CHAPTER 3- The evolution of Health Services in the US Flashcards
Eras of health care
- preindustrial era
- postindustrial era
- corporate era
- Era of health care reform
preindustrial era
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
pre.i: medical practice in disarray
- 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
pre.i: primitive medical procedures
- tradition over science, five senses and experience
- bleeding
- surgeries limited no anesthesia
- antiseptic techniques not developed
pre.i: missing institutional care
- no development of hospitals pre 1880 (did in Europe)
- most hospitals served as social welfare function (poor, no families, travelers) (almshouse, pesthouse)
pre.i: unstable demand
- 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
pre.i: substandard medical education
- training received from individual apprenticeship
- only 4 medical schools in US during 1800
- deficient in science based training
postindustrial era
- 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
post.i: growth of professional sovereignty: urbanization
- 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
post.i: growth of professional sovereignty: science and technology
- 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
post.i: growth of professional sovereignty: institutionalization
- professionalization, tech. advance, and urbanization called for an institutionalization of medical care
- hospitals expanding, physicians had large control over hospital policy
post.i: growth of professional sovereignty: dependency
- patients depended on medical professional’s judgment and assistance
- developed through social norms, cultural authority
post.i: growth of professional sovereignty: autonomy and organization
- government really isn’t involved
- ama established
post.i: growth of professional sovereignty: licencing
- state licensing hospitals and physicians to practice
- Medical Practice Acts 1870’s
post.i: growth of professional sovereignty: education reform
- 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
rise of private health insurers: tech. social, and economic factors
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
rise of private health insurers: early blanket insurance policies
- 1911 insurance companies offered blanket policies for large industrial populations
- usually covered life insurance, accidents and sickness, and nursing services
rise of private health insurers: the Baylor Plan
- 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
Blue cross
hospital care
Blue shield
physician care
employment based insurance plans
- 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
1943
wagner, murray, dingell bill dies
1946
Harry Truman National Health care
1992
Bill Clinton Nation health care
