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Healthcare Strategies Overview

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Historical Overview

Shanna Holliday

American Intercontinental University



Over the course of centuries hospitals have evolved and become multifaceted municipal institutions. Before 1920 physicians were limited in the amount of knowledge of diseases to provide useful care to the sick. Of course with the growth of knowledge in diseases and treatments came advancements in technology, development of hospitals, and a rise in healthcare costs. This paper will examine the historical developments of hospitals in the United States, hospitals in countries outside of the United States, and a comparison and contrast of both the U.S. and outside hospitals level of care with an opinion of which hospitals have effectively evolved to provide patient care.


In the early 19th Century Americans endured illnesses and diseases without fail. These Americans belonged to a society of no hospitals or doctor visits; unless of course those visits were house calls. The healthcare system we have now did not always exist. Before the 1920s not much was known by physicians of medicine, illnesses, and diseases. Sick people were often treated with drinking alcohol for pain, bleeding to rid the blood of diseases, and laudanum filled with high concentrates of medicines. Often time's laudanum was abused due to their "high" effects, and temporary cures of the patients for which it was given. Over time, however, as advancements in knowledge and technology grew, so did the number of Americans without health insurance and quality care.

Major Historical Developments of U.S. hospitals

As physicians learned more about diseases and treatment changes was the cost of care. Before physicians became fluent in the type of care that could be provided, the sick were not charged much at all. As the knowledge in how to treat and what to treat grew, so did the cost of the care. This of course started a trend worse than the Great Depression itself. Hospitals in the U.S. merged from institutions notably almshouses which provided care for the ailing poor (NAPH, 2012). The American hospital emerged over the course of 60 years. Physician's staffed hospitals and wide economic expansion made the future of hospitals look great. From 1860-1930 public hospitals were established by the work of counties, states, and municipalities. They were public and not for profit. By the 1920s, the hospital was a place where one could hope illness might be treated and even cured. Not-for-profit hospitals at this time began reducing their traditional charitable role in favor of creating prestigious institutions attractive to an upper middle class clientele. But public hospitals operated with their commitment to treat the poor and a consequent fiscal challenge (NAOH, 2021).

Hospitals were now no longer a place for the sick and homeless but rather a special place where treatment and exact diagnosis aided by modern technology was possible. At the same time the cost of hospital care increased dramatically and hospitals came to be placed in direct competition with private practitioners who usually could afford the costly equipment. The development of medicine was specialization which was also achieved by the end of nineteenth century and beginning of twentieth century. Due to specialization in medicine many hospitals were constructed in United States in a relatively short period of time.

The American Medical Association became a major development in hospitals healthcare delivery. According to PBS the AMA re-organized the national organization of state and local associations which in turn created "organized medicine," (PBS, 2021). Other developments happened during 1910-2005. American hospitals were more modern in its scientific values within the institution making strides in medicine, technology, staffing, and legislative laws. While these changes we taking place the Social Security Act and insurance premiums were established for the wealthy. This of course created an issue as the increase in quality of care meant an increase in payment for care. In the 1960's many Americans could not afford insurance and the hospital system, which eventually eroded for millions of Americans, left the indigent and elderly without resources at a time when medicine had grown capable of treating literally thousands of diseases in new and effective ways.

In 1965 President Johnson enacted Medicaid and Medicare to provide some access to care for the indigent and elderly. This act enabled patients to apply to hospitals of their own choosing, but did not resolve what experts had begun to call the "plight of the public hospital."(NAPH, 2012). Like all advanced industrial countries, the health care system in the U.S. has been primarily influenced by the development of modern medical science that has affected the basic education and training of health care professionals and determined the nature of treatment for most patients for most medical conditions. The development of health insurance to offset the individual cost to American for health care and the Medicare and Medicaid acts transformed the U.S. hospitals into competitive franchises that did away with the majority of public hospitals and pushed development of private for profit facilities.

Major Historical Developments of hospitals in outside country

Other countries healthcare system evolved over the past century in a fashion very similar to ours. They emphasize private, fee-for-service practice even more than we do. In the 1930s, the French for example instituted a system quite similar to our Medicare system although it covered wage earning workers, not the elderly. For those workers, it was mandatory although it initially



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