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Archive 1Archive 2Archive 3Archive 4

Standards for U.S. Hospitals?

How should the "Standards" field be filled out for U.S. Hospitals? The explanation on the Template page is unclear to me. What is the standard that is supposed to be used for U.S. hospitals (Joint Commission, ISO, etc) and how should it be worded in the infobox?--Daveswagon 16:51, 31 July 2007 (UTC)

As stated in the documentation "This optional parameter provides details of Quality Standards that the hospital may have achieved and is meant to be used for hospitals where there are no automatic national standards and external internal organisations (e.g. ISO) have been invited in to provide certification". As such it was introduced for hospitals in developing countries which use an outside internatitional standards agency (ISO in the cases where it has been used until now), as there was not any accreditation from their national government. So I'm not sure applies to the US, where I presume it can be assumed that any hospital that is operational will have been vetted by the relavant state medical board ? If this is not the case (I live in the UK), then please bring me up to speed in this - thanks :-) David Ruben Talk 01:52, 26 November 2007 (UTC)

Problem

Can someone look at University Medical Center of Southern Nevada and see why it is not converting to display the Level 1 trauma center link? I copied the line from another hospital that is working without any luck. Vegaswikian 22:16, 29 October 2007 (UTC)

Did not work because the country parameter wrongly defined as "USA" rather than the 2-letter code that the template uses of "US". Now "Emergency" parameter and "List of Hospitals in..." show correctly :-) David Ruben Talk 01:46, 26 November 2007 (UTC)
Thanks. Vegaswikian (talk) 07:13, 26 November 2007 (UTC)

Heliport add

Can we update the template to add an optional parameter to accept the heliport identification, at least in the US. This is an official FAA registration number so it is important since it identifies which hospitals have air transport capabilities. In the US the coding example would be {{airport codes|||NV34}} which displays as (FAA LID: NV34). Vegaswikian 22:16, 29 October 2007 (UTC)

What about in other countries - are codes given to hospitals having helipads ? If not then just US Federal Aviation Administration location identifier need be given in this infobox template and the (airport codes) template can be called. Else need consider how to pass upto 5 parameters for that template (if all 5 used will look awkward in this infobox) David Ruben Talk 02:06, 26 November 2007 (UTC)
Don't know about other countries. So maybe just for the US for now? For the US, we should be safe just using the FAA id since most of these are not likely to have an IATA or ICAO code. Vegaswikian (talk) 07:12, 26 November 2007 (UTC)

Affiliated University Unknown

A lot of the articles using this template seem to have:

Affilitated University Unknown

which appears to be the default value if the affiliation= parameter is not specified.

The implication of this default behaviour is that we know that all hospitals are affiliated to universities, and hence the lack of an affiliation= parameter is because WP knowledge is incomplete. But I'm not sure that is the case. Do non-teaching hospitals have such an affiliation?. If not then I would suggest that the default behaviour if no affiliation= parameter is presented should be not to report an affiliation at all. -- Chris j wood 13:13, 4 December 2007 (UTC)

Sorry missed this edit change on my watch list. Totally agree and so implemented. Of course where it is known that there is no affiliated linked university, then editors free to specify "None" for this to be shown. David Ruben Talk 02:48, 13 January 2008 (UTC)

Suggested enhancements

Hallo, I've just used this template to expand the record for Chapel Allerton Hospital in the UK, and have a few comments on how it could be improved.PamD (talk) 13:56, 3 April 2008 (UTC)

Thank you, for your many sensible points - thought best to offer an opinion against each of your points rather than as a list at the bottom. David Ruben Talk 23:33, 8 April 2008 (UTC)




  • Could the website link show the web address? That way, anyone printing out a copy of the WP page has this useful information included. It's done this way on many other websites (see my first 2 examples above).PamD (talk) 13:56, 3 April 2008 (UTC)
    Some website addresses are quite spectularly long. We either show in normal size and accept may extend over many multiple lines, or show so small as to be unreadable by those with visual impairment. There is no requirement to show external web addresses, indeed they normally are not in External link sections; one would code as:
    * [http://www.leedsteachinghospitals.com/patients/aboutus/hospitals/chapel_allerton.php Chapel Allerton Hospital] official website
    To be shown as:
    and are never so shown if a web address is given as an inline link, appearing as thus:[1] David Ruben Talk 23:34, 8 April 2008 (UTC)


  • Could the location info accommodate UK postcodes? It's helpful to be able to give the full postal address of the hospital, but the way I've done it for CA produces a non-standard layout for the address!PamD (talk) 13:56, 3 April 2008 (UTC)
    Why ? It is of no importance to the rest of the world readership. IMHO, WP:NOT#Directory needs to be applied here. Similarly articles and this infobox do not go giving telephone numbers for the hospitals, travel directions etc. Furthermore the placement position of Post Code/ZIP codes within an address varies by country and so the UK standard may be wrong elsewhere.David Ruben Talk 23:33, 8 April 2008 (UTC)


