Question

How did the historical evolution of healthcare in the United States contribute to the way care is being delivered? Did this process lead to over-utilization? Did it address needs in ways that were appropriate for a particular time period?

Answer 1

In the past,patient behaviours within the health care delivery system were formed from the authoritarian positions of better-educated providers who expected patients to be compliant and grateful.Today health care providers and consumers encourage more proactive roles for patients participation in health care decisions with shared decision-making.From the colonial times to late 1800s,medical education and practice were far more advanced in Great Britain,France,and Germany than they were in the US.Practice in the US was domestic rather than professional because the medical practices were primitive.Medical education was not grounded in science-medical practice was more of a trade than a profesion.There was no health insurance at the time;health care had to be purchased using private funds and health care was delivered in a free market.The first hospital was created in Philadelphia in 1752,Benjamin Franklin,realized that not only did the sick and injured need a place to be cared for,but there also needed to be a place to isolate immigrants who might be carrying diseases from Europe.In the 20 years betwen 1890 and 1910,surgery became established,with commonly performed surgeries for appenddicitis,gallbladder disease and stomach ulcers.Home Surgery was discontinued as more hospitals were formed.Existing hospitals began focusing on more acute periods of illness,instead of being places where chronically ill people lived.The average length of stay fell from 30 days in 1870 to 15 days in 1900.Additionaly middle class persons started coming to the hospital.Between 1960-1980 ,patients out-of-pocket costs declined and public insurance increased in the form of Medicare and Medicaid.Medical technologys rapid growth transformed hospitals into places for treating all patients ,whether they are rich or poor .Hospitals attracted physicians by offering them perks such as office space and the latest in technology.Between 1980 and today,HMOs have become a more common source of patients.Hospitals advertise more and more purchase previously private physician practices.Because of managed care,inpatient admissions have declined and many smaller hospitals have closed or have merged.Surgical procedures are more likely to be done on an outpatient basis.