In Sickness and in Wealth: American Hospitals in the Twentieth Century

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Edition: 1st
Format: Paperback
Pub. Date: 1999-01-01
Publisher(s): JOHNS HOPKINS UNIV PRESS
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Summary

"Stevens brilliantly views the hospital as a prism of the values and mores of society... She sees the stratification of the hospital population into private, semi-private, and charity patients as a manifestation of the social stratifications of American society."-- "Reviews in American History"American hospitals are unique: a combination of public and private institutions that are at once charities and businesses, social welfare institutions and icons of U.S. science, wealth, and technical achievement. "In Sickness and in Wealth" helps us understand this huge and often contradictory "industry" and shows that throughout this century the voluntary not-for-profit hospitals have been profit-maximizing enterprises, even though they have viewed themselves as charities serving the community. Although our hospitals have provided the most advanced medical care for acutely sick and curable patients, they have been much less successful in meeting the needs of the chronically ill and the socially disadvantaged. That, Stevens concludes, is the next urgent task of social policy."For me, personally, the book constituted an invitation to rethink the relationship -- warts and all -- among the benevolent, charitable, and business missions of the hospital, while at the same time disabusing me of my inclination to cite history to support or defend a view I might otherwise have preferred to hold." -- Merlin K. DuVal, M.D., Senior Vice President, Samaritan Health Service, Phoenix, Arizona"This book is beautifully written... and is must reading for anyone involved in the current debate on health policy. It will also make delightful reading for those who merely wish to view the shifting social andeconomic climate in modern America, as seen from the perspective of the hospital." -- "New England Journal of Medicine"

Author Biography

Rosemary Stevens is the Stanley I. Sheerr Professor in the Department of History and Sociology of Science at the University of Pennsylvania. She is the author of American Medicine and the Public Interest.

Table of Contents

PREFACE, 1999 xi(26)
ACKNOWLEDGMENTS xxxvii
1. Introduction
3(14)
American Dilemma: Technological versus Social-Welfare Goals
Characteristics of the American Hospital System
The Process of Change
2. Charities and Businesses: Hospitals in the Early Twentieth Century
17(35)
Establishing the Power Base: Patterns of Allegiance
Charities as Businesses: The Pay System
The Public Role of Private Hospitals
The Hospital as an Instrument of Progressive Ideas
3. A National Enterprise: Setting Basic Rules
52(28)
Scientific Medicine as a Basis for Authority
Standardizing Medical Education
Hospitals and the Internship
Regulating Hospitals: A Posse of Players
Hospital Administrators and Scientific Management
Coming to Grips with Standards in Surgery
4. The Case for Cooperative Medicine: World War I
80(25)
Organizing Medicine for the Service of Patients
The Health-Insurance Movement
Hospitals at War
Influence of Wartime Practices at Home
Nursing as Patriotism Made Visible
Military Men and Civilian Institutions
A "Negative Instrument of Evolution"?
5. Hospitals in the 1920s: The Flowering of Consumerism
105(35)
Constructing the Consumer Institution
Standardization Is Achieved-Within Limits
Consumers and Communities
The Public Power of Private Interests
Problems and Limits of a Marketplace Ethos
6. The Political Creation of the Voluntary Ideal: Hospitals During the Depression and the Early New Deal
140(31)
Hard Times
Defining Hospital and Medical Interests Against the Threat of Government Domination
Hospital Administration as a Profession
Carving Out the Middle Ground: The Voluntary Sector
Hospital Associations as Political Lobbies
The Political Utility of the Voluntary Ideal
7. Technology and the Workers: The Genesis of Blue Cross
171(29)
The Necessary Institution
The Technological Bureaucracy
Beginnings of Group Hospitalization
Blue Cross and National Policy-making
How Should Hospital Technology Be Distributed?
Policies and Politics in the Late 1930s
8. Consolidation Without Jeopardy: Planning in the Shadow of World War II
200(27)
Hospital Medicine as Medical Science
A Knowledge-Based System?
Wartime Programs and Their Implications
Laying the Base for Postwar Planning
Hospital Planning: Consensus from Within
The Hill-Burton Act: Expansionism and Independence
Hospital Planning and the Voluntary Ethos
Planning as a Process, Science as a Mission
9. Pillars of Respectable Independence: The 1950s
227(29)
Government Policy-making by Incentives
The Community Institution
The Industrial Model of Organization
Hospital-Medical-Staff Relations
Hospitals and the Quality of Care
Emergence of Larger Community Interests
10. The Drive for Reimbursement
256(28)
Hospital Financing: Largesse and Limitations
Blue Cross on the National Scene
Selling Hospital Services to Government
New Elements in the Public-Private Mix
Is Voluntary Planning Feasible?
Medicare: The Watershed
11. Pragmatism in the Marketplace: 1965-80
284(37)
Medicare and Medicaid Are Implemented
Capital: The Keystone of the Arch
Planning and the Politics of Debt
The Death of Charity?
New Alignments by 1980
12. Hospitals at the End of the Twentieth Century
321(30)
The New Standardization: Federal Control
Quality: A Question of Measurement or a Question of Trust?
Hospitals as Businesses
Redefining the Workshop: Hospitals and Doctors
Voluntarism Redux: Charity and Tax Exemption
Ironies and Inconsistencies
13. The American Hospital System in Historical Perspective
351(16)
Ideals and Ideology in Hospital Policy
Coping with Ambiguity
The Not-for-Profit Sector
What Next?
NOTES 367(52)
INDEX 419

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