American Health Care Systems and Depression: The Past, Present, and the Future

American medicine has witnessed 3 major periods in this century that have all played key roles inthe evolution of today’s medical systems, practice, and education. The first of these periods followedthe publication of the Flexner report in the early 1900s that was critical of the then current medicaleducation system. The second came with the development of specialties in the 1920s and 1930s, andthe third with the growth of HMOs and managed care and with the reemergence of primary care. Mentalhealth practice has also evolved, moving from a specialist-based direct access to a primary caremodel. Although great strides have been made regarding the treatment of depression, an overwhelmingmajority of patients are still undertreated. Treatments for the future must focus on programs toimprove recognition of depression, reduce stigma, and increase compliance.