HEALTHCARE ADMINISTRATION AND LEADERSHIP

Healthcare Administration and Leadership

Healthcare Administration and Leadership

Introduction

Leadership in health care presents opportunity for unique challenge and self-fulfillment. It also calls on deep personal strength, values, and vision. In addressing health care leaders, we are reminded of the clear differences among them: Some lead academic medical centers, others are responsible for health systems comprising multiple hospitals, and still others work in long-term care services, rehabilitation and specialty hospitals, hospice care, outpatient and ambulatory care, teaching and research institutions, managed care organizations, and other divergent organizations—all of them participants within a continuum of care. In some cases, hospitals stand alone as the sole provider in their communities, smaller in size, more narrow in scope of services, and limited to the primary and secondary care services that are within their range of technology and practitioner skill. Still others are of moderate size and scope. In each case, leadership is faced with similar challenges related to changing reimbursement systems, clinician workforce shortages, new technologies, and waves of patients unable to pay for their services.

Discussion

In the post-war era, as the country organized under the concentration of new social influences, interest in the health insurance debate waned. But the prosperity and hope that ushered in the 1920s was met by economic depression at the end of the decade. This downturn was blamed on President Herbert Hoover, a Republican, and in the 1932 election, Democratic nominee Franklin Delano Roosevelt defeated him. The election of Roosevelt and his New Deal program included the creation of Social Security, which once again brought to the fore the issue of governmental health insurance.

Throughout the years of his administration, Roosevelt and his advisors—several of whom were from the social work and medical communities—balanced the politically delicate issue of health insurance. During his first term, Roosevelt favored a national health insurance program as part of the Social Security Act, but deferred the plan when he detected that special interest opposition to it would likely jeopardize passage of the entire act. By the end of his administration, and despite the onset of World War II, Roosevelt managed to organize and publicize health reform so that it could be elevated to a more contentious political issue.

In 1943, Congress began debating the introduction of the Wagner-Murray-Dingell Bill, and Roosevelt out-right endorsed national health insurance the following year. However, Roosevelt died in April 1945. Health reformers perceived his successor, Harry S. Truman, as too much a moderate conservative to maintain the liberal Roosevelt agenda. Yet, in one of his early presidential acts, Truman outlined a plan to Congress based almost entirely on policy developed during Roosevelt's administration. The plan, delivered by special message, sought to improve healthcare by providing federal funds: to attract doctors to underserved areas; for the construction of new hospitals, and for medical research; establishing national standards for hospitals and health centers; and creating a national health insurance fund, under the Social Security system. National health insurance remained the most ambitious aim of the ...