Healthcare In The 1800s

Since 1800’s till recent years, the healthcare system of United States of America has been evolved from a simple traditional system of home remedies and itinerant doctors who were without proper training to a complex, scientific, technological, and bureaucratic system which is also referred as the "medical industrial complex." The authority of medical professionals and medical science and technology have been the basic building blocks for this complex. Prior to 1800’s, domestic medicine had been practiced in United States. Doctor was summoned to the patient’s house by family members to carry out checkup onsite. During that era, the practice of midwifery was a well-known profession for a woman too. Midwifery was the one who attended to every
in-house childbirth. However, those ‘doctor’ and midwifery did not go through any official training and was without any credentials which were required in these days. Until the late colonial period, physicians with medical degrees and scientific training had been arising in United States. University of Pennsylvania had introduced the first medical college in 1765 and this was followed by the arising of Massachusetts Medical Society which was incorporated in 1781. This was the body that sought license physicians.(rmb to add citations [Symbol]) Then this was followed by the arising of medical schools which were opened by licensed physicians who were willing to train more people to be licensed physicians in order to improve the American medicine and raised the physician’s status. Therefore, physicians or doctors had been more recognized by public. This also had given rise to the building of great institutions for professional training and healing as well as the beginning of medical insurance introduction. Later on, governmental institutions, controls, health care programs, drug regulations, and medical insurance had also been evolved within this period [28]. In the early 1800’s, the credited physicians had determined that germs and social surroundings were the root cause of spreading diseases. Government had been more concerning on healthcare system and decided to build up health departments. Studies and research on bacteria and germs had been funded by government and gave rise to ‘Germ Theory’ which was the root of illnesses. In addition, government had also offer sponsorship for private medical centers and private healthcare was diverging systematically. Hence, the traditional healthcare system had been evolved with the acceptance of the ‘germ theory’ to cure disease. This had been a significant enhancement in healthcare technology. (rmb to add citations [Symbol]) In the mid 1800’s when the city of the United States was developing and transforming to an urbanized area, government had funded in building more hospitals and doctors began to treat person under one roof. The home remedies healthcare system had been reduced and doctors did not have to travel often. Instead, doctors were centralized under one roof, hospital. In 1846, doctors had come together and unified under a professional organization named the American Medical Association (AMA) and came out with the regulation of drugs. The influence of AMA in both political and medical area had been increasing dramatically afterwards. (rmb to add citations [Symbol]) During the years of United States Civil War in 1861-1865, hospitals had become either private or public.
In this period, medical research had been stressed in most medical schools and institutions. Then it was determined that medical students require more extensive training to be a physician. For instance, John’s Hopkins University’s medical school had decided and announced that a medical student had to complete 4 years of medical bachelor degree and continue for 4 more years to be a physician. After the Civil War ended, nursing schools emerged. Since then, nursing had been a stereotyped professional job for women for the next hundred years [29]. By late twentieth century, the amount of nurses who were receiving advanced degrees was increasing. Due to the drastic improvement in chemistry, biology and medical science in the end of nineteenth century, diseases such as tuberculosis, cholera, yellow fever and so on had been under control with the development of vaccines and diagnostic tests. More public health projects had been carried out as an effort to fight against disease spreading, disease cause and increase the public health level. (rmb to add citations
[Symbol]) In the early of twentieth century, the strength of AMA as well as America Hospital Association (AHA) which was founded in 1899 had been growing. Employers and labor unions had decided to offer paid medical care benefits to the workers. In 1920’s after World War 1, the first huge medical insurance company, Blue Cross was established. This was the beginning of private health insurance sector in United States. Then in 1930s, it could be seen that the medical cost in US was increasing and burdening the citizen. Following this, insurance company had come out with a variety of insurance plans. Within that period, a system called ‘fee-for-service’ was created to manage payment to doctors. New insurance plans such as Blue Cross and Blue Shield assisted the members in their hospitalization and doctor consultation fees. In this matter, AHA had been supporting strongly the insurance hospitalization plan. Henry J. Kaiser had utilized pre-paid program for his employees during the World War 2. This medical plan had been applied by Health Maintenance Organizations (HMOs) 40 years later. After World War 2, medical science and medical care had enhanced drastically with increasing healthcare cost. There was a sudden increase in childbirth after the war and this was called as Baby Boom Generation. This incident had led to the introduction of a higher level of preventive and medical care in 1950s. This had followed by the enhancement of diagnostic techniques, drugs as well as inoculations against diseases. Nevertheless, improvement in medical technologies had also further increased the medical cost at the same time. Consequently, medical programs such as Medicare and Medicaid were created to assist medical care for aged and poor respectively. This had followed by the foundation of Indian Health Service, US Public Health Service as well as Food and Drugs Administration. Meanwhile, the cabinet-level agency called Department of Health and Human Services had been established [30].

In the middle of 1980s, doctors did not realize a sudden growth of Health Maintenance Organizations (HMOs) and this body had dominated both the reimbursement to physicians and organization of health.
HMO’s had revolutionized the US healthcare organizations. As a result, the fee-for-service system had faded out in the 1990s. Doctors were finding themselves working under bodies that gained profits from pre-paid healthcare. A system based on ‘capitation’ called Managed Care had slowly replacing the fee-for service system. Doctors were being paid with a set fee and their job was to take care of all of their patients, the sick and the well. This system had stressed on preventive medicine, consumer’s choice and being accountable for one’s own health and healthcare [31]. This was followed by the enhancement in communication technology via Internet and World Wide Web. Hence, most of the health details were available online. Furthermore, ‘telemedicine’ had allowed patients to be diagnosed and treated by doctors via Internet too. (rmb to add citations
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