Throughout this century, profit has been an underlying motor force for health sector developments. However, as the concentration and centralization of health care delivery has proceeded in the United States, the pursuit of profit has become central. Even before the Reagan policy redirections raised “marketplace efficiency” as the supreme determinant of how the population's health needs are to be (or actually will not be) met, the rise of the nationwide proprietary hospital conglomerates over the last 15 years signified a new organization form. No longer camouflaged under an out-moded “not-for-profit” designation, the delivery of health care is now officially to be a “business” run for economic gain. Corporatization and proprietization trends have unmasked that profit regulates which people in which social groups get care. This article focuses upon developments leading toward this monopolization within health services delivery. Specific attention is given to historical tendencies that have set the stage for its extension under conditions of a continuing general economic crisis, conservative health policy redirections, and rapid industrialization of the health sector. Scientific and technological advances have reshaped professional roles and relationships, and increased bureaucratization of provider organizations. Coinciding with these are major actions by the corporate class in health policy and planning, and an impending demographic shift where aging population cohorts give rise to expanding “markets” of middle-class patients for proprietary health care firms.
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