Failure of hospitals in urban areas is a well documented, spreading phenomenon that is resulting in decreased care for the medically indigent. As financial conditions force greater closures and cutbacks among providers, this dismantling of institutions that have historically served the unfortunate deepens the crisis in access to medical care. In this article, pressure on private health care institutions to adhere to a more bottom-line approach is viewed in the light of an overall attempt by government to divert public capital into private sector coffers, a trend that is particularly significant because of the ongoing concentration and centralization within the delivery system. Set in a historical analysis of the corporatization of health care, a case is made to reveal the underdevelopment of public hospitals, certain urban voluntary institutions, and community-based clinics, i.e., those institutions left to serve the most needy, in the face of rampant financial success by proprietary providers catering to a middle-class clientele requiring less intensity of care.
MullnerR.McNeilD.AndesS.National trends in hospital closure 1980–1984. American Hospital Association, Office of Policy Analysis Publication no. 59, pp. 1–32, Chicago, 1985.
4.
RheinR. W.Hospitals in trouble: Crisis for doctors. Medical World News21: 58–68, 1980.
5.
RelmanA. S.The new medical industrial complex. N. Engl. J. Med.303: 963–970, 1980.
6.
ReinholdR.Treating an outbreak of patient dumping in Texas. New York Times, May 25, 1980, p. 4.
7.
Chicago's private hospitals deny care to the poor. All-Chicago City News, July 23, 1983, p. 6.
8.
SchiffR. L.Transfers to a public hospital: A prospective study of 467 patients. N. Engl. J. Med.314 (9): 552–559, 1986.
9.
DowdD. F.The Twisted Dream: Capitalist Development in the United States Since 1776. Winthrop Publishers, Cambridge, Mass., 1974.
10.
NavarroV.Medicine Under Capitalism. Prodist, New York, 1976.
11.
McKinlayJ. B. (ed.). Issues in the Political Economy of Health Care. Tavistock Publications, New York, 1984.
12.
StarrP.The Social Transformation of American Medicine. Basic Books, New York, 1982.
13.
BrownE. R.He who pays the piper: Foundations, the medical profession, and medical education reform. Int. J. Health Serv. 10 (1): 71–88, 1980.
14.
MarkowitzG. E.RosenD. N.Doctors in crisis: A study of the use of medical education reform to establish modern professional elitism in medicine. Am. Quarterly25 (1): 83–107, 1973.
15.
GordonD. M.Capitalist development and the history of American cities. In Marxism and The Metropolis, pp. 26–63. Oxford University Press, New York, 1984.
16.
SalmonJ. W.The competitive health strategy: Fighting for your health. Health Med. 1 (2): 21–30, 1982.
17.
SalmonJ. W.Corporate Attempts to Reorganize the American Health Care System. Doctoral dissertation, Cornell University, 1978 (unpublished).
18.
Highlight of an Effective Employee Benefit Management System. Position paper, BPI, Inc., Westmont, ***Ill., 1980.
19.
The Formation of a Medicine and Business Coalition. American Medical Association, Office of Corporation Liaison, Medical Practice and Professional Relations Group, 1981.
20.
Health Care Horizons ‘77. Touche Ross & Co., New York, 1977.
21.
JohnD. E.Chains integrate health care services into local networks. Mod. Health Care15 (12): 2, 1985.
22.
GottliebS. R.Reducing excess capacity is a tough but necessary job. Hospitals52: 63–68, 1978.
23.
The Killing of Philadelphia General Hospital. Health Information and Action Group, Philadelphia, 1976.
McLaffertyS.Neighborhood characteristics and hospital closure. Soc. Sci. Med.16: 1667–1674, 1982.
26.
NavarroV.The crisis of the international capitalist order and its implications on the welfare state. In Issues in the Political Economy of Health Care, edited by McKinlayJ. B., Methuen/Tavistock Publications, New York, 1984.
27.
MontgomeryJ.Corrections Corp. seeks lease to run Tennessee's prisons. The Wall Street Journal, September 13, 1985, p. 8.
28.
KraftS.Corporations enter the classroom: Private companies fill the gap left by dwindling government funding. Valley Advocate, Springfield, Mass., January 1, 1986, pp. 1–6.
29.
ShillerH. I.Information: A shrinking resource. The Nation, December 28, 1985/January 4, 1986, pp. 708–710.
30.
HullJ. B.Medical turmoil: Four hospital chains facing lower profits, adopt new strategies. The Wall Street Journal, October 10, 1985, p. 1.
31.
HernandezS. R.KaluznyA. D.Hospital closure: A review of current and proposed research. Health Serv. Res.18 (3): 419–436, 1983.
32.
WeissK.Corporate medicine: What's the bottom line for physicians and patients?New Physician9: 1–25, 1982.
33.
Health Care Financing Program Statistics/The Medicare Medicaid, Data Book 13, p. 111. Health Care Financing Administration, 1981.
34.
DallekG.The loss of hospitals serving the poor. Health Serv. Res.18 (3): 593–597, 1983.
35.
KoenigR.Humana earnings increased by 15% in fourth period. The Wall Street Journal, October 9, 1985, p. 2.
36.
M. D. behavior seen as cause of losses. Am. Med. News, May 2, 1986, p. 2.
37.
PunchL.Investor-owned chains lead increase in beds. Mod. Health Care15 (2): 126–136, 1985.
38.
PunchL.Chains expand their operations, expecting prospective pay boom. Mod. Health Care14 (5): 131–140, 1984.
39.
WallaceC.Ambulatory care facilities multiply. Mod. Health Care15 (12): 142–146, 1985.
40.
PunchL.Freestanding units lose money, but that doesn't stunt growth. Mod. Health Care14 (5): 150–153, 1984.
41.
HendersonJ.Surgery centers double: Consultant. Mod. Health Care15 (12): 148–150, 1985.
42.
GondelaE.Franchise, retail dental operations record major gains. Mod. Health Care14 (5): 160–163, 1984.
43.
GondelaE.More clinics opening, but growth rate falls. Mod. Health Care15 (12): 152–154, 1985.
44.
HollieP. G.Ambulances go private. New York Times, May 25, 1986, Section 3, p. 1.
45.
SchwartzW. B.NewhouseJ. P.WilliamsA. P.Is the teaching hospital an endangered species?N. Engl. J. Med.313 (3): 157–162, 1985.
46.
ReadingA.Involvement of proprietary chains in academic health centers. N. Engl. J. Med.313 (3): 194–197, 1985.
47.
BerlinerH. S.BurlageR. K.Proprietary hospital chains and academic medical centers. Int. J. Health Serv. 17 (1): 27–45, 1987.
48.
WilsonJ.W.Don't expect any miracles at the hospitals. Business Week, January 13, 1986, p. 98.
49.
WattJ. M.The comparative economic performance of investor-owned chains and not-for-profit hospitals. N. Engl. J. Med.314 (2): 89–96, 1986.
50.
HymanR. H.Are public hospitals in New York City inferior to voluntary, nonprofit hospitals? A study of JCAH hospital surveys. Am. J. Public Health76 (1): 18–22, 1986.
51.
BedrosianJ. C.Uncompensated care: A critical national issue. FAH Rev. September/October 1985, pp. 42–44.
52.
YoungQ.Toward a Cook County Public Health Delivery System: A New Vision. Position paper, Health and Medicine Policy Research Group, Chicago, 1986.
53.
SalmonJ. W.Local building blocks toward a national health plan: The case of Chicago's Cook County Hospital. Gray Panther Network, Spring 1986.
54.
WaitzkinH.The Second Sickness: Contradictions of Capitalist Health Care. Free Press, New York, 1984.
