General Information

Combining medical technology and human resources, the health services industry administers care around the clock, responding to the needs of millions of people, from newborns to the critically ill.

The health services industry includes establishments ranging from small-town private practices of physicians who employ only one medical assistant to busy inner-city hospitals that provide thousands of diverse jobs. Most non-hospital health services establishments employ fewer than 10 workers, while most hospital employees are in establishments with more than 1,000 workers.

Size and Scope About 518,000 establishments make up the health services industry in the United States; all vary greatly in terms of size, staffing patterns, and organizational structures. Three-fourths of all health services establishments are offices of physicians, dentists, or other health practitioners. Although hospitals constitute only 2 percent of all health services establishments, they employ 41 percent of all workers.

Technology In the rapidly changing health services industry, technological advances have made many new procedures and methods of diagnosis and treatment possible. Clinical developments such as organ transplants, less invasive surgical techniques, skin grafts, and gene therapy for cancer treatment continue to increase the longevity and improve the quality of life of many patients. Advances in medical technology have also improved the survival rates of trauma victims and the severely ill, who need extensive care from therapists, social workers and other support personnel. In addition, advances in information technology continue to improve patient care and worker efficiency with devices such as hand-held computers that record notes on each patient. Information on vital signs and orders for tests are transferred electronically to a main database, eliminating paper files and reducing record-keeping errors.

Cost-Cutting Cost containment also is shaping the health services industry, as shown by the growing emphasis on providing services on an outpatient, ambulatory basis, limiting unnecessary or low-priority services, and stressing preventive care, which reduces the eventual cost of undiagnosed, untreated medical conditions. Enrollment in managed care programs, predominantly preferred provider organizations, health maintenance organizations, and hybrid plans such as point-of-service programs, continues to grow. These prepaid plans provide comprehensive coverage to members and control health insurance costs by emphasizing preventive care. Cost-effectiveness is also improved with the increased use of integrated delivery systems, which combine two or more segments of the industry to increase efficiency through the streamlining of functions, primarily financial and managerial. According to a 2002 Deloitte & Touche survey, only 48 percent of surveyed American hospitals expect to be stand-alone, independent facilities in 2005, compared with 61 percent in 2002. These changes will continue to reshape not only the nature of the health services workforce, but also the manner in which health services are provided.

Physicians Physicians and surgeons practice privately or in groups of practitioners who have the same or different specialties. Many physicians and surgeons prefer to join group practices because they afford backup coverage, reduce overhead expenses, and facilitate consultation with peers. Physicians and surgeons are increasingly working as salaried employees of group medical practices, clinics or integrated health systems. Skilled nursing or medical care is sometimes provided in the home, under a physician’s supervision. Home healthcare services are provided mainly to the elderly. The development of in-home medical technologies, substantial cost savings, and patients’ preference for care in the home have helped make this once-small segment of the industry into one of the fastest growing in the economy.

Outpatient Services Among the diverse establishments in this group are kidney dialysis centers, outpatient mental health and substance abuse centers, health maintenance organization medical centers, and freestanding ambulatory surgical and emergency centers.

Nursing and Residential Care Facilities Nursing care facilities provide inpatient nursing, rehabilitation, and health-related personal care to those who need continuous nursing care, but do not require hospital services. Nursing aides provide the vast majority of direct care. Other facilities, such as convalescent homes, help patients who need less assistance. Residential care facilities provide around-the-clock social and personal care to children, the elderly, and others who have limited ability to care for themselves. Workers care for residents of assisted-living facilities, alcohol and drug rehabilitation centers, group homes, and halfway houses. Nursing and medical care, however, is not the main focus of establishments providing residential care, as it is in nursing care facilities.

Other Healthcare Services The industry also includes chiropractors, optometrists, podiatrists, occupational and physical therapists, psychologists, audiologists, speech-language pathologists, dietitians, and other miscellaneous health practitioners. Demand for such services is related to the ability of patients to pay, either directly or through health insurance. Hospitals and nursing facilities may contract out for these services. There are also a variety of alternative healthcare services provided, including acupuncturists, homeopaths, hypnotherapists, and naturopaths. Other healthcare services include ambulance services, blood and organ banks, pacemaker monitoring services and smoking cessation programs.

Medical Laboratories Medical and diagnostic laboratories provide analytic or diagnostic services to the medical profession or directly to patients following a physician’s prescription. Workers may analyze blood, take x rays and computerized tomography scans, or perform other clinical tests. Medical and diagnostic laboratories provide the fewest number of jobs in health services.