Prior to beginning work on this discussion, review your textbook chapters for this week and read the article The History of Healthcare Quality: The First 100 Years 1860–1960 and review Healthcare Timeline (Links to an external site.) and A Brief History: Universal Health Care Efforts in the US (Links to an external site.) and A Brief History: Universal Health Care Efforts in the US (Links to an external site.).

Chapter 2 in your textbook discusses the evolution of our health care system. Much of it evolved due to the political landscape, societal constraints, consumer demand, escalating costs, and technological advancement. Legislation and legal cases also influenced the health care system considerably. After reading Chapter 2 in your textbook, review the time line simulation Global Perspectives: Shifts in Science and Medicine That Changed Healthcare (Links to an external site.) in the Summary and Resources page.

Consider how the U.S. health care system has evolved over the past 50 years. In your post,

  • Choose one of the influencing factors from the Global Perspectives: Shifts in Science and Medicine That Changed Healthcare time line and discuss its impact on the health care system.
  • Rationalize why your chosen influencing factor has been revolutionary for the health care system.

Guided Response: Review your classmates’ posts and find two who mentioned factors different from yours. Explain how this factor has influenced one of the following stakeholders: patient, family, and professional. Consider how this factor has affected the patient and the family and how it has changed the role of the health care professional.



Early hospitals

Before the Civil War, many hospitals were more concerned with religion and morals than health. Maintained by volunteers and trustees, they depended primarily upon charity for their existence. As a result, hospitals typically served as the last resort for the infirm, the mentally and physically disabled, and the homeless, while wealthier patients received home care from their private physicians. It was rare for an American doctor to set foot in a hospital ward where a patient had a better chance of dying than leaving alive.

In 1752, Pennsylvania Hospital opened in Philadelphia, becoming the United States’ first permanent general hospital to care for the sick. Financed by voluntary donations, New York Hospital opened in 1792 and Boston’s Massachusetts General Hospital in 1821.

By the end of the Civil War, with the discovery of anesthesia and advancements in diagnostic medical devices and surgical procedures, hospitals had become safer places. Surgeons prepared before surgery and cleaned their instruments with antiseptics. Anesthesia allowed for slower and more careful surgeries, which were performed earlier in the course of disease and included a variety of previously inoperable conditions such as appendicitis, gall bladder disease, and stomach ulcers (Rapp, 2012). With the introduction of fees in the 1800s, hospitals began to offer more effective treatments and ones that the middle and upper classes viewed as more useful. Physicians, eager to enhance their education and increase the size of their private practices, vied for hospital positions. As a result, hospitals moved from the fringes of medicine to become large businesses and educational institutions focused on doctors and patients rather than on patrons and the poor. With the advent of urbanization and new modes of transportation, hospitals became more accessible and created more opportunities for physicians to increase their prestige and income (Starr, 1982, pp. 146–162).