  • I read the discussion about suppressing Speciality, only after I'd wondered why my input didn't appear. CA is a General hospital with a specialised unit which I wanted to mention. How about allowing for this? Or, if not, then add something to the comment in the template to say that this field will not appear unless the hospital type is ... . PamD (talk) 13:56, 3 April 2008 (UTC)
    We previously had problems with hospitals all seeming to claim they had various speciality units and little ability to confirm the notablity of such claims (eg it seemed almost every General Hospital claimed specialist Endocrine units), and what was being confused was often a long list of specialities (i.e. distinct from having General Medical or Surgical consultants) vs regional or national super-speciality centres of tertiary referral which is what this parameter is meant to encompass.
    I have taken your suggestion to amend the comment in the template - is its meaning/usage now clear ? David Ruben Talk 23:34, 8 April 2008 (UTC)
     DoneDavid Ruben Talk 13:57, 24 April 2008 (UTC)


Strange

Infobox hospital/Archive 3
Geography
LocationMontreal, Quebec, Canada
Organization
Care systemRAMQ (Quebec medicare)
Affiliated universityMcGill University Faculty of Medicine
Services
Emergency departmentPsychiatric hospital
History
OpenedJuly 19, 1881
Links
Website(in English) Official Website
ListsHospitals in Canada

This template appears to be either defective or incomplete, or both, and may need "tweaking". See what happens when Psychiatric hospital is inserted. Strange.... Peter Horn 17:03, 3 October 2008 (UTC)

See Douglas Hospital etc etc Peter Horn 17:14, 3 October 2008 (UTC)
Yes, see Douglas Hospital after the template has been used with additional parameters. Vegaswikian (talk) 18:33, 3 October 2008 (UTC)

Health care system parameter

Is "HealthCare" supposed to represent the ownership of the hospital? I'm not sure what "US:Medicare/Medicaid/Charity/Public" means. Medicare and Medicaid are just insurance programs, which are accepted in almost all hospitals, just like most private insurance plans. This is distinct from Veterans Health Administration-owned hospitals. It should be clarified if "Public" means government-owned, or open to the public, and if "Private" means privately owned or restricted-use. -- Beland (talk) 00:22, 1 January 2009 (UTC)

I clearly had not fully understood the US system. Are there not public funded (whether that be state healthcare or national) hospitals for those unable to afford private health insurance (or would these people be covered by Medicare)? Likewise if Medicare is just another insurance program, do all privately owned commercial hospitals accept such patients routinely (i.e. the hospitals themselves accept, or Medicare deems that the higher rates should not be covered and Medicare-recipients should instead be seen at "cheaper" hospitals)?
In UK most hospitals part of publicly (government) funded NHS where care free at point of service (paid for through taxation), and some private hospitals also exist. In Canada seems mostly Medicaid based, but again a few private (patients pay directly). US clearly has some Charity care hospitals - owned by charities which provide free care to patients, I was not sure of other models of patient-hospital insurance/alternative funding options. Are there Veterens-only hospitals (ie funded on behalf of veterens outside of any specific insurance scheme) ?
As you can seen from Canada examples: Toronto General Hospital and Vancouver General Hospital the "Medicare" parameter value is combined with the state parameter to link to the correct health system. David Ruben Talk 20:19, 22 January 2009 (UTC)

Background on U.S. hospitals

I suppose you could classify hospitals in the U.S. by ownership:

There are a number of different government entities that own hospitals.

  • There are federally-owned hospitals only open to military personnel, such as the Walter Reed Army Medical Center, and provide government-funded care.
  • The Veterans Health Administration operates hospitals open only to veterans for the purpose of providing government-funded care, though veterans who seek medical care for conditions they did not receive while serving in the military are charged for services (which they might pay for themselves or through private insurance).
  • Local counties and cities sometimes own hospitals open to the general public, such as San Francisco General Hospital.
  • Not all locations have government-owned hospitals open to the general public. For example, all of the Boston-area hospitals are owned by private non-profits, and there are no city or county hospitals anywhere in New Jersey, according to charity care.

Medicaid is a nationally funded program operated separately by each state (sometimes with supplemental local funds), which covers poor children, the disabled, and very poor adults, and various other eligibility restrictions including immigration status. Medicare (United States) is an entitlement for almost everyone over 65 years old, with caveats depending on immigration status. Both are simply government-operated health insurance plans (and Medicare requires small payments from participants for drugs and many services).

