Evolution of the US Health System Organization, Finance, and Policy since 1945: A Critical Analysis of the History to Inform the Present and Guide the Future

Since the end of World War II, the health system in the United States (US) has evolved into a multi-layered web of complex institutional relationships, ever-changing financing, and highly variable performance outcomes. Innovations in services, structures, and policies have been spurred and confounded by changing demographics, advances in biomedical knowledge, and dramatic expansion of information technology. Given the fragmentation of the US health system, each event and trend affected various services and sectors in different ways, often with unintended consequences, making it challenging to ascertain or explain a uniform trajectory.How did we get to the present system of high quality, high costs, fragmentation, and inequitable distribution of assets, where the only constant seems to be change? Have the driving forces been public policies, population demand, financing models, provider insights, or environmental externalities? What lessons have been learned to guide those who will lead healthcare policy and management in the future? The genesis of evolution over the past eight decades offers insights into why the health system in the US today is so complicated and difficult to change, while also revealing which approaches have been effective and in which circumstances. We know of no single textbook that captures the historic landscape within and across programmatic silos to educate the students who will become the health leaders of the future. The intent of this Research Topic is to fill this gap with data and insights from historic progressions informed by theory and evidence. We invite papers that track the evolution of health services, finance, structure, policy, or management mechanisms, among other topics. Manuscripts may take the format of review articles, original research, case studies, policy analyses, or other article types as appropriate for the subject matter. Reference to and analysis of historic and seminal publications are encouraged. Historic and trend data and accompanying analyses that evaluate success, or a lack thereof, from the original policy or programmatic goals are welcome. Comparisons with parallel developments in other countries are useful to provide international context and add to evaluation of generic or specific applicability. We encourage papers from those who participated in the developments over the past decades to share behind-the-scenes explanations and lessons learned in the early days of implementing innovations to improve the US health system.To gather further insights, we welcome articles addressing, but not limited to, the following themes:• Emergence and disappearance of services• Changes in financing models• Refinements of management methods, especially information systems• Development of federal and state policies• Innovations in biomedical technologies to diagnose, treat, cure, and prevent illnesses that affect the delivery and finance of health services• Advancements in cross-cutting integrating mechanisms• Impact on services of changes in workforce availability and skills• Implications for the health system of externalities in the environment or context• International health system policies or practices that directly or indirectly affect the US Topic editors: Connie J Evashwick, Cory E. Cronin, Leonard Howard Friedman Source: https://www.frontiersin.org/research-topics/76834/evolution-of-the-us-health-system-organization-finance-and-policy-since-1945-a-critical-analysis-of-the-history-to-inform-the-present-and-guide-the-future