Chapter 15

1. Chapter 15 Health Care

2. The Components of the Health-care System The health-care system embraces the professional services, organizations, training academies, and technological resources committed to the treatment, management, and prevention of disease. • Physicians • Although physicians constitute only about 10 percent of health-care workers in the United States, they establish the working framework for everyone else. • Nurses • Possibly as a result of this initial orientation, nursing experiences frequent controversy regarding education, professional roles, and compensation. • Hospitals • Hospitals provide specialized medical services to a variety of inpatients and outpatients. • Patients • People usually enter the health-care system only because others defined them as ill or injured.

3. Sociology and the Study of Medicine and Health • Medicine is a society’s standard way of dealing with illness and injury. • Profession, a bureaucracy, and a big business • Study how medicine is influenced by ideals of professional self-regulation, the bureaucratic structure, and the profit motive. • How illness and health are related to cultural beliefs, lifestyle, and social class. • “Sickness” and “illness” are social labels that can stigmatize people.

4. Theoretical Perspectives and the Health Care System: Symbolic Interactionism • Health is affected by Cultural Beliefs. • Ex. Hearing voices and seeing visions • “Sickness” and “Health”: We are provided with guidelines to determine whether we are healthy or sick. • Sociologists analyze the effects that people’s ideas of health and illness have on their lives and even how people determine that they are sick. • Health is a human condition measured by four components: • Physical, mental, and social, and spiritual. • Health is state of complete physical, mental, and social well-being

5. Theoretical Perspectives and the Health Care System: Functionalism Talcott Parsons first proposed a view of sickness that was distinctively sociological rather than merely medical. • Health problems are a threat to society. • Society must set up ways to control sickness • If people are sick and cannot fulfill their roles, society will not function smoothly. • Society must develop a system of medical care andmake rules to keep too many people from “being sick”

6. The Sick Role A social role that you are forced to play when you are not well. The sick are permitted to withdraw temporarily from other roles or at least reduce their involvement in them It is assumed that the sick cannot simply will the sickness away. The sick are expected to define their condition as undesirable. The sick are expected to seek and to follow the advice of competent health-care providers.

7. Theoretical Perspectives and the Health Care System: Conflict Theory • The same political and economic forces that determine the nature of capitalism determine the nature of the medical institution. • Primary focus is the struggle over scarce resources. • The concerns of conflict theorists areissues of inequality within the health care system. • Health comes with wealth • Globally

8. Conflict Perspective High-Income Nations Infant mortality rate – number of babies who die in their first year of life for each thousand births Low – less than 10 deaths for every 1,000 births Life expectancy at birth – number of years people in a society can expect to live Longer - on average into their seventies or early eighties

9. Conflict Perspective High-Income Nations Chronic diseases – an illness that has a long-term development More prevalent in high-income countries In U.S., a high fat diet and little physical work result in 2/3 of adults as overweight

10. Conflict Perspective Low-Income Nations Poverty and poor health Poverty and malnutrition Poverty and lack of safe drinking water Poverty and poor sanitation Acute disease-illness that strikes suddenly Infectious diseases

11. Focus on Theoretical Perspectives: Health Care in the United States

12. Global Health Care: Health Care in the Developed World Of the highly developed countries of the world, the United States is the only one without national health insurance for all its citizens. The United States has the dubious distinction of having the most expensive health care and one of the worst performing health-care systems in the developing world.

13. An explosion in medical costs • Medical costs continue to soar • Americans will spend over $4 trillion on health care in 2018, up from approximately $200 billion in 1960. • Reasons for the explosion in costs • Increase in the standard of living, people live longer • Development of expensive technology • Seek out health care after illness arises, rather than investing time and energy in preventive care • Corporatization of Medicine – Accepted view that medical care is a commodity that should be sold for profit • Hospitals • Decline in not for profit • Proliferation of profit based corporate care

14. Global Health Care: Health Care in the Developed World Americans spend over $7,000 per person for health care annually. U.S. health-care expenditures as a share of GDP are the highest in the world (16 percent) Despite its high price tag, the United States finishes last on access to medical care, organizational efficiency, equity of treatment, and health results, next to last on quality care. Lack of insurance and cost are the biggest barriers to health-care access for Americans.

15. Global Health Care: Health Care in the Developed World • The United States ranks at the bottom of the seven countries on efficiency of delivery, while • the United Kingdom and Australia rank first and second, respectively. • The United States performs poorly in terms of national health-care expenditures, administrative costs, information technology, re-admittance to hospital, and duplicative medical testing. • The United States ranks last on almost all indicators of equal access to treatment. • The United States ranks dead last on each of the measures of health outcomes.

16. Per Capita Health Expenditures

17. Health Care Expenditures as a Share of GDP

18. Progress on Key Health Indicators

19. Socialist Systems The People’s Republic of China Government administers health care Barefoot doctors Modern scientific medicine Traditional forms of medicine Acupuncture Medicinal herbs

20. Capitalist Systems Sweden Government run health care system Funded through taxes Physicians are government employees Health care a basic right Form of socialized medicine

21. Capitalist Systems Great Britain Socialized system of health care since 1948 Dual system National Health Service – funded by tax dollars and covers all British citizens Private health care for those that can pay

22. Capitalist Systems Canada Not state controlled but managed system of health care Japan Physicians and hospitals operate privately in a market system Government programs and private insurance pay the majority of health care costs

23. Health Care in the United States: A system in Crisis? U.S. Health Care System Direct-fee system – medical care system in which patients or their insurers pay directly for the services of physicians and hospitals Obama wants to overhaul health care system Issues are access and soaring costs

24. Medicine for profit: a two-tier system of medical care • Medicine for profit is also known as a fee-for-service system. • Two-tier system of medical care: one for those who can afford insurance, and another for those who cannot • The Haves • Can afford individually, or through employer provided health plans, insurance adequate to meet demands of system • The Have Nots • Cannot either individually, or through employment, afford adequate insurance

25. The Cost Problem Health care costs were 2.2 trillion in 2007 Six reasons behind the soaring cost: Spread of private insurance Specialization of doctors More high technology Lack of preventive care Aging population More lawsuits *Corporate Greed

26. Health Care Reform in the United States A large majority of Americans believe that the U.S. health-care system requires reform. Moreover, almost three-fourths of Americans approve of a government-backed healthcare program for children, and almost 60 percent prefer a universal health-care system.

27. Why is there a need for health-care reform? Too expensive Limited access to medical care Quality of life Aging population

28. Percentage of Persons Not Covered by Health Insurance in the United States by Age: 2009

29. What are the health-care reform options? There are a few basic options to delivering health-care services: Modified competitiveness bases its approach on market principles such as consumer cost sharing. Managed competition is combination of free market forces and government regulation. Single payer approach is a model where the government finances medical services. Play or pay mechanism where employers either offer employees health coverage (play) or pay into a public fund for covering the uninsured.

30. The Health Reform Road Taken • Obama 2010 Health Reform • requires most citizens and legal residents to purchase health insurance • penalizes employers with more than fifty employees who do not offer some form of health coverage • extends coverage to some 32 million uninsured people through Medicaid, particularly providing health coverage for all uninsured children • includes subsidies for purchasing health insurance provided by the government to lower-income families • establishes health-insurance exchanges designed to promote more competitive insurance coverage rates