The delivery of healthcare has been a specialized task from early in recorded history. The ancient Greeks developed medicine and surgery as scientific endeavors, and Hippocrates, in the fifth century B.C., established the foundational ethics of the medical profession: what is known as the Hippocratic Oath. By the second century A.D., the Roman physician Galen significantly advanced anatomical study and the practice of medicine. Even early physicians were liable for their mistakes, and the profession has been subject to continuous legal regulation. Into the twentieth century, however, most doctors were paid directly by their patients for services rendered. Medical procedures were relatively inexpensive because they were severely limited by a variety of technological and scientific constraints. The scientific advances of the nineteenth and early twentieth centuries – anesthesia, disinfectants, etc. – increased the scope of procedures that doctors could effectively perform, as well as the cost of those procedures. Early twentieth century “sickness insurance” had mainly covered wages lost because of illness or injury rather than the less significant cost of healthcare itself, and modern insurance plans did not become widespread until the middle of the century.
Wage controls during the Great Depression encouraged employers to offer health insurance as a way to attract quality workers without violating caps on pay. Employer-provided health insurance increasingly became a characteristic of the US healthcare system, while Europeans experimented with government-provided healthcare coverage, with Germany establishing the first national system in 1883. The UK passed the National Insurance Act of 1911 that eventually produced the National Health Service in 1948. Many other European countries also established national healthcare systems after WWII. US federal regulation of healthcare and health insurance produced Medicaid and Medicare in 1965, and continued in the 1970s when Medicaid expanded and child-specific plans were introduced in an effort to reduce the rising number of uninsured Americans.