JessicaSellitto

GregColes
English137H
30October2015
Humanhistory,upuntilthelate1800sandearly1900s,wasmarkedbythe
prevalenceofacute,infectiousdiseases,withcharacteristicsandsymptomsthatare
severeandepisodicinnaturebutatthesametime,oftentreatable.Patientssometimes
recuperatedathomebut,inthemostacutecases,werecaredforinshorttermfacilities
suchashospitals(ShiandSingh,2013).Smallpoxandtuberculosiswereamongthemost
commoninfectiousdiseases,withevidencedatingbacktothreethousandyearold
mummies.Inaddition,papyruspaintingsdepictcasesofpoliomyelitisandsubsequent
culturessoughttounderstandhowacutediseaseswerespread.Forthousandsofyears,
leprosy,plague,syphilis,cholera,yellowfever,typhoidandotherinfectiousdiseases
werethenormassocietysoughttocontroltheirspread(Brachman,2003).
Asscienceandtechnologyhaveevolvedoverthecenturies,however,andnew
medicineandtreatmentmethodshavebeendiscovered,theprevalenceofacute,
infectiousdiseaseshassignificantlydecreased,tothepointwheresomediseases(like
smallpox)havebeencompletelyeradicated.By1900,theprevalenceofmanyofthese
diseaseshadbeguntodeclineduetopublichealthimprovementssuchasbetterliving
conditions,education,improvednutrition,sanitationandmedicalcare.Asaresult,there
hasbeenashiftawayfromtheemphasisonthetreatmentofacutediseasesasanew
dangertothehumanconditionarose.Chronicdiseases,whichhaveasignificantimpact

2
onthequalityoflifeofallindividuals,especiallytheelderly,havebecomeanewareaof
concern.Achronicconditionordiseaseisoflongandcontinuousdurationfromwhicha
patientmaynotfullyrecover.Itmaybecontrolledthroughappropriatemedical
treatment,butifleftuntreated,itmayleadtosevereandlifethreateninghealthproblems
(ShiandSingh,2013).Chronicillnessesincludevarioustypesofcancer,cardiovascular
diseaseanddiabetes,forexample.Sinceacutediseasesarenoweradicated,peopleare
livinglongerandthustheyaremorelikelytodiefromchronicdiseasesthatappearlater
inlife.Thistransitionintheprevalenceofacutetochronicdiseaseshasfostereda
paradigmshiftinthewaydiseasesmustbecaredfor,aphenomenonthathasinspired
economical,politicalandsocialchangesinsociety.Whilemuchchangehasoccurred,
thereisstilladireneedforimprovementandrefinementintheUnitedStateshealthcare
system.Overall,mostcriticsagreethattheUnitedStatesisnotspendingenoughonwhat
makesushealthy,theaspectsofourlivesthathelppreventdisease.Rather,theU.S.is
spendingtoomuchonmedicalcare,whichonlytakescareofusoncewearealreadysick.
Withtheshiftfromthetreatmentofacutetochronicillness,thismodelmustbemodified
tomeetthenewneedsofsociety.Whileitisnoteasytotransformamultitrilliondollar
industrythathasbeenbuiltupoverthepastfewcenturies,itisimportanttofacilitate
changewithinthehealthcaresystemthatalignwiththeshiftsthatareconstantly
occurringinsociety.

Medicalcarehasbecomemorecomplexasnotonlythetypesofdiseaseswemust

facearechanging,butalsothesystemitselfthatservicestheirneedsevolves.Theearly
practiceofmedicinewasregardedmoreasatradethanaprofession,anditlackedthe

