Unbiased Analysis of Today's Healthcare Issues

How medical care was financed 2000 years ago

Written By: Jason Shafrin - Dec• 03•07

A paper by Alexander S. Preker and April Harding at the World Bank analyze the roles of the public and private sector in health care.  One of the more interesting portions discusses medical care financing using some examples from ancient history.

Ideological views on the roles of the state and the private sector belong to a long list of false antitheses in the field of medicine and health care. Since the beginning of written history, the pendulum has swung back and forth between minimalist and heavy-handed state involvement in the health sector.

During antiquity, people used home remedies and private healers when they were ill. Yet, as early as the second millennium B.C., the papyri give fascinating evidence that Imhotep, archetypal physician, priest, and court official in ancient Egypt, introduced a system of publicly provided health care with healers who were paid by the community.

This early experiment in organized health care did not survive the test of time. The Code of Hammurabi (1792–50 B.C.) laid down a system of direct fee-for-service payment, based on the nature of services rendered and the patient’s ability to pay. For the next three thousand years, the state’s involvement in health care revolved mainly around enforcing the rules of compensation for personal injury and protection of the self-governing medical guild.

At best, financing, organization, and provision of health care was limited to the royal courts of kings, emperors, and other nobility who might have a physician for their personal use and for their troops at the time of battle. The masses got by with local healers, midwives, natural remedies, apothecaries, and quacks.” 

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