The Growth of Hospitals: An Economic History in Baltimore

摘要

This study describes the origins and early development of the modern American hospital sector, with particular reference to Baltimore prior to World War II. It finds that hospitals grew rapidly in the last quarter of the nineteenth century in response to various forces associated with immigration, urbanization and industrialization. In order to finance growth and rising costs in the twentieth century, Baltimore's voluntary hospitals competed intensely for paying patients. In the process, they encountered a conflict between the exigencies of market competition and charity care; many hospitals sacrificed the latter. After World War I, a three-tiered hospital sector evolved in which Baltimore's teaching hospitals treated both paying and charity acute-care patients; most other voluntary hospitals treated mainly paying patients; and the municipal hospital picked up indigent acute and chronic cases. And during the Great Depression, voluntary hospitals created a unique system of local monopolies in hospital prepayment to finance their own services.