• Friday , 6 December 2019

When form follows profit: a study in healthcare

The statement ‘Form follows profit is the aesthetic principle of our times’[1] has never been so relevant, especially in a time when consumerism has had an increasing influence on both how we design healthcare facilities and what we design them for. One location that has perhaps experienced this phenomenon at an accelerated rate is New York City.

Since the passage of social security amendments in 1965, the US hospital system underwent its greatest transformation. Hospitals earned large profits from the introduction of Medicare and Medicaid, which alleviated their obligation to provide free care to the elderly and poor, allowing hospitals with capital to expand and improve their design. But as hospitals grew in size and became increasingly more complex (to treat an expanding range of illnesses), the situation that emerged proved less profitable by the 1990s.  As healthcare costs rose to new heights, increased awareness of healthcare issues regarding safety and patient dissatisfaction with the quality of medical care provided became a huge concern for regulators and the general public.  

Today, healthcare in the United States has come under substantial pressure to reduce its expenditure and, at the same time, have a greater appeal to its consumers. The elderly account for the heaviest users of healthcare services and, as life expectancy increases, the percentage of older patients in our hospitals is increasing steadily. Hospitals have had to accommodate this demographic shift.

Mental health also plays a major role in how we design; in the USA forty-six percent of the population will face a mental illness throughout their lifetime. On the other side, our advancement in technology and our need to provide more sophisticated techniques and equipment to perform more intricate procedures has consequentially further increased the cost of healthcare. As money becomes more of an issue, medical facilities have become more reliant on effective architectural design to entice not only patients but highly skilled practitioners. Given the reliance on private insurance and healthcare providers, Americans approach hospitals as consumers and act accordingly. People in need of treatment will choose where to be seen based on accessibility, quality of care, and the associated cost. With this level of competition in mind, having an aesthetically pleasing environment becomes a key factor to both attract and retain clients.

With a large percentage of hospitals in New York being ‘for profit’, healthcare providers have directed their attention to more profitable models. The ambulatory model has now grown extensively in popularity as hospital stays have become too expensive for the average patient, even with insurance. To the far end of this scale are ‘micro hospitals’ which can be built for a fraction of the price of a full-size hospital and are often situated close to major highways for accessibility, similar to large retail outlets.

Dignity Health micro hospital. Source: https://hitconsultant.net.

The attraction to ambulatory services lies in the ability to provide more specialised services at a lower cost than larger hospitals. In focusing on fewer areas of medical treatment, such providers have lower wages and running costs without the same level of competition. One such example of a successful ambulatory care hospital is New York Presbyterian.

New York Presbyterian, main lobby. Source: https://www.hok.com.

This hospital is ranked as number one in New York and number five in the USA for a myriad of reasons. It has been described by some as the hospital that sets the bar for contemporary design: ‘The 734,000-square-foot center champions an architectural model that integrates 21st-century care with patient-centered design. Hallways run along the perimeter, taking in sunshine and city views. And MRI facilities are aboveground, rather than relegated to the basement, as is usually the case’.[2] It incorporates the most cutting-edge equipment: ‘New York’s first MRI-guided linear accelerator’[3] and a forty-foot-tall main lobby exhibiting artwork by Beatriz Milhazes with an interchangeable facade. Although this exhibits good use of architectural space, it comes at a hefty price as New York Presbyterian is one of the highest recipients of donations, having received funding of $600,000,000 from Herbert and Florence Irving in 2017.

For design to succeed it needs to anticipate important emerging issues. Healthcare is becoming increasingly competitive. Hospitals are like any other buildings; without users, they have no purpose. The aforementioned hospital types show that, as healthcare has become more commercial, it has evolved like other sectors of design in the way it markets itself, where it situates itself, the business model it has adapted to, and how it has become smaller and more focused in the services it provides. It is uncertain whether these new variations will be of long-term benefit to the end user or if such typologies will be relegated by obsolescence due to their limited service provision. We can be certain, however, that the way we have come to view and receive medical care is rapidly changing.


1. Demakis, Joseph, The Ultimate Book Of Quotations, Raleigh, Lulu Enterprises Inc., 2012.

2. Fazzare, Elizabeth, ‘New York-Presbyterian Sets the Bar for Contemporary Hospital Design’, Architectural Digest, 22 September, 2018.

3. Ibid.

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