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During the 1992 presidential campaign, candidate William J. Clinton praised Rochester's hospital experimental payment (HEP) program for containing costs and providing access to high quality health care. "If Rochester, New York, can do it with two-thirds of the cost of the rest of us," Clinton asserted, "America can do it too." This book is a detailed case study of a community that devised and implemented a unique, successful, and celebrated hospital cost containment experiment in the 1980s. Author Sarah Liebschutz describes the economic and social culture of Rochester dating to the early part of the twentieth century that provided the fertile soil for regional health planning and the HEP program. This study also examines how the changing economy ultimately stimulated robust competition among health care insurers and providers.
What does Rochester's experience tell us about the role communities play in organizing and financing health care? The national government has long played --and will continue to play -- a central role in determining health policy, funding health insurance, and reimbursing health care providers. The responsibility for dealing with the interlocking issues of access, quality, and costs, however, is not exclusively national. State governments shape the health system as they legislate, regulate, and finance such key components of health care as insurance coverage, quality of care, hospitals, and other providers.
Communities matter because they organize and deliver health care at the ground level through private and employed health care professionals and public, private, and nonprofit hospitals. They matter because they ultimately determine whether health care in America is available, efficient, and effective.
The book draws heavily on files of the Rochester Area Hospitals Corporation, made available specifically to the author, and on extensive interviews with business leaders, hospital trustees, and administrators whose decisions fostered collaboration and then competition.

Sarah F. Liebschutz is Distinguished Service Professor Emerita at the State University of New York, College at Brockport.

Gesundheitsfürsorge --- Krankenhaus --- Gemeinschaft --- Medical care. --- Hospitals --- Community health services. --- History, 20th Century. --- Health Planning Organizations --- Hospital Planning --- Insurance, Hospitalization --- Reimbursement Mechanisms --- Prospective Payment System --- Community health services --- Medical care --- Neighborhood health centers --- Public health --- Regional medical programs --- Delivery of health care --- Delivery of medical care --- Health care --- Health care delivery --- Health services --- Healthcare --- Medical and health care industry --- Medical services --- Personal health services --- Benevolent institutions --- Infirmaries --- Health facilities --- Insurance --- Nursing homes --- Psychiatric hospitals --- Rural hospitals --- Planning. --- history. --- Planning --- History. --- Prospective payment --- Rochester, NY --- New York (State) --- New York. --- Nyu Yorḳ (State) --- NYS --- Niyū Yūrk (State) --- Nʹi︠u︡-Ĭork (State) --- Shtat Nʹi︠u︡ Ĭork --- State of New York --- State of N. York --- NY (State) --- N.Y. (State) --- N. York (State) --- نيويورك (State) --- ولاية نيويورك --- Wilāyat Niyū Yūrk --- Штат Нью-Ёрк --- Нью-Ёрк (State) --- Ню Йорк (State) --- Nova York (State) --- С̧ӗнӗ Йорк (State) --- Śĕnĕ Ĭork (State) --- Efrog Newydd (State) --- Kin Yótʼááh Deezʼá Hahoodzo --- Nííyóó Hahoodzo --- New Yorgi osariik --- Νέα Υόρκη (State) --- Nea Yorkē (State) --- Πολιτεία της Νέας Υόρκης --- Politeia tēs Neas Yorkēs --- Nueva York (State) --- Estado de Nueva York --- Nov-Jorkio --- Ŝtato de Nov-Jorkio --- État de New York --- Nua-Eabhrac (State) --- York Noa (State) --- Eabhraig Nuadh (State) --- Estado de Nova York --- Néu-Yok (State) --- Шин Йорк (State) --- Shin Ĭork (State) --- 뉴욕 주 --- Nyuyok-ju --- 뉴욕 (State) --- Nyuyok (State) --- Nuioka (State) --- Nú Yọk (State) --- Tchiaq York (State) --- New York Isifunda --- New York-fylki --- ניו יורק (State) --- מדינת ניו יורק --- Medinat Nyu Yorḳ --- Stat Evrek Nowydh --- Evrek Nowydh (State) --- Nou Yòk (State) --- Novum Eboracum (State) --- N̦ujorka (State) --- Niujorko valstija --- Niujorkas (State) --- Niorche (State) --- Њујорк (State) --- Njujork (State) --- Yancuīc York (State) --- ニューヨーク州 --- Nyū Yōku-shū --- ニューヨーク (State) --- Nyū Yōku (State) --- New York (Colony) --- City of Rochester (N.Y.)