Yes, whether you have government or private insurance, you must generally find a public, for-profit, or non-profit hospital that accepts your insurance, or bear the cost yourself. Any for-profit, non-profit, or government hospital can choose to accept or not accept either type of government health insurance, just as they choose to accept or not accept each private insurance plan (though there might be strings attached in some cases).

I believe the way reimbursement rates are set is that the insurance plans negotiate the amount they will pay for any given type of service. This amount is fixed, and usually lower than the rate that people with no insurance are billed by the hospital. If the rate is lower than the cost of providing the service, the hospital is expected to eat the difference. Hospitals have the option to refuse to accept patients with any given type of insurance, if they feel the rates are too low or they are unable to reach agreement with the insurance provider. But this also means fewer patients for the hospitals, since the insurance company usually won't reimburse patients who get non-emergency care at non-participating hospitals, or they expect the patient to bear a larger percentage of the cost of service than they would at an "in network" hospital.

I think Medicare and Medicaid are "take it or leave it" deals. It seems like Congress is constantly fiddling with reimbursement rates, and they are reportedly set very low to save the government money. This does create situations where no local doctors will accept Medicare or Medicaid, and patients must either travel long distances to get certain types of care, or go without it.

I don't know of any hospitals that provide free care to just anyone who shows up like the NHS in the UK does. If you have health insurance of a type the hospital accepts, or if you can afford to pay on your own, you will be charged for services, even by a hospital that would provide free care to someone who can't pay. As far as I know, there are no hospitals dedicated solely to Medicare and Medicaid patients, though obviously hospitals that choose to provide care to people who cannot afford to pay will generally accept these types of insurance.

If you don't have health insurance or are unable to pay for your health care, you can show up at any emergency room, where I believe by federal law you must be seen by a doctor. This creates problems whereby people who should be seeing a primary care physician or visiting an urgent care clinic, end up getting expensive emergency room care instead. And the emergency room isn't necessarily going to provide you the long-term care you might need, or do complicated surgery you don't need right this minute.

For non-emergency medical care, if you are unable to pay, you can try to find a local hospital or doctor that will provide you free care. You might find a local government-owned hospital that will do this, such as San Francisco General. You may also find a private hospital that will take care of you, which relies on federal assistance (e.g. disproportionate share hospital program), local government assistance (e.g. the New Jersey indigent care program described by charity care, or Boston Medical Center which got funding from the city of Boston - at least before universal health insurance in Massachusetts), or private donations (often through a foundation, bequest, or religious order).

Government assistance doesn't necessarily cover the cost of providing emergency room or non-emergency hospital care to people who can't pay for it, which is creating financial problems for hospitals. Many emergency rooms are overcrowded with very long wait times, and many are so full that they must be put on "diversion" on a regular basis, meaning that ambulances are directed to bring patients elsewhere.

Not everyone who cannot afford to pay for needed medical care is eligible for Medicaid. Only Massachusetts has a universal health insurance policy, where everyone is supposed to have access to health insurance, paid for by their employer, themselves, or with full or partial government subsidy. In many cases across the country, people are simply screwed and have to go without needed medical care. Lots of people are aghast that this can happen in such a highly developed country, and universal health care is one of the top five most important national political issues right now.

As for the use of the word "system", because of the diversity of ownership, unlike the UK, there is no nationwide "system" into which government-owned hospitals open to the general public fall.

Confusingly the word is also used in other ways here:

Health care in the United States should probably be updated to make all of this clear. -- Beland (talk) 00:35, 23 January 2009 (UTC)

I have completed the proposed update of that article. -- Beland (talk) 10:12, 29 January 2009 (UTC)

Proposal for template parameters

As for the template parameters, I think the parameter "Care System" is confusing when applied internationally. I think an "owner" parameter would be useful to show the actual owner of a hospital, since from what I can tell in the UK that would be something like "University College London Hospitals NHS Foundation Trust" rather than simply "NHS" and in the U.S. there are lots of small independent chains and individual hospitals. A second parameter showing "owner type" as either public hospital, non-profit hospital, or private hospital might be a good supplement.

It looks like in the UK and Canada, you can either go to a free government-funded hospital, or a payment-expected private hospital, but in the U.S. most hospitals are payment-expected regardless of ownership type. I think a separate parameter for payment model would be useful. Some illustrative examples:


UK:

Owner: University College London Hospitals NHS Foundation Trust
Payment: Free (NHS)
Owner: XYZ Corp.
Payment: Fee for service, insurance accepted


Canada:

Payment: Free (Medicare (Canada)/OHIP)
Payment: Fee for service

(Medicare (Canada) says that outside of Quebec, it is illegal to buy basic health insurance.)


U.S.:

Owner: VA Boston Healthcare System [2] (government hospital)
Payment: Free (Veterans Health Administration) with some fee for service
Owner: San Francisco (government hospital)
Payment: Fee for service, insurance accepted, charity care available

Details about when "free" doesn't mean "free" (eyeglasses, non-citizens, etc.) can be left to the linked articles.

