SOC 475 Final Exam

(20) In "Countervailing Powers," Donald Light describes a "buyer's revolt" in which several purchasers of healthcare rebelled against skyrocketing healthcare costs. List two stakeholder groups (payers) who led the buyer's revolt?

- Federal government - Corporate purchasers of healthcare - Insurance industry

(17) In Beyond Obamacare, James House introduces the concept of a "demand side" approach to healthcare reform. If we follow a demand-side approach, what changes in social policies that do not involve healthcare are likely to improve population health? (List 3)

- Improved wages and work standards/environments - Better sanitation - Universal K-12 schooling - Housing assistance - Redistributing income - Policies that make healthy food more accessible - Limit advertisements of harmful substances such as cigarettes and alcohol

(13) What are two consequences of the Flexner Report (lecture) for the nature of contemporary medical practice?

- Medicine became university-based - Medicine became an elite profession - Proprietary schools were closed - Exclusion of women and minorities - Sects of medicine were abolished except for chiropractic and osteopathy

(1) What are three major differences between the medical and sociological perspectives on health and illness?

1.) Definition: Sociological: medicine varied according to time, place, and social group Medical: medicine is invariant; assumption of generic diseases 2.) Cause Sociological: emphasizes social causes Medical: emphasizes biological causes 3.) Reactions Sociological: shaped by society and culture Medical: emphasizes physiological reactions 4.) Medical Decisions Sociological: emphasizes social factors; decisions are social processes Medical: diagnosis & treatment based primarily on signs seen by doctor (organic signs)

(9) Give two potential pitfalls of medicalization childbirth and reproduction

1.) Increased C-sections or other unnecessary interventions: childbirth was once a natural, home process, but medicalization views it as a condition which can lead to the overuse of unnecessary hospital procedures which could cause more harm to the mother or baby 2.) Loss of personal autonomy: mothers lose autonomy over the birth of their baby because the authority of the birthing process gets handed to the physician/other health workers

(7) List two consequences of de-hospitalization in general hospitals

1.) Payers struggle to control costs: fee for service leads to diagnosis-related groups 2.) Patients are discharged sicker and quicker 3.) Doctors' autonomy is challenged: administrators now dictate when doctors can discharge patients 4.) Inpatient care is ONLY for the sickest patients (usually elderly) 5.) Medical care is transferred from inpatient to outpatient facilities 6.) Care transfers from professionals to families (most often women); leads to crisis in caregiving

(10) What are two ways in which managed care (eg. HMOs) controls costs? What are two consequences of managed care presented in lecture and/or the readings?

Controls cost by: 1.) Educational techniques -- practice guidelines, statistics on practice patterns 2.) Monitoring practice patterns for high-cost utilization 3.) Incentives -- withholds, salaries, capitation 4.) Sanctions/physician selection 5.) Utilization management: avoid unnecessary hospitalization, specialists, expensive procedures i.e. case management, second opinion programs, prior authorization, retrospective approval gatekeeping Consequences of managed care: 1.) Erosion of physicians' autonomy 2.) Erosion of patients' trust 3.) Patients and providers rebel against managed care -- legislation limits excesses of managed care, patients shift from HMOs to PPOs leading to rising cost

(5) What is the rule of triage and how is it used to allocate scarce resources in medical care?

Divide people into 3 categories: 1.) Those who will make it with or without medical care -- will not die 2.) Those who are so sick, no matter how much medical care they receive, they will die 3.) Those who will only recover if given medical care Scarce resources are allocated using the rule of triage by giving top priority to those in group 3

(4) Cite one example of an epidemiological finding that lends support to a "personal responsibility" (downstream) approach to prevention. Cite another example of an epidemiological finding that lends support to an "upstream" approach to prevention.

