{"id":5051,"date":"2025-04-14T07:33:00","date_gmt":"2025-04-14T07:33:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=5051"},"modified":"2025-04-14T07:33:00","modified_gmt":"2025-04-14T07:33:00","slug":"health-care-vs-healthcare-signals-change-greater-than-grammar","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=5051","title":{"rendered":"\u201cHealth Care\u201d vs. \u201cHealthcare\u201d Signals Change Greater Than Grammar"},"content":{"rendered":"
\n<\/div>\n

By MICHAEL MILLENSON<\/p>\n

\u201cThe New Yorker<\/em> House Style Joins The Internet Age\u201d announced the magazine\u2019s daily newsletter<\/a> under the byline of Andrew Boynton, whose appropriately old-fashioned title was \u201cHead of Copy.\u201d Among the alterations Boynton acknowledged readers might feel \u201clong overdue,\u201d were \u201cInternet\u201d becoming \u201cinternet,\u201d \u201cWeb site\u201d consolidating to \u201cwebsite\u201d and \u201ccell phone\u201d becoming \u201ccellphone.\u201d Other quirky spellings (teen-ager, per cent, etc.) were deliberately retained.<\/p>\n

But what about \u201chealth care\u201d vs. \u201chealthcare\u201d?<\/p>\n

A New York Times<\/em> interview<\/a> described Boynton as \u201ctight-lipped\u201d about the style changes, which came as the publication celebrated its 100th anniversary year. When I nonetheless sought to discover whether a descriptor central to a massive chunk of the U.S. economy was more like a cellphone or a \u201cteen-ager,\u201d the magazine graciously responded.<\/p>\n

\u201c\u2019Health care\u2019 is our style,\u201d a spokesperson wrote me in an email. \u201cThere has not been any discussion of diverging from this.\u201d\u00a0<\/p>\n

Not even a discussion? This was shocking news! But as I dug deeper, it seemed to me that the choice of the one-word versus two-word term often sent an underlying signal about the evolution of not just language, but of how those in the field perceive themselves.<\/p>\n

Debating Evolution<\/strong><\/p>\n

Back in 2012, after I dived into the \u201chealth care vs. healthcare\u201d debate<\/a> for The Health Care Blog<\/em>, my friend and colleague, the determinedly data-driven David Muhlestein, PhD, JD, accused me of ignoring language evolution by insisting on the \u201ctwo words\u201d usage. He eventually presented me with Google searches showing that the ratio of uses of the one-word to the two-word term ineluctably indicated \u201chealth care\u201d was going the way of \u201cWeb site.\u201d<\/p>\n

When I solicited a 2025 update, Muhlestein obliged with a Google trends graph<\/a> tracing relative usage since 2004.<\/p>\n

\u00a0Apart from a brief time that \u201chealth care\u201d was more prevalent as discussion of the Affordable Care Act dominated the news, the preference for \u201chealthcare\u201d has steadily strengthened. \u201cAs of now, people use the one-word version more than twice as often as two words,\u201d Muhlestein wrote in an email.\u00a0<\/p>\n

He added, \u201cYou can\u2019t predict how language will evolve, you just have to go with what it is, and for the U.S., healthcare is definitely going to one word.\u201d<\/p>\n

Perhaps. But even a cursory qualitative analysis suggests a more nuanced picture than volume alone provides. After poking into the preferences of publications, corporations, the U.S. government and others, I decided that a 2022 April Fool\u2019s column in Health Affairs<\/em> actually provided a rough guide to understanding many usage decisions.<\/p>\n

<\/span><\/p>\n

\u201cHealth Care\u201d Emerges<\/strong>\u00a0<\/p>\n

The Hippocratic Oath doesn\u2019t mention health care. In fact, no one does (as opposed to medicine) for a couple of thousand years afterwards. The first citation in the sense that we use in what the online Oxford English Dictionary<\/em> calls an American term is in an 1883 article from the Women\u2019s Herald of Industry<\/em>: \u201cWe hope that good housekeeping, good cooking, good health-care, will receive their share of attention.\u201d\u00a0<\/p>\n

Etymology enthusiast Jeffrey K. Aronson, writing in The BMJ<\/em><\/a>, uncovered the term in the title of a 1906 textbook, The Health Care of the Baby<\/em>. This popular publication, he added, may have been instrumental in introducing the term into Britain, where a British journal in 1907 referred to the \u201chealth care of the working classes.\u201d\u00a0<\/p>\n

