Private choices, public obligations: New York City and its hospitals since 1900.

摘要

Urban hospitals are sensitive barometers of community life; indeed, they are stages upon which are played out most of the political, demographic, social, and economic changes that shape a city's experience. Urban hospitals also provide an illuminating way of looking at the interplay between public and private sectors in American life. This dissertation focuses on the experience of two great hospitals in New York City--Bellevue, a municipal institution, and the private New York Hospital (NYH). Three themes shape the account: (1) the impact of the city's history on these two hospitals; (2) the changing nature of large urban hospitals; (3) the growing gulf between New York's public and private hospitals. The study begins around 1900--as the transition to "scientific medicine" was starting to take hold--and ends in 1995.;In 1900, NYH and Bellevue shared a single primary mission: providing free care to the poor. Over time, however, the two institutions' patient populations diverged. NYH, like other voluntary hospitals, concentrated on patients who either could pay for their treatment or were useful for research and teaching. During these years, the circle of paying patients expanded, as new funding mechanisms like hospital insurance and Medicare enabled most middle- and even working-class New Yorkers to purchase care in the private sector. This left public institutions like Bellevue to serve a disproportionate share of the city's homeless, minority, and fundless patients. Public funding came to play a major role in NYH's financing, yet NYH retained most of the advantages of private ownership, diverging sharply from Bellevue in its physical plant, its level of public accountability, and in its relationships with its affiliated medical school, its employees, and its neighborhood. The two institutions were also affected differently by changes in the city's demography, politics, and economy.;By the 1990s, Bellevue and NYH were both famous institutions, but the gulf between them illuminated the inequalities within the city's network of hospitals--and, in a larger sense, within the city itself. How New York's network of hospitals developed and how it was shaped by the surrounding city represents a compelling chapter in medical history, in urban history, and in America's continuing exploration of how best to divide the work of our society between public and private sponsorship.