Evolution of the Hospital Industry: A Comparative Analysis

The healthcare system has undergone significant evolutional milestones since the 19th century. Healthcare payment systems, staff education, and hospital structural environments have evolved. Advancements have been realized in healthcare delivery to improve healthcare quality and access, reduce care costs, and improve quality of life. This paper aims to describe the significant evolution of hospital care from the 19th century to the early 21st century in the hospital environment, staff education, level of care, and care payment, and comparatively analyze these evolutions.

Evolution of the Hospital Industry: A Comparative Analysis

Hospital Care Evolution

Care for the patient in the hospital has evolved from the 19th century to the 21st century but structurally, systematically, quality, and procedurally. Care providers, instruments used to provide care, and supporters of hospital care have also evolved over this period (Niles, 2019). These changes were gradual advancements in the previous hospital care delivery, tools, and systems

Hospital Environment

The hospital environments before the 19th century were scarce. In the mid-1800s, hospitals developed were led by physicians and meant to serve the poor population. The rich received care in the comfort of their homes (Niles, 2019). By the 1960s, these physician-led institutions were taken over by churches and other large facilities for population health (Sultz & Young, 2018). Today, hospital environments are large corporates with a variety of services

Staff Education

In the 1800s, the medical staff consisted mainly of physicians and nurses. Staff education was mainly through an apprenticeship where the upcoming physician could learn by observing and performing physical skills. By the 1960s, formal medical and nursing schools had been established, and medical staff had to achieve formal learning and internship to acquire the knowledge and skills (University of Pennsylvania School of Nursing, n.d.). Today staff education is systematic with different qualifications and stages of education. Professional hospital staff members are certified and licensed before practice.

Level of Care

In the 1800s, hospital care was for low-income families, and the quality of care was not the same for the rich who received care at home (University of Pennsylvania School of Nursing, n.d.). In the 1960s, technical advancements had been implemented in healthcare and care efficacy improved (Niles, 2019). Various surgeries and surgical techniques also emerged in the 1960s. Currently, hospital care is more accessible for the rich because the poor cannot afford it.

Paying for Your Care

Healthcare insurance started as sickness insurance in the 1800s. In the 1960s, the federal government’s involvement in healthcare payment was legitimized through the legal implementation of Medicaid and Medicare. Payments before this time were majorly through out-of-pocket methods (Niles, 2019).

After the 1960s, about 50% of Americans had insurance, and this prescription increased in the 2000s after the implementation of policies such as ACA and the Children’s Health Insurance Program (CHIP) (Lee et al., 2021). Paying for care nowadays relies majorly on health insurance coverage

Comparative Analysis

The comparative analysis has shown positive improvements in hospital environments, staff education, levels of care, and healthcare payments. With these improvements, changes have been experienced in care quality and safety. The evolutions in the hospital industry have had setbacks on the general system. The 1800 systems were accessible to the poor, but the 2000s systems are not accessible to the poor.

Evolutions led to complexities in health environments that led to increased costs that reduced access and insurance coverage in the late 20th and early 21st century. Key milestones in the 1800s were changes in education and treatment, while in the 1960s, payment systems improved. In the 2000s, evolution led to professional developments with limited public access. These evolution trends showed improvements in quality and safety but not access and coverage.


Hospital care evolution from 19th to 21st century. The 1960s was a significant turning point for staff education and hospital care payment systems. Medical education and professional advancements have been steady and gradual over the three centuries. Levels of hospital care have improved for the public, but access to these services has not improved significantly owing to the evolution in payment of care and hospital environments.

Evolution of the Hospital Industry: A Comparative Analysis References

  • Lee, L. K., Todd, H., & Galbraith, A. A. (2021). Children’s coverage vulnerabilities with loss of a parent’s employer-sponsored insurance. Pediatrics147(2), e2020032730. https://doi.org/10.1542/peds.2020-032730
  • Niles, N. J. (2019). Basics of the U.s. health care system (4th ed.). Jones & Bartlett.
  • Sultz, H. A., & Young, K. M. (2018). Health care USA: Understanding its organization and delivery (9th ed.). Jones & Bartlett.
  • Tu, R. K. (2018). Legislative, payment policy milestones of racial inequality in health care: Medicare and Medicaid as the final catalyst. Journal of the American College of Radiology: JACR15(9), 1346–1348. https://doi.org/10.1016/j.jacr.2017.11.013
  • University of Pennsylvania School of Nursing. (n.d.). History of Hospitals. Upenn.edu. Retrieved September 9, 2022, from https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-hospitals/
  • Vogenberg, F. R., & Santilli, J. (2019). Key trends in healthcare for 2020 and beyond. American Health & Drug Benefits12(7), 348–350. https://www.ncbi.nlm.nih.gov/pubmed/32055282


