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We know that Esperanto has two ways to create a word: Using a root word and adding suffixes, or borrowing a word from other languages and reforming it. However, I doubt that the former method could cause some misunderstandings.
For example, we have malsanulejo and hospitalo, and both mean "hospital". However, analysing by morphology, malsanulejo should mean "where unhealthy people be at", and it could be a hospital, a clinic, a refugee camp, etc. It is not accurate and under some circumstances may cause misinformation.
I know that many English words have differed from their original meanings as the language evolves, like, "hospital" basically has nothing to do with "hospitality". Is the same thing happening in Esperanto? It's still quite new compared with natural languages.

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The answer is: no, it is not accurate. Esperanto is now a living language. As such, it behaves like all the other living languages.

In particular, languages that build up words like Esperanto cannot be completely accurate (if by accurate you mean that the meaning can be unequivocally inferred from the components), they rely on the basic meaning of the compound, that is then fixed by the usage of the community.

Even in other languages, that do not favor that word building model, you find the same "lack of accuracy" and meaning definition through usage. You probably don't think of a black horizontal surface when you read blackboard or a board made of chalk when you read chalkboard.

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Welcome to the world of word formation! It is not an easy topic in any human language, not even in Esperanto.

The Wikipedia article Vortfarado gives quite a deep analysis of the word formation in Esperanto, but the article requires a good language level. Let me explain how I see things.

Who decides about new words?

There is La Fundamento, the Foundation, laid out by Zamenhof. It consists of his groundlaying works. There is Akademio de Esperanto which publishes official amendments. So far there are nine Oficialaj Aldonoj, each covering multiple words.

Of course every speaker is free to come up with his/her own words and expressions, but the inertia of the community is quite strong against changes which would be against the Foundation. Especially changes in the grammar get very easily labelled as kontraŭ­fundamentaj.

But of course some new words and expressions get accepted by the community, and if they stick, they might eventually end up in an Officiala Aldono. Or they can remain in unofficial use.

Malsanulejo vs. hospitalo

When it comes to your specific example, you're right about that technically the word malsanulejo can denote any place where sick people are, but the word got very early a more or less specialised meaning of a hospital.

The original Zamenhofian vocabulary was a mixture of about half a dozen languages. While French was one of those languages, many francophones felt a need to introduce more French words into Esperanto. They felt that the existing words were not accurate enough or that you could not express nuances well enough. One of those pushed words is hospitalo, which was even accepted in 1-a Oficiala Aldono. So we ended up having the fundamental malsanulejo and the amended hospitalo.

My limited observation is that hospitalo is far seldomly used for a hospital than malsanulejo, and I think why it is that way. When you introduce a new word, you do not introduce just a single new word but a root. For the root san/ there are a lot of usable combinations created by adding pre- and postfixes to it. For hospital/ there are very, very few.

The current situation

The wind blows from English now. The anglophones feel that the existing words are not accurate enough or that you can not express nuances well enough, so they introduce new words. I think a major reason for this feeling is the many loanwords English has. The language has loaned words with ultimately same meaning, that they have had to come up with some nuance difference between them. Having an exact same meaning word twice would just be less than smart.

It remains to see which of the words now being pushed into Esperanto will stick, so that they end up in an Oficiala Aldono, and even that does not guarantee a widespread use.

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