-- Beland (talk) 00:35, 23 January 2009 (UTC)

Aren't all US hospitals required to accept emergency patients without regard of a persons ability to pay? Or is that a function of state law? Vegaswikian (talk) 02:37, 23 January 2009 (UTC)
Thanks Beland - I'll need to reread the above a few times, clearest explanation I've had :-) As a quick 1st response:
  • The "owner" that you give examples of above would be the existing role of the Org/Group parameter. For UK hospitals is indeed used for the relevant NHS Trust groups of hospitals, and likewise for that "VA Boston Healthcare System" example. I'm less sure of your next example of "San Francisco" - is it really of the city as a whole, or better as some department of the city (eg "San Francisco Department of Health" if there were such a thing)?
  • HealthCare type is the parameter for UK NHS linkage and so for similar 'government hospital' status in US examples you give (ie the 3 options of public hospital, non-profit hospital, or private hospital that you list).
  • Whilst above just issues of tweaking current usage or explanation, clearly your examples would need a new additional parameter, perhaps Payment, for the more specific information given. Would need be a freetext paramater, but one that is ignored as redundant for UK / AU / CA cases where HealthCare been set as NHS/Medicare and the field displaying 'Free' / Free (Medicare (Canada)) / Free (Medicare (Australia)) as appropropriate (on secnd thought there might be redundancy here across what the fields might show, so perhaps just showing as "Free" for this parameter in these 3 countries).
I'll re-read yours (and mine) posts again tomorrow to see if I'm still as clear on things, and then see if I can put up a firmer proprosal for options :-) David Ruben Talk 04:41, 23 January 2009 (UTC)

We also need to make sure we can cope with the future shape of the NHS. With Monitor (the body that oversees foundation trusts) saying that these organisations will be independent of the NHS within two years, we need to be clear that the NHS won't own the FT hospital buildings - the NHS will (through PCTs) fund the services that are run there, through Payment By Results. That's not to say that all UK hospitals will be non-NHS, since community hospitals run by PCTs will still be very much in NHS ownership. waggers (talk) 09:03, 23 January 2009 (UTC)

Perhaps at that stage the HealthCare parameter would have option of NHS for central ownership (as present) & NHS-independant (or however this is then termed) for Independant (ex NHS-owned) hospitals providing service on behalf (or whatever the expression would be) of the local PCT. Alternatively the HealthCare paraeter would remain as "NHS" as continued free-at-source for patient experience, but the Payment parameter then would go "live" in UK setting and might take values of "Central" or "PCT" for central government funding vs local PCT commisioned service. Specific parameter values & terminology can be worked out later, but yes I agree such an additional parameter might prove helpful in the future for UK situation, as well as allow better current US usage. David Ruben Talk 12:12, 23 January 2009 (UTC)

Has anyone given further thought to this issue?

  • Use of the Org/Group parameter can be a bit ambiguous in the US. While this variable is being used for UK hospitals as the "owner," US hospitals often have an owner (sometimes called a "system"), in addition to being a member of a group of separately-owned hospitals (commonly known as a "network"). In the US, system or network is rarely a defining quality of the hospital, and it probably should not be featured prominently at the top of the infobox. The problem is that in the US, organization/group more closely means "network" than "owner." Therefore, for US hospital use, I think there should be separate variables for Network and Owner. In the UK, would you say that the Org/Group variable is synonymous with "owner?" Would it be more confusing to UK hospitals if Org/Group was depreciated in favor of Owner?
  • HealthCare type does not really fit US hospitals. It seems like "Medicare/Medicaid/Charity/Public" was initially provided as an option for HealthCare due to lack of understanding of US hospitals. Using this variable for "hospital type" is a poor descriptor of the business model of the hospital (public hospital, non-profit hospital, or private hospital). Linking one of these 3 models under the heading "care system" does not make sense. The business model of the hospital does not correlate with the type of payments it receives (private insurance/charity/Medicare/Medicaid). Why not just make a new variable called Business model, or just Model? I would not want to call this "owner type," because stand-alone hospitals (without a larger owner) also have a business model that should be displayed. Would depreciating HealthCare in favor of Model, and renaming the field "Model" be inaccurate for UK hospitals?
  • I do not think a Payment variable is needed. Or at least it is a completely separate issue - independent from the Model. All hospitals will gladly take cash. Almost all also take some types of private insurance (depending on negotiations with insurance companies, which can change often). Most hospitals also take Medicare. Private hospitals are unlikely to take Medicade or provide charity care, but public hospitals probably do. Additionally, physicians may take different payment types than the hospital in which they work. I don't think this information is necessary on Wikipedia. In general, people without insurance would be more likely to go to a public hospital than a private hospital. I don't think we need a separate parameter to elucidate that.

