Question

THIS IS A HEALTH SYSTEMS CLASS

Health care is ever evolving. What are some characteristics of health care preindustrial America? Which one (or ones) do you believe were the most influential? Why? What are some characteristics of health care postindustrial America? Which one (or ones) do you believe were the most influential? Why?

Answer 1

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in human beings. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

"Health care services" means the furnishing of medicine, medical or surgical treatment, nursing, hospital service, dental service, optometrical service, complementary health services or any or all of the enumerated services or any other necessary services of like character, whether or not contingent upon sickness.

Health Care Delivery in Pre-industrial America

• Medical training and education not grounded in science
• Primitive medical procedures were practiced.
• Intense competition existed because any tradesman could practice medicine
• People relied on family members, neighbors, and publications for domestic remedies
• Physicians’ fees were paid out of personal funds
• Health care was delivered in a free market
• Hospitals were few and located only in big cities
• Hospitals had poor sanitation and unskilled staff
• Almshouses served the destitute and disruptive elements of society and provided some basic nursing care
• State governments operated asylums for patients with untreatable, chronic mental illness.
• Pesthouses quarantined people with contagious diseases.
• Dispensaries delivered outpatient charity care in urban areas.
• Until around 1870, medical training through apprenticeship (rather than university)
• Ironically, those doing the training themselves were poorly trained!
• Training a class could make more money than just training individual apprentices, so some tried to open schools
• Lack of facilities and ability to confer degrees prompted these “physicians” to affiliate with local colleges
• In 1850, about 42 of these “medical schools” were in operation in the U.S.

Medical Services in Post-industrial America

• Since 1847 (pre-industrial), took a back seat to uncoordinated actions of individual physicians competing in marketplace
• Organized members into state- and county-level societies
• Started controlling medical education
• Lobbied states for medical licensing laws
• Discouraged “corporate control” – physicians working for hospitals or insurances
• AMA (American Medical Association) succeeded!
• Prescriptions require physician authorization, health insurance only pays when prescribed by physician, etc.
• 1869-Howard University School of Medicine got established to prepare black physicians to practice medicine.
• 1871-Harvard Medical School changed the academic year to follow the European model
• 1876-Meharry Medical College established to prepare black physicians to practice medicine
• 1893-Johns Hopkins University changed entrance requirements to medical school to include an undergraduate degree, not just high school diploma
• 1910-Flexner Report found widespread inconsistencies in medical training.
• 1910-Council on Medical Education formed by AMA, it pushed for state laws requiring graduation from medical school for licensure.

Development of Hospitals

• The industrialization of medicine
• Physicians could no longer afford equipment, facilities, etc.
• Hospitals needed physicians to keep their beds filled
• Informal alliances between physicians and hospitals – physicians were not employed there, but had a strong say in hospital operations
• As more hospitals became available, competition for physicians’ patients started to influence hospital policy