Health Plan and Health Organization Development: Key Events

Introduction

A multitude of historical events in the modern era have drastically changed the way in which health — and the relationship between society and healthcare — has been understood and organized. The following sections examine five key milestones and the socioeconomic forces that shaped them.

Five Key Historical Events in Healthcare

In Germany in 1883, Chancellor Otto von Bismarck implemented a national insurance-like healthcare scheme that ensured basic access to medical care for many working-class Germans who would otherwise have gone without it. A closely related development occurred in England in 1911 with the establishment of a national health insurance program, which eventually became the National Health Service of the United Kingdom — an institution that still provides healthcare services to the nation's citizens today.

The Social Security Act of 1935 represents a major shift in the direction of healthcare policy in the United States, as this legislation laid the groundwork for significant federal involvement in social welfare programs such as Medicaid and Medicare. Challenges with these specific programs began to surface in the 1960s, and the rising costs of medical care prompted a series of legislative efforts to curb healthcare spending beginning in 1966. Healthcare costs continued to rise over the ensuing decades, and spending in medical research and practice in the United States continued to grow as a matter of policy, while actual government provision of medical services remained extremely limited for certain economic and political reasons.

The passage of the Affordable Care Act in 2010 represents the most recent major event signaling a transformation in healthcare plans and organizations in the United States.

Socioeconomic and Legislative Influences

In the latter part of the nineteenth century and the first half of the twentieth century, industrialization began to create ever more stark and extreme differences in the living standards of individuals and families at different rungs on the socioeconomic ladder. Medical care had become far more effective, but remained unaffordable for much of the working class. Governments therefore increasingly recognized both a need and a political pressure to intercede and provide at least a minimum standard of care for their citizens.

There are directly pragmatic economic benefits to such intervention. Improved healthcare leads to increased productivity and reduced costs in other areas of social spending, and may even reduce criminality, as fewer families would find themselves in destitute situations without reliable wage earners due to illness or injury. All of these socioeconomic factors have contributed to a growing sense of social and civic responsibility for healthcare. Nevertheless, the initial and direct expense of a nationally organized system with universal coverage has consistently acted as a dissuasive factor in policy debates.

Healthcare organizations in the United States have been significantly shaped by several key pieces of twentieth-century legislation, including the Social Security Act of 1935 and the adjustments to Medicare and Medicaid made in 1966 and in subsequent years throughout the following decades. The Affordable Care Act, set to go into full enforcement in 2014, was already prompting healthcare organizations and insurance providers to make substantial adjustments in anticipation of those changes — continuing a long pattern of legislative events reshaping the structure and delivery of healthcare in America.

Conclusion