3
prestigeithastoday.Beforethe1880s,theUnitedStateshadonlyafewisolated
hospitals,whichwerefoundinlargecitiessuchasNewYork,Boston,NewOrleans,St.
LouisandPhiladelphia(ShiandSingh,2013).Medicalcarewasprovidedbyonedoctor,
whousuallymadehousevisitsandcallstopatientstotreattheirshorttermorinfectious
illness.Asmedicineandtechnologyhavebecomemoreadvanced,however,andthe
challengesofchronicillnessesmustbemet,medicalcarenowrequiresmultipledoctors
withmultiplevisitswithinmultiplespecialties.Thischangehascreatedaneconomic
burdenonboththepatientandtheinsurancecompaniesbecausebothhavetobe
financiallyresponsible.Insteadofmedicaltreatmentsbeingaonestopexperience,
patientsnowhavetovisitmultipledoctorstogettheanswersandtreatmenttheyneed.
Themorespecializedthesefacilitiesbecome,thelargertheeconomicburden.Asdisease
becamemorecomplexduetoitschronicnature,onedoctorinafewshortvisitscouldnot
addresstheneedsofpatients.Inaddition,medicalcaretodayincorporatessocialand
personalattentionaswellasservicestoaddressphysicalsymptomsbecauseofthe
durationandseverityofdiseases.Asaresult,costsriseduetotheneedforextensive
treatment.

Asmedicalcarehasbecomemorespecialized,thehealthinsurancesystemhas

transformed.ThefirstbroadcoveragehealthinsuranceintheUnitedStatesemergedin
theformofworkerscompensation.Itwasoriginallydesignedtomakecashpaymentsto
workersforwageslostbecauseofjobrelatedinjuriesanddisease.Privatehealth
insuranceeventuallysurfacedintheearly1900'sasmedicaltreatmentsandhospitalcare
becamemoreexpensiveandunpredictable.HealthinsuranceintheUnitedStatessoon

4
becameemployerbasedafterWorldWarIIandprivatehealthinsurancebecamethe
primarymediumforthedeliveryofhealthcareservicesintheU.S.(ShiandSingh,
2013).Basicmedicalinsurancethroughemployers,however,soonwouldnotprovide
sufficientfundstocovertheeconomicburdenoflongtermillnessessuchascanceror
cardiovasculardisease.Inaddition,astheneedforlongterm,chroniccareincreased,
shorttermhealthinsurancewithnarrowprovisionswerentenough.Insurancethat
addressedonlyjobrelatedinjuriesalsobecameinsufficientastheneedforlongtermcare
expanded.Ashealthcarecostsonlyincreasedwiththegrowthofchronicillness,there
becameaneedforapublic,nationalhealthinsurancesystem.OnJuly30,1965,President
LyndonB.JohnsonsignedtheSocialSecurityAmendmentsof1965,creatingMedicare
andMedicaid.Atanannualcostof$260billion,Medicareisoneofthelargesthealth
insuranceprogramsintheworld.Providingnearlyuniversalhealthinsurancetothe
elderlyaswellastomanydisabled,Medicareaccountsforabout17percentofU.S.
healthexpenditures,oneeighthofthefederalbudget,and2percentofgrossdomestic
production(Nesvisky,2015).EvenwithMedicareandMedicaid,therewerecopays,
deductiblesandotherfinancialresponsibilitiestoconsider.Itwas,however,the
governmentsfirststepinattemptingtoprovidemedicalservicesandfinancialrelieffor
victimsofchronicillness,focusingspecificallyontheelderlyandimpoverished.
Further,aslifeexpectancyhasincreasedandcausesofdeathhavebecomemore
lifestylerelated,therehasbeenagrowingneedforcaregiversinfamilies.Theroleof
caregivershasbecomeanecessarycomponentofthetreatmentofchronicillness.
Complicationsariseaselderlypeopledonothavefamilymemberstotakecareofthem.

