ABSTRACT

This chapter provides a historical analysis of the changing role of philanthropy and non-profit hospitals in the structure and operation of the US health care system from the early decades of the twentieth century to the present. Charity Begins at Home: Generosity and Self-Interest Among the Philanthropic Elite, reveals a serious lack of perspective regarding the continuing importance of philanthropy and the non-profit sector in the delivery of health care. Perhaps the chief distinguishing characteristic of the US health care system is the dominant role that philanthropy and non-profit organizations have played, and continue to play, in the acute care area where non-profit hospitals account for over two-thirds of all beds and admissions. There are many who believe that the introduction of national health insurance under federal or federal-state operation holds the answers to universal coverage, cost containment, and quality control.