L4_Quiz_4_Questions
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L4: Evolution of Healthcare Services Post-Quiz
The post-quiz each week IS GRADED. The post-quiz is designed to assess that you have learned key points by
the end of the week. You must take the post quiz by Sunday midnight EST.
Learning Objectives:
1. Demonstrate key learnings from previous week’s learning objectives
2. Summarize the characteristics of the three “eras” that the text describes.
3. Describe the drivers of change in the healthcare system
4. Identify major societal events and their contribution to healthcare system change
5.
Explain themes or trends in healthcare system change in the United States
Questions:
1. Identify and describe characteristics of three eras of the U.S. healthcare system from the Mid-18
th
century to
Present.
The three eras discussed are Pre-Industrial, Post Industrial, and Corporate.
The Pre-Industrial era was premature, disorganized, and the U.S. had less medical development that Europe.
Development of poor houses and almshouses, and asylums. There was limited medical study and licensure.
Demand was unstable. There was substandard education and few medical schools. Limited scientific
knowledge. 1800’s through late 19
th
c.
Post industrial era ushered in advancements in medical care. This was the introduction of 3
rd
party payer
scheme. Payment methods change, there was an increase in medical training due to the proliferation of hospitals
and medical schools. The geography of the country was changing with increases in urban population,
improvements in transportation. Science and technology were improving with the proliferation of vaccines,
medical procedures and medical testing. Flexner Report, the American Medical Association (AMA), Blue Cross
Plan, Wage Stabilization Act, Workers Compensation, and the introduction of Medicare and Medicaid in 1965
were other important characteristics of this time. Late 19
th
c. through 20
th
c. Development of Public health
programs; VA programmes.
Corporate era began around 1973 and stretches through today, and introduces HMO, Medicaid expansion,
COBRA (post-employment insurance), Medicare Part D, CHIP (Childrens Health Insurance Program), and
other managed care programs. The HMO Act of 1973 was a political effort to grow prepaid medical service.
During this time There was a concerted effort to get employers to provide health insurance coverage. President
Bill Clinton tried to introduce healthcare reform in 1993. The Patients Protection Affordable Care Act was
introduced to the Congress. Although it was repealed and rejected the first time, it was passed during the
administration of President Obama in 2010.The proliferation of globalization is paramount to medicine and
development of medical profession.
2. Describe what a free market consists of and when if ever this existed in the U.S. related to the delivery of
healthcare.
Free market healthcare existed in the pre-Industrial era. Consisted of payment fee for services rendered.
Medical services rendered depended on factors such as if the consumer could pay for themselves and their
family to even get to a doctor. Not a lot of government or organized delivery systems yet developed. Consumer
would go to whoever was available, whoever was trained and had knowledge of medical procedure.
3. Identify and describe the early settings where healthcare was provided in the U.S.
Well, prayerfully, we all know that Pennsylvania Hospital was established in 1751 in Philadelphia and that Penn
opened the nation’s first medical school in 1756. These were the early developments of our medical schools.
The developing medical care began with the almshouse, based on offering public charity to the poor and
disenfranchised. The pest house offered public health care to persons who needed to be quarantined with
contagious disease symptoms. Dispensaries were established as outpatient clinics where citizens could get free
care. Mental asylums developed out of the responsibility of the government to provide help with persons who
were experiencing mental health difficulties.
Early settings were often ambiguous because there was a primitive approach to medicine during the early
1700’s. The practice of medicine was considered a trade, not a profession. There was no formal education,
licensure or training in the medical profession. The medical profession was weak and disorganized. There were
hardly any standards. Medical procedures were also primitive.
4. What does the term “third party” refer to, what is an example, what era did they arrive and why?
Third party refers to the payment function of healthcare. The government (Medicare/Medicaid), insurance
companies (Blue Cross/Blue Shield, MCO’s) change the way healthcare is delivered. These third-party payers
combined with the patient and the provider determine fees, rates and other charges for service. Third party
payers enter the market as early 1900’s provider plans, such as the Western Clinic Prepaid Plan, and in 1929,
Farmers Insurance, and 1933 Blue Cross Plan. Third party payers expanded the delivery and utilization of
healthcare services to consumers.
5. Identify 5 factors that influenced the nature and delivery of healthcare over the past 250 years.
Urbanization; Licensing; Education; Infrastructure; Organized medicine.
6. What was the Council on Medical Education and Flexner Report and what did they prompt?
Founded in 1904, the Council on Medical Education recommends educational policies. The council collaborates
with other key organizations in medical education, supports the accreditation of medical education programs
and gathers and disseminates medical education data and products/services.
The Flexner Report 1910 established State law requiring graduation from medical school accredited by the
AMA. Established licensure. This resulted in an explosion of hospital built and propagated medical school
education.
7. What were examples of two societal events in the 20
th
century that were instrumental in influencing changes
to the healthcare system with changes lasting until today.
The Great Depression 1929-1939; WWII 1939-1945.
8. What is managed care and a political effort to promote it?
Managed care is a health delivery system that allows for the management of quality and cost of service. This
changed the way healthcare is delivered. This is a value driven delivery based in no overbilling to the consumer,
It established boundaries on what kind of care is delivered. The HMO Act of 1973 was a political effort to grow
prepaid medical service; increase the demand that employers provide an HMO alternative.
9. What are Medicare and Medicaid and when were they passed?
Medicare and Medicaid are government sponsored health policy programs established in 1965. Congress passed
amendments to Social Security Act sponsoring a direct responsibility for paying for healthcare for the poor and
the elderly.
10. What are examples of political administrations that attempted healthcare reform in the 20
th
and 21
st
century?
FDR 1933-45; Kennedy 1961-63; Johnson (Medicaid) 1963-69; Nixon (HMO) 1973; Clinton attempted to
reform healthcare in 1993; Obama (ACA) 2010.
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