

NEJM Interview: Nancy Tomes on the century-long transition to a corporate business model in U.S. health care.
6 snips Aug 6, 2025
Nancy Tomes, a history professor at Stony Brook University, discusses the century-long shift of the U.S. healthcare system toward a corporate model. She highlights how this transition began in the 1920s, changing the dynamics of patient care and physician practices. Tomes delves into the rise of patient-centered office environments and the impact of insurance-based healthcare, including the challenges of surprise billing. She also tackles the corporatization of healthcare, examining its implications for physician autonomy and patient access in today's profit-driven landscape.
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1920s Shift to Business Model
- The 1920s shifted U.S. medicine from direct patient billing to a business model emphasizing investment and systematic billing.
- Physicians were urged to think like businessmen, investing in new technologies and professional education.
Welcoming Medical Offices Replace Home Visits
- Doctors began creating more patient-friendly office spaces, replacing home visits with office visits.
- Nancy Tomes recalls her family physician's welcoming office with paintings and a friendly nurse in mid-20th century Kentucky.
Insurance Arises from Hospital Costs
- Direct physician billing worked until hospitalization introduced sizable, unexpected bills beyond patients' means.
- Insurance emerged to pool risk, starting with hospital coverage, supported by employer contributions.