Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Urban and Public Affairs

Committee Chair

Whitt, J. Allen, 1940-

Committee Co-Chair (if applicable)

Vogel, Ronald K.

Author's Keywords

Healthcare politics; Social network analysis; Growth machine thesis; Local healthcare policy; Louisville; Kentucky; Social networks; Louisville; Health care policy; Growth machine; Local politics


Medical policy--Kentucky--Louisville; Political planning--Kentucky--Louisville; Cities and towns--Growth--Kentucky--Louisville


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 turn 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 of local healthcare policy.