Medical Sociology Exam #3

socialized

A system of health care delivery in which health care is provided in the form of a state-supported consumer service Health care is purchased by the government, which makes the services available at little or no additional cost to the consumer

Decentralized national health programs in Japan, Germany, and Mexico: benefits and drawbacks

Government involvement is minimized by private organizations establishing their own health services Separate programs for employees of large companies, small and medium-sized companies, and public and quasi-public institutions Some large companies even employ doctors and own hospitals Problems include: Overcrowding of hospitals and aging facilities Long waits at doctors' offices since physicians do not use an appointment system Spread of a Westernized lifestyle is leading to a rise in heart disease Rapid growth of the elderly population

How U.S. healthcare compares to other developed countries; in all countries considered cost controls are a huge issue; access to care based on citizenship (entitlement) or position in the class system?

Health care delivery systems worldwide are faced with the same problems: Rising costs, aging populations, and the requirement to meet their nation's health needs Differ in the variety of their approaches Such systems do not evolve in a vacuum but reflect the social and political philosophy of the country in which they exist Entitlements based on citizenship are aimed at providing people with welfare and health benefits, regardless of their class position Social welfare systems of Europe are more advanced in this direction than in the U.S. Americans have historically been less committed to government welfare programs and more in favor of private enterprise in dealing with economic and social problems The American health care delivery system is by far the most expensive in the world Yet, on the two most common measures of a country's overall level of health—infant mortality and life expectancy—the United States does not rank especially high

canada (socialized)

Hospital insurance provided in 1961, physicians' fees covered in 1971 Ten provincial and three territorial systems rather than a single national plan Federal government influences health policy and delivery of care to a greater degree than in decentralized plans Private system of health care delivery paid for almost entirely by public money Supported by taxes and premiums collected by the federal and provincial/territorial governments Universal coverage gives government greater leverage in controlling costs Physicians are generally private, self-employed, fee-for-service practitioners Fees are paid by government-sponsored national health insurance, known as Medicare Major problems facing health care delivery Rising costs An increasing shortage of doctors and nurses Lengthy waits for cancer care and surgery Increasing costs for drugs for an aging population Most Canadians satisfied with health care High quality and low cost (to patient) Private market for health care is growing in Canada Emergence of private clinics that accept both public and private health insurance Private health insurance supplements public benefits with additional services Doctors are still prohibited from charging patients fees above government limits

britain (socialized)

In 1948 the British government formed the National Health Service (NHS) Nationalized and took over the responsibility for the country's health care Government employs health workers, maintains facilities, and purchases supplies and new equipment through the use of funds collected largely by taxation This system was the first in Western society to offer free medical care to the entire population and it is also the largest publicly funded health service in the world Patients select a general practitioner (GP) who serves as the primary source of care GPs work from an office or clinic as part of either a solo or group practice Are paid an annual capitation fee for each patient on their patient list. Patient has the right to select his or her doctor, and the doctor is free to accept or reject anyone as a full-time patient Except for emergencies, if treatment by a specialist (called "consultant" in the British system) or hospitalization is warranted, the GP must refer the patient to a specialist Physicians are also allowed to treat private patients Private patients are responsible for paying their own bills, and most of them have health insurance from private insurance companies System initially controversial British Medical Association opposed, but eventually coerced to work with government GPs not satisfied with fees, conflict between both the government and consultants, who are more highly paid Conflict and problems concerning health care delivery tend to be between providers and the government General public rarely involved in disputes Reforms in the 1990s and 2000s Intended to improve efficiency, reduce delays in receiving treatment, and assist doctors and hospitals to increase their incomes by attracting more patients Signified the application of free-market methods to a state-financed system, but the principle of state-sponsored health care remained in place Serious problems remain: Many hospitals are old and in need of renovation Waiting lists for surgery have lengthened beyond a year Different regions of the country have different standards of care Deepening dissatisfaction among doctors, nurses, and other health care workers over government budget cuts

socialist

Model of health care delivery that features central government ownership of all facilities, employment of workers, and free universal care paid out of the national budget Persists only in Cuba and North Korea Russia and China both formerly had socialist systems but have introduced major changes

mexico (decentralized)

Most of the general population covered through a variety of programs that fall into one of three broad categories: Public social security organizations for specific groups of workers The government's SSA, which covers individuals not under another social security organization Private health care Health care is focused more on curative rather than preventive medicine Health insurance plans differ in the levels of benefits provided Decentralized system of health care delivery promotes a lack of coordination, planning, and fiscal control in a country that lacks great national wealth

japan (decentralized)

