HCM632 Unit 1 Individual Project CH
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UNIT 1 INDIVIDUAL PROJECT
1
Unit 1 Individual Project: The Evolution of American Healthcare in the Postindustrial Period
Colorado Technical University HCM632
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Unit 1 Individual Project
The delivery of healthcare in America has changed significantly since its inception, in the
form most recognizable to that of the modern day, in the 1930s following the Great Depression. Rapid, uncontrolled inflation in healthcare cost prompted the creation of workers compensation plans and voluntary health insurance, which more closely resembled disability insurance than the
managed care health insurance plans of today (Shi & Singh, 2019). The American postindustrial period incited as much change in healthcare as in all other forms of industry during that time. Scientific and technological advancements in the medical field led to increased medical sovereignty and cultural authority of physicians, while medical educational reform advanced the public’s trust in and reliance on medical professionals. American physicians benefited professionally and financially from the organization and autonomy attained during that period, a harbinger of their resistance to the implementation of nationalized healthcare throughout the 20
th
century. In lieu of a national healthcare system, legislation has enacted incremental changes in that direction through the federally funded programs of Medicare and Medicaid, which provide healthcare to the elderly and indigent. The rest of the American population relies heavily on employer-based health insurance, controlled predominantly by private insurance companies and managed care organizations. The transformation of healthcare delivery in America following the postindustrial period, denoted by significant medical technological advancement, the conception of organized medicine, and revolutionary medical education reform, laid the foundation for the highly privatized and fragmented healthcare delivery system in America today.
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Several factors played key roles in the evolution of the delivery and financing of healthcare in America during the postindustrial period. Three of these factors specifically focused on in this paper are scientific and technological discoveries, educational reform, and the organization and autonomy of the medical profession. Scientific advancements including the discovery of anesthesia, the widespread acceptance of antiseptic and sterilization techniques, and
the development of diagnostic testing such as radiography simultaneously helped legitimize the medical profession and required more specialized training to become a physician (Emanuel, 2017). Science-based medical practice and the invention of effective therapeutic drugs caused a shift from the family and community-based healthcare of the past toward more costly services that could only be provided by medical professionals. The delivery of healthcare became heavily influenced by physicians’ decisions, dictating which patients required hospital stays, surgical intervention, and access to prescription medications. Payment on workers compensation and private insurance claims became contingent upon a physician’s assessment, inextricably linking the processes of healthcare delivery and healthcare financing. Medical education in America lagged far behind that of European medical schools throughout the 19
th
century. As the medical profession gained complexity, longer and more specialized training was required to produce effective physicians. At the turn of the 20
th
century, American medical colleges began implementing the European model of medical education by increasing the number of years of study required, introducing clinical and laboratory courses in addition to literary learning, and making an undergraduate degree a requirement to attend medical school (Shi & Singh, 2019). While this more rigorous medical education cultivated legitimacy and trust in the medical profession, that combined with the introduction of more
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advanced medical procedures and technology, healthcare costs began to increase significantly. These rising healthcare costs provided a foot hold for privatized and employer-based health insurance plans to dominate the American healthcare industry.
The organization and autonomy of the medical profession granted physicians influence and leverage to directly affect the healthcare delivery system in America for their own benefit. At the start of the 20
th
century, the American Medical Association (AMA) touted goals of increasing quality of patient care, protecting patients from undereducated physicians, and advancing the professionalization and respect of their members. The AMA played a pivotal role in medical educational reform by creating a process of accreditation for medical schools and advocating for medical licensure to be predicated on graduation from one of these accredited facilities. Formerly an individualistic and divisive group, American physicians began to unify and use that strength to push for change within the medical profession, demarcating the beginning of the era of organized medicine. This collaborative effort did not only benefit physicians, but also contributed to numerous patient safety initiatives, such as the shift towards more comprehensive medical record keeping and the enforcement of disciplinary action for licensed physicians found guilty of incompetence or malpractice (Roy, 2021).
While American healthcare was progressing rapidly compared to the previous century, there remained a significant shortcoming in comparison to healthcare in many European countries; the inability to implement a nationalized healthcare system providing access to medical care for all citizens. This can be attributed to varying factors throughout the 20
th
century.
Physicians, having gained significant prominence and wealth during this time, opposed a national healthcare system that they feared would lead to excessive government oversight, loss of
autonomy, and lowered payments for their services. The AMA supported the opinions of their
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membership by fundraising and successfully lobbying against nationalized healthcare whenever legislation was proposed by Congress. Another major obstacle to the implementation of national healthcare in America is the significant cost of such a program, including infrastructure changes to the entire healthcare system at the governmental and provider level, as well as the considerable cost of insuring and treating previously uninsured citizens who have not had sufficient preventative care up to this point (Zieff, 2020). The introduction of the Medicare and Medicaid programs to provide healthcare coverage for elderly and low-income populations and the recent healthcare reform initiated by the Affordable Care Act to cover citizens without employer-based health insurance demonstrate incremental progress towards a national healthcare
program that serves all people. As the process of healthcare delivery in America is constantly changing and evolving, the realization of a national healthcare system at some point in the future will remain a distinct possibility.
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References
Emanuel E. J. (2017). Reforming American Medical Education.
The Milbank Quarterly
,
95
(4), 692–697. https://doi.org/10.1111/1468-0009.12291
Roy C. G. (2021). Patient Safety Functions of State Medical Boards in the United States.
The Yale Journal of Biology and Medicine
,
94
(1), 165–173.
Shi, L., & Singh, D. (2019). Delivering Health Care in America: A Systems Approach
(7th ed). Jones & Bartlett Learning.
Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal Healthcare in the United States of America: A Healthy Debate.
Medicina (Kaunas, Lithuania)
,
56
(11), 580. https://doi.org/10.3390/medicina56110580
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