Problems of Health and Health Care

1. Problems of Healthand Health Care Chapter 2

2. Health Careas a Global Social Problem • United Nations and the scope of health problems • Life expectancy is related to the quality of health care in a society • Infant mortality is associated with: • The number of health-care professionals in a society • Nutritional intake and health • Sanitation and health • Health facilities and health

3. The Scope of Health-CareProblems in America • Micro-level: how we experience health care on a personal level • Terminating the life-support of someone we know and love • Placing an elderly parent in a nursing home • Macro-level: the social forces that affect how health care is distributed in society

4. Unequal Access to Health Care • About 18 percent of Americans under age 65 do not currently have any health insurance • Factors related to the lack of insurance are : • Poverty • Occupational status • Minority status • Rural populations

5. Unequal Access to Health Care • Inequalities of race and ethnicity • Life expectancyfor white males is about six years longer than for African American males • Life expectancyfor white females is about four years longer than for African American females • Infant mortality rate for African-Americans is more than twice that of whites

6. Unequal Access to Health Care • Racial and ethnic minorities are likely to receive less or inferior care for: • Heart disease • Asthma • Breast cancer • HIV infection • Nursing home care

7. Unequal Access to Health Care • Inequalities of social class • Lower class - higher rate of illness: untreated illness disability higher mortality well-being

8. Unequal Access to Health Care • Inequalities of social class • Low-Income and infant mortality: • Low birth weight • Nutrition • Smoking • Drugs • Lack of prenatal care and infectious disease • Reduction in Medicaid for the poor

9. Unequal Access to Health Care • Inequalities of gender • Women are less likely to receive adequate health care • Delayed needed health care needs • Lack of insurance • Lacked jobs that gave access to health care insurance

10. The High Cost of Health Care • Unequal access to health care: • Related to its cost • In 2002, health care expenditures were $5,804 per capita • Costs exceeded inflation • Declining incomes • Declining resources at State and Federal level

11. The High Cost of Health Care • Unequal access to health care: • New drugs • New medical procedures • Medical technologies • Lifestyles and risky behaviors

12. The High Cost of Health Care • Hospitals and costs • Costs rose in the 1980s • Little incentive on part of hospitals to control costs • Use of hospitals for out-patient treatment • Few self care facilities • Health care insurance companies and the lack of cost controls

13. The High Cost of Health Care • Hospitals and costs • Recent attempts to control costs • Improvements in hospital administration • Preadmission testing • Reducing hospital stays • Move from inpatient treatment to outpatient

14. The High Cost of Health Care • Physicians and the cost of health care • Physician shortages in certain regions • Specialization of Doctors • Malpractice insurance costs • Medical technologies and health care costs • The cost of new medical technologies in health care

15. The High Cost of Health Care • Prescription drugs • Growing costs of new prescription drugs • Demographic and cultural factors • Demographic • Aging of the population • Increased life expectancy and chronic illness of the elderly

16. The High Cost of Health Care • Demographic and cultural factors • Cultural and lifestyle • Obesity • Smoking • Risky Behaviors and Costly Procedures • Unequal Access

17. Inadequate Protection • Prevention v. Treatment • Access to health care • Pay as you go • Health Insurance • Commercial insurance • Independent prepaid group insurance such as health maintenance organizations (HMOs) • Public insurance Medicaid and Medicare

18. Inadequate Protection • The Uninsured • Over 45 million Americans lack insurance • Large percent work fulltime • Small firms • Young adults • Minorities • Rural • Many Americans lack sufficient insurance coverage

19. Inadequate Protection • Problems with Medicaid and Medicare • 1. Inequity in the distribution of services • Poor receive the fewest of services • Geographic inequity in services • Medicare and high deductibles • 2. Costs due to administrative waste and abuse • Cost shifting practices from nonpaying to paying patients • The poor and the increased use of emergency rooms

20. Women and Health Care • Women’s movement and health care • Abortion rights • In 1973 Roe v. Wade • Use of public funds for counseling and abortion • Increase the awareness of medical personnel to the health needs of women • Less intervention in the birth process

21. Women and Health Care • Medicalization of women • Women and their needs are underrepresented in the health care industry

22. The Disabled and Handicapped • The disabled and unemployment • Technological improvements and the disabled

23. Ethical Issues • The right to die • Assisted suicide • When does life end • When the heart stops • Brain quits functioning

24. End-of-Lifeand Advanced Directives • With regard to the Schiavo case, although religious beliefs explained many of the differences of opinion, even a slim majority of evangelical Protestants supported the decision: 46 percent favored removal of life support • Advanced directives have two parts: a living will and a health-care proxy.

25. Ethical Issues • Patients’ rights: • Right to privacy • Control over medical records and information

26. AIDS - A Modern Plague • HIV - Human immunodeficiency virus • AIDS acquired immune deficiency syndrome • AIDS - a global epidemic • Approximately 40 million people are infected world wide • The problem is more extensive in : • Sub-Saharan Africa • Developing Asian countries

27. AIDS - A Modern Plague • HIV virus is transmitted through the exchange of bodily fluids from an infected person’s • Blood • Semen • Vaginal fluid • Transmission often occurs through • Sexual activity • Blood transfusion • Hypodermic needles • From an infected mother to her unborn or newborn infant

28. AIDS and Global Poverty • Poor and AIDS • Mobile populations • Women in poor countries and AIDS

29. AIDS Orphans • Over 15 million AIDS orphans in the world of which 80% are from sub-Saharan Africa • Psychological impact on families • Economic impact on families and the country • Lack of affordable drugs in poor nations to treat the symptoms

30. AIDS Orphans • AIDS as three epidemics rolled into one • 1. Spread of the HIV virus • 2. Disease of AIDS • 3. The social, political, psychological and ethical reactions to the disease and those who suffer from AIDS

31. Explanations of Health-Care Problems • Class and Class Conflict • Class and class conflict-as the cause in the health difference between the rich and poor: • Cite the privatization of hospitals • Poverty and its impact on health • Outcomes are a function of conflict between groups over health care and health care policies

32. Explanations of Health-Care Problems • Institutions and Health Care • Functionalist explanations focus on how health care is distributed to meet the needs of society • How health care resources are allocated according to shared values and beliefs

33. Explanations of Health-Care Problems • Health and Social Interaction • Health is related to patterns of interaction (lifestyle) • Health is related to our symbolic orientation to those lifestyles, perceptions and attitudes toward health

34. Politics and Social Policy • The issues: • Too many households lack medical insurance • The mounting costs of medical goods and services • Medical malpractice insurance costs and the effect on services • The rising costs of health care insurance for those that are covered

35. Social Policy • Managed care (including HMOs, PPOs, and POSs) – a wide range of health care plans and practices that set limits on individual treatment or medical visits • Reduction in the quality of health care • Insurance reform • Patients rights bill • Medicare reform • Other

36. Social Policy • Working, but without Health Care • The current crisis in the U.S. medical care system is significantly worsened by a large-scale retreat from employer-provided health insurance.

37. Social Policy • The Disabled and Handicapped • Rehabilitation Act of 1973 - prohibited government agencies from discriminating against the handicapped • Education for All Handicapped Children Act of 1975 • Mainstreaming • American with Disabilities Act of 1990 - prohibits discrimination

38. Social Policy • Social Policy and AIDS • WHO (World Health Organization): • Prevent HIV infection in woman • Reduce the impact of HIV/AIDS on women • Care for women with HIV • Educational programs and behavioral change • Testing and production of medicine