By using data from business history the first objective of this article is to provide new empirical evidence that demonstrates the diversity of ownership and management styles in the health care system before the era of large public hospitals of the 1960s. The second objective is to provide indices that suggest that, in times of innovation and rapid expansion, inefficiency in the management of resources can have a negative influence on the development of health systems and in welfare potential, from a local and business history perspective. The article presents new data from hospital and clinic archives that may contribute to debates about the supposed automatic link between increases in health spending and improvements in welfare, arguing that such a link cannot be analysed independently of the efficiency in the management of that health spending.