History of Health Care In the United States, Research Paper Example

The history of health care in the United States dates back years prior to the nineteenth and twentieth century with many forms of transformation. With the deep early relationship between medicine and religion, priests were the first documented doctors; before formal education. Historical and societal changes have helped shaped the contextual foundations of health care delivery through the years. Health care originated in the philosophy of easing sickness and illness. Through the years economics began to be a factor in health care and created a new dynamic to the concept of health care delivery. Preventive medicine and patient accountability entered the health care delivery concept. Medicine in the marketplace also entered the equation with insurance and fee structures.

The 1920s is recognized as the beginning of modern medicine. Up until this point in time medicine was limited in knowledge, technology and progression. Very early medicine was delivered by priests in archaic settings. Formal medical teaching began in the mid 1700s. The College of Philadelphia, later named the University of Philadelphia is cited as being the first medical school in the United States. Originally the degree earned was a Bachelor’s of Medicine (M.B.), later expanded to Doctor of Medicine (M.D.) Columbia, Harvard and Maryland were the next institutions to develop medical teaching.

Early medicine delivered by physicians included house visits and payment with live stock and baked goods. This was a time when doctors were treating patients to ease illnesses, disease and suffering. The 1800s were a time of limited medical knowledge and virtually no technology. Medications were restricted and based in the form of primarily natural concoctions. Cocaine was legal and was used for pain and various ailments. The addictive nature of substances was not understood at this time. Today there is research performed on substances, but in the early years of medicine trial and error was dependent on the actual use on patients.  Substances such as mercury and lead were considered medicines; today these are recognized as harmful. By the 1860s the practice of medicine and medications began rapid changes and controversial ideas were not yet widely accepted (nineteenth Century Medicine, 2009, para. 3).

Ancient theory of medicine consisted of the ‘four humors’ developed by Roman physician Galen. The concept revolved around four humors comprising the human body which included blood, phlegm, black bile and yellow bile (Nineteenth Century Medicine, 2009, para 4). These humors were used to determine the health of a person. Too little or too much of one humor created an imbalance in the person and the practitioner was challenged with correcting the balance. Many of the nineteenth century practices used this concept for treatment.

“According to this theory, the body is made up of four humors – blood, phlegm, black bile, and yellow bile. The relative amounts of each humor in the body determined state of health and temperament (a person with more blood was “sanguine”; with more phlegm “phlegmatic”; with black bile “melancholic”; and if yellow bile predominated, “choleric” or “bilious”)” (nineteenth Century Medicine, 2009, para 4).

There was also the availability of nonprescription drugs for individuals who were mistrusting of physicians. Much like over-the-counter medications of today, there were ointments, pills and nostrums to choice between.

Baths were taken infrequently in the nineteenth century. Recognizing the benefits of cleanliness, bath houses were created. Bath houses include vapors and herbs to cleanse the body, believing this was a remedy for some illnesses. Although there were no real proclamations for curing certain illnesses, it is probably the first form of herbal medicine recorded. This practice was not supported by the physicians of the nineteenth century any more than the practice of phrenology  was used by many doctors. Phrenology was the practice of lumps on the head having meanings depending on size, shape, and location. Similar to medicine today, some methods were considered quackery and untrustworthy.

By the 1840s innovations in medical equipment began to develop. Thermometers, stethoscopes hypodermic needles were introduced. Drugs were also developing with the use of anesthetics and the understanding of how illnesses spread. By the end of the 1700s with popular medicine including bloodletting, innovation was readily welcomed. Bloodletting was the practice of withdrawing blood from a patient with the belief it will cure or prevent disease or illness.

Bloodletting is one of the oldest practices known. It originated from the observation of natural events. Animals were seen scratching on trees until they bled. Spontaneous nosebleeds and menstruation of women were believed to be nature’s way of ridding the body of bad humors in a natural manner (Arbittier, 2009,para 1). Therefore, the concept was conceived and practiced for many aliments. However, no real benefits have ever been documented.

