Knox P L, Bohland J, Shumsky N L
Soc Sci Med. 1983;17(1):37-43. doi: 10.1016/0277-9536(83)90077-1.
This essay traces the evolution of the American urban medical care delivery system and examines the implications in terms of social and spatial variations in accessibility to medical care. It is suggested that the foundations of the present medical care delivery system were laid during the urban transformation which took place in the latter part of the nineteenth century, when changes in the division of labor, specialization, the role of the family, urban transportation technology and attitudes to social protectionism interacted with changes in science, medical technology and professional organization to produce radical changes in both the settings used to provide medical care and their relative accessibility to different sub-groups of the population. The medical care delivery system is thus interpreted largely as a product of the overall dynamic of urbanization rather than of scientific discovery, medical technology and the influence of key medical practitioners and professional organizations.
本文追溯了美国城市医疗服务提供体系的演变，并探讨了其在医疗服务可及性方面的社会和空间差异所带来的影响。研究表明，当前医疗服务提供体系的基础是在19世纪后期发生的城市转型期间奠定的，当时劳动分工、专业化、家庭角色、城市交通技术以及对社会保护主义的态度等方面的变化，与科学、医疗技术和专业组织的变化相互作用，在提供医疗服务的场所及其对不同人群亚组的相对可及性方面产生了根本性变化。因此，医疗服务提供体系在很大程度上被解释为城市化整体动态的产物，而非科学发现、医疗技术以及关键医疗从业者和专业组织的影响。