Downstream approach: Fuchs states that the most important causes of poor health are individual factors such as diet, habits, family life, etc. Fuchs found that increasing medical care overall for people will not significantly increase health but rather the marginal contributions to increasing health is in what they do themselves such as diet, exercise, smoking, etc. Upstream approach: McKinlay states that focusing upstream is better because re-focusing on the manufacturers of illness such as marketing industries who tactfully advertise unhealthy food and smoking in areas where residents are of low SES can help Americans become healthier

(14) What is medicalization? Give one positive and two negative consequences of the medicalization of deviant behavior

Medicalization: defining a problem in medical terms usually as an illness or disorder; redefining a phenomenon that was once seen as natural or a form of deviant behavior as an illness Positive consequence: decreased stigma for mental health issues such as ADHD in schools Negative consequences: pressure to submit to medical treatment, over-diagnosis, medical control over patient which increases power of doctors

(16) List one old and two new engines of medicalization described by Conrad

Old Engines of Medicalization: - Profession's power of authority - Social movements and interest groups - Organized interprofessional groups New Engines of Medicalization: - Managed care - Consumers - Biotech, especially pharmaceuticals

(18) List two signs that, according to McKinlay and Marceau, the "golden age of doctoring" is ending. The declining independence and status of physicians challenges the ________________ theory of professions presented in lecture.

Signs that "golden age of doctoring" is ending - Changing nature of the state and loss of partisan support - Bureaucratization/corporatization of doctoring - Emerging competitive threat from other healthcare workers - Consequences of globalization and the information revolution - Epidemiologic transition and changes in public conception of the body - Changes in doctor-patient relationship and the erosion of patient trust - Weakening of physicians' labor market position through oversupply - Fragmentation/weakening of the AMA (physicians' union) professional dominance

(2) What is the concept of social worth and how does it influence treatment decisions? The role of social worth in medical decisions suggests that the medical profession is _______________________.

Social worth: related to how much one's social value, social acceptance, social popularity, social desirability, and/or social status can contribute to society Social worth influences treatment decisions by dictating who gets treatment and who doesn't e.g. in the ER, younger more affluent patients and those health workers identify with more are more likely to be treated aggressively versus old deviant patients particularistic

(19) What mistake does the limitations of modern medicine argument as presented by the McKinlays imply that we are making in funding health care?

The usual explanations for the dramatic changes in patterns of diseases from 1700s-2000s are advances in science and technology, but most of the decline in mortality from infectious diseases happened before treatments were developed. Thus, modern medicine is not the primary cause of decline in infectious diseases but they are actually the improved social conditions such as: - improved sanitation - improvements in nutrition - overall rise in standard of living Therefore, funding should be allocated to these social movements

(15) According to the Ehrenreichs (The American Health Empire) as presented in class, what are the three major functions of the healthcare system? What are three groups that comprise the "medical industrial complex?"

Three major functions of healthcare system: 1.) Profits 2.) Teaching 3.) Research Groups that comprise the "medical industrial complex:" - Hospitals - Insurers - Drug companies - Nursing homes - Biotechnology companies

(8) What is a "total institution" as described by Goffman and presented in lecture, and what is its effect upon patients' sense of self?

Total institution: patients do everything -- such as everyday mundane tasks -- together, whereas in the real-world they are done separately; created to control & manage large crowds and separate the socially deviant from society Patients' lose their sense of individuality in total institutions

(6) According to Anspach, physicians generally used an ___________ model rather than an __________________ model in interacting with parents in life-and-death decisions.

assent; informed consent

(12) According to Eliot Freidson (class), the major characteristic of a profession is _________. According to this view, is nursing a profession? Why/why not? According to this view, is pharmacy a profession? Why/why not?

autonomy Nursing is a semi-profession because nurses still have to run some decisions past doctors which means they are not completely autonomous Pharmacy is a semi-profession because pharmacists need prescriptions from physicians which dictate what medicine the patient receives; therefore, they are not completely autonomous

(11) According to Marcia Millman, the medical review board __________ medical mistakes. This finding supports the ___________ view of professions. According to Charles Bosk, __________ errors were more severely punished than ________ errors. This finding supports the _________ view of professions.

neutralized; professional dominance normative; technical; functionalist

(3) The major conclusions of Victor Fuchs' article "A Tale of Two States" lend support to the ___________________ perspective on the healthcare crisis.

sociological