Complete the

Health Care Timeline

worksheet to create a timeline in which you describe the evolution of the United States health care industry. Explain why you chose each event, as well as the causes and effects of each event, particularly as they relate to the Iron Triangle of cost, access, and quality of care.

Please ensure that you submit the worksheet as an attached Microsoft Word document. Support your opinions and any facts by citing credible sources in the body of the worksheet.

 List all references in the reference section . See tips on citing references in Class Announcement and in the Reference and Citation Generator below.

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Health Care Timeline

HCS/235 Version 10

1

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Health Care Timeline

Complete the following timeline.

Select seven events that have helped shape health care as it is today. Write a 50- to 150-word summary per event that discusses the event and its effect on the health care industry. An example has been provided for you.

Cite your sources below. For additional information on how to properly cite your sources, check out the

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References

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TABLE 1-1 Milestones of Medicine and Medical Education 1700–2015 ■ 1700s: Training and apprenticeship under one physician was common until hospitals were founded in the mid-1700s. In 1765, the first medical school was established at the University of Pennsylvania. ■ 1800s: Medical training was provided through internships with existing physicians who often were poorly trained themselves. In the United States, there were only four medical schools, which graduated only a handful of students. There was no formal tuition with no mandatory testing. ■ 1847: The AMA was established as a membership organization for physicians to protect the interests of its members. It did not become powerful until the 1900s when it organized its physician members by county and state medical societies. The AMA wanted to ensure these local societies were protecting physicians’ financial well-being. It also began to focus on standardizing medical education. ■ 1900s–1930s: The medical profession was represented by general or family practitioners who operated in solo practices. A small percentage of physicians were women. Total expenditures for medical care were less than 4% of the gross domestic product. ■ 1904: The AMA created the Council on Medical Education to establish standards for medical education. ■ 1910: Formal medical education was attributed to Abraham Flexner, who wrote an evaluation of medical schools in the United States and Canada indicating many schools were substandard. The Flexner Report led to standardized admissions testing for students called the Medical College Admission Test (MCAT), which is still used as part of the admissions process today. ■ 1930s: The healthcare industry was dominated by male physicians and hospitals. Relationships between patients and physicians were sacred. Payments for physician care were personal. ■ 1940s–1960s: When group health insurance was offered, the relationship between patient and physician changed because of third-party payers (insurance). In the 1950s, federal grants supported medical school operations and teaching hospitals. In the 1960s, the Regional Medical Programs provided research grants and emphasized service innovation and provider networking. As a result of the Medicare and Medicaid enactment in 1965, the responsibilities of teaching faculty also included clinical responsibilities. ■ 1970s–1990s: Patient care dollars surpassed research dollars as the largest source of medical school funding. During the 1980s, third-party payers reimbursed academic medical centers with no restrictions. In the 1990s with the advent of managed care, reimbursement was restricted. ■ 2014: According to the 2014 Association of American Medical Colleges (AAMAC) annual survey, over 70% of medical schools have or will be implementing policies and programs to encourage primary care specialties for medical school students. TABLE 1-2 Milestones of the Hospital and Healthcare Systems 1820–2015 ■ 1820s: Almshouses or poorhouses, the precursor of hospitals, were developed to serve primarily poor people. They provided food and shelter to the poor and consequently treated the ill. Pesthouses, operated by local governments, were used to quarantine people who had contagious diseases such as cholera. The first hospitals were built around areas such as New York City, Philadelphia, and Boston and were used often as a refuge for the poor. Dispensaries or pharmacies were established to provide free care to those who could not afford to pay and to dispense drugs to ambulatory patients. ■ 1850s: A hospital system was finally developed but hospital conditions were deplorable because of unskilled providers. Hospitals were owned primarily by the physicians who practiced in them. ■ 1890s: Patients went to hospitals because they had no choice. More cohesiveness developed among providers because they had to rely on each other for referrals and access to hospitals, which gave them more professional power. ■ 1920s: The development of medical technological advances increased the quality of medical training and specialization and the economic development of the United States. The