ABSTRACT
Hospitals may become more peripheral institutions in the health system but they may also become health care systems themselves. The idea of the hospital's disappearance at the end of the twentieth century presents a tempting, even an aesthetically pleasing theme for the historian, who could cast the twentieth-century history of the American hospital as a simple narrative of rise and fall. The federal government remains a powerful player, if only as a silent partner to marketplace initiatives and as a giant purchaser, auditor, and potential regulator of hospital services through Medicare. The not-for-profit sector retreated from its traditional emphasis on voluntarism, charity, and community; the word "voluntary," as in voluntary hospitals, is now rarely used. Hospital governance, the changing character of management, and hospital-physician relations were all important themes of the 1990s, with strong historical resonance.
