History of Health Care in America (D393)
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History of Health Care in America (D393) - Study Notes
1. Introduction to Health Care History in the U.S.
Health care in the United States has evolved over centuries from informal community-based care to a complex, institutionalized, and technology-driven system. Studying its history helps us understand current challenges, including disparities, financing issues, and reform efforts.
2. Colonial to 19th Century Developments
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Medical care in colonial America was largely home-based and provided by family members or midwives.
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Physicians were scarce and poorly trained.
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The first hospitals were founded, like Pennsylvania Hospital in 1751.
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Medical schools began forming but lacked standardization.
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Health care was reactive rather than preventative.
3. Public Health Movement and Sanitation
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Rapid urbanization led to overcrowding and disease.
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The Sanitary Movement emphasized clean water, waste disposal, and hygiene.
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Led by reformers like Lemuel Shattuck, who pushed for organized public health systems.
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Public health agencies formed to manage outbreaks and promote sanitation.
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Cholera, yellow fever, and tuberculosis outbreaks spurred action.
4. The Emergence of Hospitals and Professional Medicine
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The 20th century saw standardization of medical training.
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The American Medical Association (AMA) formed in 1847 to regulate practice.
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Sponsored by the Carnegie Foundation.
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Assessed the quality of medical education.
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Led to the closure of substandard schools and improved medical curricula.
5. Health Insurance Evolution
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Began with sickness funds and workers’ compensation.
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Baylor University Hospital created a prepaid model for teachers in the 1920s (a precursor to Blue Cross).
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Grew during WWII due to wage freezes.
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Tax incentives encouraged employer-provided benefits.
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Medicare and Medicaid introduced in 1965.
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Covered the elderly, poor, and disabled.
6. Government Involvement and Health Programs
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Provides coverage for individuals 65+ and certain disabilities.
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Includes hospital (Part A), medical (Part B), and prescription coverage (Part D).
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Joint federal-state program for low-income individuals.
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Coverage and eligibility vary by state.
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Offers services to military veterans.
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Social Security Act (1935)
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Health Maintenance Organization Act (1973)
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Children's Health Insurance Program (CHIP, 1997)
11. Case Study 1: The Flexner Report
Scenario: In the early 1900s, U.S. medical education was fragmented and poorly regulated. Abraham Flexner was commissioned to evaluate medical schools across North America. His 1910 report criticized substandard institutions and called for reform. Schools that did not meet academic and clinical standards were shut down or merged.
Analysis: The Flexner Report reshaped American medicine by promoting rigorous scientific training and institutional accountability. It led to the closure of many for-profit schools and increased the prestige of the medical profession. This case illustrates how policy-driven evaluation can enhance quality and standardization. It also highlights the importance of aligning education with evolving public needs—a key theme in health system evolution.
12. Case Study 2: The Impact of Medicare
Scenario: Before 1965, nearly half of Americans over 65 lacked health insurance. With rising costs and declining employer support, the elderly were especially vulnerable. The introduction of Medicare ensured nearly universal health coverage for seniors, improving access to care and financial stability.
Analysis: Medicare exemplifies how targeted federal intervention can address structural gaps in the health system. It reduced poverty among seniors and enhanced their access to hospitals and physicians. The program's implementation reflects a key shift from private to public responsibility in health care financing. This case also underscores the lasting effects of social insurance policies on population health outcomes.
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The questions align closely with the WGU D393 objectives, covering essential topics such as public health evolution, industrialization’s impact, and key legislation influencing modern health care.
The guide includes 300+ practice questions, detailed rationales, real-world case studies, and concise reviews of historical milestones, health policies, and equity in health care.