User:Mkaddache/Healthcare in the United States

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History[edit]

Polio vaccine was invented in the US by Hilary Koprowski and Jonas Salk (above, right).

The healthcare system in the United States can be traced back to the Colonial Era.[1] Community-oriented care was typical, with families and neighbors providing assistance to the sick.[2][3] During the 19th century, the practice of medicine began to professionalize, following the “Anglo-American model” where these new medical professionals were empowered by the state to govern their own affairs, leading to various collaborations to acquire status and win legislation granting them the power to self-regulate.[4] The establishment of medical schools and professional organizations led to standardized training and certification processes for doctors.[5] Despite this progress, healthcare services remained disparate, particularly between urban and rural areas. The concept of hospitals as institutions for the sick began to take root, leading to the foundation of many public and private hospitals.[6]


In the early 20th century, advances in medical technology and a focus on public health contributed to a shift in healthcare.[7] The American Medical Association (AMA) worked to standardize medical education, and the introduction of employer-sponsored insurance plans marked the beginning of the modern health insurance system.[8] More people were starting to get involved in healthcare like state actors, other professionals/practitioners, patients and clients, the judiciary, and business interests and employers.[9] They had interest in medical regulations of professionals to ensure that services were provided by trained and educated people to minimize harm.[10] The post–World War II era saw a significant expansion in healthcare where more opportunities were offered to increase accessibility of services. The passage of the Hill–Burton Act in 1946 provided federal funding for hospital construction, and Medicare and Medicaid were established in 1965 to provide healthcare coverage to the elderly and low-income populations, respectively.[11][12]

The latter part of the 20th century saw continued evolution in healthcare policy, technology, and delivery. Following the Stabilization Act of 1942, employers, unable to provide higher salaries to attract or retain employees, began to offer insurance plans, including healthcare packages, as a benefit in kind, thereby beginning the practice of employer-sponsored health insurance, a practice that is cemented into the work culture of today.[13] The Health Maintenance Organization Act of 1973 encouraged the development of managed care, while advances in medical technology revolutionized treatment. In the 21st century, the Affordable Care Act (ACA) was passed in 2010, extending healthcare coverage to millions of uninsured Americans and implementing reforms aimed at improving quality and reducing costs.[14]

Impact of drug companies[edit]

The US, along with New Zealand, make up the only countries in the world that allows direct-to-consumer advertising of prescription drugs. The Food and Drug Administration in the United States, mainly under the Federal Food, Drug, and Cosmetic, oversees the advertising of prescription drugs to ensure accurate and truthful communication. In 2015, the American Medical Association called for the banning of direct-to-consumer advertising because it is linked with increased drug prices.[15] Physicians, via various FDA surveys, conveyed varying thoughts regarding ads as they believe while patients were getting more involved in their own healthcare, they felt pressured to prescribe specific drugs or felt concern over methods of communication about risks and benefits of the drug.[16] Still, other evidence cites that there are some benefits to direct-to-consumer advertising, such as encouraging patients to see the doctor, diagnosis of rare diseases, and the removal of stigma associated with the disease.[17]

When healthcare legislation was being written in 2009, the drug companies were asked to support the legislation in return for not allowing importation of drugs from foreign countries.[18] There were and are many complications regarding drug legislation due to the relationship between pharmaceutical companies and the federal government. Legislation relating to drug prices in particular tends to cause several issues.[19] The Inflation Reduction Act of 2022, while still undergoing negotiations for roughly the next two years, attempts to renegotiate drug prices by amending the non-interference clause in the Medicare Part D program.[20] The non-interference clause states that the government is prohibited from interfering in negotiations with drug manufacturers, insurers and pharmacies.[21]

Demographic Differences[edit]