establishment of hospitals became the symbol of the institutionalization of health care. In 1929, President Coolidge signed the Narcotic Control Act, which provided funding for construction of hospitals for patients with drug addictions. ■ 1930s–1940s: Once physician-owned hospitals were now owned by church groups, larger facilities, and government at all levels. ■ 1970–1980: The first Patient Bill of Rights was introduced to protect healthcare consumer representation in hospital care. In 1974, the National Health Planning and Resources Development Act required states to have certificate of need (CON) laws to qualify for federal funding. ■ 1980–1990: According to the AHA, 87% of hospitals were offering ambulatory surgery. In 1985, the EMTALA was enacted, which required hospitals to screen and stabilize individuals coming into emergency rooms regardless of the consumers’ ability to pay. ■ 1990–2000s: As a result of the Balanced Budget Act cuts of 1997, the federal government authorized an outpatient Medicare reimbursement system. ■ 1996: The medical specialty of hospitalists, who provide care once a patient is hospitalized, was created. ■ 2002: The Joint Commission on the Accreditation of Healthcare Organizations (now The Joint Commission) issued standards to increase consumer awareness by requiring hospitals to inform patients if their healthcare results were not consistent with typical results. ■ 2002: The CMS partnered with the AHRQ to develop and test the HCAHPS (Hospital Consumer Assessment of Healthcare, Providers and Systems Survey). Also known as the CAHPS survey, the HCAHPS is a 32-item survey for measuring patients’ perception of their hospital experience. ■ 2007: The Institute for Health Improvement launched the Triple Aim, which focuses on three goals: improving patient satisfaction, reducing health costs, and improving public health. ■ 2011: In 1974, a federal law was passed that required all states to have certificate of need (CON) laws to ensure the state approved any capital expenditures associated with hospital/medical facilities’ construction and expansion. The act was repealed in 1987 but as of 2014, 35 states still have some type of CON mechanism. ■ 2011: The Affordable Care Act created the Centers for Medicare and Medicaid Services’ Innovation Center for the purpose of testing “innovative payment and service delivery models to reduce program expenditures … while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits. ■ 2015: The Centers for Medicare and Medicaid Services posted its final rule that reduces Medicare payments to hospitals that have exceeded readmission limits of Medicare patients within 30 days. TABLE 1-3 Milestones in Public Health 1700–2015 ■ 1700–1800: The United States was experiencing strong industrial growth. Long work hours in unsanitary conditions resulted in massive disease outbreaks. U.S. public health practices targeted reducing epidemics, or large patterns of disease in a population, that impacted the population. Some of the first public health departments were established in urban areas as a result of these epidemics. ■ 1800–1900: Three very important events occurred. In 1842, Britain’s Edwin Chadwick produced the General Report on the Sanitary Condition of the Labouring Population of Great Britain, which is considered one of the most important documents of public health. This report stimulated a similar U.S. survey. In 1854, Britain’s John Snow performed an analysis that determined contaminated water in London was the cause of a cholera epidemic. This discovery established a link between the environment and disease. In 1850, Lemuel Shattuck, based on Chadwick’s report and Snow’s activities, developed a state public health law that became the foundation for public health activities. ■ 1900–1950: In 1920, Charles Winslow defined public health as a focus of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts. During this period, most states had public health departments that focused on sanitary inspections, disease control, and health education. Throughout the years, public health functions included child immunization programs, health screenings in schools, community health services, substance abuse programs, and sexually transmitted disease control. In 1923, a vaccine for diphtheria and whooping cough was developed. In 1928, Alexander Fleming discovered penicillin. In 1933, the polio vaccine was developed. In 1946, the National Mental Health Act (NMHA) provided funding for research, prevention, and treatment of mental illness. ■ 1950–1980: In 1950, cigarette smoke was identified as a cause of lung cancer. In 1952, Dr. Jonas Salk developed the polio vaccine. The Poison Prevention Packaging Act of 1970 was enacted to prevent children from accidentally ingesting substances. Childproof caps were developed for use on all drugs. In 1980, the eradication of smallpox was announced. ■ 1980–1990: The first recognized cases of AIDS occurred in the United States in the early 1980s. 1988: The IOM Report defined public health as organized community efforts to address the public interest in health by applying scientific and technical knowledge and promote health. The first Healthy People Report (1987) was published and recommended a national prevention strategy. ■ 1990–2000: In 1997, Oregon voters approved a referendum that allowed physicians to assist terminally ill, mentally competent patients to commit suicide. From 1998 to 2006, 292 patients exercised their rights under the law. ■ 2000s: The second Healthy People Report was published in 2000. The terrorist attack on the United States on September 11, 2001, impacted and expanded the role of public health. