Evaluate the impact of at least two major trends that occured in the U.S. health care system during the twentieth century that continue to significantly influence the access to health care in the twenty-first century. How have these trends challenged health care organizations and their leaders?
Two of the biggest trends in US health care in the 20th century were the rise of the employment based insurance model and the condensing of the health care system into large corporate networks. Both of these trends affected and continue to affect access to health care services in the US.
Unlike many other industrialized nations, the US has never implemented a true nationalized health care system despite efforts to do so throughout the 20th century. The first major effort was in the early part of the 20th century when health care beyond home remedies was becoming a reality for much of the country. Another major push came around the WWII era, and finally from the 1990's onward. President Obama's recent Affordable Care Act utilizes the existing health insurance industry and so its effects as a national system remain to be seen. Instead of a nationalized system, the US gradually adopted an employment based insurance system whereby the majority of Americans obtain their health insurance through plans offered by major insurance companies through their employers. This way, businesses are responsible for a major share of employee health care costs but both benefit from economies of scale (at least for large companies with lots of employees). The problem with the system in terms of access are costs of health care and insurance for people who do not work for companies that offer health insurance. This system worked for the majority of Americans during the postwar years where many people worked for large companies and collective bargaining from employee unions really made healthcare coverage a major job benefit. But in recent years large company employment has declined and many people are employed by small businesses or work for themselves as contractors going from job to job. Also, many people work a series of part time jobs that do not offer health care benefits as a way to reign in business costs. These people have no access to large employee sponsored cost sharing and must shoulder the considerable cost of health care coverage themselves. Also, having US businesses having to pay for healthcare costs for their employees puts them at a disadvantage over businesses in other countries that do not have to factor in that cost.
The other major trend in US health care is consolidation under large corporate networks. It is getting harder for doctor's practices to exists independently outside of the corporate network. As a result, doctors must adhere to corporate policies of more defensive medicine to protect the company from legal action. This results in more and often unnecessary tests being run as a precaution. This increases the general cost of health care which in turn is simply passed on to the consumer (the patient). Again, those without large company health care plans shoulder the majority of this cost themselves, thus restricting their access to health care.