Evolution of the American healthcare delivery system structure

¶ … structure of the American Healthcare System has long been a topic of much debate. The purpose of this discussion is to trace the evolution of the structure of the American system delivery service. We will begin with a timeline of the healthcare system. We will then examine the evolution of the structure of the healthcare delivery system.

Timeline

According to a timeline created by PBS the evolution of healthcare delivery services has been dramatic. At the start of the 20th century the American medical Association becomes a very important organization for doctors. In the ten years between 1900 and 1910 the membership of the American Medical Association goes from 8,000 to 70,000. It is during this time frame that the AMA gained a tremendous amount of respect and physicians focused on ways to deliver organized medicine to Americans. ("Healthcare Crisis: Healthcare crisis")

During the ten-year span between 1900 and 1910, Surgeries to remove tonsils and tumors were common. It was during this time that many surgeries were being perfected by physicians. This allowed doctors all over the country and around the world to better understand the human body and doctors could share their expertise with other physicians. ("Healthcare Crisis: Healthcare crisis")

The most significant development of the time was that doctors were allowed to charge patients in hospitals a fee for the care that they received. Prior to that time physicians performed the work for free. Compensation for physicians was a milestone in the medical world at that time and ultimately physicians would become some of the highest paid professionals in the country. ("Healthcare Crisis: Healthcare crisis")

Compensation for physicians also led to some of the first employer sponsored medical programs for workers. According to the PBS timeline, the Railroad industry was among the first to implement comprehensive employee medical benefits. ("Healthcare Crisis: Healthcare crisis") Medical benefits allowed workers to receive healthcare with very little out of pocket expense. The development of health benefits was beneficial to the railroads because the cost associated with losing an employee to illness was greater than the cost of providing the workers with healthcare benefit. So then the implementation of such benefits was beneficial to both the employee and the employer.

During the 1920's the cost of healthcare rose sharply and affected the middle class in ways that had never been seen before. The rise in expenses associated with the delivery of healthcare services was compounded by the fact that the federal government was not attempting to stabilize the cost of healthcare. However, employers were attempting to aid employees with healthcare expenses and General Motors teams up with Metropolitan Life to ensure that 180,000 employees had the proper medical coverage.("Healthcare Crisis: Healthcare crisis")

By the 1950's healthcare expenditures compose 4.5% of GDP. Many working Americans had private insurance and the poor were granted healthcare through welfare programs. ("Healthcare Crisis: Healthcare crisis")

The 1970's saw the advent of Health Management Organizations (HMO). Richard Nixon implemented HMO's which are susceptible to certain government regulations and government assistance. Also during this time,

Healthcare costs are escalating rapidly, partially due to unexpectedly high Medicare expenditures, rapid inflation in the economy, expansion of hospital expenses and profits, and changes in medical care including greater use of technology, medications, and conservative approaches to treatment. American medicine is now seen as in crisis." ("Healthcare Crisis: Healthcare Timeline")

During the 80's and 90's the structure of the hospital system begins to become more centralized because corporations begin to consolidate the system. During the 80's the structure of Medicare also changes and begins to grant payment by diagnosis. In the 90's the cost of healthcare increased to twice the rate of inflation and managed care was expanded. By the year 2000, sixteen percent of America's citizens did not have any healthcare coverage.

As you can see the American healthcare system changed drastically during the twentieth century. Much of this change was due in part to the industrial revolution and the increase in the number of women that joined the workforce. The industrial revolution caused such changes in the healthcare system because production became essential to the American way of life. Business owners understood that the productivity of employees was essential to the prosperity and success of the business. Employers wanted to make sure that employees had access to medical care so that absenteeism would be minimized because absenteeism leads to a reduction in productivity.

The increase in the number of women joining the workforce also had an impact on the changes in the healthcare system. Businesses found that women were good workers and they wanted them to remain a part of the workforce. To accomplish this business had to offer the women health benefits and maternity leave. In addition, during the 80's and 90's there was an increase in the number of single mothers. Business owners recognized that healthcare benefits needed to be extended to these women and their children.

Now that we have discussed the societal influences that led to many of the changes in the healthcare system during the twentieth century, let's discuss the technical side of the evolution. The technical aspects of the evolution have to do with the institutions that make up the healthcare system and the logistical changes these institutions have undergone and a result of the information age.

Conclusion

The purpose of our discussion was to examine the structural changes in the delivery of healthcare services. We discovered that the healthcare system changed dramatically during the twentieth century. These changes included the advent of healthcare plans and the development of Medicare. We also found that many structural changes have also occurred within the institutions that make up the healthcare system. We concluded that rates of change for the institutions are at different levels which have left the healthcare system broken.