The Consequences of Consensus: American Health Policy in the Twentieth Century

Abstract

For most of the twentieth century the central theme in the history of health policy in the United States was the elaboration and implementation of a consensus that health services should be organized in regional hierarchies. This consensus was based on shared beliefs about how medical advances were made and disseminated. Hierarchical regionalism became national health policy in several stages that culminated in the 1960s. Since the 1970s, however, the national policy of hierarchical regionalism has been eroded by the unexpected consequences of its success.