Medical Sociology Final

Smoking prevalence rates in China

-301 million smokers (1/3rdof smokers in world) -52.9% of adult males and 2.4% of adult females -1.2 million Chinese die each year b/c of smoking

"Face" (Goffman)

-Bring social identity

Conditions allowed by Colorado law

-Cancer -HIV/AIDS -Glaucoma -Cachexia -PTSD -Seizures -Severe nausea -Muscle spasms

Four phases of development

-Center for religious practice -Poorhouses -Deathhouses -Center of medical technology

Stripping

-Divest person of past status, self-representations

Doctors per capita (Russia)

-More doctors/capita than any other country -High percentage (3/4ths) female, low pay, few incentives -Accept gifts or bribe

Control of resources

-Person's belongings taken away -Restrictions on visitors -Control items in room and information about condition

Restriction of mobility

-Sick people in gowns restricted to patient areas (wards) -Discharged via wheelchair

Multipurpose hospitals

1. Treat patients -Primary goal 2. Provide laboratories 3. Train practitioners 4. Conduct medical research 5. Support health education

Fee-for-service

American health care system

Characteristics of people who use CAM

People who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor

Dietary supplements

•$1 billon/year spent on supplements in U.S. •Various supplements and uses -Algae to increase alertness -Shark cartilage to cure cancer -Fish oil to reduce heart attacks -Garlic to prevent blood clots -Variety of supplements to increase life expectancy •1994 Dietary Supplement Health and Education Act -Food products can be sold as cures, but cannot include beneficial health claims on labels -Claims can be included on books, pamphlets, store signs

Great Britain

•1st Western country to offer free healthcare for entire population •General practitioner (GP) is 1stline of medical care -GPs are paid per patient •2,000 patients per GP on average -Higher capitation for patients 65+ -Can be long waiting periods for appointments, elective surgery -Not paid exceptionally well •Periodically go on strike •Maternity benefits •Sickness benefit -Supplemental income for sick, injured •Survivorship benefits •Social gradient in health (Marmot) -Poor have healthcare but unhealthy lifestyles, worse environments

Chiropractors

•4-year training program -3 years in classroom, 1 year in practice -Doesn't require internship or residency •Manipulate bone in spinal column -Relieves pressure on nerves •Eases pain, reduces illness -Can help reduce back, shoulder, neck pain •Licensed to practice in all states -Can receive payments from insurance, Medicare •Medical opposition due to -Weak theories, low education standards

Acupuncturists

•Acupuncture, incl. 5-needle protocol •Stress relief and relaxation •Ancient Chinese treatment -Insert needles into body •Eases pain •Stimulates body functions -Restore flow of energy -Becoming more mainstream -Considered effective

Folk healers and remedies, inc. benefits

•Common folk remedy ingredients (Baer 2001) -Ginger tea -Honey lemon juice -Aspirin-Garlic -Mustard -Sassafras •Treat acne, urinary disorders, high fevers -Whiskey was fairly common in early elixirs -Kerosene •Kills head lice •Causes burns, can be fatal if inhaled •African-American Folk Healers: •Two types of healing -Traditional -Caribbean •Voodoo in Haiti •Santeria in Cuba •Obeah in the West Indies •Both use -Rituals, herbs, charms, prayer, concoctions •Curanderismo Healing: •Curanderos/curanderas, Mexican-American healers -God provides them the powers -Examine root causes rather than symptoms -Request small donation

European welfare systems

•Comprehensive health insurance •Provide income when workers become -Sick, disabled, unemployed •Supplement family income for children -Provide clothing, school lunches •Provide for elderly

Problems with ACA

•Constitutionality challenged -Govt. can compel people to buy ins. through taxation •Religious exemptions -Some don't have to pay for contraceptive service •Groups where payment would violate religious beliefs -Roman Catholic nuns at convent •Family-owned corporations based on religious principles -Conestoga Wood Specialties, Hobby Lobby •ACA at risk of being repealed and replace

Dual systems of authority

•Decentralized system of authority •Administrative -Enforces hospital policy -May create rules, regulations for doctors -Focus on efficiency •Medical -Makes medical decisions •Dual authority can result in inconsistency •Nurses -Affected by system of authority -Carry out doctor's orders -Also answer to supervisors and hospital administration

Depersonalization

(Goffman 1961) •Result of the way many patients are managed -Embarrassed, devalued, disoriented, objectified •Related to the patient's subjective experience of feeling sick

Folk Healers by SES and Race

•Not especially common in U.S. •Low-income and minority individuals and those in rural areas more likely to use -More common among: •African Americans •Hispanics •Native Americans

Canada

•Often considered a model for U.S. -High quality at low cost •Private system paid by government -Physicians private, self-employed -Population covered for doctor, hospital expenses •Drawbacks -Shortage of nurses and doctors -Delays for some diagnostic tests, surgery, cancer care -Aging population, fewer workers to pay for system -High income and sales tax -Doesn't cover prescription drugs for persons under age 65, dental, ambulance service, eyeglasses

