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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 5 of 40)

Health Care Struggles and Conflicts

Politics and Economics - A Class Struggle

Health care has been a contentious issue throughout history. Three young boys are standing before a furnace in a glass factory; a fourth boy is standing in the background to the right. Click the image for a larger view.Access to services and the quality of health care often are influenced by struggles between various classes and organized interests in society. (Note the working conditions and age of the boys in the image).

American ideology emphasizes individual responsibility while many European countries and former socialist states have adopted social welfare policies for health and medical care.

The political climate and economic health of an era influence the types of health services provided as well as the research questions studied.

Health Insurance Coverage

The history of insurance coverage for medical care (Starr, 1982 and Rosen, 1993) reveals the conflicts among government, business, physicians, unions, and social reformers.

In the late 19th Century and early 20th Century, amidst political and labor unrest, the German and English governments adopted medical insurance as a way to secure the allegiance of the working class.

View Key Projects and Milestones in Health Services Research.

Discussion Questions

  1. Discuss why the political climate and economic health of an era influence the types of health services provided as well as the research questions studied.
  2. Why did the concept of "insurance" arise in Germany and England before it arose in the United States?
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