History

• Consumers of the 17th and 18th centuries relied on individuals with limited medical or nursing skills and training to provide primary care. Destitute patients in the early 19th century were treated in poorhouses, and these led to some of the first hospitals. Later, increased population led to an emphasis on public health and the creation of new hospitals and facilities.
  
  

20th Century

• Physician shortages, economic restraints and increased access to hospital facilities have propelled hospitals into an active primary care role. People look to hospitals as a central source of health education, specialty programs such as diabetes management, and medical diagnosis and care. Patients without medical insurance rely on public hospitals for free or reduced-fee medical care.
  
  

Impact

• According to the WHO, as primary care providers, hospitals share responsibility for reducing health care disparities, providing health services driven by patient need and expectations, becoming health advocates, serving as leaders for health reforms and encouraging participation by owners, staff and patients.