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 provided grants to hospitals and public health organizations to prepare for bioterrorism as a result of September 11, 2001. ■ 2010: The ACA was passed. Its major goal was to improve the nation’s public health level. The third Healthy People Report was published. ■ 2015: There has been an increase nationally of children who have not received vaccines due to parents’ beliefs that vaccines are not safe. As a result, there have been measles outbreaks throughout the nation even though measles was considered eradicated decades ago. TABLE 1-4 Milestones of the U.S. Health Insurance System 1800–2015 ■ 1800–1900: Insurance was purchased by individuals in the same way one would purchase car insurance. In 1847, the Massachusetts Health Insurance Co. of Boston was the first insurer to issue “sickness insurance.” In 1853, a French mutual aid society established a prepaid hospital care plan in San Francisco, California. This plan resembles the modern health maintenance organization (HMO). ■ 1900–1920: In 1913, the International Ladies Garment Workers began the first union-provided medical services. The National Convention of Insurance Commissioners drafted the first model for regulation of the health insurance industry. ■ 1920s: The blueprint for health insurance was established in 1929 when J. F. Kimball began a hospital insurance plan for school teachers at Baylor University Hospital in Texas. This initiative became the model for Blue Cross plans nationally. The Blue Cross plans were nonprofit and covered only hospital charges so as not to infringe on private physicians’ income. ■ 1930s: There were discussions regarding the development of a national health insurance program. However, the AMA opposed the move (Raffel & Raffel, 1994). With the Depression and U.S. participation in World War II, the funding required for this type of program was not available. In 1935, President Roosevelt signed the Social Security Act (SSA), which created “old age insurance” to help those of retirement age. In 1936, Vassar College, in New York, was the first college to establish a medical insurance group policy for students. ■ 1940s–1950s: The War Labor Board froze wages, forcing employers to offer health insurance to attract potential employees. In 1947, the Blue Cross Commission was established to create a national doctors network. By 1950, 57% of the population had hospital insurance. ■ 1965: President Johnson signed the Medicare and Medicaid programs into law. ■ 1970s–1980s: President Nixon signed the HMO Act, which was the predecessor of managed care. In 1982, Medicare proposed paying for hospice or end-of-life care. In 1982, diagnosis-related groups (DRGs) and prospective-payment guidelines were developed to control insurance reimbursement costs. In 1985, the Consolidated Omnibus Budget Reconciliation Act (COBRA) required employers to offer partially subsidized health coverage to terminated employees. ■ 1990–2000: President Clinton’s Health Security Act proposed a universal healthcare coverage plan, which was never passed. In 1993, the Family Medical Leave Act (FMLA) was enacted, which allowed employees up to 12 weeks of unpaid leave because of family illness. In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was enacted, making it easier to carry health insurance when changing employment. It also increased the confidentiality of patient information. In 1997, the Balanced Budget Act (BBA) was enacted to control the growth of Medicare spending. It also established the State Children’s Health Insurance Program (SCHIP). ■ 2000: The SCHIP, now known as the Children’s Health Insurance Program (CHIP), was implemented. ■ 2000: The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act provided some relief from the BBA by providing across-the-board program increases. ■ 2003: The Medicare Prescription Drug, Improvement, and Modernization Act was passed, which created Medicare Part D, prescription plans for the elderly. ■ 2006: Massachusetts mandated all state residents have health insurance by 2009. ■ 2009: President Obama signed the American Recovery and Reinvestment Act (ARRA), which protected health coverage for the unemployed by providing a 65% subsidy for COBRA coverage to make the premiums more affordable. ■ 2010: The ACA was signed into law, making it illegal for insurance companies to rescind insurance on their sick beneficiaries. Consumers can also appeal coverage claim denials by the insurance companies. Insurance companies cannot impose lifetime limits on essential benefits. ■ 2013: As of October 1, individuals could buy qualified health benefits plans from the Health Insurance Marketplaces. If an employer does not offer insurance, effective 2015, consumers can purchase it from the federal Health Insurance Marketplace. The federal government provided states with funding to expand their Medicaid programs to increase preventive services. MARGIN IS OFF ■ 2015: The CMS posted its final rule that reduces Medicare payments to hospitals that readmit Medicare patients within 30 days after discharge. This rule is an attempt to focus hospital initiatives on quality care