Question

• Provide an overview of how health care in the United States has evolved since the postindustrial period.
• How has the evolution of medical technology, graduate medical education, and the professionalization of medical and nursing staff affected the delivery of care?
• Why has the United States been unsuccessful in evolving the current health care system into a national health care system?

PLEASE USE EXAMPLES

Answer 1

Between the years 1750 and 2000, healthcare in the United States evolved from a simple system of home remedies and itinerant doctors with little training to a complex, scientific, technological, and bureaucratic system often called the "medical industrial complex." The complex is built on medical science and technology and the authority of medical professionals. The evolution of this complex includes the acceptance of the "germ theory" as the cause of disease, professionalization of doctors, technological advancements in treating disease, the rise of great institutions of medical training and healing, and the advent of medical insurance. Governmental institutions, controls, health care programs, drug regulations, and medical insurance also evolved during this period. Most recently, the healthcare system has seen the growth of corporations whose business is making a profit from healthcare.

Women were expected to take care of illnesses within the family and only on those occasions of very serious, life threatening illnesses were doctors summoned. Called "domestic medicine," early American medical practice was a combination of home remedies and a few scientifically practiced procedures carried out by doctors who, without the kind of credentials they must now have, traveled extensively as they practiced medicine.

The practice of midwifery

      —attending women in childbirth and delivering babies

       —was a common profession for women, since most births took place at home

Physicians with medical degrees and scientific training began showing up on the American landscape in the late colonial period. The University of Pennsylvania opened the first medical college in 1765 and the Massachusetts Medical Society

Medical schools were often opened by physicians who wanted to improve American medicine and raise the medical profession to the high status it enjoyed in Europe and in England. With scientific training, doctors became more authoritative and practiced medicine as small entrepreneurs, charging a fee for their services

In the early 1800s, both in Europe and in the United States, physicians with formal medical training began to stress the idea that germs and social conditions might cause and spread disease, especially in cities. Many municipalities created "dispensaries" that dispensed medicines to the poor and offered free physician services. Epidemics of cholera, diphtheria, tuberculosis, and yellow fever, and concerns about sanitation and hygiene, led many city governments to create departments of health. New advances in studying bacteria were put to practical use as "germ theory" became the accepted cause for illness. It was in the face of epidemics and poor sanitation, government-sponsored public health, and healthcare that private healthcare began to systematically diverge.

A trend toward physicians needing more training led to the Johns Hopkins University's medical school's requirement in 1893 that all medical students arrive with a four-year degree and spend another four years becoming a physician.

As the nineteenth century ended, advancements in biology, chemistry and related medical sciences meant that the great diseases—tuberculosis, yellow fever, diphtheria, cholera, and others—were practically eliminated with the development of diagnostic tests and vaccines. Extensive public health projects, aimed at fighting the causes of disease or to prevent their spreading, raised the levels of public health. Healthcare extended into the schools through school nurses.

The post-World War II era saw great expansions in the workforce, advancements in medical science and medical care, and increasing healthcare costs

Advances in medicine in diagnostic techniques, such as x rays, life saving drugs, such as penicillin, and inoculations against diseases, such as polio, had created an ever-deepening scientific culture that included laboratory technicians, therapists, and widening roles for nurses, and increasing specialization among physicians.

Communications advancements such as the Internet and the World Wide Web in the 1990s added to the health information available to consumers. Also at this time, consumer interest grew in "alternative medicine," such as acupuncture, herbal preparations, and vitamin therapies. These interests could be seen as a reaction against the medical industrial complex.

U.S. government research and health institutions and programs, such as the National Institutes of Health and the Centers for Disease Control, were established. The 1960s saw the initiation of social programs to aid in the medical care of the aged (Medicare) and poor (Medicaid). Prior to the founding of these institutions, the U.S. government had founded other health programs and institutions, such as the Indian Health Service, the U.S. Public Health Service, the Food and Drug Administration, and established an executive cabinet-level agency, the Department of Health and Human Services.