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Books, Journals, New Media
December 15, 2004

Health Systems

Author Affiliations

Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor.

JAMA. 2004;292(23):2919-2924. doi:10.1001/jama.292.23.2922

In this brief but compact treatise (168 pages of text and 70 pages of notes), Barbara Bridgman Perkins, PhD, leaves the advocacy position of previous work and offers a full and critical overview of perinatal, mainly hospital-based, care and its structural and organizational attributes. She begins her account roughly around the 1920s in the United States and, by a coincidence of publishing and millennial dates, takes us firmly to the end of the 20th century.

Perkins is by education not a physician nor a medical sociologist but a scientist and health planner. Fortunately for the reader, her approach in most of this book is defined by the relatively narrow focus of her basic training. She sticks to her subject, making only a few detours. Except for her introduction and concluding chapter, she refrains from being drawn into topics on the periphery of her narrative. Major methodological reference points are organizational theory and resultant behavior in the economic and industrial sphere as developed during the first third of the 20th century. Another major reference point is the structure and process methodology of operations research, which evolved by mid-century for specific applications to the field of medical care. This use of a defined methodological approach, by its very tightness, permits the reader to examine whether the results can be generalized, mutatis mutandis, to other fields of medicine and permits the author to deal only implicitly with related methodologies like classic economics of health care, access by demographic characteristics, in particular race, and statistical analysis at the national policy level. Since issues of gender and reproductive age define her patient population, links to feminist theory and politics and to nursing structures are highly relevant to her story, although Perkins is surprisingly detached in her assessments of professional and gender politics.

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