上个月刚好看到一篇文章,在讲美国这两个正在大幅扩张的医疗机构, 人家Mayo可以在Rochester开饭店, Cleveland可以治疗远道慕名而来的阿拉伯油王的心血管, 我想这些收费应该很吓人, 另外,改天有时间一定要去Rochester朝圣一下... Cities and hospitals Mayo with everything Feb 21st 2008 | CLEVELAND From The Economist print edition What happens when a clinic takes over a metropolis? VISIT Rochester, Minnesota on an average winter morning and the frozen streets are virtually empty. But inside the Mayo Clinic's lovely Gonda building, designed by Cesar Pelli, the city throbs with life. The hospital's lobby is filled with patients and visitors. At noon, underground walkways teem with nurses and doctors buying lunch. In the evening fleets of buses take them home. Visitors retreat to nearby hotels and restaurants, built around Mayo especially for its guests. All this is an extreme example of a growing phenomenon. After the 20th-century factory town, such as Flint, Michigan, comes the 21st-century hospital town. Rural hospitals are often the main employers in their communities. Even Flint is trying to re-position itself as a medical hub. But a select few cities have entered the era of the mega-hospital. The most dramatic are Rochester, a medium-sized city where Mayo has long been a star business, and Cleveland, Ohio, a rustbelt city that has seen its hospitals boom and one, the Cleveland Clinic, become a new economic force. Each hospital is a behemoth: Mayo's revenues in 2006 totalled $6.3 billion, Cleveland's $4.4 billion. Their success stems from medical innovations and excellent care. The Cleveland Clinic is America's best heart hospital; Mayo tops the rankings for neurology, digestive disorders and endocrinology. Cleveland and Mayo have also expanded through mergers with other hospitals to form regional health systems. Cleveland's system includes nine community hospitals and three affiliates in Ohio. Mayo's system extends into Wisconsin and Iowa. Ambitious investment has helped them grow, too. When two gleaming new buildings are completed in Cleveland, the clinic will cover about 12m square feet (1.1m square metres), almost twice the size of the Pentagon. Mayo's Rochester campus is bigger still, at 15m square feet. With this growth has come a steady increase in staff. Cleveland's 37,350 employees make it Ohio's second-largest private employer, after Wal-Mart. Mayo is Minnesota's biggest private employer, with a staff of more than 30,000 in Rochester and several thousand more who work for the regional health system. “One thing to note”, says the Cleveland Clinic's chief executive, Delos Cosgrove, “is that health-care jobs are good jobs.” Another thing worth noting is that neither the Cleveland Clinic nor Mayo has been touched by the national push to unionise nurses. The size of the health giants ensures that their reach extends far beyond the examination room. Each, for example, has made its city something of a destination for “health tourists” (people who come for operations or check-ups) and conferees. Rochester received 2.5m visitors in 2007; about 70% of these came to visit Mayo. At the last count, Rochester had the same number of hotel rooms as nearby Minneapolis, which is about four times as large. The Cleveland Clinic has taken on many of the traits of a hospitality group. Its main campus served almost 3m patients in 2006, bending over backwards for them. A posh international centre offers translators, coffee and foreign newspapers. The clinic owns three hotels and lets the InterContinental hotel group manage them. The most expensive hotel, built in 2003, has space for conferences and plush suites, popular among royal patients from the Middle East. In addition to importing visitors, each hospital has turned its city into an exporter of sorts. Each is spinning off technologies and start-ups. Mayo has hospitals in Florida and Arizona. The Cleveland Clinic has begun to offer management expertise, for a fee, to a handful of hospitals around the country. It already has facilities in Florida, a “wellness centre” in Toronto and projects under way in Abu Dhabi and Vienna. Cleveland's manufacturing base may have declined, but its main commodity in future may be cardiac expertise. For all this activity, community relations remain a work in progress. Mayo has dominated Rochester for so long, donating to a host of local programmes, that the mayor—himself a former Mayo employee—calls the clinic “a gorilla, but...a very nice gorilla”. The Cleveland Clinic's relationship with its city is more complex. Cleveland is much larger than Rochester and much more racially diverse; the city has an industrial hangover and the attendant headaches of poverty and urban decay. The clinic itself sits in a poor neighbourhood where few employees live, preferring to drive in from the suburbs. For years the clinic played only a minor role in the area. Under Dr Cosgrove, who became its chief executive in 2004, this has changed. The clinic is working with local groups to support redevelopment and to open community health-centres. Chris Warren, the city's regional development chief, says the clinic's relationship with Cleveland is “more positive than it has ever been ”. Mayo and the Cleveland Clinic seem likely to grow, but neither is immune to the challenges that face the rest of America's hospitals, such as low Medicaid reimbursement rates and labour shortages. The latter is a particular problem. Doctors are relatively easy to recruit to such a place. Harder to fill are the thousands of other jobs, from nurses to lab technicians. Much energy is directed towards education, through gifts to local schools and programmes to teach students about careers in health care. The premise is that the hospital cannot succeed without a successful city. “Our future”, Dr Cosgrove has said, “is intimately tied with the future of Cleveland.” And, increasingly, vice versa. --

※ 发信站: 批踢踢实业坊(ptt.cc) ◆ From: 123.193.18.244 ※ 编辑: furtwangler 来自: 123.193.18.244 (04/19 21:42)