Provision of hospital, medical, and dental services. During the 19th century there was startling progress in medical science, but also an increased awareness of health hazards and the need for improved urban public health. In the mid-20th century the development of public health-service hospitals and clinics became one of the main provisions of the welfare state, the British National Health Service being introduced in 1946. It provides a comprehensive, largely free, medical and surgical service for the whole UK population. Funded from national taxation, it is the largest employer in Europe. Although the founders expected costs to fall or remain constant as the health of the nation improved, in fact they have escalated as a result of medical advances making more therapeutic procedures available and a marked increase in longevity (largely as a result of the service), resulting in increased demands by the elderly. Successive governments have grappled with the problem of maintaining the standard of service within acceptable budgets, largely by reorganizing the way in which the service is managed and financed.

During the communist regimes of the former Soviet Union and east European republics, state health services alone were officially available, which is still the case in communist Cuba, while in Britain and many western countries health services through privately financed insurance schemes are an alternative to state services. In the USA, by contrast, most health facilities are privately funded, apart from Medicare and Medicaid, and there is widespread resistance to state intervention: reforms introduced by President Obama (2010) to reduce health-care insurance cost and increase its accessibility and coverage proved controversial, and President Trump has promised to undo them.