What do others think about changing HealthCare to Model, Org/Group to Owner, and adding Network? --Scott Alter 02:10, 9 May 2009 (UTC)

Thanks Scott for reactivating this, generally agree with at least direction of parameter renaming suggestions, and I bounce a few alternatives into the hat for consideration:
  • re confusing to UK for Org/Group to Owner - possibly mildly so, for even if one or more hospitals are part of a NHS Trust, these Trust quangos still ultimately owned by the public via state funding. But I would not actively vote against such parameter renaming (or use of alternative synonym parameter name). As an alternative rename, would something more similar to Management be more globally accurate/useful ?
  • HealthCare in favor of Model (mea culpa for my lack of understanding of US system) certainly works better for US system (with public hospital, non-profit hospital, or private hospital options). Perhaps not ideal for a parameter set as "NHS" vs "Private" in UK and as "Medicare" vs "Private" for Canada & Australia. Can we find alternative which sits more comfortably, but I agree difficult to think as what... eg HealthProvision or ServiceProvision. Provision alone possibly not self-explanatory enough, and "Service" is somewhat vague, Provider might be alternative but I'm not sure that works as well for US options ?
  • Can you elaborate on Network - if I understand correctly these are of distinct, independant of one another & separately owned hospitals, that then work collaboratively together to provide a broad range of different specialities from each other (eg one hospital is cardiology, another maternity and in a geographical area therefore collaborate to provide the breadth of medical care ?) or perhaps different levels of trauma care (eg hopsital of dermatology and office outpatient services working with a major trauma centre hospital that provides casualty and intensive care) ? Can you point out a couple of articles on US hospital networks to illustrate this further for me, thanks :-) David Ruben Talk 04:21, 9 May 2009 (UTC)
  • Management should work to encompass Org/Group and Owner. I have heard of hospitals in the US that are owned by one entity and managed by another, but these are rare. Would "Management" be an appropriate title to display in the infobox for this parameter?
  • The problem with using the word "provision" is that it implies (at least to me) the type of care provided (aka service), rather than the type of business entity of the hospital. I think we are still not on the same page regarding differences in health care systems, and it doesn't help that I am unfamiliar with other countries' systems. In the US, a non-profit hospital may choose not provide free/charity care, and a for-profit hospital may choose to provide free/charity care (although this probably would not occur). There is no association between the type of hospital (non profit/for profit/public) and payment for services (out of pocket/private insurance/charity care/Medicaid/Medicare). It does not seem like this is differentiated in the UK, since the HealthCare/"payment for services" is related to the "business structure of the hospital." Maybe HealthCare could be made optional for the US, with a new variable for Business model.
  • It is hard to elaborate as to what exactly a network is. Hospital network has some basic info. As per the American Hospital Association:

System is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital preacute or postacute health care organizations. System affiliation does not preclude network participation. Network is a group of hospitals, physicians, other providers, insurers and/or community agencies that work together to coordinate and deliver a broad spectrum of services to their community. Network participation does not preclude system affiliation.

