The book analyses how varying institutional factors, as well as specific national elements, have influenced the application of Taylorist ideas about standardization, efficiency, and productivity, to large scale hospitals. It also demonstrates the complexities in the dissemination of Taylorist styles of management in large hospitals in the world, by presenting the diversity of situations and how they depended not just on national differences but also on the balance of power of interest groups in private and public hospitals.

Chapter 1

Health Spending and Hospitals in the World in a Long-term Perspective

1.1. Health Spending and Hospital Centrism in the World

Health expenditure estimates for 1900 indicate that they may have accounted for 1% of a country’s total GDP a century ago, and jumped to an average of 10% of the world GDP in 2017, with the fastest period of growth between the 1970s and the first decade of the twenty-first century. According to OECD statistics, in 1970, health expenditure jumped to an average of 4%–6% of GDP (5.2% in France; 5.7% in Germany; 4.4% in Japan; 4% in the United Kingdom; and 6.2% in the United States). In 2015, health expenditures accounted for 11% of GDP in France, 11.1% in Germany, 11.2% in Japan, 9.8% in the United Kingdom, and 16.9% in the United States (Donzé & Fernández-Pérez, 2019). The increase has also been visible in emerging markets like China and India in the last decades with health expenditure accounting for about 4%–6% of GDP in China and 4%–5% in India between 1995 and 2014 (Donzé & Fernández-Pérez, 2019).

According to reports of the World Health Organization (WHO), global health spending has seen a rapid increase in the last years, reaching US$7.8 trillion in 2017 (about 10% of GDP and $1,080 per capita), from US$7.6 trillion in 2016. Growth has been faster in low-income countries, with average annual growth rates of around 6% (for example, in 2013 Latin American countries spent on average 6.7% of their GDP on health with situations of great internal diversity), whereas high-income countries maintain an average of 3% growth annual rate. Most of the total health spending takes place, however, in high-income countries, and 60% of world health spending is public, 40% private (20% private in OECD in 2016 and 48% private in Latin America in 2013).¹ Data on health spending for close to 190 countries from 2000 to 2017 shows the trend is clearly upwards, although it also highlights that there are enormous differences between countries (World Health Organization (WHO), 2020; Xu et al., 2019).

Most of the world health spending is hospital spending (public plus private), in 2016 on average around 50%. There are many indicators that show the heterogeneity across countries not only in the total volume of health spending on hospitals, but also on the specific relative weight of each of the many components of hospital health spending in each country. From a long-term historical perspective, there are two indicators for which it is relatively possible to elaborate, at a local and at a national level, as well as on a global scale, long-term statistics on the evolution of hospital health spending across territories. The first is the number of hospital beds; the second, the number of nurses. Since medieval times, every hospital with a decent archive has information about both. They are two of the oldest, simplest and most resilient indicators of the evolution of hospitals. Until the second half of the twentieth century, physicians in most parts of the world were not permanent staff members of a hospital (and in some poorer countries still aren’t), so it is the data on nurses (religious, or lay professional) that best reflects the long-term increase in services in most of the world’s hospitals; this, together with hospital beds. Hospital services are very knowledge intensive, but the daily assistance to incoming patients requires much labour intensive work and heavy spending on the costs involved in maintaining hospital beds over long periods of time, including all the necessary equipment and assistance of nurses or auxiliary medical staff, such as midwives.

The WHO has compiled several databases for recent years using these two indicators, from which Table 1.1 has been elaborated. The table presents the most recent data available in the WHO databases about hospital beds per 10,000 inhabitants, and nurses and midwives per 10,000 inhabitants in the world, by country. The year to which each indicator corresponds varies between 2013 and 2018. There is a small group of countries in which there is currently a high density of hospital beds and nurses and midwives, notably in five big regions of the world: (1) Germany, France, Austria, Belgium, Scandinavian countries and the Netherlands in Western Europe; (2) Poland, Hungary, Ukraine, Bulgaria and Romania in Eastern Europe; (3) Cuba and Argentina in the Americas; (4) Japan, South Korea, the Russian Federation and North Korea in Asia; and (5) Turkey, South Africa and Saudi Arabia in Africa and the Middle East. And there is a vast number of countries with very poor endowment of hospital beds and nurses. The latest pandemic, COVID-19 in 2020, has, with little variations, shown that precisely those countries with the highest indicators of density of hospital beds and nurses in the early twenty-first century are often those with the lowest number of deaths.

The concentration of health services and the coordination of health needs of the communities through hospitals of various typologies has been called hospital centrism. Hospital centrism, with its origins in the 1830s, developed in the 1880s–1930s, and became widespread in the 1950s and 1960s. This was a process by which public and private investment in large hospital facilities concentrated the access to health services for large portions of the sick population on very large hospitals. This process resulted in a rapid expansion of hospital capacity, doubling or more in some cases, in most medium sized and large cities of the world before World War II: from between 600 and 1,200 hospital beds per large hospital before the 1940s, to an average of 2,000 hospital beds per large hospital in OECD economies and 4,000 or more hospital beds in large emerging markets.

International statistics do not provide comparable indicators for all countries within the same years when dealing with a long-term perspective of around a century, when large hospitals started to change their scale, their scope, their organisation and their management. The League of Nations elaborated in 1930 a list of hospital beds for a limited sample of countries. Later, the OECD and the Pan American Health Organization of the WHO started collecting data supplied by official national institutions for a larger sample of countries co...

Table of contents

• Cover
• Title
• Chapter 1. Health Spending and Hospitals in the World in a Long-term Perspective
• Chapter 2. New Hospitals and Ideas for the Management of Large Hospitals in Western Europe (1880s–1930s)
• Chapter 3. New Ideas in Hospital Organisation in the United States: War Needs, Industrial Organisation, Philanthropy, and the New Scientific Medicine
• Chapter 4. New Hospital Organisation in Russia and Asia: Between Capitalism, Communism and Imperialism
• Chapter 5. Latin America: Between Local Innovation and the Influence of Colonial Times, Western European Science and North American Standardisation Forces
• Chapter 6. New Models of Hospital Organisation and Management in the Early 20th Century in a Large City: Barcelona
• Chapter 7. Conclusions: New Hospitals, New Managers, New Patterns of Hospital Organisation
• References
• List of Tables and Figures
• Index