Ensuring America’s Health: Publicly Constructing the Private Health Insurance Industry, 1945-1970
Chapin’s dissertation explores how insurance companies became the primary financiers and coordinators of health care by evaluating how federal policy and debates interacted with two institutional levels: first, trade and professional associations and second, ground-level organizations such as individual firms and physician offices. She showed that by 1970, government policy had helped create an expensive, corporate model of health care. Cost problems were built into the system, because doctors behaved as semi-autonomous “managers” whose interests and pecuniary concerns diverged from those of the financiers - insurance companies. Chapin concludes that federal policy helped position insurance companies at the heart of a distinctive public-private system.