Exploring and understanding the U.S. healthcare system is pivotal to understanding its growth and challenges. Healthcare systems around the globe have developed from the pre-industrial ages to the current status. Healthcare policies and stakeholders have undergone several transformations to fit the current population’s needs and changes. However, there are still challenges in achieving healthcare equity and inequality. An in-depth review of the U.S. healthcare system reveals the growth from pre-industrial change, the impact of the evolution of technology, graduate medical education, and professionalization of care on care delivery, and challenges facing the nationalization of healthcare.
Overview of How Healthcare in The United States Has Evolved Since the Post-Industrial Period
The healthcare system structure can be traced back to when the first hospital was established. Franklin was the primary co-founder of the first hospital in 1754 and highlighted the importance of healthcare delivery to Philadelphia’s early settlers. The first medical school was also founded a decade later in Pennsylvania. Even though there were several hiatuses on the healthcare structure in the early decades, these minor happenings provided an early foundation of an organized healthcare system in the U.S. Healthcare providers had rudimentary diagnostic tools and therapy conduits with little access to information and the internet. The pre-industrial period mainly consisted of agricultural activities. This allowed people to engage in barter trade for healthcare services. Those not involved in battles were in patient homes where they experienced their healthcare delivery. The exchange of agricultural products for healthcare services was primitive (Shalowitz, 2019). Similarly, medical education was limited and primitive as care providers engaged in apprenticeship and mentoring to learn medical interventions. Healthcare education was limited until 1910 when medical and nursing schools emerged. One of the critical learning strategies in the 18th and 19th strategies was to conduct trials on the injured subjects, with most considered research subjects. Thus, the era of Spanish American War gave birth to care organizing conduits, illness diagnosis, and orthopedic and surgical procedures (Shi & Singh, 2022). The doctors routinized these practices in outdoor medical aid stations and surgical areas.
The industrial came with significant changes in healthcare delivery trajectories. Care providers had to bequeath some pre-industrial practices and conform to the changing societal landscape. The emergence of industries warranted rural-urban migration to meet the employment needs in the industries. Similarly, the number of healthcare workers needed to attend to this population bulged significantly. In the same era, the federal government noted that the healthcare field lacked medical standardization, educational consistency, and licensure. This acted as the basis for developing the current health education model. The scientific model provided a platform for the evolution of modern healthcare that utilized objective assessments and data analysis to diagnose and treat diseases. The disease-centric approach promoted standardization in medical education and licensure (Shalowitz, 2019). Moreover, it led to technological advances in diagnostic machines such as X-rays and microscopes. The 20th and 21st centuries also led to the development of vaccines, gene therapies, and robots. The emergence of technology has led to various healthcare specialties such as dermatology, endocrinology, urology, and radiology. These specialties provide specific and quality diagnostic services to improve patient outcomes and goals. Some of these specialties require post-medical school training, which has since been made available in the medical education system. Technology has also led to the growth of pharmaceutical research and development. The 1940s saw the invention of penicillin. However, the food and drug administration has currently approved a repertoire of medications developed through complex research and technologies. The encroachment of technology into the pharmaceutical field has also increased drug prices skyrocketing significantly. The healthcare system is costly, which can be traced back to drug prices (Shi & Singh, 2022). Despite the improvement in healthcare quality, it has negatively impacted the nation’s healthcare budget and out-of-pocket expenditure despite insurance being available.
The idea of a national healthcare program began in 1912, with former President Teddy Roosevelt leading the campaign. The push for a federal healthcare program became more robust in 1945 under president Harry Truman. However, the proposals that he designed were rejected by Congress. However, in the 1960s, President John F. Kennedy developed a task force that recommended a program to cover adults aged 65 years and above, which Congress rejected again. During this period, most Americans did not have insurance coverage.
The period between 1990 and 1994 saw the emergence of the health security act. Former President Clinton prioritized universal coverage and wanted competition between insurers and the government to regulate costs. However, the President faced opposition from stakeholders and players in the insurance field and political pacts leading to the proposal being dismissed. In 1996, policymakers expanded the Health Insurance Portability and Accountability Act (HIPAA) to restrict some coverage determinations and address issues dealing with privacy and confidentiality (Shalowitz, 2019). The first entry of Medicare and Medicaid programs was in 1965 when the President signed them into law. The programs have existed to protect the health and well-being of Americans. Medicaid only had Part A and Part B when they were introduced. Part A and B focused on hospital and medical insurance, respectively. However, stakeholders have added other parts over the years to expand coverage. The details that have been added are parts C and D. The coverage includes people below 65 years with certain conditions (Centers for Medicare & Medicaid Services, 2021).
In the period between 2000 and 2009, there was the development of several health policies such as the breast and cervical cancer treatment and prevention act, modernization act, creation of the health savings account, deficit reduction act, Medicaid part D in 2006, amendment of mental health parity cat in 2008. The national healthcare reform was enacted in 2010, with a significant milestone being the Senate passing of the Patient Protection and Affordable Care Act. The act has expanded insurance coverage and promoted invention and invention in healthcare. The act has undergone various modifications hitherto. Private insurers still dominate the current health system. However, technology has crept into most areas. Notably, the focus has been on healthcare prevention through health promotion strategies (Shi & Singh, 2022). The current healthcare cost is enormous, access is uneven among populations, insurance coverage is still low, healthcare disparities are present, and healthcare investments are misdirected.
