Hospitals of Rome in the Early Nineteenth Century: The Apostolic Visit of 1825.

Pope Leo XII marked the 1825 Jubilee by visiting the hospitals of Rome. Italy was recovering from the French invasion that had disrupted social and religious structures. The Visitors investigated conditions, and recommended changes. By 1826, eight large hospitals were ordered to unite, but, three years later, the order was rescinded. Based on the Visit's mostly unexamined records in the Vatican Secret Archives, hospital registers, and minutes of the governing council held in the Archivio di Stato di Roma, this paper reconstructs the network of Rome's hospitals in the early 19th century. It also compares Roman hospitals to its Parisian counterparts, especially with respect to governance and education. Finally, it examines the merger as an early example of a practice that remains vibrant (if controversial) today.

The modern hospital in historical context: a modern health bonanza [retrospectroscope].

The evolution and development of hospitals in their historical context are quickly reviewed in this column, starting first as simple shelters for the sick and indigent who were waiting essentially for death, and up to the relatively recent concept of true health centers where patients face a high probability of actual recovery and rehabilitation. Anesthesia, microbiology, asepsia, antibiotics, virology, radiology, transfusion, and different biomedical engineering technologies, as well as knowledge in other basic sciences, have led to the intensive care and emergency units that were introduced in the 1960s, which lead to the specialty of critical care medicine and positioning the patient as the center of care. These brief words anticipate what we develop below.

[The hospital law of December 21, 1941: origins, consequences]. / La loi hospitalière du 21 dècembre 1941: origines, conséquences.

The first law about the organization of the French hospitals dates back to 1796 with the French Revolution which asserts the powerful administrative commission, chaired by the mayor of each town. In 1941, the new law created the job of director whose task was to apply the decisions of the commission. In the same time, the hospital practice was no longer free and the practitioners were chosen by medical boards of examiners. During the following 60 years, the commission lost its power at the advantage of the director whose authority increased at the expense of the medical autonomy. Therefore the economic necessity lead the government to keep a close eye on the operating budget of the hospitals but the search of the budgetary balance means new strategic developments for the future.

What have you done for me lately? Assessing hospital community benefit.

This issue brief reviews key aspects of the ongoing policy debate related to not-for-profit hospitals, the advantages they derive from tax exemption, and the benefits they provide to communities served. It provides a historical context for how federal standards for assessing hospitals' tax-exempt status have evolved and describes recent activities to explore additional policy changes. Legislative and regulatory actions at the state and local level are also examined. Evidence on the performance of not-for-profit hospitals in comparison to their for-profit competitors on measures of cost, quality, and access is summarized, and perspectives on the need to preserve a not-for-profit presence in health care are explored. Efforts to develop standardized metrics for measuring community benefit are described, and alternative conventions for reporting charity care contributions are discussed.

Professional and hospital discrimination and the US Court of Appeals Fourth Circuit 1956-1967.

A series of court cases litigated by the National Association for the Advancement of Colored People Legal Defense and Education Fund between 1956 and 1967 laid the foundation for elimination of overt discrimination in hospitals and professional associations. The landmark case, Simkins v Moses H. Cone Memorial Hospital (1963), challenged the use of public funds to expand segregated hospital care. The second case, Cypress v Newport News Hospital Association (1967), reaffirmed the federal government's application of Medicare certification guidelines to force hospitals to open up patient admissions, education programs, and staff privileges to all citizens and physicians. Pursuit of a legal strategy against racist policies was an essential element in a national campaign to eliminate discrimination in health care delivery in the United States.

Providers issue brief: change in nonprofit entities.

Heightened competition in the health care industry is prompting a growing number of nonprofit hospitals to merge with or sell to for-profit firms, in the hope of shoring up their financial base. The conversion trend--which has many public officials concerned about the fate of the charitable assets and care to indigent population that nonprofit hospitals have traditionally provided the communities in which they are located--has, in turn, led to an overall decline in the number of hospitals still in business. To protect the public's investment and ensure continued access to care, a growing number of states are thus exploring legislation that would open the conversion process to the public; strengthen oversight authority, typically through the attorney general; and make certain that the proceeds from such transactions are used appropriately.

Hospitals and Civil Rights, 1945-1963: the case of Simkins v Moses H. Cone Memorial Hospital.

In the 1960s, the legacy of discrimination against black persons still existed in all areas of medicine. This historical analysis investigates the strategies that were used by lawyers alongside physicians, dentists, and patients in elevating health care for black persons. Primary resources include oral histories, government documents, hospital records, archival and personal manuscripts, and professional and hospital periodicals. After World War II, leaders in the black community were determined to improve health care for black persons by ending discrimination in hospital policies and practices. Leaders of professional organizations developed a collaborative strategy that involved the court system, federal legislation, and research and education of the public and health professionals to integrate the hospital system rather than to expand the existing separate-but-equal system. Efforts culminated in the case of Simkins v Moses H. Cone Memorial Hospital; this case became the landmark decision by the U.S. Supreme Court and led to the elimination of segregated health care. Three months after the case, President Johnson ratified the Civil Rights Act of 1964, which included Title VI, thus extending the policy of equality to all federal programs. Laying a foundation for universal access to health care in the United States depended on a victory in the courts, in national health legislation, and in public opinion. All were achieved through strategic efforts to amass widespread support for the elimination of discrimination in medicine.

The development of the Hill-Burton legislation: interests, issues and compromises.

The Hill-Burton Hospital Survey and Construction Act has its roots in the social health and welfare programs of the New Deal. This paper traces its development and the positions of three groups-the hospital industry, the U.S. Public Health Service, and the Senate Subcommittee on Wartime Health and Education-on four issues: the nature of federal funding to states, the use of public funds by private hospitals, the oversight powers of a Federal Hospital Council, and health services for the poor. The analysis involves two lines of thought: the political strategy of incrementalism and the roles of the three interest groups in reaching compromises to quickly pass an "unsponsored" bill. Relevance to the current effort to pass a single payer national health insurance is explored.

The changing blueprints of the British NHS: the White Papers of 1944 and 1989.

It has recently been pointed out that the 1989 White Paper Working for Patients, which provides the basis for the current reforms of the British National Health Service, has some common features with the 1944 White Paper A National Health Service, which was the unadopted model for the service produced by the Wartime Coalition Government. Moreover, it is likely that the Conservatives, if elected in the 1945 General Election, would have introduced a service based on a modified version of the 1944 document. We can compare these two blueprints to shed some light on Conservative thinking on health care over a period of nearly 50 years. There are some similarities in terms of the notions of purchaser and provider, contracts and pluralism. However, there are striking contrasts, notably in their attitude towards planning versus competition and local democracy versus patronage. It is claimed that the profound differences outweigh the apparent similarities and consequently the two blueprints show the discontinuity rather than the continuity of Conservative thinking on health care.