Comparative Analysis Table: Hospital Care Evolution

Instructions: Fill in the chart with bullet points that describe the key milestones (events, regulations, laws, etc.) and the supporting details to explain the topics in each cell. Use your textbook and at least two other resources from the course resources for this assessment or your own research, and document where you found the information using accurate APA citations.

Subject/Topic The 1800s The 1960s The 2000s
Hospital Environment(Describe the overall hospital environment.) ·         The early 1800s – Almshouses primarily served the poor·         The mid-1800s – healthcare system environments established being led by physicians·         Hospitals were built mainly in urban areas ·         Hospital environments developed into large facilities owned by groups, churches, and governments.

·         Hospital environments incorporated air conditioning, labs, communication systems, and lighting systems

·         Health institutions became accredited and regulated by federal and state governments (Sultz & Young, 2018)

·         The hospital environment integrates various specialist and primary care with inpatient and outpatient care

Medical Staff Education Level(Describe the care providers and their education levels.) ·         Medical care learned through an apprenticeship with no formal examination or training

·         No different cadres and qualifications of healthcare staff as trainees became physicians

·         Development of medical schools and institution

·         Medical care learned through the internship·         Healthcare staff became professionals after training·         Advancements in medical and bruising education lead to various subspecialties

·         Specialization of practice ensured professional advancement

·         Professional organizations in place to regulate the standard of practice for doctors and nurses

·         HIPAA and other healthcare laws regulate information use and access  (Vogenberg & Santilli, 2019)

Level of Care(Describe the quality of care for each century and if it improved.) ·         Hospital care was for the poor, while middle-income families received care from their homes The care delivered was less technically advanced but cohesive ·         Collaboration between physician-owned hospitals allowed referrals.

·         Home-based care and some hospitals offered outpatient care (Niles, 2019)

·         Advancement in surgical techniques

·         Promotive, preventive, and curative health integrated into the healthcare

·         Hospital care focuses on quality and safety

·         Primary and referral care available in hospitals

·         More focus on ambulatory care

Paying for Care(Describe how care was paid for.) ·         Healthcare insurance was purchased just like other insurance (Niles, 2019). Insurances referred to as sickness insurance

·         Out-of-pocket payments were the primary method of payment (Tu, 2018)

·         Usually referred to as the golden age of American healthcare

·         Healthcare was less costly

·         Medicare was signed into law thus, federal government  involvement in healthcare insurance (Tu, 2018)

·         More than half the population had hospital insurance  (Niles, 2019)

·         Children’s Health Insurance Program (CHIP) was implemented to improve children’s care (Sultz & Young, 2018)·         Prescription plans included in Medicare improvement plans·         More insurance through employer insurance played a crucial role in healthcare payments (Lee et al., 2021)

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

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:

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.

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

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

Assessment 1 Instructions: Evolution of the Hospital Industry

  • Complete the Comparative Analysis Table: Hospital Care Evolution, located in the appendix of the Comparative Analysis Template [DOCX]. Provide two descriptive changes for each time period under each of the headings. Add bullet points to each cell in the table to document the descriptive changes that you have found for each topic. Document the source where you found the information for each cell in the table, using APAstyle 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.
    Note that the assessment exemplar is written about the evolution of physicians’ practices and not hospital care, which is the topic for this assessment.
    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].
    Include a brief explanation of the purpose of the paper and main ideas.
    Reference significant trends that you noticed as appropriate.
    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.
    Write the Hospital Care Evolution section in the assessment template, using the information from the Comparative Analysis Table you completed.
    Describe your findings about each topic in the different time periods under each subtopic heading.
    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.
  • 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.
  • Write a brief summary of your comparisons and analysis about the significance of the key changes from the different time periods.
  • 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.
  • 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.