Chapter 3 - Historical Overview of US Health System Flashcards
How what medical education see in the USA during the 18th and 19th century?
as a TRADE, no formal education
learned on the spot
How was medical training received in the 19th century?
individual apprenticeship, on the job training
How was medical training different in the 19th century than it is now?
- 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
Almshouses
where the elderly, homeless, orphans, ill, and disabled would stay
Asylum
what today would be called the inpatient psychiatric facility
Pesthouses
held people that had contagious diseases to contain the spread
Dispensaries
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
Medical Services in Pre-Industrial America
- began in middle of the 18th century until late 19th century
- medical education and practice was more advanced in other countries
- no health insurance
Medical Services in Post-Industrial America
- started in late 19th century
- Growth and development in various
- much of the change came after the civil war
What growth and development was seen in medical services in post-industrial America?
new scientific discoveries, refers in education, developed professional organizations, private practice
What caused the change that came after the Civil War in post-industrial America?
- 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
What is the American Medical Association (AMA)?
- protects the interests of physicians
- thanks to AMA and the physicians, income grew in post-industrial America and their profession also grew
Education Reform
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
Development of Hospitals
- 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
What was the first broad coverage health insurance in the US?
Worker’s Compensation
What was Worker’s Compensation used for?
- designed to compensate for workers lost wages
- used as a trial balloon for the idea of government sponsored health insurance
How did Private Health insurance form?
in the form of disability insurance purchased through private/personal funds
Was the legislative move in 1916-1918 to have employers pay for health insurance successful or unsuccessful?
unsuccessful
First hospital plan and the birth of Blue Cross
- 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
First physician plan and the birth of blue shield
- 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
Employment Based Health Insurance
- 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
When did national health insurance take place in Europe?
1912: became known as socialized medicine
What happened in 1946?
President Harry Truman became the first president to make an appeal for national health care
what happened in 1948?
Truman was re-elected and promised national health insurance but by 1950 the issue was dead
