The Political Economy of the Hospital in History (original) (raw)

2020, Charity and Philanthropy in the History of Brazilian Hospitals

Table 7.2 Policy statements on ownership of and financial responsibility for primary care facilities-269 10.5920/PoliticalEconomy.fulltext tions between places in the structure and organisation of hospital systems, the balance between public and private sectors, and the politics attending this. These problems break down into subsidiary objectives, which the authors tackle. From a public and private perspective, why and how were medicine, health and hospitals transformed? To what extent were the different national trajectories of the twentieth century determined by earlier configurations of funding and ownership? Why Composition of the book Our historical case studies begin with Spain and Brazil, to observe hospital models rooted in early modern charitable practices, where politics and pace of economic development forestalled moves to universalism until quite late in the twentieth century. 10.5920/PoliticalEconomy.fulltext the Medicare programme, which until the 1980s allowed private hospitals to set their own fees. Yet she also finds examples of citizens utilizing federal programmes to demand greater access to care: the medical civil rights movement's protest at segregated hospitals in the 1960s; Medicaid recipients' law suits against hospitals that refused to accept poor patients in the 1970s; and the establishment of a right to emergency care in 1986. The chapter concludes with the impact of the 2010 Affordable Care Act ('Obamacare') which provides federal subsidies to the private health insurance industry and expands Medicaid coverage for low-income people, bringing hospitals millions of newly insured patients. It thus embodies the same public-private paradox. The book closes with China, whose case demonstrates the adoption of the biomedical hospital in a great power undergoing rapid modernisation, in conditions of intense political upheaval. Xu and Mills begin by pointing out that although China was once considered an international model for low-cost rural primary health care, this reputation was founded on a short-lived combination of factors. Over the long term, China has instead suffered from chronic concentration of high-quality resources in its hospitals, despite recurrent efforts to strengthen primary care. Their chapter analyses the historical evolution of both hospitals and primary care in China from the perspective of financing, in a study covering the period 1835-2018. It shows that the developmental trajectories for earlier models of hospital and primary care diverged between 1835 and 1949, with low-cost primary care emerging only after the establishment of relatively elitist hospitals. The divergence was consolidated, they argue, between 1949 and 1978, giving rise to two different models with contrasting fiscal space, service-finance methods and administrative policies. After 1978, market-based financing mechanisms brought direct competition for patients and resources between hospitals and primary care providers, and exposed the weakness of the latter. Pharmaceuticals and technologies became critical vehicles for 10.5920/PoliticalEconomy.fulltext