Sweden

•One of healthiest populations in world •One of most egalitarian countries in world -Lowest percentage poor in Europe •Highest taxes in world •Universal health insurance, unemployment insurance, financial supplement to childbirth, family stipends, job-retraining, old-age pensions •Physicians paid by hours worked, not patients •Guaranteed to have doctor's appointment within 7 days and operation in 90 days

Benefits to individuals and society

Benefits to society -Protect family from burden of caregiving -Care for sick where they're less disruptive to society

Trends in the number of hospitals

Decline in number of hospitals from 1975-20

Therapies and their effectiveness

Homeopathy= Ineffective Acupuncture= Effective

Geographic variations and healthcare

•Access a major problem in rural areas -Physician shortage -Programs to attract doctors inc.scholarships, paid tuition •Physicians prefer large-sized cities -Well-appointed and equipped hospitals -Newest high-tech equipment -More sophisticated labs -Well-trained staff -Colleagues with high level of training/expertise -More specialized practices

Conforming attitudes (by age, SES)

•Age and education are best predictors of attitudes -Old, poor conform -Young, better educated more likely to deviate •Staff can rate individuals as "good patients" -Require little time -Cooperate -Don't complain -Often, not memorable •Difficult patients may be -Scolded -Sedated -Transferred home or to a different facility

Types of CAM

•Aromatherapy -Aromatic oils help relax •Ayurveda (Indian technique) -Use oils & massage to treat insomnia, digestive problems, hypertension •Shiatsu (Japanese massage) -Acupressure to maintain well being •Crystal healing -"Benefits" from quartz and other crystals •Yoga, tai chi, meditation -Reduces stress, relaxes •Yoga & tai chi can increase -Balance, flexibility

Reasons to seek alternative treatments

•Availability •Cultural •Religious •Services rendered •Want more control over health •Financial -inexpensive treatment •Dissatisfied with physicians -Charge less, spend more time, provide relief •Displeased with insurance companies

Chiropractors compared to physicians

•Charge less •Are friendlier •Devote more time to patients •Use more understandable words •Help people with back problems -A common and painful ailment

Hospital as a major social institution

•Delivers health care •Meets complex health needs •Benefits to individuals -Centralized •Medical expertise •Knowledge •Technology •Benefits to society -Protect family from burden of caregiving -Care for sick where they're less disruptive to society

Pentecostal Church

•Devil causes illness -Evil spirits can posses people •Devine healing -Some people can use Holy Spirit to heal or exorcise demons -Healing possible through faith •Healing process -Laying on of hands -Anoint with holy oil -Pray for health or demon removal •Members may still seek professional medical care

Ways to reduce costs

•Diagnostic related groups (DRGs) -List what government would pay for medical procedures -Initially for Medicare -Also adopted by insurance companies, HMOs, PPOs -But procedures may be more expensive for some •E.g., those with comorbid conditions •Requiring second opinions from doctors •Increase amount employees pay for healthcare -Saves money for employer

Doctor of Osteopathy (D.O)

•Doctor of Osteopathy (D.O.) degree -Now considered mainstream -Is a physician •Can specialize, e.g., in pediatrics, surgery, radiology •1960s, Andrew Taylor -Illnesses caused by dislocation of bones in spinal column •Training in spinal procedures and manipulation -Also deals with general health issues

Religion and health / various faiths and health

•Ellen Idler (1987, 1995, 2010, 2011), and Rogers and colleagues (1999, 2000, 2004) -Religious attendance •Better health, longer lives -Less physical disability -Lower levels of depression -Healthier behavior »Less smoking, drug and alcohol abuse, risky sexual practices -Strong social support and integration

Preferred Provider Organizations (PPOs)

•Form of managed care health organization •Employers purchase group health insurance -Agree to send employees to specific doctors, hospitals -Get discounts in return -In network is cheap

Medicaid

•Form of welfare program -Provides matching funds to states •Covers 50%-76% of costs -May also cover for poor, medically needy, blind, poor children and pregnant women -22.6% of population received Medicaid and CHIP (Children's Health Insurance Program) in 2015 •Expansion of Medicaid with the 2010 ACA -But 19 states opted out of expansion program

Socialized healthcare

•Government -Purchases healthcare -Consumer pays little additional cost -Controls health service financing, organization -Pays providers directly -Usually owns facilities -Allows patients to pay for private care if desired •Canada, Great Britain, Sweden

Decentralized national health programs

•Government -Regulates but does not operate system -Indirectly controls health service financing, organization -Regulates provider payments -Owns some facilities -Guarantees equal access -Allows patients to pay for private care •Japan, Germany, Mexico

Former socialist systems

•Government owns facilities •State employs health workers •Free universal care -Persists in Cuba, North Korea -Continues in Russia, China, former socialist systems

