Medical Sociology

Describe the general development of the hospital from medieval to modern times

1) Centers of religious practices • Religious purposes • Medical care given by clergy& nuns • Primary functions: - exercise religious practices & the extension of charity , welfare services for poor. 2) Poorhouses: • Secularized during Renaissance & Reformation • Decline of hospital system • Similar to boarding houses • Gave food & shelter to the poor . 3)Deathhouses • Physicians had little influence or involvement in early hospitals b/c their services were voluntary • 17th century - physicians provided a monopoly over the medical techniques • 19th century- hospitals taken their role as institutions for medical care - Hospitals : crowded, unsanitary, low survival rate, a place where poor people went to die. 4) Centers of Medical Technology • End of 19th century- All social classes could find high quality medical care & be cured. • Factors responsible for this change: - Improvement in medical knowledge & techniques - Implementation of sanitation - Better training of hospital employees ; especially nurses.

List the types of hospitals in the U.S & the most common type . Classified into 3 major types

1) Non profit : • Most common type about 51% in 2007 • Controlled by board of trustees , exempt from federal tax incomes . • Emphasize high quality care for all classes. 2) For Profit: • Often apart of a multi hospital chain 3) Government - local, state , federal level • Lack prestige vs other hospitals • For low income populations .

Describe the major areas of complementary & alternative medicines

1)Osteopaths • Work as physicians with added training in spinal procedures . • Transitioned from spinal manipulation to general health problems . •Trend toward absorption in medicine 2) Complementary & Alternative Medicine • Middle/ working class backgrounds • Faith & Folk Healers come from lower class backgrounds b/c they are inexpensive & culturally similar . •Treatments not commonly used in medical profession : • Chiropractors -Healing involves manipulation of bones in the spinal • • Faith healing & Religion- Use the power suggestion, prayer & faith in God to promote healing •5 General categories 1) Self treatment through prayer. 2)Treatment by a layperson thought to be able to communicate w/ God. 3) Treatment by an official church leader as one of their duties. 4) Healing obtained from a person or group who practice healing full time w/o an affiliation w/ a major religious organization. 5) Healing obtained from religious healers who practice full time & are affiliated w/ a major religious group.

Discuss the factors contributing to the rising cost of hospitalization

1)Regional cost of living 2)Occupancy Rate 3)Burdensome paperwork loads for insurance claims 4)Technological Innovations 5)Maintaining facilities - Control Cost by: 1) Reducing paperwork loads 2)National Health insurance coverage 3)Fee schedules

Explain the major issues facing US healthcare

1)Rising Costs • Highest per capita income in the world. Factors: aging population, increase in hospital expenses & doctor fees, increase healthcare insurance cost, increased use of advertising for prescription drugs. 2) Equity • Lessened with healthcare reform, but is a current problem . 3) Geographic distribution of services • Shortage of physicians in rural & urban slums.

Identify the major trends & problems facing most health care systems around the world

1)Rising costs - Controls over the cost of healthcare , regarding health policy . 2)Preventative medical services- Increase emphasis in developing countries,as more attempts to be made to keep healthy people healthy. 3) Effective Administration- Regarding large healthcare systems. 4)Aging Populations 5) Requirement to meet the nations health needs: •Demand placed on government & policy makers to provide a healthcare system that meets national needs.

Identify the major features of the healthcare systems highlighted in this chapter

1)Socialized medicine: Healthcare is provided as a state supported consumer service . • Purchased by the government, makes the cost cheaper for the consumer . -Ex: Canada- Hospital insurance is provided . Physician fees are covered . Private healthcare paid by public through taxes & premiums - Ex: Great Britain- FIRST to implement NHS( National Health Service), this took over the countries healthcare . Government employs health workers, maintains facilities ,'purchases supplies & new equipment from taxes . -Ex: Sweden- EGALITARIAN healthcare financed through taxes . Physicians employed by council councils # of hours worked. 2) Decentralized National Health Programs: Government acts primarily to regulate the system & functions as a 3rd party who mediates / coordinates between healthcare delivery and providers/payers. -Ex: Japan- Government fee schedule costs containment , providers cannot charge more than scheduled , doctors get money from prescribing drugs. -Ex: Germany- Health insurance program, the workers are tied to the state instead of the labor unions . -Ex: Mexico- Various programs like private healthcare . 3) Socialist Medicine: Central gov. Ownership of all facilities, employment of workers , free universal care paid out of the national budget. Ex: Russia - Soviet government is responsible for the states healthcare. Healthcare insurance is mandatory for all employees, funded at the federal & local level. -Ex: China- Financed w/fees paid by patients , employers , & health insurance companies . TRENDS: •Fee for service : Open market principle leads to high quality services & affordable prices resulting from competition among providers. - Regulation -Payment to providers - Ownership of facilities - Public access - Private care

Contrast the approach to health of folk Healers with modern medicines & identify trends in the use of folk Healers

Folk healers- Used by low income patients & ethnic/ minority's . They have historical knowledge & use ingredients for medicine : baking soda, honey , ginger, salt , mustard - Modern societies use it b/c of distrust of professional medicine • African American Folk healers - Science & religion are connected . Focus on the cause of the problem not the system .Believe all illnesses can be cured. - Distinguishes between natural( repentance) & unnatural (evil influences or magic)illnesses. • Mexican Folk Healers - blend religion & science . Focus on the cause of the disorder rather than the symptoms. - folk drugs & herbs • American Indian Folk Healers- Traditional rituals lasts for several days, lead by singer . Emphasis on cause of illness, diseases classified by cause rather than symptoms - Illness b/c of lost soul, possessed by spirit, witchcraft.

