Public Hospitals: Doing What Everyone Wants Done but Few Others Wish to Do

Abstract

AMERICAN PUBLIC HOSPITALS —that is, institutions owned by federal, state, or local governments in the United States—today present a series of contradictions. Among urban public hospitals are several of the oldest health care institutions on the continent, yet that heritage often earns them little respect. Public hospitals in many cities are filled to capacity and suffering severe financial and clinical problems as a result; but in rural areas, lack of business threatens many government health care institutions. Residencies in public teaching hospitals are often eagerly sought; yet many physicians who trained in such residencies hesitate to refer their patients to these hospitals. Several public hospitals —Cook County Hospital, Chicago; Bellevue Hospital Center, New York City; Boston City Hospital—are legendary in medical history; but the physical plants of the Boston and Chicago hospitals (among others) are sadly deteriorated. The demise of the public hospital was widely predicted after the passage of