(002)assessment 1 instructions: evolution of the hospital industry

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Instructions  attached

APA style (2-3 PAGES)

Due date 03/17/23

Assessment 1 Instructions: Evolution of the Hospital Industry: A Comparative Analysis

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· Write a 2-3 page paper about the similarities and differences in hospital care from the 1800s, 1960s, and today, plus your analysis conclusions. Include a research table in the appendix of your paper.

Izabella is a health care historian. She has been hired by the Philadelphia Medical Society to research and develop a storyboard of hospital care quality from the first hospital to today’s hospitals. The storyboard will cover the evolution of the hospital environment, staff education, level of care, and how hospital services were paid for.

Izabella’s storyboard begins with the fact that hospitals had humble beginnings in the United States. The first hospital in America was founded in Philadelphia in 1751! Its mission was “to care for the sick-poor and insane who were wandering the streets” of Philadelphia (Penn Medicine, n.d., para. 1). Having a historical perspective on health care changes and trends is critical to understanding how to improve health care today and in the future. What kind of medical care might a patient have received in the first 18th-century hospital?

As a health care administrator, you will often do research on a topic to provide background information for decision making, committee work, or creating policies. It is often best practice to use a comparison table to lay out and visualize your research notations.


Penn Medicine. (n.d.). 
History of Pennsylvania Hospital. http://www.uphs.upenn.edu/paharc/features/creation.html


Imagine you are a patient with a serious illness in a hospital in the 1800s, in the 1960s, and today. Think about the room configurations, the skills of the nurses and other staff, the level and type of care, and how you would pay for the care, both now and in the previous centuries.


Write a 2–3 page paper about the similarities and differences in hospital care from the different time periods (1800s, 1960s, and today), as well as the conclusions you drew from your analysis. Include a research table in the appendix of your paper.  

Complete the following:

1. The textbook is suggested as the most efficient resource for this assessment, or use at least two other resources from those provided for this assessment. You may also use resources you find on your own from the 

History of Health Care Research
 tab in the 

Health Care Administration Undergraduate Library Research Guide
 to research how the hospital industry has evolved in terms of hospital environment, medical staff education, level of care in hospitals, and payment systems.

1. You will need to reference a total of three scholarly sources in your paper.

1. Be sure to cite these references within the body of your paper correctly using APA-style citations.

. Complete the Comparative Analysis Table: Hospital Care Evolution, located in the appendix of the 

Comparative Analysis Template [DOCX]

2. Provide two descriptive changes for each time period under each of the headings. 

2. Add bullet points to each cell in the table to document the descriptive changes that you have found for each topic.

2. Document the source where you found the information for each cell in the table, using APA-style citations.

. Refer to the 

Comparative Analysis Assessment Exemplar [PDF]
 for an example of how to translate the information from the table into a written paper.

3. Note that the assessment exemplar is written about the evolution of physicians’ practices and not hospital care, which is the topic for this assessment.

3. Do not copy the exemplar text into your paper. You should submit original written work about the evolution of hospitals in your paper.

. Write an introduction to the paper using the 

Comparative Analysis Template [DOCX]

4. Include a brief explanation of the purpose of the paper and main ideas.

4. Reference significant trends that you noticed as appropriate.

4. Refer to the 

Writing Support
 page on Campus for resources to help you as you write and revise your paper.

. Write the body of the paper.

5. Write the Hospital Care Evolution section in the assessment template, using the information from the Comparative Analysis Table you completed.

1. Describe your findings about each topic in the different time periods under each subtopic heading.

1. Explain the trends in hospital environment, medical staff education, level of care in hospitals, and the payment systems in a short paragraph (3–4 sentences) for each topic, using the subheadings provided in the assessment template.

1. Cite all references used within the body of your paper using APA-style citations.

. Write the Comparative Analysis section (1–2 paragraphs) in the assessment template.

2. Write a brief summary of your comparisons and analysis about the significance of the key changes from the different time periods. 

2. Draw conclusions about how the hospital industry has evolved from the 1800s to the 1960s to today and about the significance of the key milestones from the different time periods.

2. Give specific examples of the impact on the quality of patient care during these time frames.

· Write a conclusion paragraph where you summarize the main ideas included in the paper.

. Explain why it is important to study the history of hospital care for your profession.

Additional Requirements

· Your paper should be 2–3 pages, in addition to the title page, appendix, and reference page.

· Double space your paper, and use Times New Roman, 12-point font, as indicated in the assessment template.

· Use a minimum of three resources; you may include the textbook.

· Complete all parts of the assessment template, using the headings provided in the template.

· Support all points with credible evidence, in the form of APA citations. Refer to 

Evidence and APA
 in the Capella Writing Center for help with using APA style.

· Include a references page in APA format with appropriate citations.

· Complete the Comparative Analysis Table: Hospital Care Evolution table in the appendix of the assessment template.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

· Competency 1: Analyze trends in the U.S. health care system from a historical perspective.

· Compare and contrast the hospital environments of the 1800s, 1960s, and today.

