For roughly the first half of the twentieth century and before, out-patient medicine in the United States was delivered mostly in the offices of private generalist physicians [general practitioners] - solo practitioners or members of small groups. They handled most clinical situations, including viral and bacterial infections, suturing of wounds, setting of simple fractures, and a few brave doctors in the countryside even aided in uncomplicated deliveries. Often chest X-rays, electrocardiograms, blood counts and urinalyses were also performed in the offices. Specialist consultations were unusual.
When the need for hospitalization arose, physicians alone, without the intervention of third parties would decide whether, when and in which hospital patients would be hospitalized. The private doctor took care of his patient in hospital, with the assistance of nurses and other staff. All payments were made by the patient directly to the physician and separately to the hospital. Insurance coverage of either in- or out-patient treatments was rare to non-existing. Wel