The economic prosperity following the Second World War led to a dramatic growth in the American health-care industry. By the 1970s, Americans outspent everyone else on health care. Yet, most public health indicators showed that US lagged behind most industrialised countries and up to one in five Americans had to rely on charity to get their health care. When governmental efforts failed to check the growth of spending on health care, the market responded with a system that came to be called Managed Care (MC). Driven by a motive to contain costs, many of the changes have had a profound negative impact on patients, hospitals, medical education and research.