The Early History of Regulated Health Care

by Michel Accad

[Editor’s Note: This Q & A with Dr. Michel Accad, M.D. on the economic history of modern medicine covers the “pre-Flexner era” to the Great Depression. Part 2 will feature the period from the the Great Depression to today.]

Q: What is the starting point in the history of the American health care system?

A: The American health care system was born in the 1910s out of the so-called “Flexnerian reform” in medical education and the resulting licensing laws.

Q: Why is that the starting point?

A: Prior to that time, medical care in the United States was essentially unregulated. Anyone could open up a medical practice, and many did so with little training. Patients had complete freedom to obtain medical care from whomever they wished. When such complete freedom exists, one cannot realistically talk about a “system.”

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