ABSTRACT
This chapter provides an overview of the hospital and long-term care sectors and examines several controversies. For hospitals, these include the "medical arms race;" cost shifting; hospital quality; and the effects of managed care, the Affordable Care Act, and hospital consolidation. For nursing homes and long-term care. The chapter examines various quality, demand, and cost issues, as well as the possible substitution of informal care for nursing home care. The community hospital consists of all nonfederal general hospitals that provide acute, short-term care. Many community hospitals are also teaching hospitals, with residency programs approved by the Accreditation Council for Graduate Medical Education. Early hospitals in the United States were associated with the poor or with mental and infectious diseases and medicine was practiced mainly at the home. The typical nonprofit community hospital is governed by a board of trustees that selects the president and approves most major decisions.
