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In the United States, the Federal government has so far limited itself to Medicare and Medicaid in terms of health service provision. Before the establishment of Medicare in the mid-1960s, medical delivery in the United States still retained a considerable degree of charity work by most physicians, with a heavy involvement of voluntary and philanthropic agencies in the operation of clinics and hospitals. With the introduction of Medicare, which supported a large proportion of medical and hospital costs for the elderly, and which was based on a fee-for-service system to doctors, medical purveyors and hospitals, there was a rapid rise in medical expenditures and medical delivery. Seemingly overnight, with rises in costs and volume, there was a diminution of charity and voluntary medical services. |
