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The problem with planning: Springfield hospital and the development of the United States healthcare system, 1890--1980

Bruce Saxon, University of Massachusetts Amherst

Abstract

This dissertation traces the history of Springfield Hospital from 1890 to 1980. I examine the case of Springfield Hospital as a springboard to examine the larger developments in the U.S. healthcare system in the twentieth century. Medical historians have done yeoman work in charting the story of hospitals to 1920 in terms of case studies: In this work, I try to take hospital history up to the present. Medical historians have also constructed powerful interpretative frameworks of national hospital development in the twentieth century. I build on their work and in some cases take issue with their analysis based on my examination of Springfield Hospital. Among my findings: Spingfield's medical staff records reveal real ambivalence among physicians about the development of the medical center model of healthcare. The records show as well a concurrent fight among physicians over competing definitions of professionalism. Trustee and Superintendent records suggest that the numbers of those unable to pay for healthcare was perhaps higher than has been commonly believed. Furthermore, Springfield's case indicates that private hospitals (and not just the largest urban teaching hospitals usually surveyed in hospital histories) did provide for large numbers of such individuals and did not simply try to hive them off to public facilities. Moreover, the cost and complications of caring for the medically needy substantially shaped Springfield's priorities and finances. This exacerbated tensions among the medical staff over the development of Springfield into a medical center. Most importantly, the problems associated with caring for the indigent made impossible effective realistic long-term planning. At Springfield, this helped cause the decline of the medical center model of health care and laid the basis for the dominance of local Health Maintenance Organizations.

Subject Area

American studies|Health care|American history

Recommended Citation

Saxon, Bruce, "The problem with planning: Springfield hospital and the development of the United States healthcare system, 1890--1980" (1996). Doctoral Dissertations Available from Proquest. AAI9709648.
https://scholarworks.umass.edu/dissertations/AAI9709648

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