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Teaching Hospitals and the Urban Poor

Teaching Hospitals and the Urban Poor

Eli Ginzberg
Howard Berliner
Miriam Ostow
Panos Minogiannis
J. Warren Salmon
The Eisenhower Center for the Conservation of Human Resources, Columbia University
Copyright Date: 2000
Published by: Yale University Press
Pages: 144
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  • Book Info
    Teaching Hospitals and the Urban Poor
    Book Description:

    Academic health centers (AHCs) have played a key role in propelling the United States to world leadership in technological advances in medicine. At the same time, however, many of these urban-based hospitals have largely ignored the medical care of their poor neighbors. Now one of the leading experts in American health policy and economics ponders whether current and proposed changes in the financing and delivery of medical care will result in a realignment between AHCs and the poor.Basing his discussion on an analysis of the nation's twenty-five leading research-oriented health centers, Eli Ginzberg and his associates trace the history of AHCs in the twentieth century. He claims that AHCs are once again moving toward treating the poor because these hospitals need to admit more Medicaid patients to fill their empty beds, and their medical students need opportunities to practice in ambulatory sites. He also assesses some of the more important trends that may challenge the AHCs, including financial concerns, changing medical practice environments, and the likelihood of some form of universal health insurance.Eli Ginzbergis director of The Eisenhower Center for Conservation of Human Resources, Columbia University. He has been a consultant to nine U.S. presidents and chaired the National Commission for Employment Policy for six presidents. He is the author of numerous books as well as articles on health affairs in theNew England Journal of Medicine,theJournal of the American Medical Association,and many other journals.

    eISBN: 978-0-300-13301-1
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xii)
  4. Introduction
    (pp. 1-14)

    As the title of this book suggests, our study takes up questions concerning academic health centers (AHCs) in urban settings.We attend especially to the circumstances of the twenty-five or so leading research-oriented AHCs. This cohort of AHCs (see table) is largely concentrated along the East and West Coasts, from Boston to Durham, North Carolina, and from San Diego to Seattle, but also includes representation from theMidwest and the South. We need to take particular notice of the derailment of the Clinton health reform proposal in September 1994 because it is a crucial condition for this study. A consequence of this...

  5. 1 The Impact of World War II on U.S. Medicine
    (pp. 15-24)

    Although this chapter focuses on the important changes in the structure and function of U.S. medicine between World War II and the passage of Medicare and Medicaid, we begin by identifying key interactions between the leading urban academic health centers and their low-income neighbors. We will use 1910 as a starting date, when the young educator Abraham Flexner completed the first major report on U.S. medical education under the sponsorship of the Carnegie Foundation for the Advancement of Teaching and with the support of the AMA. Flexner’s recommendations were twofold. First, he recognized the urgent need for the United States...

  6. 2 How Medicare Changed the AHCs
    (pp. 25-41)

    In passing the Balanced Budget Act of 1997 Congress decided to “save” $115 billion from 1998 to 2002 primarily by reducing payments to the providers of services to elderly and disabled Medicare beneficiaries. This will not be the last time that Congress will have to struggle with introducing radical changes in theMedicare structure, as other factors are demanding attention. The government has already restructured theMedicareTrust Fund. The babyboom generation becomes eligible for Medicare beginning in 2011. The House of Representatives turned down a Senate amendment to raise the age of eligibility for Medicare from 65 to 67. We are hearing...

  7. 3 Changes in the Physician Supply
    (pp. 42-61)

    When we look back at the twentieth century, we can clearly identify the importance of physician supply issues in the evolution of U.S. health care policy. From 1990 until the end of WorldWar II, members and leaders of the AMA largely decided most questions affecting the numbers and characteristics of students who were admitted to and graduated from U.S. medical schools. The AMA and its state affiliates, working closely with the leadership of the nation’s medical schools, operated under broad grants of authority and autonomy from state legislatures that held formal control over the licensing of medical practitioners. In cooperation...

  8. 4 Challenging the AHCs to Change
    (pp. 62-76)

    American medicine won the acclaim of most informed observers of the post–World War II era for its steady advances in biomedical research and in the delivery of high-tech medical treatment. A number of dissenters, however, have questioned whether the accomplishments warranted such unqualified praise. Experts in social medicine in Great Britain, for example, have pointed out that the greatest gains in reduced morbidity and lengthened life expectancy were more indicative of changes in the socioeconomic environment than advances in curative medicine. These researchers demonstrated that mortality rates among the various classes remained the same during the three decades that...

  9. 5 The Impacts of Managed Care
    (pp. 77-98)

    In this chapter we assess the impacts of managed care and Medicaid managed care on the AHCs and the urban poor. The outlook for the evolution of managed care remains uncertain, hence we begin by telling the story of the managed care revolution since the early 1980s, when the enrollment shift from fee-for-service insurance to managed care started to accelerate. We continue by looking at developments in the 1990s, when the shift to managed care intensified and state Medicaid managed care enrollments also accelerated. But first we offer a brief summary of events that contributed to the managed care revolution...

  10. 6 The Next Decade 2000–2010
    (pp. 99-116)

    In this concluding chapter we assess likely developments for the next ten years. The year 2010 marks an important point in the evolution of our nation’s health care delivery system because it coincides with Medicare eligibility of the first of the post–World War II baby-boom generation (unless Congress acts first to alter the age of eligibility). But first we will examine the transformations that occurred during the last decade of the twentieth century in restructuring the functioning of prestigious AHCs, the changing conditions affecting different groups of the urban poor as they continued to seek access to ambulatory and...

  11. Selected Reading
    (pp. 117-122)
  12. Index
    (pp. 123-129)