Transformation of American Health Care

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Abstract
Industrialization, the development of corporately managed systems, and the growing role of government in American health care have important implications for many groups and individuals, but for none more than physicians and patients. These two constituencies, once the central actors in medical care, have yielded the stage to two other participants: large-scale payers, such as governments, major employers, and insurers, and large, corporately organized providers, of both the for-profit and not-for-profit types. The ascendancy of large institutions in health care and their influence over physicians and patients present entirely new problems for the medical profession.1 , 2 The physician–patient relationship — once . . .

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