  • The listing at Hospital network does not differentiate networks from systems (and it doesn't help that some networks contain the word system in their names). Each member of a hospital network may provide a full range of services. If you look at the NewYork-Presbyterian Healthcare System, almost all of the hospitals are full-service hospitals, located probably within a 20 mile radius. Several of the hospitals are trauma centers, and all offer a full range of services, including intensive care. However, there are other health care facilities that provide specialized care (nursing homes, children's hospitals, rehab facilities). I am not quite sure of the purpose of a network. Some possibilities include reducing animosity/rivalry/competition between member hospitals, an opening of communication for referrals between institutions, and agreements for research (maybe data sharing/conducting multi-center trials). --Scott Alter 05:48, 9 May 2009 (UTC)
  • Some perspective as you asked from the US. In Nevada, there is a network of three hospitals, St. Rose Dominican Hospital - Rose de Lima Campus, St. Rose Dominican Hospital - San Martín Campus and St. Rose Dominican Hospital - Siena Campus. These are owned and operated by the not for profit Catholic Healthcare West which owns other hospitals. Then you have Universal Health Services which is a for profit company with a chain of hospitals in the Las Vegas area and elsewhere. Generally these company owned hospitals will all work with specific insurance companies or HMOs based on a negotiated contract so patients are able to use the hospitals associate with their plan. Vegaswikian (talk) 06:08, 9 May 2009 (UTC)
  • Just to clarify, according to the AHA definitions, Catholic Healthcare West seems to be a system, rather than a network. It owns all of the hospitals listed. Other than NewYork-Presbyterian Healthcare System (which is a network), I have not found any other Wikipedia articles on networks. I just created a stub at Robert Wood Johnson Health Network, which is a network containing multiple hospitals with multiple owners in New Jersey. Additionally, there exists a separate entity called Robert Wood Johnson Health System, which owns a few hospitals (Robert Wood Johnson University Hospital (RWJUH), RWJUH Hamilton, RWJUH Rahway and Children's Specialized Hospital), which are all also members of the network. Another reason I just thought of for networks is for insurance company negotiation. Sometimes, multiple solo-practitioner physicians will join together to create a network in order to look like a larger practice to insurance companies. The insurance company will then reimburse the physicians more money because they are bringing more patients to the insurance company (= more money). More patients gives the network of physicians more negotiating power to the insurance companies. --Scott Alter 17:25, 9 May 2009 (UTC)
Hmmm quite loose definition therefore for "network" and whilst I can seen usefulness when applied to hopsitals, I rather doubt the clubbing together of solo doctors is going to be notable per WP:ORG. Parameter is not going to be useful in UK (which is not a reason not to have the parameter) as an NHS Trust is always localised and so its group of hospitals are a single unit (ie a NHS Trust does not have a group of hospitals in one city acting as a unit, and then another group in a different city). Given though that a number of Primary Care Trust areas might feed into a single hospital (and each PCT might make additional use of several different hospitals NHS Trusts in its surrounding areas), perhaps some usefulness in considering networks (but in UK would need consider along lines of "Served by" or "Catchment group") with some national centres then being set not as the local PCT but as "National" - this for UK seems difficult to integrate well for what Network would mean elsewhere, and so probably over ambitious and better left blank for UK hospitals ? David Ruben Talk 22:05, 9 May 2009 (UTC)
I didn't mean to imply that private physician groups would be notable - I don't think any would be appropriate for Wikipedia...it was just an example of a network. Theoretically, individual hospitals may come together as a network (like private physicians), to bargain with insurance companies. I agree that network could be added as an optional variable. The "owner" of a hospital could probably remain in the Org/Group variable. Vegaswikian (talk) 17:53, 18 May 2009 (UTC)
This remaining issue is where to place public/private/non-profit status of a hospital in the US. This could use the HealthCare variable for US hospitals, and process the value or use free text. But I would also change the name in the infobox for US hospitals from "Care System" to "Funding." In Hospital, the funding section mentions public/private/non-profit, so it might be an appropriate title. I'll work on some of these changes in the sandbox. --Scott Alter 23:05, 9 May 2009 (UTC)

Revised parameters for US hospitals

Does anyone have any comments regarding the changes I made in the sandbox? If not, I'll implement it soon. --Scott Alter 04:07, 16 May 2009 (UTC)