Health disparities are well documented in the United States in ethnic minorities such as African Americans, Native Americans, and Hispanics.[22] When compared to white people, these minority groups have a higher incidence of chronic diseases, higher mortality, poorer health outcomes, and poorer rates of diagnosis and treatment.[23][24] Among the disease-specific examples of racial and ethnic disparities in the US is the cancer incidence rate among African Americans, which is 25% higher than among white people.[25] In addition, adult African Americans and Hispanics have approximately twice the risk as white people of developing diabetes and have higher overall obesity rates.[26] Minorities also have higher rates of cardiovascular disease and HIV/AIDS than white people.[25] In the US, racial demographics are as follows: Asian American (87.1 years), followed by Latino (83.3 years), White (78.9 years), Native American (76.9 years), and African American (75.4 years).[27] A 2001 study found distinguished racial differences exist in healthy life expectancy at lower levels of education.[28]


Public spending is positively correlated with age; average per capita public spending for seniors was more than five times that for children ($6,921 versus $1,225, equivalent to $11,724 versus $2,075 in 2023[29]). Average public spending for non-Hispanic blacks ($2,973, equivalent to $5,036 in 2023[29]) was slightly higher than that for white people ($2,675, equivalent to $4,531 in 2023[29]) while spending for Hispanics ($1,967, equivalent to $3,332 in 2023[29]) was significantly lower than the population average ($2,612, equivalent to $4,425 in 2023[29])). Total public spending is also strongly correlated with self-reported health status ($13,770 [equivalent to $23,326 in 2023[29]] for those reporting "poor" health versus $1,279 [equivalent to $2,167 in 2023[29]] for those reporting "excellent" health).[30] Seniors make up 13% of the population but take one-third of all prescription drugs. The average senior fills 38 prescriptions annually.[31] A new study has also found that older men and women in the South are more likely to be prescribed antibiotics than older Americans elsewhere, even though there is no evidence that the South has higher rates of diseases requiring antibiotics.[32]


There is considerable research into inequalities in healthcare where in certain cases, these inequalities are caused by income disparities that result in lack of health insurance and other barriers, such as medical equipment, to receiving necessary services. In some cases, these inequalities are caused by income disparities that result in lack of health insurance and other barriers, such as medical equipment, to receiving services.[33] According to the 2009 National Healthcare Disparities Report, uninsured Americans are less likely to receive preventive services in healthcare.[34] For example, minorities are not regularly screened for colon cancer and the death rate for colon cancer has increased among African Americans and Hispanic people. In other cases, inequalities in healthcare reflect a systemic bias in the way medical procedures and treatments are prescribed for different racial and ethnic groups. Raj Bhopal, professor emeritus at University of Edinburgh, writes that the history of racism in science and medicine shows that people and institutions behave according to the ethos of their times.[35] Nancy Krieger, professor of social epidemiology at Harvard, wrote that racism underlies unexplained inequities in healthcare, including treatment for heart disease,[36] renal failure,[37] bladder cancer,[38] and pneumonia.[39] Results from a 2023 scoping review of the literature found that in studies conducted in multiracial or multiethnic populations, race or ethnicity variables were rarely included in conceptually thoughtful and analytically informative ways concerning race or ethnicity as markers of exposure to racialized social disadvantage.[40][41] Bhopal writes that these inequalities have been documented in numerous studies whose consistent and repeated findings were that Black Americans received less healthcare than white Americans—particularly when the care involved expensive new technology. The consistent and repeated findings were that Black Americans received less healthcare than white Americans—particularly when the care involved expensive new technology.[42] One recent study has found that when minority and white patients use the same hospital, they are given the same standard of care.[43][44] The lack of equitable access to different resources is intrinsically tied to the field of public health, which works to supplement the traditional medical system with other services and opportunities.

Medical devices are expensive because the process of designing and approving them is extensive and costly, requiring that they be sold at higher than market price. The costs include research, design and development, meeting the U.S. Food and Drug Administration's regulatory guidelines, manufacture, marketing, distribution, and business plan.[45] Cost, alongside the impact of systematic oppression and inequality of communities of color within healthcare, together make medical equipment inaccessible. Most studies focused on access to medical devices and enhancement of affordable local production have concluded that increasing access to medical devices in an attempt to meet healthcare needs is highly critical. [46]