· Compare and contrast the level of care provided in hospitals of the 1800s, 1960s, and today.

· Compare and contrast the payment systems in the hospitals of the 1800s, 1960s, and today.

· Draw conclusions about how the hospital industry has evolved from the 1800s, to the 1960s, to today.

· Competency 3: Analyze the development of medical education in the United States.

· Compare and contrast the staff education level in hospitals of the 1800s, 1960s, and today.

· Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others.

· Appropriately addresses all components of the assessment prompt, using the assessment description to structure text.

· Apply APA formatting to in-text citations and references.


Use the scoring guide to understand how your assessment will be evaluated.


Resources: Health Care in History

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· Health Care in History

· Young, K. M., & Kroth, P. J. (2018). Sultz & Young’s health care USA: Understanding its organization and delivery (9th ed.). Jones & Bartlett Learning. Available in the courseroom via the VitalSource Bookshelf link.

1. Chapter 1, “Overview of Health Care: A Population Perspective,” pages 1–21.

1. Chapter 2, “Benchmark Developments in the U.S. Health Care System,” pages 23–43.

The U.S. Health Care Timeline.

2. Review this timeline for the major milestones in health care in the United States.

. Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J. S., & Kahn, J. G. (2020). 
Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLoS Medicine, 17(1), 1–18.

3. This article is an analysis of the fiscal feasibility of having a single-payer health care system in the United States.

. Tuohy, C. H. (2019). 
Political accommodations in multipayer health care systems: Implications for the United States. American Journal of Public Health, 109(11), 1501–1505.

4. This article provides the chance to learn from other developed countries’ experiences with single-payer universal health care and apply it to the U.S. multi-payer system.

. Morone, J. A. (2010). 
Presidents and health reform: From Franklin D. Roosevelt to Barack Obama. Health Affairs, 29(6), 1096–1100.

5. This resource offers a historical timeline of the U.S. health care system reforms from Roosevelt to Obama.

. PBS. (n.d.). 

Healthcare crisis: Who’s at risk?

6. This website offers a variety of topics related to health care.

6. Click on the Healthcare Timeline in the left menu of the website, under The Issues heading.

Comparative Analysis: Physician Practice Evolution


Learner’s Name

School of Business, Technology, and Health Care Administration, Capella University

BHA4002/BHA-FPX4002: History of the United States Health Care System

Capella Instructor’s Name


Note: This is an example paper written on the evolution of
physician practices. The actual assessment is a comparative
analysis of the evolution of hospitals.


Example-only Comparative Analysis Paper © Capella University, Not for Distribution

Comparative Analysis: Physician Practice Evolution

In this comparative analysis report, the evolution of physician practice is reviewed from the 1800’s

through the 2000s. The purpose of this report is to show the progress of how physician practices, their

staff and payment systems have changed over the last three centuries. The irony is that they have

changed, and they have also gone full circle as explained below.

In the 1800 and 1900 centuries, the relationship with the physician was very personal and patient-

centered. The physician knew everything about their patient, and the patient knew everything about their

hometown physician. As medicine evolved, physicians became more specialized, and focused on specific

diseases. This often removed that personal relationship between physician specialist and patient. The

irony is that the 2019 COVID pandemic put a spotlight once again on the primary care physician-patient

relationship, but in a much broader context. The pandemic showed us the importance of the primary and

community healthcare (P&CHC) systems focus (Lauriola, et al., 2021). The pandemic revealed a

weakness in P&CHC worldwide, i.e., it put a focus on hospital and intensive care beds and not on

community and primary care. In Lauriola et al. (2021), the authors propose that the pandemic has shown

us that P&CHC is where the focus needs to be though local community problem-solving to safeguard

communities, which brings us back to the primary care physician and infrastructure at the community

level, but in a context of global world health (Lauriola et al., 2021).

Comparative Grid and Analysis

In Appendix A, the table entitled The Physician Practice Evolution and Changes shows how the

physician practice has progressed. There are several major milestones that stand out in the table which

includes the evolution of the physicians’ offices, the training of their staff, and how they were paid

compared to payment systems today.

The Physician Practice

In the 1800s, physicians would often go to see the patient at their home (Nespor, 2009).

Physicians were solo practitioners around the turn of the 19th century. By the mid-1900s physicians were

more likely to be in a group practice of two or more providers (Kroth & Young, 2018). In the early 1990s,

healthcare markets began to consolidate nationwide due to rising healthcare costs and reduced

reimbursement. By the 1990s group practices began to integrate horizontally into Independent Practice


Example-only Comparative Analysis Paper © Capella University, Not for Distribution

Associations (IPAs) (Kroth & Young, 2018). The IPAs then vertically integrated with hospitals and formed

Physician-Hospital Organizations (PHOs). The PHOs were established to retain and gain market share

through managed care contracting and used shared purchasing groups to achieve cost-savings (Kroth &

Young, 2018; Williams & Cuneo,1997).

