Predecessor to Blue Cross and Blue Shield of North Carolina: The Duke Endowment, 1935

Center for Strategic Philanthropy and Civil Society (Duke)



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In the late 1920s, no public, organized, voluntary health service prepayment plan existed. Wilburt Davison, founding dean of the Duke University School of Medicine, was intrigued by the problem and began thinking about possible solutions to funding medical care. In 1933, Davison and the with prominent Durham banker and philanthropist George Watts Hill incorporated the Hospital Care Association (HCA) in North Carolina as a nonprofit corporation.

Over the next two years, Graham L. Davis of the Duke Endowment, which had been established by James B. Duke in 1924, organized a group of leaders representing hospitals, medical professionals, and the public to study hospital prepayment service plans, particularly for the poor. As a result of this study, in March 1935 the Hospital Saving Association came into being as a non-profit corporation “for the purpose of providing a prepayment plan for hospital service to people of the entire state,” in part to compete with the Hospital Care Association. The Duke Endowment provided the first and only capital in the amount of $25,000 to fund the newly chartered HSA. In the 1960s, the boards of the HCA and the HSA voted to merge into Blue Cross and Blue Shield of North Carolina, Inc.



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