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Taking Care of Our Own: A Year in the Life of a Small Hospital

by Susan Garrett

Garrett's compelling depiction of the hospital in York, Maine, that she administered for six years becomes her occasion to examine what she terms the "fix" today's medical practitioners find themselves in. Noting that market competition has not contained medical costs, she shows us the turf battles within the system as her not-for-profit hospital attempts to reinvent itself to survive. What services should be added to compete in the hospital marketplace? Contract for a traveling CAT scanner owned by a for-profit firm? Institute a cardiology lab, a market niche? The 79-bed, 80-year-old York Hospital is vexed by its perceived mandate to take care of its own. Along with the affluent summer folk, the hospital's "neighbors" include the likes of homeless Tim Bailey, who turns up with chest pains each Christmas Eve and is hospitalized so he needn't be alone for the holidays; Elizabeth Littlejohn, a 19-year-old bulimic with a hospital bill of $76,000, who defaults on her $10 monthly payments and whose dirt-poor family has looked to York Hospital for social services for three generations. As Garrett ruminates on what hospitals should contribute to their communities, she vivifies the daily happenings at her own. And if she doesn't have ready answers, Garrett, who is now a freelance writer, makes us ponder the price of valuing too highly the cold logic of cost-benefit analysis.

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