American Catholic Hospitals: A Century of Changing Markets and Missions (review)

Barbra Mann Wall's American Catholic Hospitals explores the pivotal role of Catholic healthcare institutions in the American medical marketplace. Wall examines the challenges religious healthcare providers faced over the course of the twentieth century, emphasizing the perpetual tension between their mission to minister to the needy and the demands of market competition and intensifying secularization. Increased reliance on private insurers and Medicare and Medicaid benefits altered reimbursement practices, shifting control within the healthcare industry from providers to third-party funders, while simultaneously saddling voluntary hospitals with a large portion of uninsured patients. Faced with an ultimatum to adapt or jeopardize their ability to meet their mission, Catholic hospital officials made many difficult choices - opting to incorporate lay professionals as administrators and practitioners (sometimes subverting their own control over hospital administration), abandon needy inner-cities in pursuit of wealthier suburban clientele, discourage unionization of hospital employees, and to accommodate certain transgressions of their faith, such as the provision of reproductive services in hybrid private-public hospitals.

Wall stresses that such responses were not duplicitous, but pragmatic and justifiably undertaken in order to achieve a greater good. She situates these instances of acquiescence to secularism and market competition within the context of the post-Vatican II church, wherein sisters and brothers religious answered the call for aggiornamento by actively participating in community and worldly matters in order to seek out those in need and assert universal human dignity. This ethos led many Catholic nurses and administrators, notably the Sisters of Saint Joseph at Good Samaritan Hospital in Selma, Alabama, to pioneer advancements in hospital desegregation. The embrace of community involvement enabled Catholic hospitals to perpetuate their influence over not only local community health, but national trends in American healthcare as well. Through their "joint committee" alliance with the American Hospital Association and the Protestant Hospital Association, the Catholic Hospitals Association protected voluntary hospitals' autonomy by diminishing federal oversight of funds distributed through Hill-Burton and Kerr-Mills. While Catholic hospitals were forced to adapt to changing social conditions, they also actively participated in the transformation of United States healthcare. Yet, paradoxically, just as the women's liberation movement forced greater gender equality in healthcare professions nationally, women religious, who had always played prominent leadership roles in Catholic hospitals, were increasingly subordinated to professional male administrators.

Offering a unique contribution to historiographies of American healthcare institutions and the tradition of Catholic charitable care, American Catholic Hospitals is primarily an institutional history - with attendant consideration of transformative social influences. Consequently, Wall presents a decidedly institutional perspective, eschewing exploration of the changing relationships between religious caregivers and their patients - the ultimate purpose, and arguably the most important aspect of institutional care. Despite this omission, Wall presents a compelling and well-documented narrative of the dynamic transformation of Catholic hospitals in twentieth-century America - useful for both undergraduate and advanced readers. Drawing on records from Catholic congregations throughout the United States, she reveals an admirable perseverance of religious caregivers, demonstrated by their willingness to adapt to socioeconomic forces often inimical to charitable care.