Healthcare (Health Care) in a word (or two)

By Clive Riddle, September 5, 2014

MCOL has launched a survey, albeit a little tongue-in-cheek, on solving a great question for the ages:  do we spell it healthcare (one word) or health care (two words)? You can click here to take the survey, and see real-time results, or click here to check out a one-minute video on the topic.

Early results from the survey to-date indicate a slight preference for one word: 44.7% have said one word; 31.6% have said two words; 13.2% have responded that it depends on the context; and 10.5% have answered that either is fine. Remember though, respondents work within this industry (more on that to follow.)

How have others weighed-in on this conundrum?  Major news organization, medical journals and the AP consistently use “health care” in two words.  Many major blogs have taken the same position, such as The Incidental Economist (Feb 2013) and Archelle On Health (May 2011).

But many  either take the position of one word, while lamenting the times they are a-changing, or they argue the both uses are acceptable, depending upon the context.

One of the most quoted blogs regarding this topic comes from Michael Millenson’s The Doctor Weighs In, in his August 2010 post - “Healthcare” vs. “Health Care”: The Definitive Word(s) .  Millenson makes the case that learned authorities use two words, but goes on to say: “So why isn’t that the end of the issue? Because conventions are not set in concrete. For example, at the time the Internet first became popular, the AP preferred the term “Web site” over “website” because the World Wide Web is a proper name. “ and acknowledges one word use is on the way up: “However, I think a tipping point for fusing “health” and “care” was reached with the federal legislation setting up the Agency for Healthcare Research and Quality at the end of 1999.”

Are the times a-changing? Certainly a review of Google search results placing both terms within quotations, indicates two words is the clear winner:  109 million results versus 47.8 million – a ratio of 2.28 to one.  When the results are filtered to only display content created in the past twelve months, two words still easily wins: 15 million results versus 9.4 million, but the ratio reduces to 1.6 to one.  The times it would seem are changing – but not at the rate of Bob Dylan record sales in Greenwich Village in 1961.

But what about context?

While many make the case that usage is driven by context, there isn’t agreement about what that context is.  Some say one word is used by those in the business when communicating to each other, and two words is for use with the general public. The Metropolitan Philadelphia Chapter of HFMA concluded in The Great Debate of Our Industry: Healthcare vs. Health care “so there still is no final answer here. Both health care and healthcare remain acceptable term.”  The author seems to go for the context route, stating” the single word healthcare may show you are an industry insider, and I save the term health care for those who write about our industry from the outside.”

In the March 2008 Medical Malprocess Blog post Health Care or Healthcare?, an often mentioned approach regarding context -  in which two words refers what a patient receives, and one word refers to a system:  “Health care as two words refers to what happens to a patient. …Healthcare as one word refers to a system or systems to offer, provide, and deliver health care (two words).”

Grammarist.com, in Healthcare vs. health care tells us the times are a-changing but context depends upon international use: “Healthcare is on its way to becoming a one-word noun throughout the English-speaking world. The change is well underway in British publications, where healthcare already appears about three times as often as health care and is used as both a noun and an adjective. Many American and Canadian publications resist the change, meanwhile, and health care remains the more common form in North American newswriting, as well as in government and scholarly texts. In many cases—such as on health-related U.S. government websites—health care is the noun (e.g., “your health care is important”) and healthcare is the adjective (e.g., “find a healthcare professional”), but this is not consistently borne out, and both forms are widely used both ways. Many publications and websites seem to have no policy on this at all. Short answer: Outside North America (Australia goes along with the U.K. on this one), use healthcare. In the U.S. and Canada, make it two words (unless you want to help speed the compounding process).”

What to make of all of this? Google search results, and purists would agree that two words is still king – for the general public, but eventually it would seem one word will take hold – although perhaps not as rapidly as some might think. During this transition – context will drive usage, and those in the business of healthcare might be more comfortable with one word with conversing with each other.