The increase of artificial intelligence (AI) in health care raises issues of equity and bias related to how health applications are developed and used. AI expansion is now of serious global interest towards public and private investment. The Harrow Council launched the IBM Watson Care Manager system to match individuals, considering budget, with a provider and develop individual care plans.[47] Within the US, the FDA in 2017 cleared an AI medical imaging platform for clinical use as well as future devices.[48] A recent scoping review identified 18 equity issues with 15 strategies to address them to try to ensure that AI applications equitably meet the needs of the populations intended to benefit from them.[49]

  1. ^ Carl Bridenbaugh, Cities in the Wilderness: The First Century of Urban Life in America 1625-1742 (1938) p 401
  2. ^ Robinson, Martha. 2005. New Worlds, New Medicines: Indian Remedies and English Medicine in Early America. Early American Studies (Spring): 94-110.
  3. ^ Jacob Ernest Cooke, ed. Encyclopedia of the North American colonies (3 vol 1992) 1:214
  4. ^ Adams, Tracey L. (2020-10-20). "Health professional regulation in historical context: Canada, the USA and the UK (19th century to present)". Human Resources for Health. 18 (1): 72. doi:10.1186/s12960-020-00501-y. ISSN 1478-4491. PMC 7572238. PMID 33076923.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
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  8. ^ "AMA (AMA History) 1847 to 1899". American Medical Association. Archived from the original on 9 February 2009. Retrieved 2009-02-16.
  9. ^ Adams, Tracey L. (2020-10-20). "Health professional regulation in historical context: Canada, the USA and the UK (19th century to present)". Human Resources for Health. 18 (1): 72. doi:10.1186/s12960-020-00501-y. ISSN 1478-4491. PMC 7572238. PMID 33076923.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
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  16. ^ Research, Center for Drug Evaluation and (Sat, 11/03/2018 - 08:14). "The Impact of Direct-to-Consumer Advertising". FDA. {{cite journal}}: Check date values in: |date= (help)
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  19. ^ Ahmadiani, Saeed; Nikfar, Shekoufeh (2016-05-04). "Challenges of access to medicine and the responsibility of pharmaceutical companies: a legal perspective". DARU Journal of Pharmaceutical Sciences. 24 (1): 13. doi:10.1186/s40199-016-0151-z. ISSN 2008-2231. PMC 4855755. PMID 27141958.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  20. ^ Cubanski, Juliette; Neuman, Tricia; Published, Meredith Freed (2023-01-24). "Explaining the Prescription Drug Provisions in the Inflation Reduction Act". KFF. Retrieved 2024-05-10.
  21. ^ "Medicare – Part D Non-Interference Clause | Chronic Care Policy Alliance". 2022-09-06. Retrieved 2024-05-10.
  22. ^ Goldberg, J., Hayes, W., and Huntley, J. "Understanding Health Disparities." Archived May 15, 2008, at the Wayback Machine Health Policy Institute of Ohio (November 2004), p. 3.
  23. ^ Smedley, Brian D.; Stith, Adrienne Y.; Nelson, Alan R. (2003). Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press. ISBN 978-0-309-21582-4. OCLC 853283904.
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  25. ^ a b American Public Health Association (APHA), Eliminating Health Disparities: Toolkit (2004).
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  27. ^ Sarah Burd-Sharps and Kristen Lewis. Geographies of Opportunity: Ranking Well-Being by Congressional District. 2015. Measure of America of the Social Science Research Council.
  28. ^ Trends in healthy life expectancy in the united states, 1970–1990: gender, racial, and educational differences Archived March 17, 2010, at the Wayback Machine