Women were seen as caregivers in the home in the 1700s; however, they were regarded as too emotional and unable to deliver medical care effectively beyond the home. They carried out medical remedies as best they could, to include delivering babies. Midwifery was also transforming as the nineteenth century was born. Midwifery has a long history in time, however, in 1799 formal courses were taught. Men were the predominant students. Society dictated that once a woman was married she was to assume a domestic role. Therefore, female midwifes did not become the norm until later. It was not until 1847 that the first female was accepted into a medical college, graduating at the top of the class (Feldhusen, 2000, sec 5, para 8).

Advertising medical care was not done in the early years. A physician may announce the opening of a clinic, however, further advertising was considered unethical. The American Medical Association prohibited physicians to advertise up until the mid twentieth century. It was considered not only unethical but also immoral. Around the 1980s physicians began to advertise by placing ads in the yellow pages giving their clinic names, specialties and list of practicing physicians. Physicians today advertise while attempting to maintain professionalism and most are careful in how they may choose to display banners or local ads.

Physician charges and payments have also developed through the decades. Public and private entitles in health care date back to the nineteenth century for how physician charges were paid when individuals were unable to. “Nineteenth century localities found numerous ways to support health care – from lotteries to tax policy to cash grants – while states created institutions to care for the insane, the tubercular, and in some states later in the century even the epileptic and the inebriate” (Sevens and Burn, 2006, p. 15). Health care and economics enjoyed a wide span between the two early in the history of health care. Health and medicine were not in the same league as finances. The state’s welfare responsibilities were largely a part of physician payment in this “unselfconscious yet intricately interdependent relationship between the public and the private, the community and the individual, the spiritual and the material has always characterized health care in America” (Stevens and Burn, 2006, p. 15).

The history of health care in the United States is important to study and understand as the events of health care systems often repeat itself; every twenty years or so (Stevens and Burns, (2006, p. 5). Conflicts and difficulties shape the future for anything and health care is not exempt from this concept. As health care systems began to develop, individual ideas and models began to cultivate. “Medicine is an indicator as well as a substantive component of any society” (Sevens and Burn, 2006, p. 14). As modern medicine continued progression, the idea of society coupled with government dictating some of the elements of health care became apparent. In the nineteenth century society was predominantly involved in the way medicine was delivered or how the fees were determined for particular services.

In the early 1900s, before the abundance of health insurance plans, if a person became sick or had to be hospitalized they were reliant upon their savings, generosity of co-workers, and organized charity (Murray, 2007, p. 3). The need to stay healthy in this era was different than it is today. Health today consists of phases such as ‘heart healthy’ and ‘preventative medicine.’ In the early twentieth century staying healthy meant keeping the family feed and maintaining employment. Murray (2007) states “young workers recognized the high cost of insurance relative to their good health, and older workers knew the importance of saving in advance of declining health (p. 5).

The first commercial health insurance plan offered in the United States was in 1847 called the Health Insurance Company of Philadelphia (Murray, 2007, p 74). This company failed due to inadequately calculating premiums and underestimating claims. There were no other attempts until 1891 with the emergence of group accident and health insurance firms. These were small firms originally which later sold into a large organization better able to handle the financial responsibilities of a company.

An early form of an independent insurance was created in 1901, referred to as a sickness fund, comprised of local auto manufactures. Entitled the Flint Vehicle Factories Mutual Benefit Association, this ‘sickness fund’ operated on a simple premise of premiums paid in with benefits in the case of illness. Unlike formalized insurance plans of today, there were few guidelines for how the plan was to operate. The inadequacies of the original ‘sickness fund’ were quickly realized and reformers worked and argued to develop better plans. However, unable to generate political support in any state they campaigned, the group created the first of many failures to broaden American health insurance coverage via governmental action (Murray, 2007, p. 4). Historians have reviewed the plights by the groups involved and concur that the problems involved were due to incompetency. Underhanded political efforts of employers and insurers and the general backwardness of the working class of the time were at fault (Murray, 2007, p. 5).

