[PUBHLTH 129] - Midterm Exam Guide - Comprehensive Notes for the exam (18 pages long!)

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UMASS-Amherst
PUBHLTH 129
MIDTERM EXAM
STUDY GUIDE
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Essentials of the U.S. Health Care System
CHAPTER 3: Historical Overview of U.S. Health Care Delivery
OBJECTIVES OF CHAPTER 3
1. Explain how health care delivery has evolved in the U.S. since the 1800s.
2. Discuss the evolution of U.S. health care.
3. Outline current trends.
MAJOR FACTORS THAT HAVE SHAPED U.S. HEALTH CARE
Cultural beliefs and values
Social changes
Technological advances
Economic constraints
Political opportunism
Because these factors interact, one cannot always clearly attribute a change to any single
factor.
BELIEFS AND VALUES HAVE PLAYED A DOMINANT ROLE
The health care system has been shielded from a major overhaul because any
major government intervention has been viewed skeptically by most Americans.
Social, political, and economic forces led to certain compromises, as seen in the
creation of Medicare and Medicaid.
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MEDICAL SERVICES IN PREINDUSTRIAL AMERICA
Overview
Medical education was not grounded in science.
Practice of medicine had a domestic rather than a professional character.
Medical practice was more a trade than a profession.
Medical institutions were primitive.
A few isolated hospitals could be found in the largest cities
Health insurance did not exist
Medical Training
Based on apprenticeship rather than university education
Medical schools were opened by physicians as an economic necessity, to
supplement their incomes
Low standards prevailed
Medical Practice
A trade without prestige
Medical procedures were primitive
Absence of diagnostic instruments
Family members and neighbors were equipped almost as well as physicians
Anyone could practice medicine, which created intense competition
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