National health insurance plan introduced in 1961 Benefits are relatively low by Western standards Patients pay 30 percent of the cost of health services, with the national plan paying the remainder Patients are reimbursed by the plan for expenses over specified amounts incurred during a given month Government fee schedule is the primary mechanism for cost containment Providers are prohibited by law from charging more than the schedule allows Doctors do receive supplementary income from the drugs they prescribe One-third of Japanese doctors are in private practice and are paid on a fee-for-service basis Remainder are full-time, salaried employees of hospitals National health insurance plan does not cover all Japanese Government involvement is minimized by private organizations establishing their own health services Separate programs for employees of large companies, small and medium-sized companies, and public and quasi-public institutions Some large companies even employ doctors and own hospitals Problems include: Overcrowding of hospitals and aging facilities Long waits at doctors' offices since physicians do not use an appointment system Spread of a Westernized lifestyle is leading to a rise in heart disease Rapid growth of the elderly population

germany (decentralized)

National health insurance program established in 1883 by Bismarck Means of defusing worker dissent and tying them to the state instead of labor unions Based on three principal components: Compulsory insurance Free health services Sick benefits Social insurance program currently includes Health insurance Old-age pensions Sickness benefits for income lost to illness or injury Unemployment insurance Family assistance in the form of allowances for children, rent (especially for the elderly) Public funds for the construction of low-income housing Approximately 90 percent of all Germans participate, involuntarily or voluntarily, in the nation's public health insurance program Remainder consists mainly of civil servants and high-income earners who can take out private insurance or pay for state-sponsored insurance Payment is made to the physician through the doctors' association Fee schedule is agreed upon by the association and the public health insurance plans Form of health service organization is one of corporatism, which consists of: Compulsory membership on the part of the population in a national health plan A set of institutions situated between the government and its citizens with the authority to manage health care under government auspices Reforms in the 1990s and 2000s have introduced cost containment measures Minor copayments Increased contribution rates from individuals Limits on doctors' fees Problems of an aging population and shrinking overall population (fewer people to pay for expensive elder-care)

sweden (socialized)

One of the world's most egalitarian countries when it comes to the provision of welfare benefits to the general population Inequities in living conditions have been reduced to a level that is more equal than in most other countries National Health Service is financed through taxation Enrollment in the government-sponsored health insurance program is mandatory for the entire population Physicians are employed by county councils Paid according to the number of hours worked rather than the number of patients treated Physicians' salaries are standardized by specialty, place and region of work, and seniority General hospitals are owned by county and municipal governments Local governments are responsible for maintaining and providing services The state pays the general hospitals a relatively small amount of money from a health insurance fund The balance to be paid from local tax revenues Due to pressure on government budgets in the 1990s, has moved toward a purchaser-provider model within its own government-run health system Changes introduced to Sweden's health services are not extreme Intended to improve a highly successful system by introducing limited aspects of a free market

How socialized medicine works in Canada, Great Britain, Sweden: challenges and benefits of socialized medicine

Physicians are generally private, self-employed, fee-for-service practitioners Fees are paid by government-sponsored national health insurance, known as Medicare Major problems facing health care delivery Rising costs An increasing shortage of doctors and nurses Lengthy waits for cancer care and surgery Increasing costs for drugs for an aging population Most Canadians satisfied with health care High quality and low cost (to patient)

decentralized

System of health care delivery in which government control and management of health care delivery is indirect Government acts primarily to regulate the system and functions in the role of a third party that mediates and coordinates health care delivery between providers and payers

Cultural humility framework and how it differs from traditional discussions of culturally appropriate care

"ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person]." our own hidden biases Reorienting ourselves as learners Doctors and other healthcare workers must be decisive and knowledgeable Must deliberately reframe their expertise in a matrix of continued cultural learning Expanding communication styles and models

organization characteristics

A structure to carry out a particular purpose on a regular basis Exists independently of individuals Ensures continuity Generally has: Specific goal Defined membership Shared and understood rules of behavior Relationships characterized by author

ACA impact

Add consumer protections in health insurance markets. Require citizens to have health insurance. Increase coverage among the poor by expanding Medicaid. Increase employer-based coverage by requiring most businesses to provide health insurance. Increase coverage among individuals and small businesses through the creation of health insurance exchanges. Work to change the way health care is delivered and reimbursed through experiments run by the Innovation Center. Pay for the program through a combination of tax increases and reimbursement reductions. First five items aimed at expanding coverage, while last two are trying to control costs.

