


Describe the major trends in the evolution of health care services in the United States over the past 100 years and the impact policies had on the changes.
The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by wednesday, 11:59 p.m. Eastern Time. Two scholarly sources references are required, unless stated otherwise by your professor.
Please review the rubric before posting to ensure a maximum of points.
Here are the categories of the new discussion rubric:
Initial Post relevance to the topic of discussion, applicability, and insight. (20%)
Quality of Written Communication Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)
Inclusion of DNP essentials explored in the discussion as well as the role-specific competencies as applicable.(10%)
Rigor, currency, and relevance of the scholarly references. (Use articles that are below 5 years). (20%)
Peer & Professor Responses. The number of responses, quality of response posts. (20%)
Timeliness of the initial post and the answers to the peers. (10%)

Health Care Services Evolution in America: The significant trends and policy effects during the last century.
The U.S. health care has experienced a tremendous transformation over the last decade with the influence of scientific development, demographic shift, economic pressure and policy development. Among the most prominent trends, there are the replacement of the acute and hospital-focused care with the preventive and population-based care; the rise in the coverage of health insurance; a surge in specialization and technological progress; and a greater focus on quality, safety and value-based care. Health policies have been at the forefront of bringing and spearheading these changes.
At the beginning of the 20 th century, health care in the US was quite poor, fragmented, and acute infectious illnesses oriented. Majority of care was at the homes of the patients and the hospitals were mainly charitable institutions. The advent of antibiotics, vaccines, and better sanitation vastly decreased the mortality rate and changed health care to institutional and hospital services. Under the Hill-Burton Act of 1946, hospitals were greatly expanded in the rural and underserved neighborhoods, making hospitals the center of care and forming the foundation of health systems in the modern times.
One of the biggest turning points happened in 1965 with the creation of Medicare and Medicaid, which increased the availability of care among older adults, people with disabilities, and the low-income groups. Not only did these programs cause a rise in the use of health services but they also standardized reimbursement processes leading to a blistering growth in health care expenditure and specialization of providers. The financing models of the time, which were largely policy-based, focused more on volume than results, supported a fee-based system that enhanced the amount of services instead of the quality.
In late 20 th century and early 21 st century, the rise of costs, prevalence of chronic diseases, and health disparities led to the transition to managed care, primary care integration, and population health strategies. The Affordable Care Act (ACA) of 2010 was a big milestone on the policy since it covered more people in insurance, encouraged prevention services, and encouraged the coordination of care using such models as Accountable Care Organizations (ACOs). These reforms focused on care delivery and reimbursement frameworks essentially changing the structure of care delivery, quality measurement, and patient outcomes, with a central theme of value-based care.
The most recent developments in health care services are the shift towards digital health, collaboration of professionals, and community based care. Expansion of telehealth Telehealth has been expanded by COVID-19 policy waivers and has made access more accessible, continuity of care, and geographic barrier reductions. Also, new policies in favor of electronic health records (EHRs) like the HITECH Act have enhanced data integration, clinical decision-making, and quality monitoring, but introduced new issues of interoperability and equity.
Regarding the AACN DNP Essentials, the trends are specifically related to the systems leadership, advocacy of health policy, quality improvement, and population health essentials. DNP-prepared nurses are considered to be an important force in policy-to-practice translation, organizational change, enhanced models of care delivery, and response to social determinants of health. With the ongoing transformation of health care into value-based and equitable care, the DNP leaders are in an ideal position to affect the policy implementation, promote evidence-based practice, as well as enhance system and population outcomes.
To sum up, the history of the development of health care services in the U.S. depicts a dynamic relationship between the policy choices, social needs, and the clinical innovation. Knowledge of such historical trends can help health care leaders, particularly those with DNP training, to predict upcoming issues, implement effective policies, and create sustainable health systems based on patient needs.
Citations (In the Recent 5 Years)
Your position on the Maya civilization. (2021). The future of nursing 2020- 2030: Plotting a course to attain health equity. National Academies Press.
Tikkanen, R., & Abrams, M. K. (2020). The U.S. health care in global perspective, 2019: Better spending, worse results? Health Affairs, 39(6), 1024-1032. doi: 10.1377/hlthaff.2020.01000.
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