5
Evenifpeopledohavefamilymembers,noteveryonecanfinancially,mentallyand
physicallybeartotakecareoftheirlovedones.Itisalsoexceedinglydifficultforaparent
withhisorherownchildrentohavetheaddedresponsibilityoftakingcareofaparent
withachronicillness.Additionally,asthewidespreadpresenceofchronicillnesshas
increasedinsociety,therehasbeenashiftinthetypeofcarefacilitiesavailable,
specificallytotheelderlypopulation.Today,retirementfacilities,personalcarefacilities,
nursinghomes,andassistedlivingfacilitiesareamongthemostpopularlongtermcare
facilitiesinAmerica.Theforerunneroftodayshospitalsandnursinghomeswasthe
almshouse(orpoorhouse).Almshousesexistedinmoderatelysizedcitiesandwererun
bythelocalgovernment.Theywerenotahealthcareinstitutioninatruesense,butrather
aplacewherethedestitutemembersofsocietywereconfined.Almshouseslodged
manyelderly,illanddisabledpeopleandgavethemfood,shelterandsomebasicnursing
care.Inadditiontoalmshouses,pesthouseswereoperatedbylocalgovernmentstoisolate
peoplewhohadcontractedcontagiousdiseasessuchascholera,smallpoxoryellowfever.
Theirmainfunctionwastocontainthespreadofcommunicablediseasesandtoprotect
theinhabitantsofacity(ShiandSingh,2013).
Astheprevalenceofcommunicable,acutediseasesdeclinedandmedical
advancementsalteredthemedicalcaresysteminAmerica,healthcareservicesand
facilitiesbecamemorespecializedandprogressive.Longtermcareinmoderntimes
includesavarietyofservices,suchascareprovidedinanursinghome,homehealthcare,
andassistedlivingtopredominantlyelderlypopulations.Sincetheagingprocessleadsto
chronic,degenerativeconditionsthatresistcure,olderpeoplecollectivelyusea

6
disproportionatelylargeshareoftotalhealthcareservices.Althoughpeopleolderthan65
representabout13%oftheUnitedStatespopulation,thisgroupaccountsforonethirdof
allnationalhealthcarespendingandoccupiesonehalfofallphysiciantime.Theelderly
populationintheU.S.continuestogrow,andbetween2000and2020thenumberof
Americanswithchronicconditionsisprojectedtoincreasefrom125millionto157
million(ShiandSingh,2013).Thesepeoplewillneedtotakeadvantageoflongterm
carefacilitiessuchasassistedlivingfacilitieswhicharedescribedasaresidentialsetting
thatprovidespersonalcareservices,24hoursupervision,scheduledassistance,social
activitiesandsomenursingcareservices.Likewise,skillednursingfacilitiesprovide
clinicallongtermcareservicesandretirementfacilitiesemphasizeprivacy,security,
independenceandactivelifestylestoitspatients(ShiandSingh,2013).Thisneedfor
carefacilitieswascatalyzedbytheescalatingelderlypopulationandthereforethenature
ofdiseasesthatarenowcommoninsociety.Incontrast,inpasteras,peoplewithdiseases
thatneededtobecontainedandtreatedquicklydidnotneedextensivelongtermcare
facilities.However,overthepastfewcenturies,aschronicillnesshasheightened,
especiallyintheelderlypopulation,thetypeofcarefacilitiesintheUnitedStateshave
shiftedfromhospitalemergencyroomstolongterm,specializedcarefacilitieswhere
patientscanbetreatedforasubstantialamountoftime.
Thisshiftfromcommunicable,acuteconditionstodegenerative,chroniconeshas
hadanimpactonsocietyinamultitudeofways,mostspecificallyinhowitaffectsthe
middleandlowerclassesaswellashowitisreflectedinracialdiscrimination.While
manyinequitieshavebeenaddressedonapolitical,economicandsocialscale,theremust

7
bedrasticmodificationandchangeinhealthcareintheUnitedStates.Today,theUnited
StatesPrivateHealthSystemcanbecomparedtoabigbusiness.Smallmedical
practicesarenotsocommontodayintheU.Sastheyoncewere.Thisisduetotheneed
forextensive,longtermcare.Currently,theU.S.healthcaresystemisoutrageously
expensive,yetformanypatientsitisinadequate.Despitespendingmorethantwiceas
muchastherestoftheindustrializednations($7,129percapita),theUnitedStates
performspoorlyincomparisononmajorhealthindicatorssuchaslifeexpectancy,infant
mortalityandimmunizationrates(Shaw,2010).Thereisnowadesperateneedforreform
andthereforejusticeinourhealthcaresystem.Ourhealthcaresystemisunjustbecause
patientsofminoritybackgroundgetlesscareandinadequatecarecomparedtowhite
patients,basedonevidencepublishedinnumerousmedicalstudies.Also,itisunjust
becausepatientsarediscriminatedagainstbasedontheirabilitytopay(Shaw,2010).
Theseproblemshaveinspiredtheneedtodrasticallyalterhowourmedicalcaresystem
works.Thereneedstobeashiftinfocusfromthevolumeandprofitabilityofservices
providedtothepatientoutcomesachieved.Thatmeanstodaysfragmentedsystemmust
bereplacedwithonethatservicesforparticularmedicalconditionsareconcentratedin
healthdeliveryorganizationsandintherightlocationstodeliverhighvaluecare(Lee
andPorter,2013).Inshort,oursystemmustbemodifiedsothatallpeoplemayreceive
thecarethattheyneedthroughawidereachingnetworkoffacilitiesthatcanprovidea
broadrangeofcare.Wecannotallowhospitalstoberunlikeabigbusinessthatis
technologydrivenandfocusedonacutecare,andmustpushforemphasisonthepatient
physicianrelationship.

