"This model served a dual purpose: It provided needed services to the poor and enabled both physicians and medical students to gain experience diagnosing and treating a variety of cases" (Shi, & Singh, 2019, p. 123).
These disparities provided care to those who could not afford healthcare.

Education ws provided through apprenticeship. "Medical schools in the United States did not have laboratories, and clinical observation and practice were not part of the curriculum" (Shi & Singh, 2019, p. 126). Education schools in the U. S. lacked structure and standards for their programs.

"It did not require the rigorous course of study, clinical practice, residency training, board exams, or licensing without which it is impossible to practice today" (Shi, & Singh, 2019, p. 121). Healthcare was in disarray, medical procedures were primitive, and the institutional core was missing, unstable demand, and there was a lack of education.

Medical Practice Acts were established. "As biomedicine gained political and economic ground, the biomedical community expelled providers such as homeopaths, naturopaths, and chiropractors from medical societies; prohibited professional association with them; and encouraged prosecution of such providers for unlicensed medical practice" (Shi & Singh, 2019, p. 130). Medical school standards increased and licensing became harder to obtain due to the ability to reject candidates if schooling was inadequate.

"The Mayo Clinic, started in Rochester, Minnesota, in 1887, become the model for consolidating specialties into group practice-an arrangement that presented certain economic advantages, such as sharing of expenses and incomes" (Shi & Singh, 2019, p. 144).
Multiple services were offered under one group practice making healthcare convenient for consumers.

"By 1900, most states had health departments that were responsible for a variety of public health efforts, such as sanitary inspections, communicable disease control, operation of state laboratories, vital statistics, health education, and regulation of food and water" (Shi & Singh, 2019, p. 134). These health departments provided vaccines for children and health screenings. "Fear of government intervention, loss of autonomy, and erosion of personal incomes created a wall of separation between public health and private medical practice" (Shi & Singh, 2019, p. 134).

"State laws were established, requiring graduation from a medical school accredited by the AMA as the basis for obtaining a license to practice medicine" (Shi & Singh, 2019, p. 131). Based on the investigation of medical schools by Abraham Flexner standards were set in place for school operation and those schools not up to standard closed.

"Thus for the first time in U.S. history, the government assumed direct responsibility for paying for health care on behalf of two vulnerable population groups-the elderly and the poor" (Shi & Singh, 2019, p. 142).
Medicaid limited physician involvement due to the lack of autonomy over billing and charges.

"Globalization refers to various forms of cross-border economic activities, characterized by transnational movement and exchange of goods, services, people, and capital" (Shi & Singh, 2019, p. 146).
Telemedicine, consumer options, access to medical equipment, and job satisfaction all benefit from globalization.
In events of a pandemic, like the one we are facing now, globalization and result in a negative impact on healthcare.
There is currently a shortage of medical supplies, and medical care across borders are no longer permitted.

The ACA was an attempt to make affordable healthcare insurance available for everyone. The act did increase the insurance benefits of the population but mostly by the new qualifications of Medicaid. Those who did not purchase healthcare insurance or who did not qualify for governmental healthcare insurance were then subjected to a tax penalty. (Shi & Singh, 2019, p. 149).