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  31. ^ Tronetti P (January 11, 2011). "Senior consult:Check drugs supplements to avoid interactions". Florida Today. Melbourne, Florida. p. 1D.
  32. ^ O'Connor A (September 25, 2012). "Well: Antibiotic Prescription? It May Depend on Where You Live". The New York Times.
  33. ^ "How Trends in the Health Care System Affect Low-Income Adults: Identifying Access Problems and Financial Burdens", Issue Brief: Kaiser Commission on Medicaid and the Uninsured, December 21, 2007. Retrieved February 26, 2008.
  34. ^ Habib JL (2010). "Progress lags in infection prevention and health disparities". Drug Benefit Trends. 22 (4): 112. Archived from the original on January 20, 2013. Retrieved June 11, 2010.
  35. ^ Bhopal R (June 1998). "Spectre of racism in health and health care: lessons from history and the United States". BMJ. 316 (7149): 1970–3. doi:10.1136/bmj.316.7149.1970. PMC 1113412. PMID 9641943.
  36. ^ Oberman A, Cutter G (September 1984). "Issues in the natural history and treatment of coronary heart disease in black populations: surgical treatment". American Heart Journal. 108 (3 Pt 2): 688–94. doi:10.1016/0002-8703(84)90656-2. PMID 6332513.
  37. ^ Kjellstrand CM (June 1988). "Age, sex, and race inequality in renal transplantation". Archives of Internal Medicine. 148 (6): 1305–9. doi:10.1001/archinte.1988.00380060069016. PMID 3288159.
  38. ^ Mayer WJ, McWhorter WP (June 1989). "Black/white differences in non-treatment of bladder cancer patients and implications for survival". American Journal of Public Health. 79 (6): 772–5. doi:10.2105/ajph.79.6.772. PMC 1349641. PMID 2729474.
  39. ^ Yergan J, Flood AB, LoGerfo JP, Diehr P (July 1987). "Relationship between patient race and the intensity of hospital services". Medical Care. 25 (7): 592–603. doi:10.1097/00005650-198707000-00003. PMID 3695664. S2CID 11637921.
  40. ^ Cené, Crystal W.; Viswanathan, Meera; Fichtenberg, Caroline M.; Sathe, Nila A.; Kennedy, Sara M.; Gottlieb, Laura M.; Cartier, Yuri; Peek, Monica E. (2023-01-19). "Racial Health Equity and Social Needs Interventions: A Review of a Scoping Review". JAMA Network Open. 6 (1): e2250654. doi:10.1001/jamanetworkopen.2022.50654. ISSN 2574-3805. PMC 9857687. PMID 36656582.
  41. ^ Cené, Crystal W.; Viswanathan, Meera; Fichtenberg, Caroline M.; Sathe, Nila A.; Kennedy, Sara M.; Gottlieb, Laura M.; Cartier, Yuri; Peek, Monica E. (January 2023). "Racial Health Equity and Social Needs Interventions: Rapid Review".
  42. ^ Council on Ethical Judicial Affairs (May 1990). "Black-white disparities in health care". JAMA. 263 (17): 2344–6. doi:10.1001/jama.263.17.2344. PMID 2182918.
  43. ^ Darrell J. Gaskin, Christine S. Spencer, Patrick Richard, Gerard F. Anderson, Neil R. Powe, and Thomas A. LaVeist, "Do Hospitals Provide Lower-Quality Care To Minorities Than To Whites?," Health Affairs, March/April 2008
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  45. ^ "Thought Leadership Archives". Sterling Medical Devices. Retrieved 2023-04-27.
  46. ^ "Towards improving access to medical devices through local production". www.who.int. Retrieved 2023-04-27.
  47. ^ "AI in healthcare and research". The Nuffield Council on Bioethics. Retrieved 2024-05-10.
  48. ^ Gerke, Sara; Minssen, Timo; Cohen, Glenn (2020-01-01), Bohr, Adam; Memarzadeh, Kaveh (eds.), "Chapter 12 - Ethical and legal challenges of artificial intelligence-driven healthcare", Artificial Intelligence in Healthcare, Academic Press, pp. 295–336, ISBN 978-0-12-818438-7, retrieved 2024-05-10
  49. ^ Berdahl, Carl Thomas; Baker, Lawrence; Mann, Sean; Osoba, Osonde; Girosi, Federico (2023-02-07). "Strategies to Improve the Impact of Artificial Intelligence on Health Equity: Scoping Review". JMIR AI. 2: e42936. doi:10.2196/42936. ISSN 2817-1705. PMC 11041459. S2CID 256681439.
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