Some of the reasons for rapidly increasing healthcare costs in the U.S

Aging of the population Increases in hospital expenses and doctors' fees; increasing use of technology and testing Increased cost of health insurance - system where for-profit corporations are legally bound to shareholders Increased use of and advertising for prescription drugs - only the U.S. and New Zealand allow direct-to-consumer marketing of drugs to patients

Weber's ideas about bureaucracy

As societies become more complex, bureaucracies become more common Highly formalized and structured organization governed by rules and laws Not all formal organizations are bureaucracies

hospital as an organization

Built facilities and social environment and organization Experienced by Patients Families and friends of patients Different groups of staff Purpose? Provision of healthcare: ed/er, outpatient clinics, surgery, inpatient care, intensive and terminal care Generating income Advancing science/careers

Hospital-patient role: pay attention to the "career" of the patient, clinical gaze, and discourse in shaping patient compliance

Career of a patient Pre-patient - patient - outside world Career (goffman) Regular sequence of changes Turning points in career Contingencies which move career is one direction or another Recovery, setbacks, critical episodes Time takes on pace of the organization, rather than being 'spent' in ways decided by the patient Hospital-Patient role Teaching patients to be patients Standardization Stripping - putting on gown Control of resources Stuff and information (how much do they tell you? Restriction of mobility Signing out/discharge procedures Patients are always within clinical gaze Discourse and subjectification Conversation limited to physiological, care, recovery topics, deny access to alternative topics Role of nurses in ensuring patient compliance: Fox, may 'Knowing' patients as individuals, opportunity for relationship, making patient "At home" Social relations as a site of work Involvement of nurses in clinical gaze

Historical stages of hospital development

Centers of religious practices Hospitals as poorhouses Hospitals as death houses Centers of medical technology

culture, sub- or micro-cultures

Culture: The sum total of life patterns passed on generation to generation within a group of people and includes institutions, language, religious ideals, habits of thinking, artistic expressions, and patterns of social and interpersonal relationships Sub or Micro Cultures Multiplicity of groups that we participate in The interaction of these memberships shape individual identity, values, communication styles, and beliefs We know this affects how people interact with healthcare and how doctors and other healthcare workers approach the patient Culture is fluid

Enactment of the Affordable Care Act (ACA or Obamacare): Key components of the law and legal challenges to it

Eliminates lifetime caps on coverage Young adults can remain on a parent's insurance plan until the age of 26 Shift toward prevention: preventative care at no cost to patient for Medicare recipients and new insurance plans; also Prevention and Public Health Fund & National Prevention Strategy for the first time Insurance company cannot deny coverage due to a pre-existing condition or disability to people under 19; temporary national high-risk pool to help people 19+ with expensive health problems maintain coverage Millions of seniors are getting help with prescription drug costs - remember that doughnut hole in Medicare? They now get a 50% discount on name brand drugs that they need while in that gap Physician training: Hundreds of millions in grants to boost primary care residency programs, train PAs, and help individual states fund programs to meet their health care workforce needsSmall business mandate (if 50+ employees) but also cost sharing for small businesses providing insurance No subsidy can cover a plan that includes abortion coverage; employer sponsored insurance is required to provide birth control Impose new fees on the pharmaceutical manufacturing industry > $4.0 billion in 2017 Impose an annual fee on the health insurance sector > $13.9 billion in 2017 Require insurance plans to disclose how much is spent on clinical services, quality, etc. and issue a refund to customers if that amount is less than 85% of premiums Requires U.S. citizens and legal permanent residents to have qualifying health insurance or pay a tax penalty Premium credits and cost-sharing limit out of pocket payments for insurance to a % of income

Where socialist medicine persists: Cuba and North Korea; Russia and China previously had socialist medicine but have undertaken reforms - what are they, and what are outcomes like in these places?

Established a system of health insurance, consisting of compulsory and voluntary plans Health insurance is mandatory for all employees Provides the same basic benefits without choice Most important change was to shift funding from the federal to the local level Financing of health care (about 60 percent) comes mainly from local budgets (which are based on both federal and local allocations) Remainder from health insurance Serious problems remain, including low financing of health care services and declining life expectancy Life expectancy began declining in the 1960s Accelerated in the 1990s after the collapse of communism and worsening living conditions Most significant developments in world health in the late 20th century Declining life expectancy largely the result of high rates of heart disease and to a lesser extent from alcohol abuse and alcohol-related accidents Especially among middle-age, working-class males Unhealthy lifestyle appears to be the primary cause Socialist Medicine: China Has abandoned a socialist model of health care in favor of one that is financed largely by fees paid by patients, employers, and health insurance companies The only country that consistently treats traditional and scientific medicine equally Both are legally available and Western-style physicians are required to learn traditional methods Following the establishment of communism, the so-called barefoot doctors movement trained 1.8 million paramedical personnel in rudimentary medicine and sent them to rural areas to provide basic medical treatment and assist in efforts at preventive medicine and public health However, with the dissolution of collective farms in the 1980s, many barefoot doctors left health care altogether or went into private practice Financial burden in rural areas was shifted to individual households who have to pay for health care out of their pockets Lifestyle choices among certain segments of society promote unhealthy outcomes Well-educated and higher-income Chinese tended to have worse health in these cohorts than less-educated and low-income persons Difference is attributed to unhealthy lifestyle choices (where certain choices represent the privilege of wealth) Smoking is widespread among men Contributing to major health problem

