Hospitals and Health Services Systems

"Who is to say that a hospital is doing more harm than good in surgery, and that its funds would be better expended as an institution for nervous diseases?"
- Ernest A. Codman M.D (1869-1040), fired from the Harvard Medical School for seeking evidence about the outcomes of hospital care.

For centuries care of the sick and injured had consisted of acts of empathy and love largely conducted by religious orders and financed by charitable contributions. Although providing succor and support, largely for the destitute, they were often poorly run and too frequently harbored more disease than they cured. In many ways they reflected the social culture of their times and places. Over the ages hospitals provided care in every sense of the word and often a place to die. To the possibility or promise of cure they gradually added preventive measures, and most recently rehabilitation. At the pinnacle of the hospital hierarchy are medical schools and their affiliated university hospitals, now called “academic health centers”, that train doctors and other health personnel, conduct fundamental, applied and population-based research. In recent decades a growing number of hospitals have been a source of profit for owners and shareholders while their academic contemporaries struggle to stay afloat financially...
Over several centuries the management of hospitals has been extended from the purview of nuns to nurses, sometimes physicians and more often well-meaning lay administrators. Only in the late twentieth century was formal university training for hospital administrators provided. Initially salaries were negligible to low but they have gradually morphed into those of major corporate entities, as their titles have shifted to CEO. Those of commercial insurance companies are even greater.

Florence Nightingale (1820-1910), the founder of modern nursing, born to a wealthy family and well-connected socially, was horrified with the conditions she found in military hospitals during the Crimean War. She embarked on a life-long crusade to improve the care and accountability of British hospitals. Her writings on management, organization, nursing, health statistics (she prepared the first Hospital Discharge Abstract Form) and hygiene are landmarks in the evolution of hospitals and related caring facilities.

In Germany Prince Otto Bismarck (1815-1898) an aristocratic conservative with impeccable right-wing credentials introduced national health insurance as part of his overall social insurance plan – later used as a model for the Social Security arrangements in the United States. Sir William Beveridge’s (1879-1963) report on “Social Insurance and Allied Services” contributed the intellectual foundations for the United Kingdom’s National Health Service. An exhaustive report by a Royal Commission in Canada resulted in that country’s national health insurance legislation. In the United States Theodore Roosevelt and later Harry Truman and Richard Nixon and most recently Bill Clinton tried to introduce some form of national health insurance but all failed. Today over 46 million citizens have no health insurance. Most national insurance systems and the U.S. Social Security system have overhead charges of about 3%; commercial firms have overheads of 30% or more.

Systems of care that link the various levels of care started with the work of Lord Dawson (1864-1945) whose landmark report defined and diagrammed links of care from primary health centers, secondary health centers, teaching hospital and home care. In the United States the Henry J. Kaiser, a construction magnate, founded the Kaiser-Permanente Health Plan in the latter part of the twentieth century.

Works dealing with health care institutions, facilities, staffing and insurance, systems and their sponsorship, ownership and management are all represented in this collection.