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At least 19 recordsLinked to original sources
PubMed1998

Whither the almshouse? Overutilization and the role of the emergency department.

The problem of emergency department (ED) overutilization or "inappropriate" utilization is commonly conceptualized in terms of inadequate access to appropriate primary medical care. Although medical care access is a critical issue, a focus on increased access to medical care as the sole solution to "inappropriate" ED utilization may obscure other, perhaps equally relevant, issues from consideration. This article reports findings from an ethnographic study focusing on heavy users (HUs) of EDs in two inner-city hospitals. Drawing on fieldwork and on interviews with HU patients and ED clinicians, I argue that the emergence of heavy ED utilization as both a clinical and policy problem is a function not merely of unmet medical care needs for individuals, but of "almshouse" needs in a changing health care context. The emergence of ED overutilization as a problem occurs in the context of market forces that are contributing to shifts in the role of EDs and in the moral boundaries of accepted ED practice. If the problem of heavy ED use is more broadly conceptualized in terms of this role shift, not solely in terms of medical care access, a different set of issues and priorities for research, policy, and clinical practice emerges.

Adult↗
PubMed1982

From almshouse to hospital: the shaping of Philadelphia General Hospital.

After almost 250 years, one of the nation's first, and most illustrious, hospitals closed. Its demise was a particularly dramatic but representative symptom of a more general decay in the quality of public medicine in America's older cities. The gradual differentiation of municipal welfare mechanisms from almshouse to hospital is traced; it has been an elusive and incomplete evolution.

Chronic Disease↗