Identify the reasons most health occupations are subordinate to physicians

Freidsons 4 characteristics : 1) Technical knowledge of health occupations must be approved by the physician . 2) Usually assist physicians in their work . 3) Their work occurs at the request of the physician . 4)Physicians have the greatest prestige .

Describe past attempts to reform & major changes in the U.S healthcare system

• 20th century presidents attempted or recognized the need for healthcare reform . • President Johnson established Medicare & Medicaid . 1)Medicare: • Federal administered program . • Provides hospital & medical insurance for people 65+ • Disabled people under 65 who receive cash benefits from social security . • Covers 14.8% population 2)Medicaid: • Welfare program operated by the states • states + federal government = share cost • For poor • states requires to cover all people who get cash assistance . • Can include medical needy , the blind & disabled poor/ their dependent children & families . • Covers 15.5% of population - Clinton failed national health insurance (NHI) b/c of anti-insurance lobbying, lack of consensus between democrats , republicans & congress , public and uncertainty. - reform > managed care ( private)

Explain how the development of nursing resulted in the fields current organization & how this is changing .

• Before 19th century nursing was performed by nuns. • Transformation- 19th century into a formal occupation by Florence Nightingale • Occupation stratified by sex, women inferior to men's position . • Changing : 3 types of programs for RNs. 1) two year associate degree programs 2) hospital based diploma schools 3) Four to five year university baccalaureate program. • AD program Role changing from supervisor to management • AD nurses have to get their BSN. All registered nurses must have their bachelors degree. • Nurses are now not taking the subordinate position to doctors .

Identify major features of the hospital patient experience

• Focus on depersonalization: isolated from other people, de-valued • Hospital is focused on being efficient . - favor rules that reduce patient autonomy . • 3 Basic Mechanisms 1) Stripping of personal belongings & control visitors routines 2) Control of resources by the staff, including medical information . 3) Restriction of patient mobility- Can't leave the ward unless w/ a nurse . • Some patients conform : older & less educated • Doctors & staff define patients based on how demanding : Good patients require less time & attention from staff. • Similarities between Parson sick role & hospital patient role: Universalistic, affectively neutral, functionally specific, collective oriented .

Describe the structure of nursing training & the major phases of socialization for nursing students .

• Fred Davis 6 distinct stages in the course of nursing education: 1) Initial Innocence - Lay image of nursing . " Motherly",kind Role 2) Labeled recognition of incongruity- weren't valued like the doctors . Wondered why the became nurses 3) Psyching Out- Focused on what the instructors wanted them to know & satisfying those requirements. 4) Role stimulation - Students learned to have a detached attitude towards their patients. 5) Provisional internalization 6) Stable internalization * (Temporary) self identify as a professional nurse . Applies to the last two stages .

Describe the basic organization of the non profit hospitals , explain how this organization came about

• Hospitals as a multi- purpose institution - Satellite outpatient clinics - Affiliated group practices - Smaller hospitals - Management organization providing administrative services to physicians - Employ primary care doctors as part of their physician network

Discuss the role gender plays in doctor-nurse interaction

• Male physicians regard male nurses as more competent & treats them better . • Male nurses are less passive in their interactions with doctors & less likely to play the doctor nurse game . • Female doctors were not likely to play the doctor nurse game with either male or female nurses . • Female physicians were more likely to have their actions questioned by nurses.

Describe basic features & roles of additional health occupations: physician assistants, pharmacists, midwives

• Physician assistant- practice medicine under supervision of a physician & are trained to handle routine medical problems . - Resolve the issue of providing more primary care practitioners in American healthcare. •Pharmacists - Require approval from physician to dispense prescription drugs. - Explain the effects of prescription drugs & levels of doses to the patients & instructions for their use. • Midwives- Women who assist Mothers during child birth. - Lay midwives assist births on their own. - Nurse mid wives assist to deliver babies under the supervision of physicians.

List the changes introduced by the 2010 healthcare reforms

• President Obamas Patient Protection & Affordable Care Act. • 95% covered by 2019 • Minor changes for people with insurance . 1) People with pre-existing medical conditions can't be denied coverage . 2)Minimum level of benefits set by federal government must be in all health insurance plans . 3) State insurance exchanges will offer a range of competitive health care plans at affordable prices. 4) People not covered by employer can buy coverage through state exchanges . 5) People under age 65 w/ health insurance may buy plans from the exchanges & who earn up to 4X the federal poverty line will revive government to help pay the costs . 6) Low income people under age 65 earning below the poverty line will be covered by Medicaid. 7) Small businesses can buy insurance for their employees through exchanges & tax credits . 8) Children can stay on their parents plan until the age of 26. 9) Most Americans ( except American Indians& religious) would be required to purchase health insurance or pay a fine as well as employers with over 50 employees.