IN SICKNESS AND IN WEALTH: American Hospitals in the Twentieth Century

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.