History of the U.S. Health Care System Aaron Saenz

Three Eras of U.S. Health Care  Pre-Industrial 1700s – 1800s  Post-Industrial 1800s s  Corporate Era 1900s - Present

Pre-Industrial Era  Medical Training--not science based.  Two year program--three to four months in classroom setting and repeat same courses for second year.  Medical schools usually a group of three or four doctors that taught on a fee for class service. Doctors learned under an apprenticeship process similar to that of other trades.

Pre-Industrial Era  No licensure process, therefore, anyone could be a “doctor.” Barbers were often the town doctor that is where the red/white pole comes from: blood and bandages.  House calls—the doctor was usually called to the home of the sick and was paid by trading goods for services

Pre-Industrial Era  Family—households relied heavily on family members to nurse back to health  Penthouses—institution to isolate contagious people (TB, smallpox)  Almshouses—a place for the poor and sick to receive “healthcare,” which usually meant a place to lock them away from society.

Post-Industrial Era  Medical Education expanded—3 year graduate program at Harvard and Johns Hopkins.  Flexner Report—found that medical schools were not the same.  Council on Medical Education— Accrediting body of the AMA set the standard of a medical degree. Schools not accredited were closed.

Post-Industrial Era  Urbanization—as the population moved to the city, the need for physician offices increased Office based services replaced housecalls  Specialization—as the need for more doctors arose, the need for specialties such as ENT, Pediatrics, and so on.

Post-Industrial Era  Germ Theory—disease was caused by microorganisms. Antiseptic practices—sterilize equipment, room and barriers between patient and doctor. Development of drugs  antibiotic, vaccine, anesthesia More complex surgeries could be performed

Post-Industrial Era  Hospitals—the modern hospital began to take shape. More funding to purchase advance technology that doctor's offices could not afford. Doctor and hospital relationships began to build  AMA worked to keep physician power, but not allowing hospitals to employ doctors directly.

History of Health Insurance  Worker’s Compensation—program developed to pay workers that were injured on the job, died, or disabled.  Blue Cross—First private health plan offered for hospital coverage.  Blue Shield—First insurance for coverage of physician care  Failure of National healthcare—due to the capitalistic nature of U.S. no universal healthcare was ever started

History of Health Insurance  Medicare—A, B, C, and D 1960—A and B coverage for elderly Americans for hospital and doctor care C coverage of low income Medicaid a state sponsored program 2003—D provided prescription drug benefit

Corporate Era  Health Maintenance Organization— dominance as major form of insurance because use immense purchasing power to obtain huge discounts on care.  Information Age—electronic health record began to be use to transport patient information scans for consultation Webinar

Corporate Era  Globalization—patients can travel out of country to receive care. Bioterrorism—hospitals must be equipped to manage community threats Epidemics—increased air travel allows the spread of communicable diseases across the globe.

Conclusion  Without the development of the germ theory, medicine would not be the same No vaccines, anesthetic drugs, antibiotics  Capitalistic values—the American society will most likely never pass universal healthcare  Hospitals actually provide care for the patient instead of a hide-a-way insituitution.