Historical evolution - History of Health Care System...

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History of Health Care System Historical evolution: several perspectives Doctor as independent businessman Evolution of hospital system – non governmental -government at best a distant third party Evolution of government role in traditional non-governmental sector Some early developments Medical training -the beginning: midwives -physicians trained as apprentices -19 th century growth of medical schools, many associated with hospitals -rise in scientific basis of medicine -American Medical Association forms around same time -becomes powerful in licensing of health care providers -profession became controlled by doctors (midwifery illegal) -had status, able to eliminate other health care providers -care-giver: the nurse, woman, day-today basis -underlying principle is business Private practice: ideology; laizze-faire; fee for service -government, hands off -once you begin licensing, there is some public involvement -(yet it’s self-policing since the doctors control it) By 1920’s health services organized around: Voluntary health system -originally self-supporting -charging patients for service -local government reimbursed hospital for charity patients -there were public, charity hospitals; also religious, nongovernmental, not-for-profit hospitals = voluntary sector established in 19 th century -established to care for group/congregation by religious organizations -public governmental (n-f-p), public nongovernmental (n-f-p), private nongovernmental (n-f-p), for-profit -little public involvement -early US: costal, received goods from ships, dealt with men off ships by quarantining Fee for service doctors Supplemented by hospitals By 1945: Steps to change -reframing of debate: moved past doctors making a living, responsibility of individual to take care of health -public health clinics provided immunizations (established with federal money)
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