Healthcare institutions are often overlooked in discussions of healthcare policy, biomedical ethics, and the allocation of resources. Institutions, however, are major players within the ethical and policy arena of healthcare and should be considered when one examines the forces at work in any specific issue in healthcare.
A healthcare institution usually has been thought of as a hospital, a nursing home, a rehabilitation facility, or another such single-site entity. Such an institution consists of the human beings who work in many different capacities within it, the leaders who direct and manage it, and its governing body—usually a board of directors or board of trustees that is responsible for hiring (and firing) the chief executive officer (CEO) or president of the institution and for setting policy and direction in partnership with the employed leaders. Many institutions now, however, are much larger than a single facility. For example, there are integrated hospital healthcare networks that include everything from physician group practices to long-term-care facilities. There are also networks that provide a single level of care, such as nursing home chains and hospital chains. As the competitive environment of healthcare continues to drive efforts to reduce costs and capture market share, institutions made up of multiple components will become increasingly more common. Nonetheless, whether institutions are single units or made up of multiple units, they have important characteristics in common that must be considered.
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