ABSTRACT
American healthcare has always been a local phenomenon. This does not mean that the way healthcare developed and operated at the local level was unaffected by events involving the country and the world. Epochs for our purposes represent periods of time in American history that are characterized by new developments and changes. During each epoch, a dominant influence that is at work in the country and in healthcare is identified. Healthcare reflects the environment in which it exists and the perceptions of the people that work in it and receive care through it and the influences of national changes. Hospitals emerged as the foundation for the delivery of healthcare services in America based on the historic precedent set in England. American dispensaries grew in number and importance throughout the nineteenth century and remained significant providers of healthcare into the twentieth century, according to Charles Rosenberg.
