Howard S. Berliner

The Holistic Alternative to Scientific Medicine: History and Analysis

The resurgence of the holistic health movement in the 1970s can be in part attributed to increasing consumer dissatisfaction with the present system of medical care delivery. This article traces the rise and decline of modern medicine by analyzing the assumption of hegemony by scientific medicine and its practitioners. Then it describes the challenges that holistic medicines theories and therapies currently pose to scientific medicines organizational form and practical content. Holistic medicine is assessed in terms of its organizational and conceptual basis, and the relationship between holistic medicine and the needs of advanced capitalist society is discussed.

The Walk-in Chains: The Proprietarization of Ambulatory Care

In this article we examine the previously little-studied development in U.S. health care-the growth of a proprietary ambulatory care system composed of health maintenance organizations, urgent care centers, ambulatory surgicenters, ambulatory diagnostic centers, large group practices, and other delivery modalities. The growth of this system as a result of the ease of access to capital, limited or nonexistent regulation through Certificate of Need or other mechanisms, the growing surplus of physicians, decreases in the use of hospitals as a result of changed insurance benefits and inpatient utilization review, new developments in biotechnology, and computerization and miniaturization of new technological advances is discussed. The reasons for the expanded growth of proprietary chains over nonprofit systems of ambulatory care are also discussed. The article concludes with a discussion of the negative consequences for individual health and the health care system that may be generated by the continued growth of proprietary ambulatory care.

Proprietary Hospital Chains and Academic Medical Centers

This article examines the reasons why proprietary hospital chains have become interested in buying or managing academic health center hospitals. Among the explanations that are discussed are such factors as vertical integration of health care, chain legitimation, integration of finance and delivery systems, and short-term profit potential. These factors are further examined through the use of a structured analysis of the interpenetration of proprietary chain hospitals and academic medical centers. We also discuss the consequences of these linkages in terms of such issues as continued educational mission, types of sponsored research programs, degree of indigent care provision, and changes in the nature of physician and other health worker training. The larger social implications of the movement of proprietary chains into tertiary medical care are evaluated.

The Crisis of the Los Angeles County Public Hospital System: A Harbinger for the Nation

The public hospital system in Los Angeles County, California, is in the midst of a major fiscal crisis that has already led to a serious reduction of capacity and could continue to worsen. Given the importance of the public system in a county where 30 percent of the population is uninsured and private hospitals provide very little uncompensated care, what happens in L.A. County is a harbinger for other cities and counties in the United States. This article highlights the issue of the extent to which local taxpayers, as opposed to state or federal taxpayers, are responsible for the continued operation of public hospitals and safety-net facilities in their communities.