History, Department of


Date of this Version

December 2007


Published in The Annals of Iowa 66 (Winter 2007), pp. 1–74. Copyright © 2007 The State Historical Society of Iowa. Used by permission. http://www.culturalaffairs.org/shsi/publications/annals/annals.html
Grateful acknowledgment is made to the Nebraska State Historical Society for the loan of their copy of this publication.


This article, the last of this three-part series, briefly lays out some of the major changes in medical organization and institutions in Iowa between 1929 and 1950. The bulk of the essay then focuses on the effects that the rising costs of medical care had on ordinary Iowa physicians. Anxiety about the expense of medical services for the respectable working and middle classes joined worries about paying for the basic health needs of the indigent and marginally poor. In the 1910s and 1920s, more physicians and more patients expected hospital stays for surgery and childbirth, looked to laboratory-based tests for diagnostic information, and required office visits for vaccinations, health checkups, and ongoing monitoring of treatments, and all of these cost money. These changing standards of medical care had already started to reshape the meaning of access to adequate medical practice, especially in rural areas and among lower income groups, by the late 1920s. The disjunction between what scientifically trained physicians could provide and what people perceived they could afford, along with the widening gap between professional knowledge and common lay understanding of health and disease, led to a widespread crisis of confidence in the traditional fee-for-service, individualistic system of private medical practice. The worsening of the Iowa economy in the late 1920s and the national depression throughout the 1930s turned the problem of medical care for the poor and for those on the margins of solvency into a major issue for Iowa doctors.

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