A Century of Care Healthcare Trends in America

Healthcare Trends in the US

Introduction

The evolution of health care services in the United States over the past 100 years has been due to significant technological and procedural advancements, the advance of specialized medicine, societal shifts in needs, policy changes, and the roles of various healthcare professionals as they have become more defined. The United States\\\\\\\' healthcare system has thus changed drastically from its early stages in the early 20th century, to the rise of consumer culture in medicine, to the more technologically advanced and policy-driven health arena of the 21st century. This century-long change tells a story of one nation’s health beliefs, priorities, challenges, and solutions. This paper looks at the major trends that have shaped healthcare services in the U.S. over the past 100 years, and it also examines the important role that policy has played in shaping this change.

Early 20th Century (1900-1940)

Tomes (2001) notes that in the early 20th century, commodification of health got underway. The US was in the midst of industrialization and urbanization, and a new consumer class had emerged. Medical companies came into existence, which led to the widespread trend of patent medicines. These were often over-the-counter remedies, touted as cure-alls for a variety of ailments, even though many had questionable efficacy (Conrad & Leiter, 2008).

At the same time, there was the emergence of pharmacies as commercial hubs. Prior to this, pharmacies were more like general stores and sold a mix of medicinal and non-medicinal products. However, with the rise of consumer culture, these shops transformed into specialized establishments focusing solely on medicines and health-related products. This change was also influenced by the increasing complexity of drug formulations, which required specialized knowledge and equipment (Zebroski, 2015).

There were also efforts to standardize practice in the medical profession. Before this era, the field of medicine in the U.S. was somewhat chaotic. Quality of care might vary considerably, and medical professionals began to organize to address concerns about safety and best practices. The establishment of professional organizations like the American Medical Association (AMA) was instrumental in setting standards for medical education and practice and later policy. These organizations advocated for rigorous medical curricula, standardized examinations, and the establishment of licensing boards (Lemley, 2022).

At this time, the Flexner Report of 1910 was also commissioned by the Carnegie Foundation. Abraham Flexner conducted an evaluation of medical schools across the U.S. and made recommendations for improvements. His report drew attention to the importance of scientific research in medical education and called for graduation standards (Christophers et al., 2022). The result was that many substandard medical schools closed.

Mid 20th Century (1940-1980)

The mid-20th century brought about further changes. In fact, a lot of the kernels of what is today associated with healthcare were brought about at this time. After World War II, for example, there was a significant expansion of employer-sponsored health insurance. This expansion was in response to wage controls that made work benefits more attractive. A landmark policy shift occurred in 1965 with the introduction of Medicare and Medicaid in the U.S. (Tuohy, 2023). These programs provided health insurance for the elderly and low-income populations, but as Andersen and Newman (1973) show, the social determinants of healthcare depended on factors like social structure, health beliefs, and the ability to pay. These were key issues in determining who had access to healthcare.

Late 20th Century to Early 21st Century (1980-2020)

The period from 1980 to 2000 saw the rise of managed care organizations. These organizations came about so as to control for healthcare costs by managing the type of services that they offered to the public. Nurse practitioners began to play a more central role in healthcare delivery at this time as well, as doctors left primary care for specialized medicine, leaving a gap that needed to be filled in primary care (O’Brien, 2003). As O’Brien (2003) shows, nurse practitioners achieved provider status through advanced training for the specific purpose of becoming primary care providers. However, not all states recognized them as being able to act to the full capacity of their training. Thus, even though they could theoretically improve access to care by acting independently as primary care providers, many advanced practice nurses still continued to work in a secondary role. Additionally, this era was marked by a rise in pharmaceuticals.