📘 Study Guide: History of Healthcare in America – D393
🧭 1. Big Picture Themes (Know These Cold)
These show up everywhere in the course:
Access to care – Who gets healthcare and why?
Cost & affordability – Why healthcare is so expensive in the U.S.
Quality of care – How standards evolved (licensing, hospitals, etc.)
Public vs. private roles – Government vs. market-based systems
Equity & disparities – Differences based on race, class, geography
🕰️ 2. Key Historical Periods
🏺 Pre-1800s: Early & Colonial Medicine
Based on humoral theory (balance of bodily fluids)
Care mostly provided at home
No formal medical education standards
Heavy use of herbal remedies
👉 Think: unregulated, informal, trial-and-error medicine
🏥 1800s: Professionalization of Medicine
Rise of medical schools (but inconsistent quality)
Hospitals begin shifting from poorhouses → treatment centers
Nursing becomes formalized (influenced by Florence Nightingale)
👉 Key shift: medicine becomes a profession, not just a trade
🔬 Early 1900s: Scientific Medicine
Flexner Report
o Standardized medical education
o Closed substandard schools
1
, Growth of licensing laws
Advances in germ theory
👉 Think: science replaces guesswork
🏛️ Mid-1900s: Expansion of Healthcare Systems
Creation of Blue Cross (hospital insurance)
Creation of Blue Shield
Employer-based insurance expands during WWII
👉 Why employer insurance?
Wage freezes → employers offered benefits instead
🏥 1960s: Government Enters Big
Creation of:
o Medicare
o Medicaid
👉 HUGE turning point:
Federal government becomes a major payer
💼 Late 1900s: Managed Care Era
Rise of HMOs (Health Maintenance Organizations)
Focus on:
o Cost control
o Preventive care
Increased regulation
👉 Tradeoff:
Lower costs vs. limited provider choice
2
, 🧑⚕️ 2000s–Present: Reform & Complexity
Affordable Care Act
o Expands coverage
o Individual mandate (originally)
o Marketplace plans
👉 Current system = mix of:
Private insurance
Employer-based plans
Government programs
🧠 3. Key Concepts You’ll Be Tested On
💵 Fee-for-Service vs. Value-Based Care
Fee-for-service: Paid per treatment → more services = more money
Value-based care: Paid for outcomes → quality over quantity
🏥 Types of Healthcare Systems
Know these comparisons:
System Examp
Key Idea
Type le
Private U.S. Market-driven
Single-
Canada Govt pays
payer
Govt owns
Socialized UK
facilities
⚖️ Health Disparities
Influenced by:
3
🧭 1. Big Picture Themes (Know These Cold)
These show up everywhere in the course:
Access to care – Who gets healthcare and why?
Cost & affordability – Why healthcare is so expensive in the U.S.
Quality of care – How standards evolved (licensing, hospitals, etc.)
Public vs. private roles – Government vs. market-based systems
Equity & disparities – Differences based on race, class, geography
🕰️ 2. Key Historical Periods
🏺 Pre-1800s: Early & Colonial Medicine
Based on humoral theory (balance of bodily fluids)
Care mostly provided at home
No formal medical education standards
Heavy use of herbal remedies
👉 Think: unregulated, informal, trial-and-error medicine
🏥 1800s: Professionalization of Medicine
Rise of medical schools (but inconsistent quality)
Hospitals begin shifting from poorhouses → treatment centers
Nursing becomes formalized (influenced by Florence Nightingale)
👉 Key shift: medicine becomes a profession, not just a trade
🔬 Early 1900s: Scientific Medicine
Flexner Report
o Standardized medical education
o Closed substandard schools
1
, Growth of licensing laws
Advances in germ theory
👉 Think: science replaces guesswork
🏛️ Mid-1900s: Expansion of Healthcare Systems
Creation of Blue Cross (hospital insurance)
Creation of Blue Shield
Employer-based insurance expands during WWII
👉 Why employer insurance?
Wage freezes → employers offered benefits instead
🏥 1960s: Government Enters Big
Creation of:
o Medicare
o Medicaid
👉 HUGE turning point:
Federal government becomes a major payer
💼 Late 1900s: Managed Care Era
Rise of HMOs (Health Maintenance Organizations)
Focus on:
o Cost control
o Preventive care
Increased regulation
👉 Tradeoff:
Lower costs vs. limited provider choice
2
, 🧑⚕️ 2000s–Present: Reform & Complexity
Affordable Care Act
o Expands coverage
o Individual mandate (originally)
o Marketplace plans
👉 Current system = mix of:
Private insurance
Employer-based plans
Government programs
🧠 3. Key Concepts You’ll Be Tested On
💵 Fee-for-Service vs. Value-Based Care
Fee-for-service: Paid per treatment → more services = more money
Value-based care: Paid for outcomes → quality over quantity
🏥 Types of Healthcare Systems
Know these comparisons:
System Examp
Key Idea
Type le
Private U.S. Market-driven
Single-
Canada Govt pays
payer
Govt owns
Socialized UK
facilities
⚖️ Health Disparities
Influenced by:
3
