History of the U.S. Health Care System

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.