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HTH354 > CHAPTER 3- The evolution of Health Services in the US > Flashcards

CHAPTER 3- The evolution of Health Services in the US Flashcards

1
Q

Eras of health care

A
  • preindustrial era
  • postindustrial era
  • corporate era
  • Era of health care reform
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2
Q

preindustrial era

A

colonial times to 20th century
Europe doing well Americans neglected research and American attitudes strong emphasis on natural history and conservative common sense
domestic rather than professional

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3
Q

pre.i: medical practice in disarray

A
  • medical practice did not require education and training
  • midwives, clergy men, barbers
  • competitive
  • unorganized
  • physicians did not enjoy same benefits as today
    1870 reformed education and licensing required
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4
Q

pre.i: primitive medical procedures

A
  • tradition over science, five senses and experience
  • bleeding
  • surgeries limited no anesthesia
  • antiseptic techniques not developed
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5
Q

pre.i: missing institutional care

A
  • no development of hospitals pre 1880 (did in Europe)

- most hospitals served as social welfare function (poor, no families, travelers) (almshouse, pesthouse)

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6
Q

pre.i: unstable demand

A
  • professional services suffered from low demand
  • competent physicians located in more populated communities
  • people accustomed to treating sick using folk remedies no one sought out doctors
  • people couldn’t afford doctor care because the cost of transportation was too high
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7
Q

pre.i: substandard medical education

A
  • training received from individual apprenticeship
  • only 4 medical schools in US during 1800
  • deficient in science based training
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8
Q

postindustrial era

A
  • American physicians unlike others were able to retain private practice
  • advanced services
  • organized medical professional, with power prestige, and financial success
  • medicaid and medicare and MCO’s
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9
Q

post.i: growth of professional sovereignty: urbanization

A
  • increased reliance on the specialized skills of paid professionals because urbanization:
  • distanced people from families who would usually care for them
  • women worked cant care for family
  • less expensive due to transportation advancements
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10
Q

post.i: growth of professional sovereignty: science and technology

A
  • bacteriology, antiseptic, anesthesia, immunology, diagnostic techniques, new drugs
  • cultural authority: general acceptance of and reliance on the judgment of the members of a profession because of their superior knowledge and expertise
  • demand for advanced services
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11
Q

post.i: growth of professional sovereignty: institutionalization

A
  • professionalization, tech. advance, and urbanization called for an institutionalization of medical care
  • hospitals expanding, physicians had large control over hospital policy
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12
Q

post.i: growth of professional sovereignty: dependency

A
  • patients depended on medical professional’s judgment and assistance
  • developed through social norms, cultural authority
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13
Q

post.i: growth of professional sovereignty: autonomy and organization

A
  • government really isn’t involved

- ama established

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14
Q

post.i: growth of professional sovereignty: licencing

A
  • state licensing hospitals and physicians to practice

- Medical Practice Acts 1870’s

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15
Q

post.i: growth of professional sovereignty: education reform

A
  • shift in profiting medical schools that were biased, to schools like hopkins and harvard
  • standardizing of training
  • AAMC founded in 1876 `council of medical education
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16
Q

rise of private health insurers: tech. social, and economic factors

A

need for for insurance to cover financial risk

  • new and better treatments, prices increase
  • medical care was desirable because of its well established benefits = growing demand
  • economically people cant predict when they will need health care
17
Q

rise of private health insurers: early blanket insurance policies

A
  • 1911 insurance companies offered blanket policies for large industrial populations
  • usually covered life insurance, accidents and sickness, and nursing services
18
Q

rise of private health insurers: the Baylor Plan

A
  • Great depression forced hospitals to require patient fees
  • patients stopped coming all together
  • 1929 blueprint for modern health care, Justin Kimball
  • enrolled teachers who paid 50 cents a month for 21 days of hospital care
  • Turned into blue cross plans
  • beginning of employment based insurance
19
Q

Blue cross

A

hospital care

20
Q

Blue shield

A

physician care

21
Q

employment based insurance plans

A
  • ww2
  • wage freezes
  • incentives people to work for them by offering health insurance
  • 1948 supreme court, offering health insurance can be a part of union bargaining
  • 1954 HI is tax exempt
22
Q

1943

A

wagner, murray, dingell bill dies

23
Q

1946

A

Harry Truman National Health care

24
Q

1992

A

Bill Clinton Nation health care

25
Q

who were the two presidents that proposed nation health care?

A

Bill Clinton and Harry Truman

26
Q

Title XVIII social security act
part A
part B

A 
1965 FDR
part A --> kerr mills --> medicaid 
hospital insurance, nursing homes
part B 
covers physician bills through gov. subsidized insurance
27
Q

Opponents of national health care

A

AMA (communist commercial)
Labor Unions
Insurance and pharmaceutical companies

28
Q

Title XIX social security act

A

1965 FDR

medicaid

29
Q

Who singed the social security amendments

A

Johnson

30
Q

Corporate era

A
  • cost increase
  • coporization of health care delivery
  • information revolution (internet)
  • globalization
31
Q

Era of Health care reform

A
  • passage of ACA, 2 supreme court rulings, states set precedence
32
Q

What are the two states that set a precedence for health care reform?

A

Oregon and Mass.

33
Q

Oregon plan

A

1980

  • expansion of medicaid
  • insurance pool (gave insurance to people who were being denied coverage due to preexisting conditions)
  • tried to get an employe mandate
34
Q

Massachusetts plan

A

2006 romney

  • individual mandate everyone needs insurance
  • employer mandate
  • large gov subsidies
  • “health exchange”
  • ACA modeled after this
35
Q

ACA

A
  • individual mandate
  • expansion of public programs; states have choice whether to expand medicaid
  • health benefit exchange
  • changes to private insurance: have to cover pre existing conditions, 26 yrs coverage
  • employer requirements: 50 or more employees

HTH354 (8 decks)

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