The postindustrial decentralization of the hospital and the urban analogy.
The hospital in the United States as an institution, a community, an organizational form, and a social phenomenon shares many striking commonalities with the city. It has highly important technical functions which are accompanied, and at times overshadowed, by broader social purposes and roles. The hospital also has undergone a number of transformations over time and has experienced a distinct, if idealized, golden age fostered by key technological advances. It has been the site of significant political and social tensions and conflicts. And in recent years, it has begun to evidence a decline in social significance and standing, and a general deconcentration which further underscores the usefulness of the urban analogy. The application of an ecological perspective aids in framing this intriguing parallelism between these two great social institutions. This perspective emphasizes the interdependence and mutual causality which key contributory trends--such as technological and organizational developments, environmental change, and shifting population characteristics--have had on the forms and functions of both hospitals and cities. The urban ecologist Hicks has written: "The city is being redefined ... [t]he transforming city is a predictable response to changing demographic, economic and technological realities. While the image of the city's form is etched into our consciousness, it is the city's function that will always be its sine qua non; in time its form will adjust to the new roles that cities will come to society." In a like fashion, a similar ecological interpretation of the transformation of the hospital can and will be made. This article will propose that examining the modern hospital through the urbanization-deurbanization parallel can be an instructive way to explore and interpret its changing character and role in American society. It will suggest that the hospital evolved into a dominant central position--more in a functional than a territorial sense--in the health services sector with other service entities arrayed concentrically about it. However, powerful centrifugal forces in recent years have reversed this trend, and dispersion is becoming increasingly evident. These processes will be detailed and contrasted with those documented in urban decline and deconcentration of selected future trends from this perspective and some public policy implications in a ecological interpretation.
D003159:Community-Institutional Relations; D003469:Culture; D006761:Hospitals / Q000639:trends*; D012922:Social Change; D014481:United States; D014507:Urbanization