Still, until 1960 the term was used very rarely (0.05 per million words), according to etymonline<\/a>. Then it begins a gradual, then steep rise. My informal review of a thick anthology of significant health services articles<\/a> published from 1914 to 1991 also showed the term only gradually seeping into writing about the delivery system. For instance, a 1966 article by Irwin Rosenstock in the Milbank Fund Quarterly<\/em> was entitled, \u201cWhy People Use Health Services\u201d \u2013 what today we would surely call health care.\u00a0<\/p>\n

The First Health Care Crisis<\/strong>\u00a0<\/p>\n

But as Cyndi Lauper would sing many years later, \u201cMoney Changes Everything.\u201d Medicare and Medicaid took effect July 1, 1966. After a mere seven months, the impact on the federal budget of \u201ccost-plus\u201d reimbursement of hospitals and \u201creasonable, usual and customary\u201d payments to physicians was so alarming that President Lyndon Johnson ordered the Secretary of Health, Education and Welfare to convene a National Conference on Medical Costs \u201cto discuss how we can lower the costs of medical services without impairing the quality.\u201d\u00a0<\/p>\n

The terms \u201chealth care,\u201d \u201cmedical care,\u201d \u201cmedical services\u201d and \u201chealth services\u201d were largely used interchangeably during this period. For instance, the that June, 1967 conference<\/a> characterized the attendees as individuals \u201cwho have studied the rising costs of health care and the effect of these costs on the availability of medical care to all Americans.\u201d\u00a0<\/p>\n

In 1969, President Richard Nixon became the first of a long line of presidents to declare a health care \u201ccrisis\u201d due to rising costs. (Congress would hold its first hearings on the \u201cHealth Care Crisis in America\u201d in 1971).\u00a0 Nixon\u2019s declaration was accompanied by issuance of an HEW report, The Health of the Nation\u2019s Health Care System<\/em><\/a>, that warned of a \u201cbreakdown in the delivery of health care unless immediate concerted action is taken\u201d to address \u201ca crippling inflation in medical costs.\u201d\u00a0<\/p>\n

That description was markedly similar to the challenge posed four decades previously to a blue-ribbon Committee on the Costs of Medical Care charged with addressing \u201cthe inability of the people to pay the cost of modern scientific medicine.\u201d In 1927, one recommendation was that medicine be organized for \u201cthe most efficient production of services.\u201d In 1969, the HEW report recommended \u201cgood management\u201d and \u201cconstructive policies in delivery and pricing of services.\u201d\u00a0<\/p>\n

Although many problems and proposed solutions seemed (and still seem) to remain constant, the language was changing to reflect a cottage industry morphing into something far larger and more complex.\u00a0<\/p>\n

The Industrial Model<\/strong>\u00a0<\/p>\n

The same year the government declared an imminent health care \u201cbreakdown,\u201d a television show about a kindly family practitioner whose patients had no such worries debuted on ABC. The American Medical Association at first fretted that the show, Marcus Welby, M.D.<\/em>, would cause a backlash once the public discovered most doctors didn\u2019t actually behave like the TV one. Instead, the fictional drama came to be seen in later years as an accurate portrayal of the times. The health care reality, however, was better reflected by an influential 1969 article, \u201cThe Medical Industrial Complex,\u201d which set the stage<\/a> for a national reckoning, now largely forgotten, of how the pursuit of profit by individual practitioners and large organizations alike was changing medicine.\u00a0<\/p>\n

In the 1970s and 1980s, the business of health care started to boom. That, in turn, prompted the emergence of a modernized noun that reflected the new era. In 1976, a decades-old trade publication once known as Modern Hospital<\/em> was transformed into Modern Healthcare<\/em>. In 1977, UnitedHealthcare Corp. was founded by a Minneapolis businessman who\u2019d previously been involved in a health maintenance organization (a new kind of insurance product) organized by doctors who\u2019d named it Physicians Health Plan. Marcus Welby never dreamed of owning an HMO.\u00a0<\/p>\n

In 1978, the health services research pioneer Kerr L. White called attention to how the field had changed to include a vast amount of \u201ctechnology, equipment, buildings, and above all, people\u2026concerned with the provision of health care. It is an array that is referred to broadly as \u2018the health care enterprise,\u2019 and in many ways it constitutes a worldwide \u2018health-industrial complex.\u2019\u201d\u00a0<\/p>\n