8
Itshouldbenotedthatwhiletheshiftfromacutetochronicillnesshasoccurred
andisstillhappening,thereisstillaneedforacutecaresystemsandtreatmentsinthe
UnitedStates.Inacountrywherealargepercentageofthepopulationremainsuninsured,
acutecarecentersarehelpingpeoplekeepmedicalcostsdown(whencomparedto
EmergencyRooms)whilestillprovidingtheemergencycareneeded.Inaddition,acute
carecenters,wherepatientsareevaluatedforurgent,nonlifethreateningmedical
problemsorinjuries,tendtooperateduringextendedhours,whenotherhealthcare
optionswouldbeunavailable(PhysiciansNow,2014).Theseclinics,however,are
utilizedlessthanchroniccarefacilitiesbecausetheroleoftheacutecareinpatient
hospitalisdiminishing.Thisisbecausediseasesarebeingcaughtearlierandfewer
patientsreachthepointwhereacutecareservicessuchasurgentcareorcriticalcareare
required.Whilechronicillnessisextremelyprevalentinsociety,U.S.healthcareinvolves
atechnologydrivensystemthatfocusesonacutecare.Thishaspromptedtheneedfor
changeinhowwedealwithtodayscommonillnesses.
Thereisanothersignificantchangethatmustbemade.Thefactthatpeopleare
nowlivinglongerbutaredyingfromconditionscausedbydiet,lifestyle,andhabitshas
exhibitedtheneedfortheU.S.governmenthealthcaresystemtoenableandpromote
healthierbehaviors.Promotinghealthybehaviorandhelpingpeopletostopbehaviors
suchassmoking,poordiet,inadequateexercise,alcoholanddrugabuse,andunprotected
sexthatcanleadtochronicphysicalillnessiscrucialforthefuturesuccessfortheUnited
Stateshealthcare.Enablinghealthierbehaviorswillreducetheonsetofmildandsevere
chronicphysicalillness,thelikelihoodofurgentevents(e.g.,heartattacksfromcigarette

9
smoke),aswellastheonsetofmentalillnessesassociatedwithdrugabuse.Enabling
thesebehaviorswillalsoreducetheneedformedicationsforlifestylerelateddisorders
includingasymptomatichypertensionandhighcholesterol.(PennStateDepartmentof
HealthPolicyandAdministration,2015)Everyyear,millionsofdollarsarespenton
advertisingcampaignstopromotehealthybehavior.Whilesomeoftheseattemptsto
motivatebehaviorchangeareeffective,somearenot.Infact,certainpositivebehaviors
maybemoreeffectivelyencouragediftheyareframedintermsofthebenefits(gain
framing)versusthecostsofthatbehavior(lossframing).Furthermore,somepeopleseem
torespondbetterwhenmessagesaretailoredtothewaytheytendtopersonallyprocess
healthinformation.Inaseriesoffieldexperiments,psychologistPeterSalovey,PhD,and
hiscolleaguesintheHealth,Emotion,andBehaviorLaboratoryatYaleUniversity
haveinvestigatedtheeffectsofframinghealthmessages.Framingmessagesinvolves
highlightingeitherthegains(benefitsoradvantages)orlosses(risksordisadvantages)
anticipatedwhenabehaviorisadopted,whilekeepingtheinformationfactually
equivalent.Forexample,gainframedmessagesforcancerpreventionmightbe"Use
sunscreenlotiontodecreaseyourriskofgettingskincancer.Ontheotherhand,an
exampleofalossframedmessagecouldbe"Withoutsunscreenyouincreaseyourriskof
developingskincancer.Saloveyandhiscolleagueshaveconductedtheirexperimentson
beaches,inpublichousingdevelopmentsandatcommunityclinics.Experimentswere
conductedusingpersuasivemessagesdesignedtopromoteavarietyofcancerprevention
anddetectionbehaviors,suchasmammographyutilization,sunscreenuse,andsmoking
cessation.Theresultsfromtheseexperimentsconcludethatmessagesframedasgainsare

