The distinctive mixing and continuous remixing of public and private roles is a defining feature of health care in the United States. The Public-Private Health Care State explores the interweaving of public and private enterprise in health care in the United States as a basis for thinking about health care in terms of its history and its continuing evolution today. Historian and policy analyst Rosemary Stevens has selected and edited seventeen essays from both her published and unpublished work to illustrate continuing themes, such as: the flexible meanings of the terms public and private, and how useful their ambiguity has been and is; the role of ideology as ratifying rather than preordaining change; and the common behavior of public leaders and corporate entities in the face of fiscal opportunity. The topics--covering the period of 1870 through the twenty-first century--represent Stevens' research interests in hospital history and policy, the medical profession, government policy, and paying for health care. The volume also considers her involvement with policy questions, which include health services research, health maintenance organizations, and physician workforce policy. Section I demonstrates the long history of state government involvement with private not-for-profit hospitals from the 1870s through the 1930s. Section II examines the federal role in health care from the 1920s through the 1970s, including the establishment of veterans' hospitals and the implementation of Medicaid. Section III shows how shifting governmental roles require constantly changing organizing rhetoric, whether for inventing a federal role for health services research and HMOs, regionalization in the 1970s, or defining civil rights and equity as mobilizing vehicles in the 1980s. Section IV examines growing concerns from the 1970s through the present about the traditional public role of the largely private medical profession. Section V returns to the ambiguous public-priv

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This outstanding collection of essays by Renee C. Fox encompasses almost thirty years of original, pioneering research in the sociology of medicine. Based on fieldwork in a variety of medical settings in the United States, Belgium, and Zaire, these ethnographic essays examine chronic and terminal illness, medical research, therapeutic innovation, medical education and socialization, and bio-ethics. Within this framework, three empirical "cases" have been singled out for special scrutiny--the process of becoming a physician, the development of the artificial kidney machine and organ transplantation, and the evolution of medical research in Belgium. Without ignoring social structural or psychodynamic factors, Dr. Fox has explored basic cultural phenomena and questions associated with health, illness, and medicine: values, beliefs, symbols, rites, and the nuances of language: ethical and existential dilemmas and dualities; and the complex interrelationships between medicine, science, religion, and magic. She draws systematically and imaginatively upon anthropological, psychological, historical, and biological insights and integrates observations and analyses from her own studies in American, Western European, and Central African societies. This second, augmented edition includes Professor Fox's more recent contributions to the expanding field of the sociology of medicine. They are "The Evolution of Medical Uncertainty; The Human Condition of Health Professionals; Reflections on the Utah Artificial Heart Program; Is Religion Important in Belgium?; Medical Morality is Not Bioethics"--"Medical Ethics in China and the United States; "and "Medicine, Science and Technology. "The work also includes a new introduction, "Endings, Beginnings and Continuities." Now, anthropologists, sociologists, medical educators, scientists, researchers, and students can join her on her "journeys into the field" and share with her the priceless insights to be gained from the physicians, nurses, medical students, patients, and their families, who are working, living, and dying on the edge of what is known, scrutable, and remediable--on the edge of medical science.

Because medicine can preserve and restore health and function, it has been widely acknowledged as a basic good that a just society should provide its members. Yet there is wide disagreement over the scope of what is to be provided, to whom, how, when and why. In this uniquely comprehensive book some of the best-known philosophers, doctors, lawyers, political scientists, and economists writing on the subject discuss the concerns and deepen our understanding of the theoretical and practical issues that run through the contemporary debate. The first section lays a broad theoretical basis for understanding the concept of justice, particularly as it relates to the distribution of health care. The second section critically examines how medical care is distributed in different countries around the world and the particular advantages and injustices associated with those systems. The third section draws attention to the special needs of different social groups and the specific issues of justice that are raised by the impact of various policies on health care distribution. The concluding section delves intothe dilemmas that confront those designing health care systems--the politics, the priorities, and the place of desires as opposed to needs in a socially just scheme.