The Hospital City in an Ethnic Enclave

Abstract

Many leading hospitals and medical centers in the United States are located in large urban centers. This has meant that the post–World War II growth of the U.S. health care sector has been deeply intertwined with wider changes in the political economy of American cities. Through an examination of Boston’s Tufts-New England Medical Center (T-NEMC) and the surrounding Chinatown neighborhood, this article explores the implications of this relationship by assessing the spatial, economic, and community consequences of the growth of a major urban academic medical center. It treats the history of health care and health care policy as a key part of urban history, using the T-NEMC case to tell a larger story about the role of local and federal policy in transforming urban health care institutions.. T-NEMC deployed federal urban renewal and hospital construction programs to finance an ambitious expansion program designed to allow it to compete with Boston’s many prestigious medical centers. T-NEMC faced determined opposition from Chinatown residents who forged political alliances that helped them gain concessions from the medical center, including housing, schools, and health care and community centers—even as their neighborhood was transformed. Ultimately, T-NEMC’s larger strategy proved problematic. It took on excessive debt during the period of its expansion and then, in the 1990s, failed to form critical network alliances with other hospitals. The story of health care redevelopment in Boston thus proves to be deeply enmeshed in the changing political economy—and politics—of health care in the United States.