The closure of Philadelphia General Hospital: An historical analysis of public policy, politics, and healthcare delivery.

摘要

This historical public policy inquiry identifies, describes, and explains the circumstances surrounding, and the factors contributing to, the 1977 closure of Philadelphia General Hospital (PGH). Data collection methodologies comport with accepted practices of historical research and are subjected to rules of reliability to interpret and synthesize the data. Primary and secondary sources include archival documents gleaned from public records, private archives, and media sources; and key informant interviews using oral history techniques. Key informants include governmental agents and appointees, civic activists, hospital and academic professionals, and other persons with knowledge and experience of the PGH closure. Political phenomena and legislative actions are examined within a political and social science paradigm. This study adds to the body of knowledge regarding public hospital closures by examining large-scale public policy decisions and their intended and unintended consequences, with focused consideration of the passage and implementation of Hill-Burton legislation; Medicare and Medicaid; the significance of the creation of the Philadelphia Hospital Authority; the complexities of multi-institutional bureaucracies; the impact of the media on public policy decisions; notions of geopolitics, race, and class; and the dichotomy of health care advancement and evolution versus institutional and political failure with systemic social consequences.