The Evolution of Healthcare in the US: From HCAHPS to Universal Health Care Efforts

Ben H.

Hatched by Ben H.

Jul 17, 2023

4 min read


The Evolution of Healthcare in the US: From HCAHPS to Universal Health Care Efforts


The healthcare landscape in the United States has undergone significant changes over the years. From the implementation of the HCAHPS survey to the ongoing efforts for universal health care, this article explores the key milestones and developments in the healthcare system. Despite their differences, these two aspects share a common goal: improving patient experiences and access to quality care.

HCAHPS: Enhancing Patient Perspectives on Hospital Care

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey, introduced in 2008, was a groundbreaking initiative aimed at capturing patients' perspectives on hospital care. This standardized, publicly reported survey consisted of 29 items that measured various dimensions of the hospital experience. By allowing valid comparisons across hospitals, HCAHPS empowered consumers to make informed decisions about their healthcare providers.

In April 2015, CMS (Centers for Medicare & Medicaid Services) introduced the HCAHPS Star Ratings. These ratings provided a simple format for consumers to assess the quality of healthcare services. Quarterly updates to the ratings ensured that the latest information was available to the public. The HCAHPS Summary Star Rating, displayed on the Care Compare website, became a reliable indicator of patient satisfaction.

Hospital VBP: Linking Quality Measures to Payment

CMS's Hospital Value-Based Purchasing (Hospital VBP) program revolutionized the way hospitals were reimbursed for their services. Under this program, a portion of the payment was linked to a hospital's performance on quality measures, including HCAHPS. The Person and Community Engagement (PCE) domain, which accounted for 25% of a hospital's Hospital VBP Total Performance Score, was based on HCAHPS data.

By incorporating HCAHPS measures into the Hospital VBP program, CMS aimed to incentivize hospitals to prioritize patient experiences and engagement. This integration not only promoted accountability but also highlighted the importance of patient-centered care.

The Quest for Universal Health Care: A Century-Long Journey

The pursuit of universal government-funded health care in the United States has spanned nearly a century. Various countries, including Germany, Austria, and Britain, initiated their own systems of universal health care as early as the late 19th century. Paradoxically, some of these systems were established by conservative governments as a means to counter socialist and labor movements.

In the United States, the push for universal health care gained momentum during the Progressive Era. President Theodore Roosevelt supported health insurance, recognizing that a healthy and prosperous nation required its citizens to have access to healthcare. However, the initiatives for reform predominantly originated outside of the government.

Efforts to introduce compulsory health insurance faced opposition from different quarters. The American Federation of Labor expressed concerns about a government-based insurance system undermining the role of unions in providing social benefits. The commercial life insurance industry also resisted national health insurance proposals that threatened their profits.

The Role of Medicare and Medicaid:

Franklin D. Roosevelt's tenure marked significant milestones in the journey towards universal health care. The exclusion of health insurance from the Social Security Bill, fearing opposition from the American Medical Association (AMA), delayed progress. However, in 1958, Rhode Island congressman Aime Forand introduced a proposal to cover hospital costs for the aged on social security, which garnered grassroots support.

The AMA responded by introducing an "eldercare plan" as an alternative to government insurance. This led to the expansion of proposed legislation to cover physician services, ultimately resulting in the establishment of Medicare and Medicaid. The compromises made to appease various stakeholders resulted in a three-part plan, which included comprehensive health insurance, voluntary physician insurance, and Medicaid.


The combination of HCAHPS and the ongoing efforts for universal health care in the United States demonstrates the commitment to improving patient experiences and access to quality care. As the healthcare landscape continues to evolve, it is essential to prioritize patient perspectives and find innovative ways to ensure universal access to healthcare services.

Actionable Advice:

  • 1. Advocate for Patient-Centered Care: Encourage healthcare providers and policymakers to prioritize patient perspectives and experiences in decision-making processes. This can be achieved by actively involving patients in quality improvement initiatives and incorporating their feedback into policy development.
  • 2. Support Comprehensive Health Insurance: Engage in discussions and advocacy efforts that promote the expansion of comprehensive health insurance coverage. Emphasize the importance of accessible and affordable healthcare for all individuals, regardless of their socioeconomic status or age.
  • 3. Stay Informed and Engage: Stay updated on healthcare policies, initiatives, and reforms. Actively participate in public forums, community discussions, and grassroots movements that aim to improve the healthcare system. By staying informed and engaged, individuals can contribute to shaping the future of healthcare in the United States.

In conclusion, the combination of HCAHPS and the ongoing quest for universal health care represents important milestones in the evolution of healthcare in the United States. By focusing on patient perspectives and advocating for comprehensive coverage, we can work towards a healthcare system that prioritizes the well-being of all individuals.

Hatch New Ideas with Glasp AI 🐣

Glasp AI allows you to hatch new ideas based on your curated content. Let's curate and create with Glasp AI :)