Chapter 2: The Expansion of the Market

a. I was surprised to learn that medicine in England was largely regarded as philanthropic. For a time, physicians were assumed to be "above" material gains, due to the nature of their work, as well as their social status. I was surprised to learn this because my view of physicians is that most of them do not come from elite backgrounds, and must do some kind of work. Further, it does not seem a coincidence that the highest paid specialties are also among the most popular and competitive in medical practice today.

b. One point that I agree with is the author's statement that limited training was more a response to effective demand, rather than ignorance. This is evident when you take into consideration the fact that during this time, medicine was only just emerging as an economic institution, and was mostly limited to the realm of family and home. There simply was not enough demand to justify the necessary level of training and education, yet.

c. The author states that "the social history of medicine in the nineteenth century is a history of both the extension of the market and its restriction," noting a "double movement." I would disagree that there was double movement. It seems as though there was clear movement in one direction, with merely a certain amount of reticence acting against it. Medicine in the 19th century was definitely expanding its presence in the market, and did not seem to retract during this time. The author even states that "the market expanded continuously."

d. Much of medical care was provided on credit, and substantial amounts of money were lost through unpaid bills. This applies to an aspect of the health care system that I have had experience with in that many times, a patient seeks care and is not able to pay when they are treated, or in a timely manner, or perhaps ever. The difference is that hospitals are now the ones losing money, while physician salaries are fixed.

e. The information on the Starr book has influenced my view on medicine in that I am now beginning to see how medicine exists as a market. I am also beginning to see how economic patterns influence the dispersion of physicians in urban and rural areas. For instance, easy entry into medical practice and a surplus of physicians meant that physicians often had to travel to remote or "frontier" areas and to under charge for their services in order to set up a practice. This resulted in dispersion among rural areas. The transportation revolution and emergence of medicine as a market helped to drive physicians out of rural areas, and into cities, where they could see more patients. The effects of this migration are seen today, with critically low numbers of health care professionals in rural areas, such as the Missisipi Delta region.