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The Public-Private Health Care State - Essays on the History of American Health Care Policy (Hardcover)
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The Public-Private Health Care State - Essays on the History of American Health Care Policy (Hardcover)
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The distinctive mixing and continuous remixing of public and
private roles is a defining feature of health care in the United
States. "The Public-Private Health Care State "explores the
interweaving of public and private enterprise in health care in the
United States as a basis for thinking about health care in terms of
its history and its continuing evolution today. Historian and
policy analyst Rosemary Stevens has selected and edited seventeen
essays from both her published and unpublished work to illustrate
continuing themes, such as: the flexible meanings of the terms
"public" and "private," and how useful their ambiguity has been and
is; the role of ideology as ratifying rather than preordaining
change; and the common behavior of public leaders and corporate
entities in the face of fiscal opportunity. The topics--covering
the period of 1870 through the twenty-first century--represent
Stevens' research interests in hospital history and policy, the
medical profession, government policy, and paying for health care.
The volume also considers her involvement with policy questions,
which include health services research, health maintenance
organizations, and physician workforce policy. Section I
demonstrates the long history of state government involvement with
private not-for-profit hospitals from the 1870s through the 1930s.
Section II examines the federal role in health care from the 1920s
through the 1970s, including the establishment of veterans'
hospitals and the implementation of Medicaid. Section III shows how
shifting governmental roles require constantly changing organizing
rhetoric, whether for inventing a federal role for health services
research and HMOs, "regionalization" in the 1970s, or defining
civil rights and "equity" as mobilizing vehicles in the 1980s.
Section IV examines growing concerns from the 1970s through the
present about the traditional "public" role of the largely
"private" medical profession. Section V returns to the ambiguous
public-private status of not-for profit hospitals, buffeted in the
1980s and 1990s by assumptions about the efficiency of the market.
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