上個月剛好看到一篇文章,在講美國這兩個正在大幅擴張的醫療機構,
人家Mayo可以在Rochester開飯店,
Cleveland可以治療遠道慕名而來的阿拉伯油王的心血管,
我想這些收費應該很嚇人,
另外,改天有時間一定要去Rochester朝聖一下...
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.
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