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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 6 of 40)

Health Care Policy and Economics

A similar level of political upheaval did not exist in the United States at this time. Labor organizations developed under a more conservative leadership during the early 20th Century and were less involved in issues of social reform, such as health insurance.

John Adams, second President of the United States, signed into law on July 16, 1798 the Act for the Relief of Sick and Disabled Seamen, which established what is now the Public Health Service. Twenty cents was deducted from the monthly wage of each merchant seaman to build or rent hospitals and pay for the medical care provided.Most health care delivery systems were private; there was not the same tradition of social support for health care that existed in Europe. Even when the government established the Public Health Service in 1912, it limited its power and authority.

The Progressive movement fought for social insurance during this time; however, WWI and the post-War "red" scare diverted attention from its campaign.

More About the U.S. Public Health Service

The Old Butler Building, the early home of the Public Health Service (PHS). Click for larger image.The image to the left shows an exterior view of the Old Butler Building, the early home of the Public Health Service (PHS). The PHS was formed by the passage of an Act by the U.S. Congress in 1798 that provided for the care and relief of sick and injured merchant seamen.

It came into its own during and after World War I when its Six men are posed wearing the first uniform of the Public Health Service, ca. 1878. Click for a larger view of this image.commissioned officers were given the responsibility of working with local health departments to keep the areas around military training camps free from disease, especially venereal disease. (Web site)

After the war PHS was given the responsibility for the care of all returning veterans. This responsibility was later transferred to the Veterans Bureau in 1921.

The Hill-Burton Act authorized PHS to make grants to the states for surveying their hospitals and public health centers and for planning construction of additional facilities, and to assist in this construction.

Group portrait of nine men standing behind a makeshift table upon and around which are displayed kettles, buckets, lanterns, and other equipment used in catching rats during the Public Health Service campaign against the New Orleans' plague epidemic of 1914-1920. Click image for a larger view.The PHS expanded its efforts in the area of industrial hygiene, radiation and toxic chemicals, water pollution and other environmental areas, including reducing the number of rats (as shown in the accompanying image).

Bureau of Indian Affairs Becomes the Indian Health Service

Image of an Indian Health Service field nurse demonstrates chest x-rays to a group of Navajos. Click for a larger image. In 1955, under Hill-Burton, PHS became fully responsible for the health of American Indians and built hospitals in remote areas for Native American patients. In that same year all Indian health programs of the Bureau of Indian Affairs (BIA) were transferred to PHS and became the Indian Health Service (IHS).

View Key Projects and Milestones in Health Services Research.

Discussion Questions

  1. Is political upheaval or conservativism important to change - especially with respect to changes in health care, or not?
  2. Is it reasonable to lay all the blame for a late start to health insurance in the United States on the "red" scare? Why or why not?
  3. Why is the work of the U.S.P.H.S. so important to maintaining health in various populations in the U.S.? In the Native American population?
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