I'm not convinced that the 'HealthCare' parameter works in the US. 'US=Medicare/Medicaid/Charity/Public' what exactly does this mean? Medicare and Medicaid are essentially insurance plans. So are we trying to classify hospitals by the insurance plans they accept? How would this work for, say HealthSouth hospitals? What about Kindred Healthcare's hospitals? Don't most hospitals accept Medicare? Hospitals are generally publicly or privately owned, even the VA hospitals are government owned. Hospitals are for profit or not for profit. Most hospitals provide charity care to some extent. Vegaswikian (talk) 05:25, 16 May 2009 (UTC)
'US=Medicare/Medicaid/Charity/Public' is how the existing infobox works for the 'HealthCare' parameter - and it is not working for the US. The change I made in the sandbox (but not to the documentation, since the sandbox is using the live version) was to change the 'HealthCare' parameter to use 'US=Non-profit/For-profit/Public/Private'. That is a better use of the variable than the current 'Medicare/Medicaid/Charity/Public'. I don't really think Private is necessary, since most privates are for-profit (but theoretically could also be non-profit), but I stuck it in there anyway. Public is usually a government-owned hospital, so I don't think we need a government value separate from public. Government hospital redirects to public hospital, and the terms are used synonymously. --Scott Alter 15:01, 16 May 2009 (UTC)
I have added a few examples in to see how this works. The hospital type is vague, the listed types may be country specific. I'm not what it means. We have Community Health Network, hospitals which include community hospital in their name, some of which are teaching hospitals like Community Hospital East. If you look at Community hospital it is clear that at this time, with the possible exception of th UK this term should be avoided. Where do VA hospitals go? They are a very specific type. Are these covered by listing them in the VA network? What about Kindred Healthcare and HealthSouth hospitals, how are they listed? I added one example and removed the documentation form the template for now. Maybe adding more examples would be useful at this time? I'd also like to recommend pulling the adding of the list of hospitals by countries. If someone is looking at a hospital in Hawaii, it would be better to either not provide a list of hospitals in the country but limit it to the state. I think dropping the list in these cases would be better since the list is already included in the hospital's category. Also how do you break out acute care from non-acute care?Vegaswikian (talk) 18:18, 16 May 2009 (UTC)
Just noticed that listing the VA as a system may not work since there are sub systems like VA Boston Healthcare System. Vegaswikian (talk) 18:26, 16 May 2009 (UTC)
To date, no one has revised this template such that it makes sense for US hospitals. Most of the fields are from {{Infobox NHS hospital}}, which was merged to this 2.5 years ago. Because of the wide use of this template, no variables have been changed or deleted. This has resulted in deprecated and ambiguously-named variables that require you to read the documentation to make sure the right values are put in the right variables. 'Type' reflects Hospital#Types, and may be General/Specialist/Teaching. Other values are treated as free text. I agree that community is not appropriate, as a community hospital is still a general hospital. The 'HealthCare' variable has been misused for US hospitals since this template's creation. I believe the meaning of this variable was "Does this hospital participate in the national healthcare system?", with appropriate values of NHS (UK) or Medicare (AU/CA). This is not appropriate, nor is there an equivalent for US hospitals. Something more informative for the infobox is what I call "funding type" - Non-profit/For-profit/Public. I don't think "Private" is needed as an option, as private hospitals are still incorporated as either non-profit or for-profit. Perhaps "government" could be added, too, even though government hospital redirects to public hospital. I combined this US scheme with the 'HealthCare' variable, but now that I really thought about the purpose of 'HealthCare', maybe 'Funding' should be its own variable, and no longer make 'HealthCare' required.
This template was designed for individual hospitals, not entire systems. Hospital systems (Kindred Healthcare, HealthSouth, etc) should have another infobox, such as {{Infobox Company}}. Hospitals that are owned by these systems should use this infobox, with "Kindred Healthcare"/"HealthSouth"/etc in the 'Org/Group' variable. Articles on VA systems should not use this template. Articles on VA hospitals should use this template, with the appropriate VA system in the 'Org/Group' variable, perhaps with "government" in the 'HealthCare' variable. A hospital, such as Community Hospital East, would have 'Org/Group'="Community Health Network", 'HealthCare'="For-profit", 'Type'="General." --Scott Alter 22:46, 16 May 2009 (UTC)
Scott I like your sandbox workup - I've been holding quiet as probably best for others to comment what works best for US setting. Few quick points, mostly on positioning of parameters in the infobox :
  • "Community hospitals" in UK provide limited services compared to District Generals, indeed might not have any inpatients (so outpatients, investigations and possibly day-surgery) - whilst this mentioned in template documentation, it is not explicitly coded and would drop through as freetext default (could be coded to link to Community hospital but that itself is currently a poor rather unhelpful article).
  • You've lost US option of "Charity" for Charity Hospital, I presume deliberate given how that change to being a disambig page and the closure of its main example ?
  • I wonder if "Funding" should not come immediately after "HealthCare" rather than having "Type" inbetween - they are both parameters dealing with the administration running of the hospital, whereas Type starts to lead into more the patient services.
  • Indeed I wonder if "Funding" & "HealthCare" need be cross-linked in the coding ? In UK: HealthCare=NHS which would always imply Funding=Government, whilst HealthCare=Private may be Funding=Non-profit or Funding=For-profit (so I see a role for Funding being useful not just to US hospitals). In Canada similarly HealthCare=Medicare implies a fixed setting of Funding, whilst their rare HealthCare=Private then similar range of Funding options which would need be specified. Only problem is that where Funding is set to these public systems, the display includes links to the public status already (and I'm not sure then having Funding=Public duplicates or helps clarify).
