ABSTRACT
Hospitals for the poor and sick have existed since ancient times; the modem hospital is a relatively recent institution. Medical science was transformed through two concurrent movements between 1880 and 1914, with effects lasting to the present. Surgery became—and has remained—the heart of the American hospital, the most obvious evidence of medicine's success and an emblem of twentieth century American values: science, know-how, the willingness to take risks, decisiveness, organization, and invention. Medicare provided the force of national regulation and national expectations, while allowing for substantial local service variations. The courts have had a role to play in defining national community norms, whether through asserting hospitals' responsibility for the quality of their medical care, requiring racial desegregation, or providing definitions of life and death. The diagnosis related group (DRG) program can be seen as an extension of national standard-setting through attempts to define and standardize courses of hospital treatment across the United States, for Medicare patients at least.
