Historical Overview of U.S. Health Care Delivery

The history of health care delivery began in earnest after the Flexner Report was published in 1910. The Flexner Report established the supremacy of science and medical education as the foundation of the U.S. health care system. Following the Flexner Report, medical schools began to implement strict eligibility requirements for prospective students and rigorous scientific standards for medical school graduates ((University of Rochester Medical Center, 2014). As a result, licensed medical providers and health care professionals began practicing medicine in rudimentary hospitals and traveling on house call circuits. Over time, these care delivery models would later give way to the modern medical office-based visits, urgent care centers, outpatient surgical centers, and various classifications of hospitals (Lathrop & Hodnicki, 2044).
The health care landscape is still evolving because of government efforts toward health care reform and the emergence of innovative integrated care delivery models, such as accountable care organization and patient-centered medical homes. Over the past decade, health care reform has ushered in the rapid advancement of state-of-the-art clinical information systems to modernize health care delivery. The future landscape of health care is a partnership between patients and providers, facilitated through federal health policy and health information technology.
Case Report

The University of Rochester Medical Center (URMC) is one of the nation’s leading academic, health research, teaching, and patient care medical centers (University of Rochester Medical Center, 2014). The medical center was co-founded in 1921 by Abraham Flexner to fulfill his vision for scientific medical education and a health care delivery system and university hospital (University of Rochester Medical Center, 2014). URMC’s health care delivery has expanded beyond traditional office-based visits toward a coordinated care model that integrates mobile health technology as a vital component of disease prevention and management (University of Rochester Medical Center, 2014). For example, the use of mobile personal health records can enable patients to obtain a clinical summary from a recent visit and review physician orders. Mobile health services and applications are an ideal self-management tool for patients with chronic diseases (Odier, 2016). The innovative coordinated care model is built upon the historical foundations of the house call, office visits, and hospital stays by broadening care delivery through mobile health, personal health records, and telemedicine.
In 2013 URMC launched a pilot telemedicine program called Tele-I-Care. The goal was to increase the number of eye examinations for as many as 3,000 patients in underserved areas of the community (University of Rochester Medical Center, 2014). URMIC also provides telemedicine services for pediatric, diabetic, and neurology patients. Its telemedicine program for Parkinson’s patients, for example, removes a geographical barrier to access to health services (University of Rochester Medical Center, 2014). Diagnosis of Parkinson’s disease is expected to double by 2030, and it is estimated that more than 40% of patients do not seek treatment with a neurologist (University of Rochester Medical Center, 2014).

Technological advances in telemedicine are just the beginning of exciting changes in health care such as an increase in collaboration between health systems or the consumer demand for access to personal health information through smartphone and wearable technology (Kuramoto, 2014). For example, URMS’s extensive telemedicine service line delivers health care to patients with various chronic conditions and has received high patient satisfaction ratings (University of Rochester Medical Center, 2014). URMC’s coordinated care delivery, chronic disease prevention, and treatment core objectives are born from Flexner’s scientific approach to health care delivery.


  1. How can telemedicine programs such as URMC’s reduce health disparities and inequalities for patients in underserved areas of the community or of lower economic status?
  2. Despite the technological advances in health care (i.e., mobile health, wearables, and telemedicine), what barriers still exist for patients to access them to improve their quality of life?