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We are in the first decade of the twenty-first century, a new century and perhaps an overall new era for the United States. Many experts in health care policy believe that this century will bring fundamental reform and change in the health care system of the United States, and therefore in almost all of the health care policy issues and trends related to the health of the population, the overall health care system, the people who work within health care, and the institutions in which care is provided. How different will the health care system and its problems be one hundred years from now?

Perhaps one way to begin to even think about this type of long range question is to think back to the health care system of one hundred years ago. For simplicity's sake, we might consider health care as it was in the United States in 1900. The first major change would be that most people would not understand the beginning issue, since few people then ever spoke about health care. People talked about visiting a doctor, having a doctor come to the house, and some of the new wonders that could happen in a hospital, such as surgery without pain that would allow a person to go on to lead a long life. Even in 1900 and certainly before then, going to the hospital was a rare (and dreaded) event in most people's lives. Going to the doctor was something a person did infrequently, usually only when they saw no other recourse for feeling better and getting back to work was possible. In the last 50 years, all of this has changed for the average, middle-class American. Health care in the United States has grown into a multibillion dollar industry. Health care-related stocks and companies experienced rapid growth and large gains in values during the late 1980s and early 1990s, and stock in for profit health care companies were seen as valued holdings in the 1990s decade of stock market expansion.

How can we describe the health care system in the United States in the first decade of the twenty-first century? People do not dread going to a hospital today as they did one hundred years ago, when they believed that people mostly went there to die. However, staying overnight in a hospital in the United States in 2002 is a less common experience than it was in 1960, or even in 1980. Fewer people spend the night in a hospital now because so many types of health care which used to require a long hospital stay can be done in one day with the patient sleeping in his or her own bed at night. Going into a medical care facility and obtaining advice is more common now than it was in 1960, and people now visit health care providers when they feel fine, as well as when they feel sick. Increasingly, people receive health care to help them stay well, such as through a general physical examination, and to prevent new problems from developing. However, they may not actually talk with a doctor, especially if they visit with a common health problem. They may see a nurse practitioner or a physician's assistant; these health care occupations did not even exist in 1900 and were uncommon in 1980. Today, most Americans view access to health care as important. They see their own health care as generally effective and take pride in the excellent technology and up-to-date hospitals which are found dispersed across the United States. . .

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