The Changing American Hospital in the Twenty-First Century

One is always hesitant to speak about the future. A famous philosopher from New York, Yogi Berra, said "Making predictions is difficult, especially about the future," and I have some trepidation about doing so now. There is also the difficulty of understanding what really has happened in the past. I recall the Bolshevik general in 1917 who said "The future is clear, but the past is very murky." We anticipate the future with more clarity than is justified, even as we disagree on what is happening right now or what happened before. In that vein, I will describe the role of the American hospital in our health care system, and the challenges it must meet, reviewing first the murky past by summarizing trends that have made hospitals what they are today.