The Important Historical Features

Case study

The important historical features that shaped U.S health care delivery are American cultural beliefs and values, social changes, technological advances, economic constraints, and political opportunism. The changes made by social, cultural, economic, technological, and political have created the delivery of medical services in the past and will help with the future plans. Also, the development in science and technology played a major role in shaping the U.S health care delivery system. However, the U.S. health care system is mainly private industry and receives a large amount of government financing. The three major features that traced the evolution of health care delivery are preindustrial era, postindustrial era, and corporate era.

The first period was the preindustrial era which lasted from the middle of the 18th century till the final part of 19th century. "The practice of medicine in the United States had a strong domestic rather than professional character because medical procedures were rather primitive" (Shi & Singh, 2013). In this era, medical education was not grounded in science and medical practice was a skill than a profession. There was no health insurance and people had to purchase using personal fund. During this era, medical training was basically received through an individual training with a practicing physician rather than through a university. The Doctor of Medicine degree was only a two year program. There were only few medical schools existed and it was hard to teach a large number of students through apprenticeship. Therefore, the physicians started opening medical school and to increase their income by collecting students fee directly.

In this time medical practice was consider to be a trade than profession. The reason is because; it did not require a lot of education, clinical practice, residency training, and board exams. "The main consequences of nonprofessional medicine were that anyone trained or untrained could practice as a physician. The clergy, for example, often combined medical services and religious duties" (Shi & Singh, 2013). Also, physicians started to work second job because the income only from medical practice was insufficient to support a family. Medical institutions during this era were described as deplorable sanitation and poor ventilation. People only went to the hospital due to of horrible condition and not by personal choice. Then the state government operated asylums for patients with untreatable and chronic mental illness. Another type of institution called pesthouse was open to isolate people with spreadable disease. Examples like cholera, smallpox, typhoid, and yellow fever. Then the dispensaries were developed to provide free care to those who could not afford to pay. It was staffed by medical students or internes.

The postindustrial era was marked by development and growth of the medicine profession. It benefited from urbanization, new scientific discoveries, and reforms in medical education. The rise of private health insurance and creation of public health insurance programs were created in this era. "The medical profession was transformed after the America Civil War as the country developed from a rural agricultural economy to system of industrial capitalism. It was advanced in bacteriology, antiseptic surgery, anesthesia, immunology and diagnostic techniques with new drugs helped make medical practice a legitimate profession" (Shi & Singh, 2013). The American Medical Association (AMA) was opened to help stimulate the profession and protect interest of physicians. The education reform increased the studying of medical science like the academic year went from four to nine months, the length of education went from two to three years, and extra classes like physiology, and anatomy and chemistry were added. The improvement in medical science formed a need to centralize expensive facilities and equipment in an institution. As well, the development of hospitals came to indicate the institutionalization of health care.

The corporate era is from late 1900s to present. This century was marked by the progress and merging of large business corporations and remarkable advance in global communications, transportation, and trade. The three main features of the corporate era are corporatization, information revolution, and globalization. According to corporatization the United States medical care has become the domain of large corporations. In health care system the delivery is being converted in unique and permanent ways by telecommunications. The example that rise health care delivery is telemedicine and E-health. Telemedicine is the integration of telecommunication system into distant care giving. "E-health refers to health care information and services offered over the internet by professional and nonprofessional. Globalization refers to various forms of cross-border economic activities" (Shi & Singh, 2013) like information exchange, goods, and services, and interdependence of economies.

Mostly, the physicians are the participants in the health care system. Back in the days, their profession was just a trade and it was not enough income to take care