University of Louisville ThinkIR: The University of Louisville's Institutional Repository Electronic Theses and Dissertations 12-2008 Advancing the knowledge of local health care policy through the growth machine thesis. David P. Houvenagle 1965- University of Louisville Follow this and additional works at: https://ir.library.louisville.edu/etd Recommended Citation Houvenagle, David P. 1965-, "Advancing the knowledge of local health care policy through the growth machine thesis." (2008). Electronic Theses and Dissertations. Paper 641. https://doi.org/10.18297/etd/641 This Doctoral Dissertation is brought to you for free and open access by ThinkIR: The University of Louisville's Institutional Repository. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of ThinkIR: The University of Louisville's Institutional Repository. This title appears here courtesy of the author, who has retained all other copyrights. For more information, please contact [email protected]. r ADV ANCING THE KNOWLEDGE OF LOCAL HEALTH CARE POLICY THROUGH THE GROWTH MACHINE THESIS By David P. Houvenagle B.A., Iowa State University, 1987 M.Div., Bethel University, 1991 M.S.W., Southern Seminary, 1994 A Dissertation Submitted to the Faculty of the Graduate School of the University of Louisville In Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy Department of Urban and Public Affairs University of Louisville Louisville, Kentucky December 2008 ADV ANCING THE KNOWLEDGE OF LOCAL HEAL THCARE POLICY THROUGH THE GROWTH MACHINE THESIS By David P. Houvenagle B.A., Iowa State University, 1987 M.Div., Bethel University, 1991 M.S.W., Southern Seminary, 1994 A Dissertation Approved on November 12,2008 by the following Dissertation Committee: Dissertation Director , Dissertf\tion Director f 11 DEDICATION To: My parents Thomas and Shirley Houvenagle, who have financed this wonderful educational opportunity and who have encouraged me every step of the way, and I also dedicate this to the memory of my ancestor Benedict Houvenagle who had the ambition and courage to come over from Belgium to Iowa in 1854 to better his fortune in the "New World." As a result he moved from being a mere livery stable hand to owning his own farm. He reminds me of the privilege I have in America to pursue dreams and be who I can be. 111 ACKNOWLEDGEMENTS Many people supported me, encouraged me, and prayed for me during the dissertation process. There are many that I cannot mention due to space constraints, but to the following, I give heart-felt thanks. First, I thank the committee of Dr. Esterhay, Dr. Imbroscio, Dr. Sussman, and Dr. Vogel and Dr. Whitt for being on my committee. I especially thank Dr. Whitt for graciously tolerating me in 2005 and 2006 when I repeatedly came to his door for help with my dissertation idea and guidance on social network analysis. I also thank all the interviewees/informants who gave me their time and thoughts on healthcare politics. In the process I had the awesome privilege of meeting some exceptional individuals who make Louisville, Kentucky a great city. Also, thanks to the excellent archivists who helped me as I mined for historical information. Dr. Tom Owen at the University of Louisville Archives and Mr. David Morgan at the Louisville City Archives graciously gave invaluable assistance. I had the great fortune to have three very good proof readers who worked quickly and gave me excellent feedback. Thank you Anne Faulls, Amy Mudd and Pam Soto! I thank my program director, lean Henry, LCSW and Gene Hardin, CADC--my c1inicallead at Our Lady of Peace Hospital for allowing me to go out in the afternoons during the spring and summer of 2007 to conduct the field interviews. Thanks to my colleagues (especially Alice Clements CADC) in the Adult Partial Hospitalization IV Program for their support and for reading different drafts of chapters and giving me feedback. I also thank Purander Sarrnah, Ph.D. and Laverne Wheatley-Terry, Ph.D. LMFT, for listening to my angst and for their insightful support. Thanks to the different physicians who read my material and/or gave me moral support during my research and writing. These are Todd Bensenhaver, M.D., David Kissel, M.D., Michael Harris, M.D., Dante Morasutti, M.D., and Gary Weinstein, M.D .. There have been early supportive players present at the right times to give me feedback and encouragement. I thank Drs. John and Sharleen Birkimer (both U ofL emeriti) for guidance when I applied for the Ph.D. program in 2001. I also thank my 9th grade wrestlingll oth grade football coach (and now an administrator) at Southeast Polk High School in Runnells, Iowa Stephen Miller, Ed.D for his advice, feedback and support throughout my whole program. Of course I must thank my