How did peoples financial state of affairs factor into 1890s medical care

After reading Sally Wilde’s article, “The Elephants in the Doctor-Patient Relationship: Patients’ Clinical Interactions and the Changing Surgical Landscape of the 1890s,” who would you say makes most of the decisions about patients’ medical care in today’s health care system in America?
Also, how did peoples financial state of affairs factor into 1890s medical care, and how does it factor into medical care today?