Chapter 3 - Historical Overview of US Health System

Question 1

How what medical education see in the USA during the 18th and 19th century?

Answer 1

as a TRADE, no formal education

learned on the spot

Question 2

How was medical training received in the 19th century?

Answer 2

individual apprenticeship, on the job training

Question 3

How was medical training different in the 19th century than it is now?

Answer 3

• not seen as prestigious
• many physicians opened up medical schools to supplement their income
• physicians relied on their five senses due to lack of medical technology
• ANYONE trained or untrained could practice as a physician
• physicians often had second careers

Question 4

Almshouses

Answer 4

where the elderly, homeless, orphans, ill, and disabled would stay

Question 5

Asylum

Answer 5

what today would be called the inpatient psychiatric facility

Question 6

Pesthouses

Answer 6

held people that had contagious diseases to contain the spread

Question 7

Dispensaries

Answer 7

outpatient clinics to provide free care to those who could not afford to pay

-run by young physicians and med students for little to no income

Question 8

Medical Services in Pre-Industrial America

Answer 8

• began in middle of the 18th century until late 19th century
• medical education and practice was more advanced in other countries
• no health insurance

Question 9

Medical Services in Post-Industrial America

Answer 9

• started in late 19th century
• Growth and development in various
• much of the change came after the civil war

Question 10

What growth and development was seen in medical services in post-industrial America?

Answer 10

new scientific discoveries, refers in education, developed professional organizations, private practice

Question 11

What caused the change that came after the Civil War in post-industrial America?

Answer 11

• shift of more Americans living in rural areas vs. living in cities
• created more office based medicine vs. home visits
• became more science based and a specialized skill

Question 12

What is the American Medical Association (AMA)?

Answer 12

• protects the interests of physicians

- thanks to AMA and the physicians, income grew in post-industrial America and their profession also grew

Question 13

Education Reform

Answer 13

around 1870, medical schools began affiliating with universities

• 1871: Harvard extended the academic year and length of medical education
• 1893: John Hopkins established the residency program

Question 14

Development of Hospitals

Answer 14

• saw need to centralize expensive facilities and equipment
• generated an expansion into surgery and sanitation practices
• hospitals were dependent on physicals to make referrals to their hospitals to keep them full

Question 15

What was the first broad coverage health insurance in the US?

Answer 15

Worker’s Compensation

Question 16

What was Worker’s Compensation used for?

Answer 16

• designed to compensate for workers lost wages

- used as a trial balloon for the idea of government sponsored health insurance

Question 17

How did Private Health insurance form?

Answer 17

in the form of disability insurance purchased through private/personal funds

Question 18

Was the legislative move in 1916-1918 to have employers pay for health insurance successful or unsuccessful?

Answer 18

unsuccessful

Question 19

First hospital plan and the birth of Blue Cross

Answer 19

• began in great depression era
• Justin F. Kimball began a hospital insurance plan for teachers in Dallas, TX
• became model for Blue CROSS around country
• hospital insurance grew from 9% to 47% and had plans in 43 states in 10 years

Question 20

First physician plan and the birth of blue shield

Answer 20

• started in 1939 by the California Medical Association - to pay the fees of physicians
• in 1974, these plans started to merge (Blue Cross Blue Shield) and are now in nearly every state

Question 21

Employment Based Health Insurance

Answer 21

• During WWII Congress Froze Wages
• Offered health insurance to their employees to make up for the difference in lost wages
• 1948, US Supreme Court ruled that employee benefits were part of the union-management negotiations
• 1954, Congress amended the internal revenue code to make employer paid health coverage non-taxable

Question 22

When did national health insurance take place in Europe?

Answer 22

1912: became known as socialized medicine

Question 23

What happened in 1946?

Answer 23

President Harry Truman became the first president to make an appeal for national health care

Question 24

what happened in 1948?

Answer 24

Truman was re-elected and promised national health insurance but by 1950 the issue was dead

Question 25

what happened in 1993?

Answer 25

President Bill Clinton made national health insurance one of his top priorities – it was defeated

Question 26

What did Aime Forand do in 1957 to help push Medicare to cover the elderly?

Answer 26

introduced a bill to congress to include an extension to the social security benefits – necessary hospital stays and nursing home care

Question 27

Medical Assistance Act

Answer 27

federal grants that were given to states so that they could expand their welfare programs to low income elderly

Question 28

What happened in 1964?

Answer 28

Medicare was BORN! (part A and part B) by President LBJ

Question 29

What is Medicare Part A?

Answer 29

designed to use SS funds to finance hospital stays and short term nursing home stays after D/C from hospital

Question 30

What is Medicare Part B?

Answer 30

designed to cover physician bills

Question 31

What is Medicare Part C and when was it enacted?

Answer 31

1997-Medicare Advantage

Question 32

What is Medicare Part D and when was it enacted?

Answer 32

2003- Prescription Plan

Question 33

How is Medicaid funded?

Answer 33

through federal matching funds according to the states per capita income

-carried stigma of welfare

Question 34

What is the Health Care Financing Administration and when was it founded?

Answer 34

1977: managed the medicare and medicaid separately from the social security administration

Question 35

What is Telemedicine?

Answer 35

allows providers to provide care from a distance over the phone

Question 36

What is E-Health?

Answer 36

information that is transmitted over the internet

Question 37

Globalization

Answer 37

US medical systems have consolidated with other countries

-health professionals moving to other countries to have higher demand for their services