...The first phase started in the mid-nineteenth century, when the first large hospitals, such as Bellevue Hospital in Boston, began to prosper. The development of the hospitals symbolized the institutionalization of health care for the first time in the United States. The second significant historical phase began around the turn of the century with the introduction of the scientific method into medicine.
The year 1900 brought about the opening of medical schools, such as Johns Hopkins University in Baltimore, Maryland. With the development of medical schools, a need for medical education was imperative. The Flexner Reports (1900-1910) were the first serious effort of manpower planning, which established standards for medical schools. The third phase came about with the nearing of World War II. The United States went through a major social, political and technological eruption. Scientific advancements continued but were analogized by a growing interest in the social and organizational structure of health care. The interest was directed toward financing health care. During this period evolved the health insurance plans, such as Blue Cross and Blue Shield.
This epoch also witnessed an increased concentration of power in the federal government. An example of this would be the Hill-Burton Act of 1946. The Hill-Burton Act supplied federal funds to underwrite new hospital construction. Finally, 1965 brought about a turning point for Americans with the creation of Medicare and Medicaid programs. Medicare is a type of health insurance for the elderly, where as Medicaid provides health benefits to the poor. Torrens states that during this period, the principle of "health care as a right, not a privilege" was discussed and widely accepted in society. The writer feels that in society today, health care is viewed more as a privilege. Reason being, health care is expensive and employers are not providing their employees with full benefits. Individuals have more out of pocket expenses when it pertains to the health insurance. Also, health insurance is not affordable to all individual's. This is why in today's society it is important to look back on the past health care system, in order to provide the foundation for the present and institute change for the future.
Many demographic changes have occurred through the years. One major change that has happened in the United States is that people are living longer. This has an impact on the country in terms of health status, use of health services and health care expenditures. The older adults are living longer and are utilizing health care more. The older population of persons 65 years and older numbered 34.1 million in 1997. Since 1900 the percent of Americans aged sixty-five and older has more than tripled. Those 65 years of age and older comprise about twelve percent of the population. This group is responsible for over thirty percent of the total health care expenditures. As the elderly population increases, the impact on future healthcare expenditures will become climactic.
Let us take a closer look at the elderly groups and define why they are living longer. This writer has learned that the elderly can be divided into three groups. First, the young old are those persons aged 65 to 75 years old. Secondly, the old are those persons 75 to 85 years old. Thirdly, the old-old are those elderly aged 85 and older. The old-old are high utilizers of health care resources. This cohort has longer hospital stays, visit the doctor more often and spend a large amount of money on prescription medications. The writer believes the elderly are multidimensional, in that, they have multiple health problems. Some elderly persons have three to four chronic illnesses by the time they reach age sixty-five. Examples of those chronic illnesses are Arthritis, Hypertension, Poor Hearing and Heart Disease. Some elderly also encounter psychological problems, such as Depression or Delirium. The elderly may also experience functional changes with their Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)...

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