The Grammarphobia Blog

How healthy is “healthcare”?

Q: Here’s a headline from an editorial in the journal Health Care Management Review: “It’s health care, not healthcare.” What are your thoughts?

A: With Ebola still in the news, we’re seeing a lot of this term, and it’s written every which way—sometimes one word and sometimes two, sometimes with a hyphen and sometimes without.

Standard dictionaries are all over the place, but in our opinion the term is well on its way to being accepted by lexicographers as a solid word.

It’s not there yet, though, so our advice is to go with whichever dictionary or style manual you usually follow.

The style guides of the New York Times and the Associated Press, for example, recommend separating “health care.” The Times adds that the phrase shouldn’t be hyphenated when used adjectivally.

However, the one-word version is the only one listed in the online Oxford Dictionaries and the Cambridge Dictionaries Online.

“Healthcare” is also the more common version given in Webster’s New World College Dictionary (4th ed.), with the two-worder listed as an acceptable variant.

On the other hand, The American Heritage Dictionary of the English Language (5th ed.) gives “health care” as the more common form, with “healthcare” as a variant. When the term is used adjectivally, a third variant, “health-care,” is added.

Merriam-Webster’s Collegiate Dictionary (11th ed.) sticks with “health care” as the noun. It adds, though, that the term is “usually hyphenated” as an attributive adjective (as in “health-care standards”).

And here’s an oddity. The online Macmillan Dictionary, in its British and its American editions, lists “health care” as the noun and “healthcare” (no hyphen) as the adjective derived from it.

The Oxford English Dictionary gives the noun usage as “health care,” but the dictionary notes that its overall “health” entry “has not yet been fully updated.”

The OED says the compound noun, which it defines as “care for the general health of a person, community, etc., esp. that provided by an organized health service,” originated in the US.

The earliest Oxford  citation is from a pamphlet, Health Care for Children, published by the United States Government in 1940: “State and local agencies will need to make available to the staff information in regard to the facilities for health care.”

The attributive adjective is hyphenated in the OED examples: “health-care systems” (1973) and “health-care workers” (1985).

However, we’ve found much earlier examples of “health care” and “health-care.”

An 1883 issue of Popular Science Monthly referred to a paper entitled “The Health Care of Households, with Especial Reference to House Drainage,” presented at a conference the previous year by Dr. Ezra M. Hunt.

And in the early 20th century, the hyphenated term appeared in the titles of two books by Dr. Louis Fischer, The Health-Care of the Baby (1906) and The Health-Care of the Growing Child (1915).

The single word version, “healthcare,” seems to be a relatively new phenomenon. The earliest examples we could find in a search of Google Books date from the mid-1990s.

In Legal and Healthcare Ethics for the Elderly, a 1996 book by George Patrick Smith, for example, the author proposes a “new healthcare delivery ethic for the elderly.”

As we’ve said, our guess is that “healthcare” will one day be more widely accepted. Why? Because familiar nouns that are compounds tend to become joined over time, as with “daycare,” “childcare,” and “eldercare.”

In fact, our Google searches suggest that “healthcare” is already somewhat more popular than “health care.”

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