Gaining control: reform, reimbursement and politics in New York's community hospitals, 1890--1915.

This is an historical study of an early twentieth century political struggle regarding hospital reimbursement in New York City. During a period called the "Progressive Era" (1895--1915), administrators in the City's Comptroller's office sought to gain control over small, locally run community hospitals by dismantling the long-standing practice of flat-grant payments to institutions. Central office planners felt that these payments gave too much control to trustees. In its place, the Comptroller initiated a system of per-capita, per-diem reimbursement. Inspectors now judged for the institutions which services and which clients were appropriate for municipal reimbursement. From the perspective of the Comptroller's office, this change was an attempt to put rationality into the system of municipal support for charitable institutions. From the perspective of trustees and community representatives, however, this change was a political attack on the rights of institutions and local communities to control their own fate. Within the context of the larger Progressive Era "good government" movement to centralize decision-making in the hands of experts who believed strongly in the efficiency of larger institutions, it was generally the smallest, most financially troubled community institutions which felt the brunt of these changes.