Book Review: Provider of Last Resort

The author presents an insightful analysis into the closing of Philadelphia’s public hospital in 1977. The book presents the historical, political, and unintended consequences of changes in health care systems that led to the demise of the Philadelphia General Hospital. These factors are sharply focused upon and then applied to this particular hospital.

This book serves as a valuable resource even without its pooling its information into one case study. There is an excellent presentation on the history of the Philadelphia health care system from the almshouses of the 18th and 19th centuries through the patronage ridden facilities aimed towards the poor, children, and insane. It was not until the late 19th century and early 20th century when hospitals had professional nursing staffs that also lost the stigma of hospitals existing primarily for poor people. Prior, people who could afford it paid doctors to visit them in their homes and only the poor went to hospitals.

The effects of laws expanding medical care actually had the affect of imperiling public hospitals. Public financial support of private and non-profit hospitals resulted in greater commitments from these hospitals towards providing health care for poorer residents. Thus, the poor not longer needed to rely upon institutions such as Philadelphia General Hospital. Further, a city owned hospital, subject to the political whims of annual budgeting, had difficulty making long term expansions and achieving costly updating of health care services. City officials never took actions that might have qualified Philadelphia General Hospital for similar government funding streams that was being provided to other hospitals. Instead, Philadelphia General Hospital became engulfed in bureaucratic and political struggles. Failures to upgrade health care offerings caused the hospital to fail minimal government standards. A decision to close the hospital along with a promise from city officials that there would be no layoffs of PGH staff concluded a major local political battle.

This is a highly recommended book on the history and politics of hospitals with insights on how one hospital folded.