The development of modern medicine by the early twentieth century is marked by the beginnings of a formalized payment fee structure system for medical treatment. By this point in time medicine had developed enough that practitioners were more knowledgeable and able to treat diseases and illnesses more appropriately.  Physicians were sought after and they began charging fees for services; by history they were charging more than individuals were able to pay (Noah, 2007, para. 5).  The Great Depression added to the problem of high medical fees with individual hardships. Blue Cross was the first insurance company created by the administrator of Baylor Hospital in Dallas, Texas to close the gap between medical fees and payment options for patients (Noah, 2007, para. 6).

The initial Blue Cross plans were nonprofit and enjoyed charging low premiums provided by tax breaks they received. By the 1940s however, economics was playing a serious role in health care. To offset wartime wage controls, employers began offering health insurance. While this was a benefit during this time, it was quickly realized the magnitude of consequences it provided. “If government regulators had thought to freeze fringe benefits along with wages, we might have avoided making the workplace primarily responsible for supplying health insurance, a role that most people now agree was ill-advised” (Noah, 2007, para. 7).  Early this plan covered only hospitalizations and charged the same premiums for all individuals.

Some historians have interpreted the offer of health insurance and fringe benefits as an effort to coerce workers into surrendering mobility, resulting in ‘job-lock’ (Murray, 2007, p. 67). This translated into control which managers and companies could potential have over employees. It also offered employers the option of recruiting better employees through the fringe benefits offered. As health care insurances developed, employees and employers had options available. Weighing the benefits against any negatives of the health plans took employment to a new level for both employees and employers.

The first hospital was founded in 1751 by Dr. Thomas Bond and Benjamin Franklin with the core concept “to care for the sick-poor and insane who were wandering the streets of Philadelphia” (Penn Medicine, 2009, para. 1). The concept originated as the colonies were being formed and the Philadelphia region was a central location for the influx of individuals from other nations landing and bringing in various diseases. The city was dealing with fast and escalating numbers of individuals from all classes entering the city suffering from many aliments. The city was faced with taking charge to ensure the safety of the city and the current inhabitants.

Early hospitals were closely linked to the church and were tax exempt as the works they carried out were considered charity. By the late twentieth century for-profit hospitals began to spread across the United States. Private and public hospitals receive funding from differing sources. Private for-profit hospitals work primarily on patient and insurance payments for profitability. Not-for-profit hospitals are funded by religious associations, government grants and endowments. While these organizations also are covered under patient and insurance payments, they rely heavily on outside funding.

As economics began to enter the health care industry “formally transcending the material reality and reflecting the sacredness of human life and the emotional centrality and specialness of the doctor-patient relationship” the medical profession began to transform (Stevens and Burns, 2006, p. 17). The vocation of a physician was historically judged as being special and reverenced. Physicians did not charge fees early in the formative years, but were given payment based on what the individual could pay or part with such as livestock.  This added to the set of values associated with the profession. Ambiguity surrounds the medical profession and the relationship to the market (Stevens and Burns, 2006, p. 17). Through time as technology and medical advancements have been introduced, the demand for a formalized fee and payment structure became necessary. “Medicine’s traditional identification with the sacred, the selfless, and the public interest has over time burred and hybridized with the intellectual, the technical, and the instrumental” (Stevens and Burn, 2006, p. 17).

Technology in health care provides new concepts and procedures otherwise not available. Medical technology influences many aspects of health care. It aids in medical procedures, research and efficiency of insurance and payment plans. Technology provides artificial organs for longevity, imaging for diagnosing and informatics for documentation. The list for how technology assists in health care is multifold.

