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The growth of public-sector and private-sector programs in a market economy increased

the need for program management, including the functions of planning, administration,
legislation, and regulation. Planning for health services were instituted at the national
level with the 1966 Comprehensive Health Planning and at the local level by hospital
planning councils. Important about civil services health services legislation preceded
World War II: the 1935 Social Security Act included a number of titles authorizing
health services for children, people with disabilities, and others. The SSA became the
umbrella in the mid-1960s for other significant health legislation, including Medicare
and Medicaid. A spate of additional health legislation was authorized independently of
the SSA; these programs stimulated the development of multiple regulations for their
full implementation.
Much of the change in the U.S. system is occurring in the delivery system component.
The growth of a health services system depends on the level of economic support
available to it. Thirty-five percent of the economic support for the U.S. system in the
year 2004 came from private health insurance, 45 percent came from the federal
government in the form of tax-generated revenue and trust funds and from state
revenues, 13 percent came from individual out-of-pocket payments, and 7 percent came
from foundations and other charitable sources. Other resources, such as a workforce
and facilities, are essential to a health services system. The health workforce continues
to grow. Between 1960 and 1990, the supply of U.S. physicians increased 55 percent. By
the mid-1970s, the United States had doubled its capacity to train physicians in an effort
to meet perceived workforce shortages.
Growth in these and about IAS exam other professions has been aided by governmental
support to expand educational opportunities. New professions have emerged to meet
new needs: the number of billing and reimbursement specialists and business-trained
administrators is growing to keep pace with the increasingly contractual nature of the
U.S. health services industry. Over 871,000 physicians were licensed to practice in the
United States in 2003. The number of nurses has remained relatively constant at about
2.2 million, yet many work settings continue to experience a nurse shortage. The growth
of the health services system, the increasing expenditures required sustaining it; the
significant number of people without access to care, and the projections of increased
demand from an aging population are stimulating changes in both the financing and
delivery systems.
The development of health facilities reflects the growing and changing
health services system. Beginning in 1946, the growth in the number of hospitals and
other kinds of health facilities was assisted by federal funds. Hospitals, until recently the
hub of the system, grew in number and size until the 1980s. In the increasingly
competitive 1990s through 2005, however, the overall number of hospitals declined, the
number of licensed beds decreased, and the development of outpatient services and
facilities mushroomed to reflect the changing delivery system. However, increases in
hospital spending for both inpatient and outpatient services and also in Medicare
hospital spending suggest that the hospital sector is once again growing.