According to etymonline, use of the term \u201chealth care\u201d (as one or two words) rose from 0.05 uses per million words in 1959 to 0.27 per million in 1969, the year of the first presidential declaration of a health care crisis. Usage peaked of 2.13 per million in 1998, a time when the health care crisis was again a pressing political issue. That was a rate almost 43 times higher than 1969. One obvious reason was the astonishing growth of the \u201chealth care enterprise.\u201d\u00a0<\/p>\n

In 1969 health care expenditures accounted for just under 7 percent of Gross Domestic Product. In 1998 it was about 13 percent. Today, health care expenditures are closing in on 18 percent of GDP. Total health care spending amounts to nearly $5 trillion, or about $14,600 per person.\u00a0<\/p>\n

Perhaps \u201chealthcare,\u201d de-emphasizing the \u201ccare\u201d in the one-word spelling, better accounts for the plethora of indirect activities added to the mix. From electronic health record vendors to utilization reviewers to consultants of all stripes, more than 22 million people<\/a> now work in a myriad of ways in what is one of the nation\u2019s largest and fastest-growing economic sectors.\u00a0<\/p>\n

Today, for example, Marcus Welby might be an employed physician at a putatively non-profit, multi-state health system boasting a venture capital arm and partnerships with private equity firms. (Come to think of it, that actually describes my doctor, although, unlike Welby, she is female and Indian-American.) Patients, meanwhile, are increasingly labeled \u201cconsumers.\u201d\u00a0 Small wonder that the volume of online searches and, Muhlestein notes, usage in books, favors the industry-preferred, one-word term. Aronson found a similar result examining PubMed usage, where health services researchers predominate. (Disclosure: Despite my personal preference, I published in a health services journal calling itself HealthCare<\/em><\/a>.)\u00a0<\/p>\n

Who Uses What<\/strong>\u00a0<\/p>\n

Still, common usage of a term among one group doesn\u2019t necessarily translate everywhere. In government, political considerations pushed the federal Agency for Health Care Policy and Research (AHCPR) to change its name in 1999 to the Agency for Healthcare Quality and Research (AHRQ). Agency head Dr. John Eisenberg chose \u201chealthcare\u201d over \u201chealth care,\u201d one AHRQ veteran remembered, because he wanted a four-letter acronym.\u00a0<\/p>\n

But AHRQ notwithstanding, it\u2019s still mostly \u201chealth care\u201d in the federal government, as it was when the Affordable Care Act was first in the news some 15 years ago. To be fair, consistency is often lacking. \u201cHealth care\u201d and \u201chealthcare\u201d can both appear in the same regulation in the Federal Register, and the Department of Labor provides data on Health Care Workers<\/a> and Healthcare Occupations<\/a>.\u00a0<\/p>\n

Government, of course, operates in the health care world, but despite the hundreds of billions of dollars it disburses, is not technically in the healthcare business. Similarly, medical journals, however lucrative medical publishing and some medical care may be, do not see themselves as part of an industry. At the New England Journal of Medicine<\/em> family of publications and those of the American Medical Association, which together publish some of the world\u2019s most prestigious medical (not \u201chealthcare\u201d) journals, \u201chealth care\u201d remains two words. Similarly, \u201chealth care\u201d is two words at the National Academy of Medicine, even as \u201cworkforce\u201d is one word and \u201cwell-being\u201d takes a hyphen.<\/p>\n

That same sense of being outside of the industry may be why two of the most respected general-interest publications, The Washington Post<\/em> and The New York Times<\/em>, retain \u201chealth care.\u201d The same holds true for the Associated Press, whose Stylebook serves thousands of newspaper, radio, TV and online customers, including KFF Health News. Far less tradition-bound than The New Yorker<\/em>, the AP updated \u201cWeb site\u201d to \u201cwebsite\u201d 15 years ago. Nonetheless, its 2024-26 Stylebook retains \u201chealth care.\u201d\u00a0<\/p>\n

Then there\u2019s Health Affairs<\/em>, required reading for health policy mavens. In a tongue-in-cheek April 1, 2022 online letter to readers, then-Editor-in-Chief Alan Weill proclaimed that as the \u201cbible\u201d (his spelling) of health policy, the publication had decided to change its style from \u201chealth care\u201d to \u201chealthcare.\u201d Weill called it a \u201creverse-Solomonic decision to not split the baby.\u201d\u00a0<\/p>\n

