From cottage to community hospitals: Watlington Cottage Hospital and its regional context, 1874-2000.

The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals'within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region--one of the first Regions to formulate such a strategy--and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000.

Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

Sharing governmental authority: Blue Cross and hospital planning in New York City.

Hospital planning in New York has been since the 1930s an intensely political process with high stakes. The leaders of Blue Cross and their allies used the hospital planning process in the city and the state as a means to extend and protect corporate authority in what they took to be the public interest. When Blue Cross was established in the 1930s, its leaders used the mechanisms of formal planning as part of their solution to pressing problems in the organization and distribution of hospital services. In the decade after World War II, Blue Cross had an immense impact on hospital planning in New York as a result of its growth and its underwriting policies. Conflicts between Blue Cross and state regulators beginning in the 1950s led to a new formulation of the politics of planning. Blue Cross became a partner with the state in regulating hospitals. The state and Blue Cross behaved as co-regulators until the 1980s. The interpretation in this paper revises the earlier accounts of health politics in New York by Law (1976) and Alford (1975).