Medicine: No-Frills Hospitals

Few expenses have climbed faster —or higher—than hospital care. The cost of a semiprivate room in a typical U.S. hospital is now more than $113 a day, three times as high as a decade ago. In some metropolitan areas, such as New York City, Washington and Los Angeles, semiprivate-room rates have risen above $200. Most hospital officials agree that the greatest single factor in this inflationary increase has been higher salaries for long-neglected employees, whose wages now account for 70% of hospital costs.

Learning to Cope. In an economy move similar to the airlines’ no-frills flights, more and more hospitals are offering no-frills care for patients who are sufficiently well to help themselves. The patients are asked to make their own beds, keep their rooms tidy, take meals in the cafeteria rather than wait for them at bedside, even pick up their own medications. The tactic not only keeps down costs—a saving that most hospitals pass directly on to the patient —but can also be an important part of therapy. For example, at St. Mary’s in Rochester, Minn., and Michael Reese in Chicago, recent stroke victims and paraplegics bathe themselves and even cook their own meals, thus learning to cope with their handicaps.

Self-care units have been set up at 288 hospitals, roughly 5% of the U.S. total. More can be expected in the future, as hospital administrators wrestle with the difficult problem of holding down expenses while maintaining the quality of patient care. Says an official of the American Hospital Association: “It’s one of the most innovative approaches we’ve yet tried in meeting the challenge of rising medical costs.”

Waiting List. Typical is a new minimal-care unit that opened this month at University of Wisconsin Hospitals in Madison. At present its 13 beds in semiprivate rooms are limited to cancer patients who are receiving chemotherapy and/or radiation therapy and must periodically return to the hospital for several days or even weeks. The patients are carefully screened. They must be able to walk about, eat and bathe without assistance, follow their varying schedules for medications, keep their rooms neat and plan their own amusements. In spite of the unit’s lack of amenities, its occupancy rate is 95%, higher than the rest of the hospital, and a waiting list is rapidly building up.

Patients and hospital personnel alike are pleased. Relieved from routine work, nurses have more time to give patients counseling and other services that help the patient’s wellbeing. Says the unit’s director, Dr. Robert Johnson, a cancer specialist: “Patients are strangers when they come in. But then they meet, become friends and do things, like eating together in the cafeteria.” They are also freed from the usual military-like hospital restrictions and can even wear street clothes. Such relaxation of rules gives patients an enormous psychological boost. “They don’t have the same sense of being sick that other patients have,” says Johnson.

The Madison unit still has a spare, somewhat antiseptic look, but things should brighten in the future. Officials plan to put in new, nonhospital-type furnishings, a lounge with TV and other recreational facilities and even a small kitchen, where patients can prepare their own snacks. Indeed, the unit has made such a hit that doctors are asking for space for other patients, including those recovering from open-heart surgery. “You just don’t feel like a patient,” explains May Anderson of Menominee, Mich., who has been in the unit since its opening for treatment of spinal cancer. “You’re free to do what you want—sit around and gab, play cards, drink coffee. You have a good time.” And, she might have added, the happy mood is not entirely soured when it comes time to pay the room bill, which is 40% less than it used to be.