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Four Main Eras in The Evolution Of The American Health System

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The evolution of the American healthcare system was quite different from the situation in other countries. It is because American values based on social, political and even economic factors have culminated in the establishment of a unique system in America(Okma et al., 2013). The healthcare system has evolved through different phases. The first being the preindustrial era. The second is the postindustrial era, the third is corporatization with the last and the most recent being healthcare reform. Therefore, this research will be a summary of these primary evolutionary eras in the American healthcare delivery.

Pre-Industrial- Consumer Sovereignty

The first phase of the American healthcare delivery is the preindustrial era. It stretched between the middle of the eighteenth century to a later part of the nineteenth century (George). During this time, the American healthcare system lagged behind based on poor experimental research, and even medical education. Its practice also had a strong domestic in contrast to a professional touch. At this time, there was no health insurance and as a result, medical services were privately procured. In addition, the market was highly competitive and it was upon the consumer to decide the provider of the service.

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It thus meant that the consumer was supreme in this market in addition to itexisting under free conditions. There are key factors have driven this condition. They include the disarray nature of the medical practice, primitiveness of the medical procedures, an unstable demand and substandard medical education. These factors have collectively shaped the current delivery of care in America. The disarray nature of the system increased the need for the application of professionalism in the field. The primitive nature of the procedures culminated in massive bleeding and purgatives. Such factors necessitated the improvement of services.

Post-Industrial- Professional Dominance

The second phase is the postindustrial era. In this period, American physicians were famed for their professional sovereignty in addition to their resistance of the national healthcare while promoting their private practice. They, as a result, provided highly technical, professional and scientific care to patients(Press, Rajkumar & Conway, 2016). These transformations mainly took place after the occurrence of the Civil War. The delivery of care in the American health system assumed its present shape during this time. Consequently, private practice of healthcare became entrenched with the profession becoming a highly cohesive and a prestigious one.

During this period, numerous elements came into play for the realization of this gradual transformation. Some of these factors encompassed urbanization, science, and technology, dependency, cohesiveness, licensing and educational reforms. Press, Rajkumar & Conway, (2016) write these underlying factors transformed medicinal practice from a weak and an insecure trade to one that exuded power and authority. Urbanization has shaped the current healthcare delivery by creating a pool of specialized skills. In science and technology, there have been groundbreaking innovations such as anesthesia and diagnostic techniques. Institutionalization has enabled resources to be pulled in a common arena for all.

Corporatization- Corporate Dominance

This is a period that was marked by a massive transformation of hospitals into corporate entities. Gathron (2013) writes that such developments have immensely affected the manner in which delivery of healthcare was conducted. An advantage of corporatization has been the delivery of both a sophisticated, as well as, a modernized care. The increase in managed care has also played a vital role in the consolidation of purchasing power. However, the consolidation and integration of facilities during this period culminated in corporatization.

As a result of the revenue in this field, there was a strong influence on the need for corporatization. For instance, during the expansion of the inpatient capacity and outpatient services in the US, the primary underlying factors that culminated to corporatization encompassed an expanded and differentiated healthcare services, need for specialized rehabilitation, development of significant outpatient capacities, as well as, home health care. These factors have shaped the current American health system by making it highly complex consequently leading to consolidation of physicians in clinics. Other factors leading to corporatization include globalization and the information revolution.

Health Care Reform- Government Dominance

It is the last era in the evolution of the American health system. It involved two important phases. The first is the insurance reform and the other is payment reform brought about by the need for the reduction of healthcare spending. The insurance reform has been an establishment of the 2010 Affordable Care Act(Song & Lee, 2013). The main driver for the payment reform is the fact that healthcare is now considered as a part of one’s budget. As a result, the receivers of the services have slowly shifted from fee for service kind of arrangement to a one-off payment. These factors have shaped current American healthcare delivery making hospitals and physicians to consolidate these new contracts and maximize them in the provision of care.

In conclusion, this research has discussed the four main eras in the evolution of the American health system. The first era discussed is pre-industrial. It was a period when the system hugely lagged behind. The second phase was postindustrial. Here, physicians were famed for their professional sovereignty in addition to promotion of private practice. The third era was corporatization where hospitals were transformed into corporate entities. The last phase is the healthcare reforms mainly encompassing insurance and payment reforms.


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