The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900-1940

The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900-1940

The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900-1940

The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900-1940

Synopsis

Unevenly distributed resources and rising costs have become enduring problems in the American health care system. Health care is more expensive in the United States than in other wealthy nations, and access varies significantly across space and social classes. James A. Schafer Jr. shows that these problems are not inevitable features of modern medicine, but instead reflect the informal organization of health care in a free market system in which profit and demand, rather than social welfare and public health needs, direct the distribution and cost of crucial resources.

The Business of Private Medical Practice is a case study of how market forces influenced the office locations and career paths of doctors in one early twentieth-century city, Philadelphia, the birthplace of American medicine. Without financial incentives to locate in poor neighborhoods, Philadelphia doctors instead clustered in central business districts and wealthy suburbs. In order to differentiate their services in a competitive marketplace, they also began to limit their practices to particular specialties, thereby further restricting access to primary care. Such trends worsened with ongoing urbanization.

Illustrated with numerous maps of the Philadelphia neighborhoods he studies, Schafer’s work helps underscore the role of economic self-interest in shaping the geography of private medical practice and the growth of medical specialization in the United States.

Excerpt

The health care “system” in the United States has many problems, with rising costs and declining access being the two most intractable. By any measure, we have the most expensive health care system in the world. As I write this introduction, the latest data on national health expenditure (NHE) show that the United States spent $2.6 trillion in 2010. This tally was equivalent to $8,402 per person and comprised 17.9 percent of the gross domestic product (GDP). To put these daunting figures in perspective, since 1960, when the United States spent $148 per person and 5.1 percent of gdp on health care, our nhe has been increasing faster than any other nation in the world: in 2010, the next most expensive health care systems spent $5,388 per person (Norway) and 12.0 percent of gdp (the Netherlands). Unlike all other wealthy industrial nations, however, we lack universal health care, and many people in the United States have little or no access to basic health services.

Since the mid-twentieth century, our system has become a hybrid of private, employment-based health insurance and public health insurance for veterans, the elderly, poor children, and very poor non-elderly adults. Because the majority of people in the United States receive health care benefits from their employers, this system is sensitive to economic downturns: during the aftermath of the latest recession, when average annual unemployment peaked at 9.6 percent of the workforce in 2010, the number of uninsured spiked to 49.9 million. This group of uninsured people comprised more than 1 in 5 American adults (aged 18 to 64 years). To make matters worse, the size of our public insurance “safety net,” already inadequate before the latest recession, has only . . .

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.