Results by title

How the politics of “medical necessity” complicates American health care

The definition of medical necessity has morphed over the years, from a singular physician’s determination to a complex and dynamic political contest involving patients, medical companies, insurance companies, and government agencies. In this book, Daniel Skinner constructs a comprehensive understanding of the politics of defining this concept, arguing that sustained political engagement with medical necessity is essential to developing a health care system that meets basic public health objectives.

From medical marijuana to mental health to reproductive politics, the concept of medical necessity underscores many of the most divisive and contentious debates in American health care. Skinner’s close reading of medical necessity’s production illuminates the divides between perceptions of medical need as well as how the gatekeeper concept of medical necessity tends to frame medical objectives. He questions the wisdom of continuing to use medical necessity when thinking critically about vexing health care challenges, exploring the possibility that contracts, rights, and technology may resolve the contentious politics of medical necessity.

Skinner ultimately contends that a major shift is needed, one in which health care administrators, doctors, and patients admit that medical necessity is, at its base, a contestable political concept.

A surprising look at how hospitals affect and are affected by their surrounding communities.
 
An enduring paradox of urban public health is that many communities around hospitals are economically distressed and, counterintuitively, medically underserved. In The City and the Hospital two sociologists, Jonathan R. Wynn and Berkeley Franz, and a political scientist, Daniel Skinner, track the multiple causes of this problem and offer policy solutions.
 
Focusing on three urban hospitals—Connecticut’s Hartford Hospital, the flagship of the Hartford Healthcare system; the Cleveland Clinic, which coordinates with other providers for routine care while its main campus provides specialty care; and the University of Colorado Hospital, a rare example of an urban institution that relocated to a new community—the authors analyze the complicated relationship between a hospital and its neighborhoods. On the one hand, hospitals anchor the communities that surround them, often staying in a neighborhood for decades. Hospitals also craft strategies to engage with the surrounding community, many of those focused on buying locally and hiring staff from their surrounding area. On the other hand, hospitals will often only provide care to the neighboring community through emergency departments, reserving advanced medical care and long-term treatment for those who can pay a premium for it. In addition, the authors show, hospitals frequently buy neighborhood real estate and advocate for development programs that drive gentrification and displacement.
 
To understand how urban healthcare institutions work with their communities, the authors address power, history, race, and urbanity as much as the workings of the medical industry. These varied initiatives and effects mean that understanding urban hospitals requires seeing them in a new light—not only as medical centers but as complicated urban forces.