THE HEALTH AND HOSPITALS CORPORATION
The medical care system in New York City is unique. Its distinguishing features include its enormous size, with an abundant supply of both physicians and hospital beds. But the special character of New York medicine also is rooted in two other characteristics, the large role of teaching hospitals and the large role of the municipal system. 1 Whereas New York City accounts for only about 3 percent of the nation's population, it is home to nearly 11 percent of all medical residents, and nearly seven of every ten hospitals in town are involved in graduate medical education. (Nationally, less than one hospital in ten is a teaching hospital.) The large scale of the municipal system is evident in the fact that the Health and Hospital Corporation's multiple facilities account for about one-fifth of all inpatient care in the city and over 40 percent of the hospital-based ambulatory care. In contrast, most large cities have no local public hospital, and in those that do, it typically plays a much smaller role.
This chapter focuses on the agency currently responsible for operating the city's health care facilities, the Health and Hospitals Corporation (HHC). The first section relates the history of HHC's creation and its first 20 years of operation; the second section focuses on the efficiency of its operations in the late 1980s; the third considers the contribution of HHC to providing access to care for the indigent; the final section presents recommendations to enable HHC to realize better its objectives of both operating efficiently and providing care to the poor.