Managed care

•HMOs and PPOs now dominant models •Control healthcare costs -Monitor work of doctors and hospitals -Limit referrals to specialists -Limit referrals to doctors outside of network -Require pre-authorization for hospitalization •Change doctor -patient relationship -Case manager •Represents insurance company •Certifies care to be rendered is effective, least costly alternative •Capitation financing -Individual and employer pay fixed monthly payment to guarantee care

Uninsured individuals

•Have less access to health care -Hesitate seeking treatment even for emergencies -Some doctors may deny treatment -Reduces preventive care -Reduces prenatal visits •Pregnant women may have limited access until delivery -Increases distance to facilities that will treat uninsured -Individuals in worse health once they become eligible •E.g., worse diabetes and heart disease once individuals eligible for Medicare

Justification for healthcare services

•Healthy population •Productive population -Economic, military power •Reduce political dissatisfaction -Was way to prevent revolt in some European countries

Opposition to reform

•Higher costs •Higher taxes •Reductions in Medicare benefits •More federal funding for abortions -ACA follows restrictions in Hyde Amendment -Federal funds cannot be used for abortion services except in instances of rape, incest, or risk of woman's life •Increased government bureaucracy

Hospital-patient role

•Hospital divided into categories -Maternity -obstetrics -Pediatrics -Neurology -Orthopaedics •Potential unintended result

Affordable Care Act (ACA)

•Individuals with preexisting conditions cannot be denied coverage •Health insurance plans must provide minimum benefit levels •State insurance exchanges will be set up to provide affordable prices, range of plans •Individuals can purchase plans thru state exchanges •Persons under age 65 can purchase plans from state exchanges even if they have other insurance •Medicaid program expanded to cover individuals earning 133% below poverty line •Small businesses can buy insurance through the exchanges •Children can remain on parents' plan until 26 years of age

Health Maintenance Organizations (HMOs)

•Managed care •Pay monthly premium for comprehensive care •Focus on preventive care -Try to prevent hospitalization •Physicians may be paid salary or capitation (per patient amount) •Patients -Usually have primary care doctor -But may see doctor on duty, esp. in off hours

Trends in and reasons for specialization

•More manageable body of knowledge -Develop expertize in focused area •Greater prestige •Less demanding personal time -Less "on call" time •Higher income -Pediatricians, $206,961/year in 2015 -Internal medicine, $223,125 -Dermatologist, $400,898 -Orthopedic surgeons, $553,688

Types of hospital ownership

•Nonprofit -Most common-Board of Trustees provides control -Do not pay federal income taxes •For profit -Increasing trend •Government (federal, state, or local) -Less prestigious -Low-income individuals rely as major source of care

Christian Science Church

•Pain and sickness are illusions •Disease indicates negative spiritual condition -Prayer heals bad spiritual condition -Medicine unnecessary or prohibited •Except for, say, broken bones -Controversies over children's needs vs. parents rights •Courts cases of manslaughter or neglect -Parents, late 1980s, did not seek medical care »2-year old boy with bowel obstruction »Prayed for relief, but child died •Court rulings -Freedom of religion doesn't include risking child's health or life

Ability to control costs

•Percentage of GDP due to healthcare rising -13.5% between 1993 and 1997 -16.2% in 2007 -17.5% in 2015 •Increases due in part to -More choice -Negative public reaction to restrictions -Pressure from physicians

High healthcare costs & reasons for high costs

•Population ageing •Increasing hospital expenses •Fees for healthcare professionals, inc.doctors •High cost of health insurance •Increase in number and cost of prescriptions •Increase in new expensive drugs •Increase in drug advertising -25% of cost of drugs is advertising -Marketing to consumers, not just doctors

Faith healers

•Promote healing with prayer, faith in God, power of suggestion •Two basic beliefs (John Denton 1978) -Psychological processes avenue toward healing -God intervenes •Denton's Five categories of healing. Treated by -Self through prayer -Layperson who communicates with God -Official church leader -Full-time healer, unaffiliated with religion -Full time religious healer

Medicare

•Provides for individuals aged 65 and over -Hospital insurance (Part A) -Medical insurance (Part B) •Also provides for Disabled under 65 if they -Receive benefits from Social Security -Receive benefits from railroad retirement program -Have chronic kidney disease -Kidney dialysis •There are some gaps in Medicare coverage

Medical marijuana

•THC -psychoactive effect •CBD -cannabidiol -No psychoactive effect •Terpenes -Flavor and aroma •Charlotte's Web -Named for Charlotte Figi •Treatment for seizures -CBD •Luck's Market now sells CBD oils -Stress reduction

Admissions to mental hospitals

•Voluntary-70% voluntarily consent to be admitted •Involuntary -Criminal offences •Insanity used as defence -Mental disorder contributed to crime •Hospital and courts determine release -Civil cases •Person danger to self, other people, or property -Consider severity, change of repeat offense, past behaviour