title: Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.
abstract: Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.
authors.affiliation: barbarabridgmanperkins@comcast.net
authors.forename: Barbara Bridgman
authors.initials: BB
authors.lastname: Perkins
mesh_terms: D004465:Economic Competition / Q000266:history*; D017048:Health Care Costs / Q000266:history*; D018166:Health Care Reform / Q000266:history; D006285:Health Planning / Q000266:history*; D049673:History, 20th Century; D006752:Hospital Planning / Q000266:history; D006801:Humans; D012936:Social Medicine / Q000266:history*; D012939:Social Planning; D014481:United States