Faith healing, religion, and health: how religious faith may impact health

Faith healers are ppl who use power of suggestions, prayer, and faith in a higher power to promote healing Religion is associated with positive levels of health and lower mortality in several studies Influence on health risk behaviors Promotes good health through encouraging positive health lifestyles practices and discouraging harmful habits like drinking and smoking Provides comfort and social support in times of stress

ACA challenges

For individuals and small businesses (up to 100 employees Standard actuarial values & minimum benefits to prevent under-insurance Bronze - actuarial value at 60% of costs Silver - 70% of costs Gold - 80% of costs Platinum: 90% of costs Catastrophic plan (up to age 30) Favorite target of ACA opponents Majority of public debate, but only 4% of the total health insurance market

Goffman's idea of total institutions and their characteristics

Goffman's - Total Institutions Mental hospitals, prisons, boarding schools, monasteries, merchant ships, military barracks Large group, place of residence, and work Disappearance of private life Communal activities - highly structured Activities arranged for organizational purpose/convenience Divisions between staff and inmates - stereotypes Mortification of the self - loss of external roles Response of inmates within a total institution Colonization Acceptance without enthusiasm Conversion Acceptance with enthusiasm Withdrawal / intransigence Reorganized concept of self Institutionalization

The rise of managed care: when and why managed care became popular, goals, what it does, unintended consequences, backlash

In the early to mid-1990s, shift to an increasingly group- or organization-based managed care system Emerged indirectly as a response to the government imposed DRGs for Medicare services Diagnostic related groups (DRGs) Schedules of fees placing a ceiling on how much the government will pay for specific services rendered to Medicare patients by hospitals and doctors Managed care organizations Control the cost of health care by monitoring the work of doctors and hospitals, limiting visits to specialists within a particular managed care network and to all physicians outside it, and requiring prior authorization for hospitalizationCapitation fees Financing system employed by managed care organizations A fixed monthly sum is paid by the subscriber and his or her employer that guarantees care to that person and the person's immediate family, with little or no additional cost Discourages inefficient and unnecessary treatment Initially kept rising costs in checkPressure by physicians, the media, and politicians responding to patients helped dilute cost controls Especially the requirement to obtain approval from a primary care physician before seeing a specialist in many managed care programs

hospitals as major private sector employers

Industries within the largest single sector of the us economy Workplaces and profit centers Sites of technological innovation

Medicare and Medicaid: Basics features, when they were passed into law, "dual eligible"

Medicare, a health insurance program for the elderly, and Medicaid, a health insurance program for the poor. --- push for Medicare in the 1965 election President Johnson enacted Medicare quickly Medicare confronted segregation effectively, by certifying hospitals based on quality and equality of care --- Medicaid: Federally administered program Provides hospital and medical insurance for people aged 65 years or older, regardless of financial resources Includes disabled people under the age of 65 who receive cash benefits from Social Security 2006 added prescription coverage to benefits Covers 14.8% of the population

folk-healing

Not used to any significant extent in US Still used by some low income and minority populations Folk practices have persisted in modern societies largely b/c of dissatisfaction w/ professional medicine and a cultural gap between biomedical practitioners and particular patients Historically relevant, less today Belief system does not differentiate between science and religion Life is generally good or bad and a cure for one problem may cure multiple problems Emphasizes cause of problems rather than symptoms Distinguishes between natural illnesses which may be divine and require repentance or unnatural illnesses caused by evil influence or magic Often employed in addition to doctor visits Not clear how effective these methods are as treatment Does appear to reduce anxiety Most effective in dealing with health problems that have some emotional basis