Physician Staff

In the 1800s, the physician most often worked as a solo practitioner without an assistant. If they

had an assistant, it was someone that they personally trained (Nespor, 2015). By the 1960s, due to

population growth and the demand for health services, physicians time became a scarce commodity, and

the nurse practitioner movement began (Kroth & Young, 2018). This movement persists today because of

population demand and the projected physician shortages (AAMC, 2021).

Payment Systems

From the 1800s to the early 1900s, physicians were paid in small amounts of cash, or in food

and services from their patients (Allen, 2016). As healthcare costs rose between 1960-2000, physicians’

fees declined. The physicians’ reimbursement changed from fee-for-service to discounted fee-for-service

and capitation (Kroth & Young, 2018). Capitation is a flat prepaid fee to providers per member per month

(PMPM) from the managed care organizations (MCOs) (Kroth & Young, 2018).

Comparative Analysis Summary

In the 1800s, the physician’s office was often their home. By the 1960s offices were centrally

located and often group practices with two or more physicians. In the 1800, physicians extenders did not

exist. In the 1960s and still today the educational programs for NP and PA are well established and the

physician extender, working under the supervision of the physician, is common.

One of the biggest changes in the physician practice has been in the reimbursement for their

services. In the 1800s, physicians received payment in cash or food and services. Blue Cross (BC) was

established in 1929, Medicare and Medicaid in 1965 as fee for service payers. However, by the early

1990s markets consolidated and managed care organizations were on the rise promoting care quality and

cost containment.


Example-only Comparative Analysis Paper © Capella University, Not for Distribution


In conclusion, the evolution of the physicians practice has been progressively positive, and the

improvements have established higher quality of care in medical practices today. The changes in the

physician’s medical practice have been and will continue to be dynamic and persistent. However, the

medical industry is unable to ignore what the 2019 COVID pandemic has revealed, i.e., the importance of

the primary and community healthcare (P&CHC) systems focus. Although, the primary care and specialty

care physicians will continue to manage patient care and prevention at the community level they will need

to do so within a broader world-health context.


Example-only Comparative Analysis Paper © Capella University, Not for Distribution


Allen, E. (2016, April 28). Paying the doctor in 18th-century Philadelphia. Library of Congress.


Association of American Medical Colleges. (2021, June 11). AAMC report reinforces mounting physician

shortage. https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-


Berenson, R. A., & Rich, E. C. (2010). US approaches to physician payment: The deconstruction of

primary care. Journal of General Internal Medicine, 25(6), 613–618.


Kroth, P. J., & Young, K. M. (2018). Sultz & Young’s health care USA: Understanding its organization and

delivery (9th ed.). Jones & Bartlett.

Lauriola, P., Martín-Olmedo, P., Leonardi, G. S., Bouland, C., Verheij, R., Dückers, M., van Tongeren, M.,

Laghi, F., van den Hazel, P., Gokdemir, O., Segredo, E., Etzel, R. A., Abelsohn, A., Bianchi, F.,

Romizi, R., Miserotti, G., Romizi, F., Bortolotti, P., Vinci, E., Giustetto, G., … Zeka, A. (2021). On

the importance of primary and community healthcare in relation to global health and

environmental threats: lessons from the COVID-19 crisis. BMJ Global Health, 6(3), e004111.


Nespor, C. (2009, March 11). 19th century doctors in the U.S. Melnick Medical (History) Museum.

Nespor, C. (2015, October 28). Doctors’ offices. Melnick Medical (History) Museum.


Williams, W. C., III, & Cuneo, K. F. (1997). Physician-hospital organizations and PHO executives. What

lies ahead for the PHO? Physician Executive, 23(2), 13–15.



Example-only Comparative Analysis Paper © Capella University, Not for Distribution

Appendix A

The Physician Practice Evolution and Changes

Theme 1800s 1960s 2000s


• Often the
providers home

• Often the patients
home (Nespor,

• Single Physician
Office (Nespor,

• Small group
Practice of 2-4
physicians (Kroth
& Young, 2018).

• Independent Physician
Associations (IPAs).

• Consolidation of market
with larger physician
groups contracted with
Hospitals, i.e., Physician
Hospital organizations
(PHOs). (Kroth & Young,


• None with formal

• Trained by the
physician to assist
them (Nespor,

• Office staff, may
include RN, LPN,
or MA

• Often trained by
the physician to
assist them
(Kroth & Young,

• Specialization, Physician
extenders, Nurse
practitioners (NP) and
Physician Assistants

• Lab Technicians,
Radiology Technologists
(Kroth & Young, 2018).


• Small cash

• Goods, such as
coffee, tea, wine,
and beer; and
services such as
carpentry, painting
and so on were
offered as
payment (Allen,

• Fee-for-Service:
Private pay.

• Early insurance
payments form
BCBS (1929),

• 1965 and
Medicare and
Medicaid (Kroth
& Young, 2018).

• Medicare Physicians Fee
Schedule (PFS),
Relative Value Scale

• Capitation, one fee per
member per month
(PMPM) (Kroth & Young,


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