Despite the stability of some essential elements, the U.S. health care system has undergone significant change in recent decades. A variety of innovations has been formulated and implemented. Some of these innovations have been sustained, others abandoned, and still others are evolving in unforeseen ways. Changes now in the process of implementation and soon to be implemented will determine access to and quality of health care that the United States will experience for generations to come.
The late twentieth and early twenty-first centuries saw fundamental changes in the ways U.S. health care was financed and delivered. Examples included selective contracting, cost sharing, and managed care. These innovations have unquestionably ...