Key themes and trends in Escape Fire

Paying More/Getting Less:We pay more, yet our health outcomes are worse. We give well-intentioned doctors, nurses, and hospitals the wrong tools and the wrong incentives, and it results in higher costs and poorer health. Who pays for this waste and excess? All of us - through higher premiums and taxes.Treating whole person: preventing disease: 75% of healthcare costs go to treating diseases that are largely preventable. That's a lot of unnecessary money, and worse, a lot of unnecessary disease. The effects of healthy living have been proven. We need a better balance between prevention and treatment. entrenched system: Pharmaceutical companies, medical device manufacturers, hospitals, and insurance companies are all profiting on our declining health. And all those companies spend their money lavishly - millions of dollars go to Washington lobbyists - to ensure that nothing ever changes. reimbursement: he healthcare system often uses a "a fee-for-service" model of payment - government or private insurers pay a hospital or a physician every time a procedure is performed. So even well-intentioned doctors are incentivized to order more tests, see more patients, and do more procedures. Hospitals are encouraged to fill hospital beds and operate more frequently. Everyone in the system is encouraged to emphasize quantity over quality. If we can start reimbursing doctors and hospitals to keep patients healthy - or better yet - keep Americans from ever becoming patients, then we'll see a rapid change in the way we give care. overtreatment: One of the hardest things to understand as a patient is that "more" doesn't necessarily mean "better." But it's imperative that we do. Recent studies have shown that "more" can often mean "worse" when it comes to our health. Any time we go to a hospital, we're taking on risk. Medical errors happen. Harmful drug interactions occur, especially with so many doctors and nurses involved in the diagnosis and treatment process overmedication: We spend roughly $300 billion annually on pharmaceutical drugs - nearly as much as the rest of the world combined. Prescription drugs play a vital role in helping patients who need them.But too many drugs are being marketed to patients who don't need them, and sometimes these drugs do more harm than good. treating whole person: Instead of being treated as a person, your broken parts get fixed separately, one by one. We have a disease-care system, not a healthcare system. It rewards fragmented care over holistic care and specialists over general practitioners. The solution is: more primary care doctors who have the time to be patient-centered - doctors who are there to provide overall care, not piecemeal treatment.

Complimentary and alternative medicine: sociodemographic factors leading to increased use and what it is commonly used for

People who use some form of CAM tend to have middle or working class social backgrounds - Those who use faith and folk healers typically come from lower SES and use these practitioners because they are inexpensive and culturally similar The use of treatments that are not commonly practiced by the medical profession: Faith healers Folk healers Homeopaths Naturopaths And many others

Per-capita healthcare costs in the U.S. compared to other countries

Per capita health care expenditures in the U.S. are the highest in the world 1980 per capita expenditures: $1,100 2012 per capita expenditures: $8,900 Average per capita expenditures for other developed countries: ~$3,000

Why the Clinton administration failed to pass a national health plan

Plan failed due to: Anti-insurance lobbying efforts Lack of consensus between the Democrats and Republicans in Congress Growing public uncertainty Highlighted the need for reform Result: more managed care

Medicaid

Public health insurance for people with low income States and the federal government share the cost of healthcare for the poor -- open ended matching Each state is required to cover all needs persons receiving cash assistance

Some reasons for high cost of hospital care

Rising costs Reimbursement rates have not kept pace with rising costs, causing hospitals to have shrinking profit margins Growing number of services Population growth and increased use rates (backlash to managed care) have resulted in growing spending on hospital care over the last several years

In the absence of national health insurance, what have some states done to address health needs?

Some individual states have implemented their own plans in order to increase coverage: Hawaii In 1974 required all employers to contribute to health insurance Tennessee Converted Medicaid into the TennCare managed care program Vermont, Illinois, Washington Provide health care for children, with subsidies for premiums Massachusetts Requires all residents to have health insurance

reasons people use CAM

To manage chronic conditions, including pain Conventional medicine has failed to provide relief Distrust conventional medicine for other reasons May be less invasive, less expensive Trying to treat whole body or root causes EX: Massage therapy and diet modification to reduce migraines

Problems of equity

age, ability to pay, geographic distribution of services

Some reasons the U.S. has no national health insurance

brief history of labor union efforts (starting with coal workers' strike), disability and Medicare pass but then the focus shifts to cost controls, role of the AMA, increasing influence of private insurance companies, Anti-insurance lobbying efforts Lack of consensus between the Democrats and Republicans in Congress Growing public uncertainty

conflict theory

conflict theory: social inequality leads to change (marx and weber), modern focus is not just on class conflict but also on competition between interest groups, as they maneuver for advantages in democratic political systems

Is healthcare a right or privilege? How each view explains the role of and access to healthcare services

right: consistent with other measures associated with being a welfare states - individual rights of citizenship, not ownership and control of property, serve as the basis for political representation and entitlement to public programs

Limits of private insurance:

unable to manage needs of older Americans without extreme price hikes, led to mounting support for Medicare