He continued, \u201cAs with all important decisions in healthcare, our primary motivation was financial;\u201d i.e., paying authors by the word, they figured they\u2019d save $3.46 per year. The letter also mentioned the Wall Street Journal<\/em>, which in 2021 announced it was turning \u201chealth care\u201d into \u201chealthcare,\u201d just as, wrote Weill, \u201cthey have consistently shown leadership in supporting policies that turn healthcare into profits.\u201d Weill also noted that \u201chealthcare\u201d provided better acronyms.\u00a0<\/p>\n

\u201cWe will stop fighting the forces of consolidation in healthcare and go ahead and consolidate health and care into healthcare,\u201d the April Fool\u2019s Day letter concluded.\u00a0<\/p>\n

Needless to say, they didn\u2019t; it remains \u201chealth care\u201d at Health Affairs<\/em>. Still, is the consolidation of \u201chealth care\u201d into \u201chealthcare\u201d inevitable? Seeking the opinion of an expert, I turned to the Linguistic Society of America, which directed me to a linguistics All-Star.\u00a0<\/p>\n

Is Health Care Like Ice Cream or Baseball?<\/strong>\u00a0<\/p>\n

In 2007, the Shorter Oxford English Dictionary<\/em> removed the hyphen from 16,000 words, Anne Curzan, a professor of English and linguistics at the University of Michigan, told me. Some of those de-hyphenated devolved into one word (pigeonhole), others separated into two words (fig leaf). Consolidation, cautioned Curzan, is not always inevitable. \u201cIce cream,\u201d for example, has not melted into \u201cicecream.\u201d\u00a0<\/p>\n

My bottom line (not yet \u201cbottomline\u201d) is this: For those who see themselves as part of a diverse industry, desire a pithy acronym or want punchier headlines or PowerPoints, \u201chealthcare\u201d fills the bill. As an extra benefit, it subtly shows you\u2019re not the kind of person who just bought a new \u201csmart phone.\u201d However, for those who perceive themselves as being outside the industry in some way \u2013 as part of the House of Medicine or for other reasons \u2013 the lexicological urge to merge is much less urgent.\u00a0<\/p>\n

After the AP changed \u201cWeb site\u201d to \u201cwebsite,\u201d the news service acknowledged there had been a clamor for them to get with the times. Editors of The New Yorker<\/em>, on the other hand, did not seem to know that the \u201chealth care\u201d vs. \u201chealthcare\u201d controversy even existed. I doubt most of the general public notices, either.\u00a0<\/p>\n

Might \u201chealthcare\u201d even start to take on a different meaning than \u201chealth care\u201d? Though a few believe that\u2019s already happened<\/a>, Curzan urged caution \u201cabout how much we load onto the meaning of whether something is one word or two words or hyphenated.\u201d\u00a0<\/p>\n

In supporting its \u201chealthcare\u201d decision, the Wall Street Journal<\/em> pointed out<\/a> that \u201chealthcare\u201d had become one word in Webster\u2019s New World College Dictionary, Fifth Edition<\/em>. \u201cCompound words inevitably close up over time,\u201d the newspaper wrote. \u201cOtherwise, we would still be watching base ball<\/em>.\u201d\u00a0<\/p>\n

\u201cTime to reprogram our brains,\u201d the newspaper advised.\u00a0<\/p>\n

Perhaps re-programming is, indeed, called for. Even if some of us atavistically continue to believe other-wise.<\/p>\n

Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor<\/em><\/p>","protected":false},"excerpt":{"rendered":"

By MICHAEL MILLENSON \u201cThe New Yorker House Style Joins The Internet Age\u201d announced the magazine\u2019s daily newsletter under the byline of Andrew Boynton, whose appropriately old-fashioned title was \u201cHead of Copy.\u201d Among the alterations Boynton acknowledged readers might feel \u201clong overdue,\u201d were \u201cInternet\u201d becoming \u201cinternet,\u201d \u201cWeb site\u201d consolidating to \u201cwebsite\u201d and \u201ccell phone\u201d becoming \u201ccellphone.\u201d…<\/p>\n","protected":false},"author":0,"featured_media":5050,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-5051","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/5051"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5051"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/5051\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/5050"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5051"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5051"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5051"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}