Community Boards in Search of Authority

Abstract

T whom should publicly financed hospitals be responsible? In the case of city hospitals the principle of accountability to city residents and taxpayers is at least given lip service. Yet translating the principle of public accountability into practice is always fraught with conflicting alternatives and difficult choices. For example, which publics are to be served and which are to govern, it' any? What private influences are and should be involved in governing and receiving benefits? The New York City municipal hospitals began, over one hundred years ago, as charity institutions supported by public funds tor the direct benefit of the poor and the indirect benefit of the rich (who had the sick poor quarantined in the hospitals). New York City now has the largest municipal hospital system in the country. Nineteen municipal hospitals provide nearly onehalt' of the city's seven and one-half million residents with at least part of their medical care, and are the primary source of medical care for over a million and one-half persons, especially members of minority groups, the poor, the young, and the old. Until 1970 the city government exercised nominal control over the city hospitals, which were, at first, directly governed by physicians who volunteered their time, and later increasingly by persons connected with medical schools and teaching hospitals. Influence was also exercised by hospital administrators, by Blue Cross, by politicians, and by others. In 1970 the New York State Legislature established the Health and Hospitals Corporation (HHC) as a quasi-public benefit corporation, outside of the direct control of city hall. The new organizational scheme avoided some of the municipal bureaucratic regulations originally designed to insure public accountability, but more recently responsible for delays in the purchasing and construction of new facilities. The mayor and city council did retain influence in the Health and Hospitals Corporation through their power to appoint members to its board of directors and through the city's financial contributions to the corporation. While the establishment of the corporation reduced formal accountability, at least at the city-wide level, to the people of New York