way of preventing the undesired visits.rnIn most hospitals, visitors are admittedrnby indicating whom they wish to see. hirnother words, the patient’s consent for thernimpending visit is not requested. In fact,rnonce a visitor is admitted to the hospital,rnhe can enter any patient’s room he wishes.rnThere is no effective way for a patientrnto refuse any visit from anyone.rnHospitals insist that they are liable forrnharm to patients and therefore mustrnhave access to the rooms at all times.rnThis is why rooms cannot be locked. Indeed,rna locked room could endangerrnsome patients (who probably wouldn’trnlock it anyway); but others could sign appropriaternforms to immunize the hospitalrnagainst liability. Further, nurses couldrnhave a master key. As it is, patients cannotrnhave the privacy with their friends,rnwives, or husbands, which is a matter ofrncourse in hotels. Privacy would help preservernthe dignity of patients as adults.rnWhy can a hospital room not be protectedrnfrom undesired nonmedical visitors?rnA hotel room is.rnIt is part of traditional hospital culturern• READERS! •rnrn>()U lUlVCrnlrieiukorrL’laliONrnwho may enjoyrnChronicles,rnplease send us theirrnnames andrnaddresses.rnWe would bernpleased to sendrnthem arncomplimentaryrnissue! /rn’,rn;rn; 1rn*rn^rnfor nurses and interns to be overworked.rnWhy? Can’t hospitals hire sufficientrnpersonnel? Hotels do while chargingrnmuch less. Indeed, hospitals make itrnhard even to ask for a service. Patientsrnusually have call buttons near their bedsrnwhich often do not elicit a response, andrnintercoms are rarely provided.rnEven the simplest things (other thanrnpurely medical ones) are hard to obtainrnin a hospital. One evening I asked for anrnextra pillow at 8:00 P.M. It arrived at ten.rnI was awakened to receive it. The wellknownrntale of the nurse who awakens thernpatient to give him his sleeping pill alwaysrnstruck me as an exaggeration. Notrnso. It actually happened to me.rnUsually hospitals are run by physicianrnadministrators who focus on the medicalrnaspect of hospitalization. They do notrnknow, or care, much about the hotel aspects.rnBut wouldn’t it be better if thernmedical and hotel aspects of hospitalizationrnwere managed separately? The provisionrnof food and lodging might becomernthe responsibility of a separate corporationrnbilling independently. It seems unlikelyrnthat medical administrators everrnwill properly manage the hotel duties,rnjust as unlikely as it is that hotel managersrnwill ever properly administer medicalrnservices.rnAlthough they now compete for patients,rnhospitals unavoidably have monopolisticrnfeatures. Once you enter arnhospital, you cannot easily leave, howeverrnbad the food or services rendered.rnThe hospital resembles a closed institutionrnnot unlike a prison or insane asylum.rnTo change hospitals, you would have tornchange doctors, but staying with yourrndoctor is likely to be more important tornyou than comfort. Medical services arernparamount in your choice, which makesrnit possible for hospitals to neglect patientrncomfort.rnMoreover, physicians usually can practicernin only one hospital. The patient’srnchoice of hospital is therefore determinedrnby his physician and limited by hisrnaccreditation to this hospital. Thus,rnunless the patient is willing to give up hisrnphysician, he does not really have arnchoice. Must this be so? Couldn’t physiciansrnbe allowed to practice in more thanrnone hospital? This change would bernhelpful to patients and not harmful tornphysicians. Similarly, the patient can getrna private nurse only from the hospitalrnregistry. Couldn’t private nurses also bernregistered to practice in more than onernhospital? why increase the monopolisticrnaspects of hospitalization beyond necessity?rnHospital charges are a mystery onlyrnprecariously related to the services performed.rnSince most patients do notrnpay—insurance companies do—hospitalrncharges are not effectively controlled.rnNo wonder they are high. But there arernalso the peculiarities of hospital bookkeeping.rnHospitals make paying customers, orrntheir insurance companies, bear the costrnincurred by uninsured patients who cannotrnpay. In effect, paying patients arerntaxed for the nonpaying ones. Yet therncost of treating the latter is a social cost,rnproperly borne by taxpayers. It seems inequitablernand capricious to make insuredrnor paying patients who happen to usernhospital services pay this cost—just as itrnwould be to make paying restaurant patronsrnpay for meals given to patrons whorncannot pay. But the restaurant patronsrncan choose a different restaurant. Thernhospital patients cannot.rnIf hospitals must continue to chargernthe paying patients for the cost incurredrnby the nonpaying ones, hospital billsrnshould list the price charged to the patientrnfor the actual cost of the room,rnfood, nursing care, etc. To the sum ofrnthese charges, the levy to pay for nonpayingrnpatients should be added explicitly.rnAt least the patient will know what hernpays for.rnA special note on hospital lodging isrnnecessary. In accounting terms, eachrnbed or room in a hospital is very expensive.rnHowever, the accounting terminologyrnis misleading. It is not the bed or thernroom that costs a lot but the medicalrntreatment, the charge for which is assignedrnto the room. Small rooms savernthe hospitals less than they would save arnhotel—a negligible sum as a percentagernof the total cost. Actually, given the totalrncost of hospitalization, the cost of spacernis even more negligible than it would bernin a hotel. There is no more reason,rntherefore, for patients to share roomsrnthan there is for hotel guests to do so.rnAnd there certainly is no reason at all forrnrestricting the size of single rooms.rnGoing even to the best hospital willrnnever be my heart’s desire. But whyrnmake it worse than it has to be?rnErnest van den Haag writes from NewrnYork City. New editions of his PunishingrnCriminals and The Jewish Mystiquernwere recently released by the UniversityrnPress of America.rn48/CHRONICLESrnrnrn