This paper surveys the major trends that shaped healthcare services in the United States over the past century. Beginning with the commodification of medicine and the rise of pharmacies in the early 1900s, it moves through the post-World War II expansion of employer-sponsored insurance and the landmark introduction of Medicare and Medicaid in 1965. The paper then examines the managed care era, the growing role of nurse practitioners, and pharmaceutical growth from 1980 onward. Finally, it considers how the Affordable Care Act, the Trump Administration's policy reversals, and technological advances such as telemedicine and electronic health records shaped care delivery into the 21st century.
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The evolution of healthcare services in the United States over the past 100 years has been driven by significant technological and procedural advancements, the growth of specialized medicine, societal shifts in needs, policy changes, and the increasingly defined roles of various healthcare professionals. The United States' healthcare system has changed drastically from its early stages in the early 20th century, through the rise of consumer culture in medicine, to the more technologically advanced and policy-driven health arena of the 21st century. This century-long transformation tells a story of one nation's health beliefs, priorities, challenges, and solutions. This paper examines the major trends that have shaped healthcare services in the U.S. over the past 100 years and considers the important role that policy has played in driving this change.
Tomes (2001) notes that in the early 20th century, the commodification of health got underway. The U.S. 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, pharmacies emerged as commercial hubs. Prior to this era, pharmacies resembled 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, and the quality of care varied considerably. Medical professionals began to organize in order 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 for policy. These organizations advocated for rigorous medical curricula, standardized examinations, and the establishment of licensing boards (Lemley, 2022).
The Flexner Report of 1910 was also commissioned by the Carnegie Foundation during this period. 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 uniform graduation standards (Christophers et al., 2022). As a result, many substandard medical schools closed.
The mid-20th century brought about further changes, and many of the foundational features of today's healthcare system were established during this time. After World War II, for example, there was a significant expansion of employer-sponsored health insurance, driven in part by wage controls that made workplace benefits more attractive to employees. 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; however, as Andersen and Newman (1973) show, access to healthcare still depended on social determinants such as social structure, health beliefs, and the ability to pay. These remained key factors in determining who actually received care.
"Managed care, nurse practitioners, ACA, and telemedicine"
In conclusion, the past century has seen many different shifts in the U.S. healthcare system, all of which were shaped by social needs and determinants, technological advancements, and policy changes. These changes came about for different reasons, but not all of them improved access to care or enhanced the quality of care.
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