  • Likewise for "Network" it too is similar in scope to "Org/Group" in as much that they look outwards to the hospital's role in wider systems, might it not be placed after "org/group" in the header area ? David Ruben Talk 02:48, 17 May 2009 (UTC)
  • In the US, there is no real definition of a community hospital. Basically, they are smaller hospitals, but still have inpatient beds, and should be classified as a "general" hospital. As a result of recent hospital closings in the US, there are now a bunch of stand-alone emergency departments on the campus of former inpatient hospitals, which may also contain various outpatient services. I believe these facilities are licensed as clinics, but they would not be called a community hospital. A new term that has arisen for these is "satellite emergency department," which could be used as a free text 'Type.'
  • I don't even know what a "charity hospital" is. Based on the name, I would think it is a hospital that gives away free care. That would never happen in the US...where would the money come from to treat the patients? Many hospitals provide "charity care," where some patients may receive free care if they qualify under certain circumstances (usually too poor to afford private health insurance, but too much income to qualify for Medicaid). I don't see any history of an article on charity hospitals. Charity Hospital (New Orleans, Louisiana) (recently moved from Charity Hospital) is a hospital that has charity in its name, but the article is about the actual hospital - not an example of a "charity hospital."
  • I'll move 'Funding' up, between 'HealthCare' and 'Type.' I see what you mean with cross-linking 'Funding' and 'HealthCare,' but is it really necessary? Rather than hard-coding all of the possible combinations for every country, it would be easier to just leave them as independent separate variables, and let the article editors get it right.
  • I see 'Network' as more akin to 'Affiliation' than 'Org/Group,' which is why I put it where I did. The hospital and 'Org/Group' are part of the same business entity, whereas a hospital collaborates with other members of a network and a university affiliate. --Scott Alter 04:17, 17 May 2009 (UTC)
Please read my comment more closely, I was not asking about the hospital systems (Kindred Healthcare, HealthSouth, but for their hospitals. This are not generate acute care hospitals. Some are, but others are clearly not. Any template need to handle these in some way.
Can you please provide example articles for these hospital systems' hospitals? What type of care do they provide? Non-acute care hospitals have been classified as 'Type'="Specialist" and 'Speciality'="Rehabilitation" (for example). I am not proposing any changes to these parameters. I have re-read your comments and am still unclear about your concerns. I think I have addressed the new variables I have added. The 'HealthCare' variable is simple not applicable to US hospitals. I don't think there is any value in specifying that US hospitals accept US Medicare and private insurance. 'HealthCare' is used to answer, "Does this hospital participate in the national healthcare system?", with appropriate values of NHS (UK) or Medicare (AU/CA). I will update the documentation to reflect this once the new variables are put into effect. Do you have any specific questions? --Scott Alter 04:37, 19 May 2009 (UTC)
A few states have healthcare systems to cover most individuals. How does your template identify the acute care hospitals which is what most people here consider a hospital? They can also have multiple specialties. How does your template handle these? Why not do the new documentation for the sandbox version, that could help explain what you are doing. As to hospitals run by Kindred Healthcare, they call themselves a post-acute healthcare provider. That probably needs to be a type of hospital if their statement is believable. Specialties are going to be varied. HealthSouth operates rehabilitation hospitals which would be different then an acute care hospital. Maybe the new documentation would help, but I don't see acute used anywhere in the template so it still seems deficient for the US. Vegaswikian (talk) 05:49, 19 May 2009 (UTC)
The template is only meant to list speciality if it is the primary feature of a hospital (eg a Childrens or Psychiatric hospital, or only treats say cardiac conditions), it is not meant to list out multiple specialities included in all general hospitals. As for "acute" - does not the presence or otherwise of an emergency department trauma level indicate this ? David Ruben Talk 10:37, 19 May 2009 (UTC)
I believe, but I'm not positive, that to be a trauma unit requires that you also be an acute care hospital. Vegaswikian (talk) 17:09, 19 May 2009 (UTC)
Vegaswikian, I don't claim this template as my own, I would just like to improve it. I would say that most hospitals are assumed to be acute care facilities, unless otherwise specified with a custom 'Type' or 'Speciality.' I'm not sure mentioning "Acute" is necessary on the template, but if you think it is, it could be added as a 'Type.' I think "General" hospitals are assumed to be acute, but you can always just use the free-text value "Acute." If you can give examples as to what you would like to see, we can try and make it happen. For your vague Kindred example, rather than having 'Type'="General", you could have 'Type'="Post-acute whatever" (or 'Type'="Specialist" and 'Speciality'="Post-acute whatever"). This template is very flexible, as it accepts free text for most of the fields. The changes I made in the sandbox do not effect existing functionality...it just adds 2 new variables ('Funding' and 'Network'). I think I've made my case for these variables, and explained them thoroughly several times here. Please let us know what other options you would like to see. --Scott Alter 22:50, 20 May 2009 (UTC)
I think Scott of the 2 alternatives, the 'Type'="Specialist" and 'Speciality'="Post-acute whatever" (or ="Rehabillitation") whould be more consistant with other not-all-inclusive hospitals, but as you correctly point out the template only tries to guide for consistency, but editor allowed adapt when specific articles require. I see nothing contentious in the proposed new variables and I think their proposed usage quite clear from the above discussions (just need be clearly set out in the revised /doc) and so I suggest updating template tomorrow (I'm away then until middle of next week if help should be required) :-) David Ruben Talk 00:25, 21 May 2009 (UTC)

Note on merge

Please note that there has been significant cleanup work performed on this template since the sandbox was forked. Please ensure that the changes required are merged to the new code rather than simply replacing it. Thanks folks. Chris Cunningham (not at work) - talk 08:33, 21 May 2009 (UTC)

Thanks for your sweeping by :-) David Ruben Talk 23:35, 21 May 2009 (UTC)
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