Intended for healthcare professionals

Observations Yankee Doodling

The end of US hospitals as we know them?

BMJ 2018; 361 doi: (Published 08 May 2018) Cite this as: BMJ 2018;361:k2023
  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, professor of family medicine at Georgetown University, and associate editor, The BMJ
  1. dkamerow{at}

Technology and financial pressures are squeezing inpatient care

It used to be that when you got very sick you went to the hospital. Now maybe the hospital—if there is one—will come to you.

We see this trend nationally and locally in the US. My favorite healthcare financing journal, the Wall Street Journal, has just reported that the median hospital operating cashflow margin of non-profit and public hospitals in the US has fallen to the lowest level in the past decade.1 The increase in payments that came with the bump in health insurance coverage under the Affordable Care Act (“Obamacare”) has peaked, and reimbursements will likely decrease with …

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