Public Hospital Systems in New York and Paris

With sixteen hospitals and almost 10,500 beds, the New York City Health and Hospitals Corporation (HHC) is the largest municipal hospital system in the United States. With forty-seven hospitals and almost thirty-three thousand beds, the Paris Hospital Corporation, Assistance Publique-Hopitaux de Paris (AP), is three times as large, the biggest municipal hospital system in France.

This book compares these two vast systems. It analyzes staffing, outpatient and inpatient core, the desirability of private faculty a practice plans, budgeting, quality assurance, and the role of medical education in these two very different systems. In addition, it reviews how both HHC and AP plan to adapt their systems over the next decade and beyond. Aging populations, the development and diffusion of new medical technologies, and the growth of hospitals and physicians throughout the 1960s and 1970s have led to massive increases in health care costs in both the United States and in France. Both New York City and Paris have suffered the shock of the AIDS epidemic. Detailed, informed, and authoritative, this book will stand for years as the standard comparative study of two large municipal hospital systems.

VICTOR G. RODWIN is Director, Advanced Management Program for Clinicians (AMPC); and Associate Professor, Robert F. Wagner Graduate School of Public Service, New York University.

CHARLES BRECHER is Professor, Robert F. Wagner Graduate School of Public Service; and Research Director, Citizens Budget Commission (NYC).

DOMINIQUE JOLLY is Director of International Affairs, Paris Public Hospital System, and Professor of Public Health, Faculty of Medicine, University of Paris.

RAYMOND J. BAXTER is Director of Public Health, City and County of San Francisco.

CONTENTS
Acknowledgments Contributors	viii ix
I. INTRODUCTION
COMPARATIVE ANALYSIS AND MUTUAL LEARNING Victor G. Rodwin and Charles Brecher	3
II. THE NEW YORK CITY AND PARIS PUBLIC HOSPITAL SYSTEMS: AN OVERVIEW
1. HHC AND AP: SYSTEM-WIDE COMPARSIONS Victor G. Rodwin and Charles Brecher	11
2. LOUIS MOURIER AND CONEY ISLAND HOSPITALS: A COMPARATIVE ANALYSIS OF HOSPITAL STAFFING AND PERFORMANCE Victor G. Rodwin with Howard Cohen, Marie-José Lauque, Lora Myers, Marie Rouquier, and Maryse Petit	29
III. THE NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (HHC)
3. HISTORICAL EVOLUTION OF HHC Charles Brecher	59
4. THE HHC's AMBULATORY CARE INITIATIVE Merle Cunningham, Jo Ivey Boufford, and Mafia I Uribelarrea	84
5. PRIVATE FACULTY PRACTICE PLANS AT HHC Steven Lenhardt and Larry Eitel	121
6. INTERNAL BUDGETING AT HHC Kathryn M. Morrison	137
7. QUALITY ASSURANCE AT HHC Kathleen Blandford	149
IV. THE PARIS ASSISTANCE PUBLIQUE (AP)
8. THE TURNAROUND: THE TRANSFORMATION OF AP FROM A GIARITABLE INSTITUTION TO A REGIONAL UNIVERSITY HOSPITAL SYSTEM Alexandra Giraud and Dominique Jolly	163
9. PLANNING FOR THE HOSPITALS OF AP IN PARIS Dominique Jolly and Victor G. Rodwin	182
10. THE COMMITTEE ON THE EVALUATION AND DIFFUSION OF MEDICAL TECHNOLOGIES (CEDIT) AT AP Catherine Viens-Bitker, Claudine Blum-Boisgard, Pierre Durieux, Genevieve Cagan, Isabelle Durand-Zaleski, and Dominique Jolly	198
11. THE ROLE OF AP IN MEDICAL EDUCATION AND ITS AFFILIATION WITH THE PARIS MEDICAL SCHOOLS Dominique Jolly and Jean de Savigny	214
V. PERSPECTIVES ON THE FUTURE
12. ALTERNATIVE FUTURES FOR HHC Raymond J. Baxter, Ronda Kotelchuck and Jo Ivey Boufford	227
13. ALTERNATIVE FUTURES FOR AP Dominique Jolly and Beatrice Majnoni d'Intignano	241

Public Hospital Systems in New York and Paris

CONTENTS

I. INTRODUCTION

II. THE NEW YORK CITY AND PARIS PUBLIC HOSPITAL SYSTEMS: AN OVERVIEW

III. THE NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (HHC)

IV. THE PARIS ASSISTANCE PUBLIQUE (AP)

V. PERSPECTIVES ON THE FUTURE