Values and structures have become the balance on which health care in the United States is founded. Whereas physicians were originally referred to as ‘healers’ they are now seen in terms of economic and administrative components. Healing is still the main concept, however, it is now a marketable talent lending towards the dollar value for the service or procedure. Culturally the nation debates various health care issues such as abortion, aging, and cloning; attitudes towards life and incapacity, technology and death (Stevens and Burn, 2006, p. 18).  Costs and benefits have come into this mix. Historically medicine was not involved in these issues; doctors healed and lived according to what their patients could afford to pay them.  This has adapted through time to big business with formalized fee structures, first introduced by Medicare.

Harry Truman in 1945 began the debate for the establishment of a national health insurance plan; a form of socialized medicine. In 1965 Medicare and its counterpart, Medicaid were signed as law. This was a plan for disabled persons and anyone over the age of 65. Initially a hospital plan, a physician office payment plan component was added. The plan consisted of a fee structure which was founded on ‘reasonable cost’ allocating formal charges based on treatment in a specific locale. In 1983 this changed over to the current plan of a prospective payment system based on diagnosis related groups. This plan takes into account the diagnosis versus treatment for payment. The plan also made allowances for location and specialty of the practicing physician. Although not a perfect plan it has several merits including cost containment, accountability and equality. Private insurance plans adopted this same fee structure during the health care reform years under the Clinton administration.

The Clinton health plan task force set up the Task Force on National Health Care Reform aided at providing health care for each individual in the United States. Although the goals were never accomplished, lessons were learned. The basic premise of this plan was to regulate health care delivery through a primary care physician acting as the ‘gate keeper.’ Patients were required to see their primary care physician and that physician was charged with determining if they could handle the problem or if it needed referral to a specialist. While the concept seemed logical, the results were disastrous. Today, there are still a few of these types of plans in place with Health Care Organizations (HMOs); however, a more lenient model has been better received by the public in Preferred Provider Organizations (PPOs).

The primary goal of both HMOs and PPOs are to reduce health care costs by focusing on preventive care. Historically health care was geared at alleviating illnesses, diseases and suffering. This new model focused on patient accountability, preventative medicine, and proactively taking care of one’s health. HMOs and PPOs are different in that the primary care physician in the HMO plan dictates the medical decisions of the patient. PPOs regulate the medical care; however, patients are given the responsibility of choosing the primary provider or specialist. PPOs are the more popular choice between the two. However, some employers only offer the most cost containing and employees often do not have a choice. For individuals not employed the cost of either is usually beyond affordability.

The history of health care in the United States is a rich and colorful account. The provisions of healing illness and disease to the economic concepts pave an interesting description for the transformation through the years of health care concepts and delivery. Society has played a vital role throughout the history of health care. From the ideas associated with gender to the concepts of marketing and economics society has helped guide the way. From the first formal hospitals and teaching institutions to the charge and fee schedules, the history of health care has evolved throughout the decades. With the continuation of evolving technology and research, health care will undoubtedly continue to advance.

Works Cited

Arbittier, Douglas. “Bloodletting Antiques.” 2009. Retrieved December 24, 2009 from http://www.medicalantiques.com/medical/Scarifications_and_Bleeder_Medical_Antiques.htm

Feldhusen, Adrian E. “The History of Midwifery and Childbirth in America: A Time Line.” Midwifery Today. 2000.  Retrieved December 24, 2009 from http://www.midwiferytoday.com/articles/timeline.asp

Murray, John E. Origins of American Health Insurance: A History of Industrial Sickness Funds. 2007.  Library of Congress: United States.

Nineteenth Century Medicine. “Medicine in the 1860s Victoria.” 2009.  Retrieved December 23, 2009 from http://web.uvic.ca/vv/student/medicine/medicine19c.htm

Noah, Timothy. “A Short History of Health Care.” Slate. March, 13, 2007. Retrieved December 23, 2009 from http://www.slate.com/id/2161736

Penn Medicine. “The Story of the Creation of the Nation’s First Hospital.” 2009. Retrieved December 24, 2009 from http://www.uphs.upenn.edu/paharc/features/creation.html

Stevens, Rosemary, Burns, Lawton R. History and Health Policy in the United States. 2006. Rutgers University Press: Piscataway.