This article reviews the past half century of medical sociology in the United States, which includes research into the structure, organization, dynamics and impact of health care services. The authors summarize three key findings developed by medical sociologists over time and outline the policy implications of these findings.

Key Findings:

1. Health services in the United States are inequitable across racial, socioeconomic and gender divisions. These inequities contribute to disparities in health outcomes.
2. Social institutions contribute to health service disparities by constraining and shaping the delivery of health care. Managed care structures that reward physicians for lower-cost care can lead to substandard care for the older and less healthy segments of the population. There are significant disparities between the quality of care provided by the public and private health sectors. The uninsured and publicly insured receive significantly worse health care than the privately insured.
3. Health care organizations shape the quality and effectiveness of health services within different populations and communities.

Policy recommendations:

• State and federal governments should become more involved in regulating health care services to address the extreme fragmentation of the current system.
• State and federal governments should invest in public health efforts to benefit the most disadvantaged members of society.

Medical sociology has improved understanding of the current United States health care system and how the system has changed over time. Research spanning five decades provides a picture of an extremely fragmented system that contributes to fundamental health care disparities.