10
moreeffectiveforcancerpreventionbehaviors,whilelossframedmessagesaremore
persuasiveforcancerdetectionbehaviors.Gainframedmessagesweremoreeffective
whentargetingpreventionbehavior,suchassunscreenuse.Incontrast,lossframed
messagesweremoreeffectivewhentargetingdetectionbehaviors,suchas
mammographyutilization(AmericanPsychologicalAssociation,2004).Anexperiment
likethisdemonstratestheneedforestablishingnewmethodsthatwemustutilizeto
communicatehowwecanlivehealthier,longerlives.Chronicdiseasescaninpartbe
preventedthroughhealthinterventions,soasmortalityrateshavedeclined,theageof
deathhasincreasedandaschronicconditionsbecomemorewidespread,itisbecoming
increasinglyimportanttofocusonpromotinghealthyhabits.
Inshort,sincemorepeoplearenowdyingatolderagesfromlifestylerelated
diseasesandnotfromcontagiousconditions,therehasbeenatransformationofhowwe
dealwithpreventionandtreatment.Theprevalenceofacuteillnesshassignificantly
decreasedanddoctorsandscientistsnow,asaresult,mustfocusonpreventingchronic
conditions.Ifhealthybehaviorsareencouraged,andhabitsthatpromptdegenerative
diseasearediscouraged,theprevalenceoflongtermconditionswilldecrease.Theshift
fromacutetochronicdiseaseshasinfluencedthewaydoctorsimplementtreatment,
whichalsoaffectshealthinsurance,healthcareandevensocialelementsasweexplore
effectivemodesoftreatment.

11

Works Cited
American Psychological Association. "To Motivate Healthy Behavior, It's Often Not
What You Say, But How You Say It." American Psychological Association. N.p.,
9 Dec. 2004. Web. 25 Oct. 2015.
<http://www.apa.org/research/action/motivate.aspx>.
Brachman, Philip S. "Infectious DiseasesPast, Present, and Future." International
Journal of Epidemiology 32.5 (2003): n. pag. Print.
Department of Health Policy and Administration. ReThink Health Student Manual. State
College: n.p., 2015. Print.
"How Acute Care Centers Are Replacing Emergency Rooms." Physicians Now. N.p.,
Aug. 2014. Web. 25 Oct. 2015. <https://www.myphysiciansnow.com/how-acutecare-centers-are-replacing-emergency-rooms/#sthash.oQC1MRrP.dpuf>.
Nesvisky, Matt. "Medicare and Its Impact." The National Bureau of Economic Research.
N.p., n.d. Web. 25 Oct. 2015. <http://www.nber.org/digest/apr06/w11609.html>.

12
Shaw, Timothy, M.D. "A Doctor Speaks About Healthcare, Big Business and Justice."
Physicians For a National Health Program. N.p., 9 Nov. 2010. Web. 25 Oct.
2015. <http://www.pnhp.org/news/2010/november/a-doctor-speaks-abouthealthcare-big-business-and-justice>.
Shi, Leiyu, and Douglas A. Singh. Essentials of the U.S. Health Care System. Third ed.
Burlington: Jones & Barlett Learning, 2013. Print.
"The Strategy That Will Fix Health Care." Harvard Business Review. N.p., Oct. 2013.
Web. 25 Oct. 2015. <https://hbr.org/2013/10/the-strategy-that-will-fix-healthcare>.