2) Historical Overview of Health Care Delivery Flashcards
Describe medical services in pre-industrial America
- Medical services were paid directly by the consumer
- There was competition btwn providers
- Demand for care was unstable & predictable bc of the number of people living in rural communities w/healers & folk remedies
- Lack of affordability bc of the costs of travel & value of time
- People didn’t seek care unless they were desperate
- Medical practice was in disarray
- Medicine was a trade, not a profession
- No educational requirements or licensure
What year did the AMA form and what was its purpose?
- 1847
- Formed to create uniformity among physicians
Describe hospitals in pre-industrial America
A social function to protect citizens; Developed w/the development of major seaports bc there was no place for sick sailors to go
Describe medical services in post-industrial America
- Growth of medical/professional sovereignty
- Licensure
- Educational reform
- Urbanization
- Science & technology
- Institutionalization
- Dependency
- Cohesiveness & organization
- Philosophical agreement that physicians should be autonomous
What was the initial role of private health insurance?
Income protection during sickness & temporary disability
Describe the first “modern” health insurance plans
People would pay a monthly fee to their local hospital just in case
What was the provider-insurer pact?
Alliance of insurers & providers where the provider controlled the insurers
What was the 1st insurance company?
Blue Cross
When was the first time that the government took on a role in the health care delivery system?
1935 w/the Social Security Act
Describe the development of employment-based health insurance
- Started in the 1940’s bc of WW2 wage freezes
- In 1948 there was a supreme court ruling for employee benefits → Incr # of peeps w/insurance
- In 1954 there was an IRS ruling that made employment-based insurance a benefit to employers bc they got a tax break for it
What was going on w/health care during the baby boom years?
- Private health insurance was the only widely available resource, leaving the unemployed or those who worked for small companies w/out coverage
- Costs started to incr
What happened in 1965?
Introduction of medicare/medicaid
What was the first govt entity to provide healthcare payment?
Medicare/Medicaid
Describe the healthcare delivery system in the 1970’s
- Escalation of costs bc of the new medical discoveries
- Incr service demands
- Fee for service, which led to a trend of overutilization
- Global economic competitions
- Businesses became concerned w/cost of health care bc they no longer got a tax break
- Incr govt regulation in attempt to monitor care & decr costs
- Beginning of utilization review
Describe the healthcare delivery system in the 1980’s
- Purchaser revolt bc they could no longer afford it
- Incr in cost of employer-sponsored health plans
- More businesses began self-insuring
- Start of cost-control measures such as PPS, selective contracting, & managed care
