A sound, readable examination of the existing mishmash, that is the
American hospital system, and how it came to be. Stevens (History
and Sociology of Science/Univ. of Penn.) believes that our
hospitals are marked by a set of culture-specific characteristics
that make them "idiosyncratically 'American' institutions." She
identifies six such characteristics as central to an understanding
of the system; these form the framework of her analysis. They are
pluralism, "the segmentation and diversity of hospital ownership in
the United States" (public, private, religious and so on); social
stratification (hospitals such as N.Y.C.'s Bellevue or Chicago's
Cook County, which began as institutions for the poor and have
largely kept those labels and functions); the money standard of
success by which hospitals judge themselves and others; the focus
on acute care and technology, particularly surgery; the "built-in
tension between hospitals and the medical profession" - by which
doctors consider hospitals to be an extension of their private
practices, while they themselves are not fully part of the internal
power structure; and "the strong yet largely informal role of
medical schools as an influence in the hospital system." These
interacting characteristics result in what Stevens calls "a
constantly negotiated hospital system." She examines how our values
have evolved through years that include such highlights as the
advent of consumerism in the 1920's the development of technology,
and the arrival of Blue Cross and other reimbursement schemes.
Finally, she puts the whole in perspective, and names the massive
main task for the future: a reorientation of the medical care
system. ". . .targeted to chronic disease, care as well as cure,
and a restatement of the meaning of professionalism." A scholarly
work, but accessible and informative for the interested consumer as
well. (Kirkus Reviews)
"Stevens brilliantly views the hospital as a prism of the values
and mores of society... She sees the stratification of the hospital
population into private, semi-private, and charity patients as a
manifestation of the social stratifications of American society."
-- Reviews in American History
American hospitals are unique: a combination of public and
private institutions that are at once charities and businesses,
social welfare institutions and icons of U.S. science, wealth, and
technical achievement. In Sickness and in Wealth helps us
understand this huge and often contradictory "industry" and shows
that throughout this century the voluntary not-for-profit hospitals
have been profit-maximizing enterprises, even though they have
viewed themselves as charities serving the community. Although our
hospitals have provided the most advanced medical care for acutely
sick and curable patients, they have been much less successful in
meeting the needs of the chronically ill and the socially
disadvantaged. That, Stevens concludes, is the next urgent task of
social policy.
"For me, personally, the book constituted an invitation to
rethink the relationship -- warts and all -- among the benevolent,
charitable, and business missions of the hospital, while at the
same time disabusing me of my inclination to cite history to
support or defend a view I might otherwise have preferred to hold."
-- Merlin K. DuVal, M.D., Senior Vice President, Samaritan Health
Service, Phoenix, Arizona
"This book is beautifully written... and is must reading for
anyone involved in the current debate on health policy. It will
also make delightful reading for those who merely wish to view the
shifting social andeconomic climate in modern America, as seen from
the perspective of the hospital." -- New England Journal of
Medicine
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