Health in America
Health in America
Health in America


Patient in Presbyterian Hospital with family member during the New York City “Blackout,” 1965.

If you are seriously ill today, you go to the hospital, where an array of doctors, nurses, technicians as well as advanced technologies will treat your ailments. But in the 1800s there were relatively few hospitals, they largely served the poor and had no medical services that a private physician could not provide. The hospital administration was not controlled by professionals, but by religious orders and laypeople.

By 1920, this system had changed. Like other aspects of life, such as welfare, work and education, health care had moved from the home into the institution and become much more organized, developed and bureaucratic. This change was driven by new technologies and practices that could be provided only in the hospital: the x-ray, antiseptic surgery and clinical diagnostics. Successful physicians saw the hospital as the place to administer treatment and convinced the middle class clientele of this as well. The transformation of hospitals and their desirability can be seen in the increase from 178 in 1873 to nearly 5,000 in 1923.

Robert C. Hinckley painting, “First Operation Under Ether,” 1882-1893.

The increasing complexity of medicine also heightened the power of doctors in hospitals as lay administrators increasingly deferred authority to the trained professionals. Hospitals also became the place where new professionals would be trained. As the number of paying patients grew, hospitals catered to their needs by placing them in more private spaces instead of wards and providing better food and services. As voluntary non-profit hospitals took in these new patients, poor and chronically ill patients were often sent to county, state and municipal institutions.

The late 20th century hospital did not wholly break away from its traditions of charity, but how it was funded changed radically, with the advent of Blue Cross and Blue Shield, third party insurance, Medicare and Medicaid and direct aid from all levels of government. As hospital costs have risen and insurers have greater cost controls, there has been a trend toward the creation of large hospital networks, the closure of public and smaller community hospitals and the growth of for-profit hospitals.

Surgeons performing one of the world’s first stopped-heart surgeries at the Cleveland Clinic, 1956.