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US Healthcare Evolution

In the post-industrial period, American physician have established a trend of retaining private practices of medicine. Becoming an organized medical professional, delivering care service using scientifically and technically advanced services to the insured patient was visible to the established capitalism society. The rising cost of Health Management have encouraged Congress to create public financing programs which can support the health requirements of community. These programs include Medicare and Medicaid. In the gradual course, several factors are responsible for the ultimate transformation of medical sector from a week isolated and insecure trade, into a profession of authority and power. This include these factors include, (i) Science and Technology; (ii) Institutionalization; (iii) Dependency; (iv) Urbanization; (v) Licensing; (vi) Educational reform; and (vii) Cohesiveness within organization (Burstin, Leatherman & Goldmann, 2016).

Reform in the medical education started around in 1870 where the medical schools were affiliated with the universities. Advanced medical training was made a necessary, the academic year was extended from 6 to 9 months and the length of medical education was increased to 3 years. The entrance requirement now became a college degree and not high school diploma for becoming a graduate in medical course. The graduate medical education also followed the European model in which the clinical subjects, physiology, anatomy, pathology and laboratory instructions were added to the curriculum. These changes were introduced under the leadership of Harvard Medical School and Johns Hopkins University (Tumialán, 2019). During this era, the Association of American Medical College was also founded comma which later created the Council of Medical Education having the responsibility to inspect the facilities in medical schools and overview the standard of medical education output. Before 1860s the social image of nursing was referred as “dark period”. Later it was Florence Nightingale, who took the initiative to improve the standard of nursing care with introduction of training program along with the theoretical lessons. After the postindustrial period, nursing was considered as a supplement to medicine practice with implementation of newer nursing theories. The nursing theories bring into the concept of collaboration risk interpretation and mitigation strategies, use of information and technology standards, and evidence best practices; which affected the delivery of care significantly for the benefit of mankind. Later, the amended guidelines of nursing profession include, professional preparedness with training (4 year baccalaureate), affiliation with professional organization, ethical codes of practice, licensing, and service orientation (Egenes, 2017).

The care delivery by medical and nursing staff was also affected with prototype for managed care in United States. Early 1900s the common arrangement was referred as capitation in which independent physicians and hospitals where contracted as per payment on basis of worker per month. This system is problem which the services at reduced rate was identified as unethical practices by AMA. Later the amendment of Hospital Association Act in 1917 as provision of medical care by for-profit corporations and label it as commercialization in medicine. Another form of corporate organization for medical care was “group medicine” (Blumenthal, Davis & Guterman, 2015). This introduces the concept of multi-specialty group for the improvement of general care practice in the community.  With time the efficiency of group practice was improved with the introduction of comprehensive services for a capitated fees, as initiated by the plan of New York in 1947. The cost management for the health issues was further controlled by Federal legislation known as Health Maintenance Organization Act in 1973 (Trein, 2017).

The primary reason that United States being unsuccessful in evolving healthcare system is its unique political culture which have strong belief in classical liberalism. In particular, American ideologies were concerned with factors such as self-determination, individualism, distrust government, and reliance on the private sector. These ideologies represent the sentiment of middle class Americans and their support was pivotal for the national land reform. The initial efforts for National Health Insurance was introduced by the American Association of Labor Legislation (AALL), founded in 1906. India appeal to social and economic concern, they argued that National Insurance would minimize the effect of poverty on the high medical cost to individual families. However, the support to national plan was opposed by American Medical Association in 1917 (Clarke & Black, 2015).

The reason was also related to the increased taxes for social program, because of which majority of Americans opposed the national initiative to expand the health coverage. It was President Clinton, who made the health system Reform as one of the top priorities in 1992. This introduces a 3-layered constitution known as part A and part B of Medicare under the Social Security Amendment Act of 1965. Soon in 2010, the introduction of Affordable Care Act managed to introduce the balance bill system for the health caste issues in America. This is a publicly financed program, Medicare and Medicaid increases the regulatory power of Federal government. The regulations also dramatically increases the power assigned to the state public health agencies and thus the health care delivery was subjected under annual scrutiny. The rise of multinational companies have also globalized and played a significant role in improving the health care delivery standard despite of a concrete national health plan (Scanlon, Beich, & Leitzell, 2016). Currently, the presidency by Democratic Party and the control of congress have implemented health care Reform legislation, however the legal challenges and public opposition remain uncertain.

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