Communities and Health Care: The Rochester, New York, Experiment

By Seavey, John W. | Inquiry, Fall 2012 | Go to article overview

Communities and Health Care: The Rochester, New York, Experiment


Seavey, John W., Inquiry


Communities and Health Care: The Rochester, New York, Experiment. By Sarah F. Liebschutz. Rochester, N.Y.: University of Rochester Press. 2011. 272 pp. $75.00.

This book is a case study of the Rochester, N.Y., experiment in hospital payment (the hospital experimental payment program or HEP) that ran from 1980 to 1990. The experiment was locally developed, and the author notes was largely done as a way to avoid a perceived threat of regulation by external forces, the state and/or federal governments. The irony is that HEP's existence depended on waivers from those same sources.

As a case study, it provides rich details that describe the evolution of hospital payments and the evolution of the insurance industry during that period. It is useful to revisit those times. The larger, swirling historical initiatives are not far from the book's narrative. As a single case study, it suffers from the usual problem of uniqueness. The author fully acknowledges the rare attributes of the time--that is, the composition of the Rochester business community, its community leadership, and the composition of the health care institutions and the local structure of insurance. For example, the dominance of the Eastman Kodak Company and its focus on community in the 1970s created a climate in which its perspective on communitywide initiatives forced others to come together. As its dominance subsided and its interests became less community oriented, so did the pressures for communitywide solutions. There is an interesting section on Kodak's decision in 2002 to forgo community rating and to self-insure--the opposite of what HEP and Kodak had been advocating, but what companies in other parts of the country had been doing in their self-interest for 20 years.

There is considerable detail about individual hospitals, community leaders, businesses, and health care organizations. HEP went through four different funding phases (the fourth actually did not really materialize). In each of these phases, organizations changed names and functions, much like a Russian novel. While the book is useful in documenting the details, an outsider may quickly become lost. There never is an explanation for the need for multiple name changes over 10 years. There are brief summaries at the end of each chapter, but there is not a useful table to walk you through the evolution of the various organizations and community leaders. The chapters are extensively footnoted and there appears to be an honest attempt to provide different perspectives on events. There are community heroes but no villains.

There are multiple assessments of what was accomplished by Rochester's experiment. …

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