Impact of the evolution of medical technology, graduate medical education, and the professionalization of medical and nursing staff on the delivery of care
Medical technology’s evolution has led to positive and negative impacts on care delivery. Healthcare services have improved significantly as there are more sophisticated technologies to deal with significant infections. Technologies have allowed for the management of chronic and cancerous conditions. The technologies have provided a platform to develop more safe drugs and medical interventions reducing mortality and morbidity rates. Moreover, complex diagnostic tools can detect rare diseases in early diseases, leading to improved population health (Sarbadhikari & Pradhan, 2020). The introduction of electronic health records has also revolutionized the storage of patient health data. However, with big data comes the risk of data breaches that goes against confidentiality and privacy principles. Medical technologies have also increased healthcare coverage (Lin et al., 2017). Nelson (2017) states that telemedicine and telehealth services have allowed care providers to provide care to those in remote areas. However, medical technology evolution has also increased healthcare prices significantly. Affording these complex medical technologies is difficult since some are scarce and require specialists. Technologies have also led to the emergence of various ethical issues in care.
The evolution of graduate medical education and the professionalization of medical and nursing staff has positively impacted healthcare delivery. According to Atwood (2021), graduate education has intensified and focused on research and evidence-based practice. Research is essential in improving care delivery and also finding new care models. For instance, the transition from the traditional medical model to patient-centered care has been guided by research. Graduate education has also allowed graduates to acquire the necessary skills to respond to the ever-changing population’s healthcare needs. Graduate education has churned out experts in the field with the required skills to improve patient outcomes. Notably, Phillips and Dalgarno (2017) state that professionalization has streamlined medical and nursing practice. Both professions have a specific code of conduct and scope of practice. Moreover, the professional and regulatory bodies have introduced licensure and various certifications. The licensure and certifications have ensured one acquires the necessary education and practical requirements to engage in care delivery. This has improved care safety and quality. It has also tamed incidents of malpractice and negligence which are met with important ramifications. Professionalization also provides a practice guide and competencies care providers should achieve to improve care delivery. Thus, without specific professions in the healthcare field, it would be hard to guide and determine who is to do what, how, where, and when.
Evolving The Current Healthcare System into A National Healthcare System
The national government has found it hard to achieve a national healthcare system in the U.S. Politics is one of the reasons why it has been hard to attain a national healthcare system. Different political factions will always reject some proposals. History shows that former presidents have tried to achieve universal coverage, but the Senate has rejected the ideas. The latest political impact was when the politicians wanted to do away with or repeal the Affordable care act (Woolhandler & Himmelstein, 2019). Thus, politics play a significant role.
Private insurers have a bigger share of the insurance market. These major private stakeholders will always oppose any drive to nationalize healthcare; the government exerts limited control on the healthcare insurance market, with private insurance dictating it, making it hard to have a level platform among all the stakeholders. Opponents suggest that a single-payer system will increase taxes and restrict innovation. Critics against the national healthcare system argue that it will lead to low physician pay, care rationing, and increased out-of-pocket expenditure. Some also say that the price controls associated with the national healthcare system will lead to long waits. Thus, transforming the current healthcare system into a national one will disrupt the healthcare system creating winners and losers. A major political conflict will ensue if the national healthcare system is adopted. Moreover, there could be a strain on the federal budget as premiums would be replaced with taxes. Private insurers would ultimately be eliminated or limited (Crowley et al., 2022). Thus, politics and policymakers have greatly impacted why it has been hard to achieve a national healthcare system.
Conclusion
The U.S. healthcare system has enormously evolved from the pre-industrial era to the current status quo. It has achieved significant milestones in care delivery models, medical education, technology, and insurance. Notably, technological advancements have revolutionized healthcare by positively impacting diagnosis and treatments. The evolution of the medical field and the professionalization of the profession have also improved care delivery through research, streamlining, and guided practice. Despite attempts to nationalize healthcare, politics is the biggest reason the efforts have been unsuccessful. Understanding the healthcare system is key to designing policies to change the current healthcare system.
References
Atwood, S. S. (2021). The State University (1st Ed). University of Texas Press.
Centers for Medicare & Medicaid Services (2021, January 12). History. https://www.cms.gov/About-CMS/Agency-Information/History#:~:text=for%2050%20years-,On%20July%2030%2C%201965%2C%20President%20Lyndon%20B.,economic%20security%20of%20our%20nation.
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Shalowitz, J. (2019). The U.S. Healthcare System: Origins, organization and opportunities (1st Ed). Jossey-Bass.
Shi, L., & Singh, D. A. (2022). Essentials of the U.S. health care system (6th Ed). Jones & Bartlett Learning.
Woolhandler, S., & Himmelstein, D. U. (2019). Single-payer reform— “Medicare for All”. JAMA, 321(24), 2399-2400. doi:10.1001/jama.2019.7031
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