Communities and Health Care

June 2011
29 black and white illustrations
272 pages
9x6 in
Rochester Studies in Medical History
ISBN: 9781580463850
Format: Hardback
Library eBook
University of Rochester Press
BISAC MED039000, MED078000, MED036000

Communities and Health Care

The Rochester, New York, Experiment

Sarah F. Liebschutz

Analyzes the Rochester, New York, Hospital Experimental Payment program (HEP) of the 1980s and its aftermath, emphasizing the importance of local and state communities to health-care decision making and legislation.
During the 1992 presidential campaign, candidate William J. Clinton praised Rochester's hospital experimental payment (HEP) program for containing costs and providing access to high quality health care. "If Rochester, New York, can do it with two-thirds of the cost of the rest of us," Clinton asserted, "America can do it too." This book is a detailed case study of a community that devised and implemented a unique, successful, and celebrated hospital cost containment experiment in the 1980s. Author Sarah Liebschutz describes the economic and social culture of Rochester dating to the early part of the twentieth century that provided the fertile soil for regional health planning and the HEP program. This study also examines how the changing economy ultimately stimulated robust competition among health care insurers and providers.
What does Rochester's experience tell us about the role communities play in organizing and financing health care? The national government has long played -- and will continue to play -- a central role in determining health policy, funding health insurance, and reimbursing health care providers. The responsibility for dealing with the interlocking issues of access, quality, and costs, however, is not exclusively national. State governments shape the health system as they legislate, regulate, and finance such key components of health care as insurance coverage, quality of care, hospitals, and other providers.
Communities matter because they organize and deliver health care at the ground level through private and employed health care professionals and public, private, and nonprofit hospitals. They matter because they ultimately determine whether health care in America is available, efficient, and effective.
The book draws heavily on files of the Rochester Area Hospitals Corporation, made available specifically to the author, and on extensive interviews with business leaders, hospital trustees, and administrators whose decisions fostered collaboration and then competition.

Sarah F. Liebschutz is Distinguished Service Professor Emerita at the State University of New York, College at Brockport.

An e-book version of this title is available (9781580467797), to libraries through a number of trusted suppliers. See here for a full list of our partners.

Table of Contents

Foreword by Paul F. Griner, MD
Communities and Health Care
Health--A Community Affair
Rochester's Community Legacy
The Rochester-Area Hospitals
MAXICAP: Precursor to HEP
The Rochester Area Hospitals Corporation: Decision-Making Forum
The Hospital Experimental Payment Program: Basic Facts
HEP in Retrospect
The Post-HEP Years: The Changed Environment
Sprinting toward the Mean
The Relevance of the Rochester Experiment


Health, they say, is a community affair, and no American community labored so impressively to fashion a disciplined and coherent local health care system as did Rochester, New York, between the 1930s and the 1980s. Sarah Liebschutz's excellent book -- meticulously researched, lucidly argued-gives an account of Rochester's distinctive corporate characters and unique instructional configuration that will not fail to fascinate and enlighten anyone who studies or practices health policy, politics, or planning. --Lawrence D. Brown, Professor of Health Policy and Management, Mailman School of Public Health, Columbia University

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