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American Medical Schools and the Practice of MedicineA History$
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William G. Rothstein

Print publication date: 1987

Print ISBN-13: 9780195041866

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195041866.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 04 December 2021

Medical Care After 1950

Medical Care After 1950

(p.181) 9 Medical Care After 1950
American Medical Schools and the Practice of Medicine

William G. Rothstein

Oxford University Press

In the years after mid-century, declining mortality rates from infectious and other diseases increased both life expectancy and the proportion of older persons in the population. These changes, the development of third-party payment systems, and new methods of treatment have led to more use of health-care services and greater demands on physicians for quality medical care. Practically all physicians have become specialists, mostly in fields other than primary care. The shortage of family physicians has led many specialists to provide primary care, for which their training has not prepared them. The major demographic change in the population after mid-century has been the increased proportion of older people. Between 1950 and 1982, the population of the United States increased from 152.2 million to 232.1 million. The proportion of the population ages 55 and over increased from 17.0 percent in 1950 to 21.1 percent in 1982, with those 65 years of age and older increasing from 12.4 million to 26.8 million, and those ages 55 to 64 increasing from 13.4 million to 22.1 million. The number under 5 years of age, by comparison, increased by only 1 million, from 16.4 million to 17.4 million. The greater proportion of the elderly in the population has resulted from lower mortality rates and increased life expectancy. The nation’s crude death rate declined from 9.6 per 1,000 population in 1950 to 8.6 per 1,000 population in 1982, even with a larger proportion of older people. The death rate for those under 1 year of age declined the most over the period, from 33.0 per thousand to 11.4 per thousand. This produced an increase in life expectancy at birth from 68.2 years in 1950 to 74.1 years in 1982. The life expectancy of those 65 years of age increased from 13.9 to 16.8 years over the same period. Lower mortality rates from infectious diseases were responsible for much of the overall decline in mortality rates. For example, the age-adjusted death rates from tuberculosis and the combination of influenza and pneumonia, the two most serious infectious diseases at mid-century, declined from 21.7 and 26.2 per 100,000, respectively, in 1950, to 1.0 and 11.3 per 100,000, respectively, in 1982.

Keywords:   Blue Cross and Blue Shield, Health Maintenance Organizations (HMOs), Malpractice, Medicaid and Medicare, Nursing homes

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