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Typically regarded as a quiet time in American medical education, the interwar period was in fact highly dynamic. Medical research advanced and medical schools grew in size, wealth, and complexity. The values associated with the Flexnerian revolution became generalized—particularly the commitment of medical schools to research. If American medical schools after World War II were to grow so large as to dwarf pre-World War II medical schools, that was because a solid institutional infrastructure was already in place that could effectively utilize the massive infusion of federal and private funds.

This chapter explores the basic structure of the Japanese medical care system, primarily addressing recent policy issues. It is observed that various policy reforms introduced in the 1990s did not effectively solve Japan's fundamental health care system problems. The rate at which Japan's population was aging was accelerating in the 1990s, far exceeding that of the United States. The price elasticity of demand for medical care was very small, generally around -0.1. A variety of policies were implemented in order to control health expenditures by means of the efficient use of resources. Increasing the copayment rate and mechanisms for sharing revenue among health insurance providers, however, were not sufficient to attain a sustainable fiscal balance in the long run. The 2003 health insurance reform was a first step toward a more comprehensive reform of the health care services sector.

This chapter explains the differing engagement of the medical associations with abortion politics by focusing on the ways in which they constructed their “interests” and priorities in the context of national medical-care systems. The chapter speaks of how the British and Canadian reforms delegated responsibility for abortion to the medical profession, removing the issue from public decision making and confining it to a realm in which decisions were made “neutrally” on the basis of “knowledge.” By contrast, the American reform made abortion a public issue decided on the basis of “values.” Finally, the minimal involvement of American mainstream medicine in abortion provision reduced the availability of abortions by concentrating provision in single-purpose clinics in large cities and being served by doctors that were often stigmatized by their mainstream peers. British abortion services were better distributed and better integrated into mainstream medicine, though Canadian ones were not.

This chapter investigates the structure of the American medical care system, especially the system of care for the elderly. It concentrates on three sets of interactions: coverage rules (how people get health insurance and who pays for it), the reimbursement system (how providers are paid), and access rules (what are the financial and nonfinancial barriers to receipt of care). Medicare is significantly less generous than the typical private insurance policy. The various reimbursement systems differ enormously in the incentives they provide. The United States' medical care system has become substantially less generous in payment for care in the past two decades, and this has affected the care provided. About three-quarters of the elderly have some supplemental insurance, through Medicaid or private supplements. In general, the coverage in the United States is spotty—quite good for the elderly, especially those with supplemental insurance, but not guaranteed for the nonelderly.

This chapter examines the overall impact of Medicare in the U.S. medical care system. It first provides an overview of the passage of Medicare and then describes how Medicare expanded the financing of the nation's leading research-oriented academic health centers (AHCs). Medicare's reimbursement policies helped improve the financial position of AHCs. One of the most important of the new financing arrangements under Medicare was the payment that the federal government made to hospitals for the direct and indirect costs connected with the operation of residency and fellowship training programs.