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

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

3. 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.

4. 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

5. 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.

6. 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.

7. 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.

8. 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

9. 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.

10. 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

11. History of Health Insurance  Medicare—A, B, C, and D 1960—A and B coverage for elderly Americans for hospital and doctor care. 1965-C coverage of low income Medicaid a state sponsored program 2003—D provided prescription drug benefit

12. 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 E-mail scans for consultation Webinar

13. 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.

14. 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.