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In 1873, Amos Jay Cummings, a decorated Civil War veteran and journalist for the New York Sun newspaper, set out on a westward journey aboard the newly completed transcontinental railroad. For some time, miners, settlers, and entrepreneurs had already been heading west to make their fortunes, and Cummings made the trip in part to see what all the fuss was about. During his six-month expedition from Kansas to California, Cummings sent extraordinary and engaging accounts of the American West back to his readers in New York. Collected in this volume for the first time are Cummings's portraits of.

Frontier and pioneer life --- Natural history --- Journalists --- Railroad travel --- Rail travel --- Railroads --- Routes of travel --- Train travel --- Transportation --- Travel --- Voyages and travels --- History --- Cummings, Amos J. --- Cummings, Amos Jay, --- West (U.S.) --- Description and travel. --- Social life and customs --- Description and travel --- Travel. --- Railroad travel. --- Natural history. --- Manners and customs. --- Journalists. --- Frontier and pioneer life. --- Border life --- Homesteading --- Pioneer life --- Adventure and adventurers --- Manners and customs --- Pioneers --- Columnists --- Commentators --- Authors --- Ceremonies --- Customs, Social --- Folkways --- Social customs --- Traditions --- Usages --- Civilization --- Ethnology --- Etiquette --- Rites and ceremonies --- History, Natural --- Natural science --- Physiophilosophy --- Biology --- Science --- Traveling --- Travelling --- Tourism --- (Amos Jay) --- 1841-1902 --- West United States. --- New York (State) --- New York (Colony) --- Nyu Yorḳ (State) --- NYS --- Niyū Yūrk (State) --- Nʹi︠u︡-Ĭork (State) --- Shtat Nʹi︠u︡ Ĭork --- State of New York --- State of N. York --- NY (State) --- N.Y. (State) --- N. York (State) --- نيويورك (State) --- ولاية نيويورك --- Wilāyat Niyū Yūrk --- Штат Нью-Ёрк --- Нью-Ёрк (State) --- Ню Йорк (State) --- Nova York (State) --- С̧ӗнӗ Йорк (State) --- Śĕnĕ Ĭork (State) --- Efrog Newydd (State) --- Kin Yótʼááh Deezʼá Hahoodzo --- Nííyóó Hahoodzo --- New Yorgi osariik --- Νέα Υόρκη (State) --- Nea Yorkē (State) --- Πολιτεία της Νέας Υόρκης --- Politeia tēs Neas Yorkēs --- Nueva York (State) --- Estado de Nueva York --- Nov-Jorkio --- Ŝtato de Nov-Jorkio --- État de New York --- Nua-Eabhrac (State) --- York Noa (State) --- Eabhraig Nuadh (State) --- Estado de Nova York --- Néu-Yok (State) --- Шин Йорк (State) --- Shin Ĭork (State) --- 뉴욕 주 --- Nyuyok-ju --- 뉴욕 (State) --- Nyuyok (State) --- Nuioka (State) --- Nú Yọk (State) --- Tchiaq York (State) --- New York Isifunda --- New York-fylki --- ניו יורק (State) --- מדינת ניו יורק --- Medinat Nyu Yorḳ --- Stat Evrek Nowydh --- Evrek Nowydh (State) --- Nou Yòk (State) --- Novum Eboracum (State) --- N̦ujorka (State) --- Niujorko valstija --- Niujorkas (State) --- Niorche (State) --- Њујорк (State) --- Njujork (State) --- Yancuīc York (State) --- ニューヨーク州 --- Nyū Yōku-shū --- ニューヨーク (State) --- Nyū Yōku (State) --- New York (City) --- American West --- Trans-Mississippi West (U.S.) --- United States, West --- Western States (U.S.) --- Western United States