family. Words cannot even begin express my gratitude to Leslie, the love of my life and wife of 14 years (half of them in this doctoral program journey) for agreeing to this journey. I thank my children Aimee and Stephen for accepting when Daddy had to be upstairs in the office alone studying or writing and accepting watching videos in my horne office as alternative daddy time too many nights. I must thank my parents, Thomas and Shirley Houvenagle, for their financial and emotional support during the past seven years. Last but certainly the most; I thank God almighty also known as "Jehovah," "EI Shaddai," "Elohim," and the "God of Abraham, Isaac and Jacob." In him I live and move and have my being. I thank him for the ability, opportunity and resources to do this. I testify that I have felt his presence and hand in this. To him be the glory! v ABSTRACT ADV ANCING THE KNOWLEDGE OF LOCAL HEALTH CARE POLICY THROUGH THE GROWTH MACHINE THESIS David Houvenagle November 12, 2008 A disciplined-configurative case study design was carried out to explore whether a growth machine exists and shapes local healthcare policy in Louisville. A historical analysis first explored whether a growth machine existed in Louisville in the past and shaped healthcare policy. Second, a network analysis was used to identify the recent contours of the Louisville growth machine. Third, qualitative interviews were conducted with central individuals as indicated by the social network analysis to assess the degree to which local healthcare policy is shaped and driven by the growth machine. The results show that Louisville has consistently had a growth machine which has shaped the limited local healthcare politics and policy allowed by the higher levels of government. The Federal Government's policy to require pluralistic boards of average consumers on public health agencies actually has detached the growth machine as the local power structure from those agencies. The growth machine has not always had consensus due to differing growth agendas as demonstrated by the construction of Southwest Hospital, the break up of the University of Louisville Hospital management consortium, and the reorganization of the Louisville Medical Center Development Corporation. Regardless the growth machine has generally been able to keep the general public out of such decisions and in VI tum find new ways to be unified in the name of growth. Local government in Louisville was and continues to be a supportive player versus dominant player in the growth machine in local healthcare politics and has not been the driver oflocal healthcare policy. Vll T ABLE OF CONTENTS PAGE ACKNOWLEDGMENTS ...................................................................... .iv.-v ABSTRACT .......................................................................................... vi LIST OF TABLES ................................................................................. xii CHAPTER I. QUESTION OVERVIEW AND INTRODUCTION TO THE STUDY ..... 1 Overview ............................................................................. 1 Introduction .......................................................................... 1 Scope and Significance of the Analysis .......................................... 1 An Overview of the Problem ...................................................... 3 Clarification of the Local Aspect. ................................................. 5 What are Local Politics? ............................................................................. 6 The Matter of Policy ................................................................ 7 Where Health Policy Comes into Play ........................................... 7 Research Methods .................................................................. 10 An Overview of the Study ......................................................... 16 II. A PRIMER ON THE GROWTH MACHINE THESIS ..................... 18 A Definition of the Growth Machine Thesis ................................... 18 Historical Background of the Growth Machine Thesis ...................... .24 A Survey of the Relevant Research on the Growth Machine Thesis ...... 33 V111 III. LITERATURE REVIEW ....................................................... 50 Early Sociological Studies ........................................................ 50 Health Policy Studies ............................................................. 53 Urban Studies ...................................................................... 57 IV. HISTORICAL ANALYSIS PT #1: THE LOUISVILLE MEDICAL CENTER .................................. 63 Overview ............................................................................. 63 Information Sources