Development of the city-county (public) hospital
F. W. Blaisdell
Department of Surgery, University of California-Davis Medical Center.
Prior to 1966, the United States had a two-tiered system of health care.
Those patients who could afford the cost of medical care were treated by
private physicians in their offices and in private hospitals. For patients
who could not afford care, ie, the indigent and retirees over 65 years of
age who developed catastrophic illnesses, the city and county (public)
hospitals provided the only health care available. All counties assumed
responsibility for their indigent patients, and all but the smallest
counties had their local hospital. In the larger cities, these hospitals
developed teaching programs and affiliations with medical schools that
provided a volunteer teaching faculty (Table) (John G. Raffensperger,
unpublished data, 1991; John E. Salvaggio, unpublished data, 1989). The
smaller county hospitals relied on a few full-time generalists, but
primarily they depended on volunteer physicians from the community to
provide patient care.
