Chapter 4: The Reconstitution of the Hospital

a. I was surprised to learn that states actually abolished home relief, making treating the sick in one's own home against policy, except in times of economic distress. This was surprising because today, many people care for the sick in their own homes. One example is caregiving of people with dementia, which is often times done in the home (albeit, often with the help of some home modifications and health care professionals). I was also surprised to learn that attempts to build hospitals in the early 1900s were met with resistance. I understood that hospitals were seen as dirty places for the homeless and indigent, but it seems that people in the town would prefer to have these people taken care of while being partitioned in an area away from the rest of healthy society.

b. I agree that developments of the Civil war helped the medical field. This is not unprecedented, as wars have brought increases in illnesses and injuries, which forced medicine to advance in order to cope. Starr describes the Civil war as increasing cleanliness and organization. Similarly, wars in the past have resulted in or contributed to advances in surgery and medication such as penicillin.

c. I disagree that modern day hospitals are "citadels of science and bureaucratic order." For example, many hospitals today are crowded and disorganized. Many hospitals can hardly be called citadels of order, although this may be the goal.

d. Starr describes the average length of hospital stays as declining from weeks to days. I have seen this in my own experiences. With Medicare and managed care organizations, along with policy and other changes, patients have limits on the length of stay allowed or reimbursed for care. Starr discusses the average length of a hospital stay as declining from weeks to days. Today, most patients rarely spend the night. Many procedures are outpatient procedures.

3. The information in the Starr book may influence my view on the idea of hospital privileges for doctors. Starr explains that hospital privileges were given to doctors as a way to feed patients into the hospital system, in order to benefit the hopsitals financially. I had always thought that hospital privileges were something which physicians primarily sought out, due to convenience, necessity, and prestige