Healthcare Access in the 19th-21st Centuries


Access to healthcare is one of the inalienable human rights, and today, the principle of freedom in relation to receiving competent medical assistance is a significant aspect of civilized society. However, in American history, there is much evidence that this practice has not always been followed, and a number of factors had a significant role in the context of the population-physician interaction.

This paper is aimed at identifying peculiarities in access to healthcare in the United States of the 19th, 20th, and 21st centuries and factors affecting approaches to communicating with patients and the quality of assistance. The development of the medical field and the establishment of democracy have allowed solving many ethical problems and achieving differences for the better as compared with the early principles of providing doctoral and nursing care.

Access to Healthcare in the 19th Century

Although the 19th-century healthcare situation was complicated by numerous ethical issues, for instance, the lack of equality among the white and black population, some important innovations were adopted. According to Sisk et al., the Code of Ethics signed in 1847 was a significant document promoting the involvement of medical staff in working closely with patients and maintaining anonymous treatment status (74).

Also, the authors note that the paternalistic principle of the doctor-patient interaction was promoted, which was typical for that era and helped to focus on the welfare of those who sought help (Sisk et al. 74). Nevertheless, a number of ambiguous nuances took place in the American healthcare of the 19th century.

The quality of the medicine was poor at that time due to the lack of appropriate treatment and diagnostic methods. As Sisk et al. note, the training of doctors and nurses were at a rather weak level, and people often preferred to seek help from non-professional healers, although the labor market full of physicians (74). Such issues as racial segregation, gender inequality, and class differences impeded the provision of skilled care.

The age variable did not have a significant effect on treatment. Despite the adopted Code of Ethics, the ideas of humanism concerned separate layers of society. Therefore, this era was characterized by the worst quality of care due to its unethical and impersonal approach.

Access to Healthcare in the Early 20th Century

The 20th century changed the concept of healthcare for the better, although some ethical problems continued to exist, in particular, racial inequality as one of the problems of access. According to Komisarow, the cost of medicine increased at the national level, and deeper problems began to be addressed, for instance, hygiene and sanitation (132).

However, the author claims that the quality of diagnosis and care was not high enough, and the rates of adult and child mortality from such diseases as measles, meningitis, pneumonia, and other serious illnesses were high (Komisarow 133). Many patients still preferred to seek help from more affordable traditional healers since access to qualified doctors was limited. The problems of racial and gender inequality still existed, despite social reorganizations in the late 19th century. Therefore, ethical issues remained a gap in healthcare, although access conditions were softer.

Physicians began to pay more attention to clinical work and focused on closer interaction with patients than before. The safety of care was not high enough, although, with the advent of antibiotics, progress in healthcare was obvious. Class division still existed, and people with low incomes, as well as the members of racial minorities, could not afford qualified counseling. The ethics of the work of medical personnel was determined by social trends. Therefore, it is difficult to characterize the period of the beginning of the 20th century as patient-oriented and comprehensively humane.

Access to Healthcare in the 21st Century

The 21st century in the American healthcare system may be called the most ethical and humane. Numerous innovations developed in the past decades have allowed creating a solid base for training specialists and achieving significant democratization in access to the services of physicians. The health insurance programs promoted by the government are the guarantee of the trouble-free help of qualified employees, and patients may seek help from professional medical workers freely. The problems of racial, class, and gender inequality are not explicitly reflected since the current legislation provides for severe punishment in the case of bias identification.

Interaction with patients has become much more respectful, which is an unconditional advantage. Special attention is paid to assisting the vulnerable categories of the population, in particular, children, older adults, and people with disabilities, and high safety is achieved through implementing innovative means of diagnosis and treatment. Douthit et al. note some barriers to access to medical services for rural residents, although today, work in this direction are underway (612). Therefore, the 21st century can be called the most developed and humane with the best quality of care and response from specialists.


In the American history of healthcare, the 21st century is the most advanced period due to numerous innovations and a patient-centered approach. Access to physicians’ help has changed significantly since the principles of racial segregation, gender inequality, and class superiority are no longer relevant. Today, the humanism and the ethics of the doctor-patient relationships are the essential aspects of medical practice, and any manifestations of inequality are a violation of legislation regarding access to healthcare services.

Works Cited

Douthit, N., et al. “Exposing Some Important Barriers to Health Care Access in the Rural USA.” Public Health, vol. 129, no. 6, 2015, pp. 611-620.

Komisarow, Sarah. “Public Health Regulation and Mortality: Evidence from Early 20th Century Milk Laws.” Journal of Health Economics, vol. 56, 2017, pp. 126-144.

Sisk, Bryan, et al. “The Truth About Truth-Telling in American Medicine: A Brief History.” The Permanente Journal, vol. 20, no. 3, 2016, pp. 74-77.