B. Historical Justification for and Development of Standard Bed/Population Ratios

B.1. Hill-Burton Act of 1946

The Great Depression (1929–1939) took a tremendous toll on America’s infrastructure, including hospitals, many of which were outdated and in poor repair by 1940. Then, World War II diverted resources to the war effort. By 1945, the country’s hospitals required major upgrades, and many regions in America had no hospitals at all.

The Hill-Burton Act, passed in 1946, was a federal grant-in-aid and matching funds program for hospital construction and public health centers. Central to the legislation were target ratios of how many beds (per 1,000 people in the geographic area) should exist in a region. Because of the potential for risk pooling ...

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