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According to the National Conference of State Legislatures, the 50 state legislatures collectively "make thousands of health policy decisions each year," not including the decisions made by local governments, which often oversee hospitals, and private bodies, such as insurers.

and implementation of laws, rules, and regulations for managing the state's healthcare system.

The federal government also enacted a number of pieces of healthcare legislation during the second half of the century: Today, the healthcare industry is an immense part of the nation's economy.

Healthcare spending amounts to about one-sixth of the nation's gross domestic product and health expenditures account for about one-fourth to one-third of state budgets.

As medicine grew more professionalized, private health insurance pools were established, and employers and unions began offering some medical benefits to workers.

The model of payment known as "fee-for-service," in which doctors are paid for each treatment, test and office visit, emerged.

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