Medicine and Health Care

Medicine and Health Care
A Look Ahead
Culture, Society, and Health: Definitions

Epidemic
A widespread outbreak of a contagious disease
Pandemic
An outbreak of a contagious disease over a very large area or worldwide
Disease
A pathology that disrupts the usual functions of the body
Health
The capacity to satisfy role requirements
Illness and Social Order
Components of The U.S. Health Care Delivery System
Do we have a health care or an illness treatment System?
Hospitals
Physicians
The Doctor-Patient Relationship
Nurses
Medical Schools
Public Health systems at various levels
Nursing Homes
Pharmaceutical / Drug Companies
Medical Device makers
Insurance Companies
Health Care in the United States
Physicians, Nurses, and Patients
Physicians (mostly male) have controlled interactions with patients and nurses (mostly female)
Increasing numbers of physicians are women; may alter doctor–patient relationship
Alternatives to Traditional Health Care
Growing interest in holistic medicine
According to WHO, 80 percent of people who live in poorest countries use alternative medicine
Health Care in the United States
A Historical View
By 1840s, health care largely unregulated
American Medical Association institutionalized its authority through standardized programs of education and licensing
Gave birth to medicalization of society
The Role of Government
Medicare and Medicaid enacted in 1965
Medical Providers
Primary Roles
Physicians
Have the authority to diagnose, prescribe treatment
Certify death or competency
Prestige results in many privileges
Most are specialists today
Nurses
Assist in medical settings under the supervision of a physician
Have less education than physician
Most are women

American Health Care Organizations
Hospitals
Divided authorities
Physicians
Administrators
Multihospital systems
Hospitals managed by a company
HMO
An insurance plan combined with a facility
A “health maintenance organization”
For a monthly fee, comprehensive health care is provided
Components of Health Care Delivery Systems
The American System
Rising Health Care Costs: Is Managed Care the Answer?
What Accounts for the Rise in Costs?
Competitive Health Services
Managed Care

Health care is managed differently in different countries.

China, Great Britain, Kenya, Cuba and Canada have some type of national health care plans.
Go see the movie Sicko by Michael Moore for a somewhat biased view of the difference between American and other health plans


Power, Resources, and Health
Power, Resources, and Health
Inequities in Health Care
Medical services concentrate where wealth is
Brain drain: immigration to the U.S. and other industrialized nations of skilled workers, professionals, and technicians who are desperately needed in their home countries
There are dramatic differences in infant mortality rates between developing countries and industrial nations
Infant Mortality Rates in
Selected Countries
Power, Resources, and Health
HIV/AIDS Cases, 2007
Negotiating Cures

Medicine
Social and Ethical issues surrounding death
When does death occur?
Do people have a right to die?
What about mercy killing?
Mercy killing is the common term for euthanasia, assisting in the death of a person suffering from an incurable disease.
The Medical Establishment.
Medicine is a social institution concerned with combating disease and improving health.
Holistic medicine is an approach to health care that emphasizes prevention of illness and takes account of the person’s entire physical and social environment. These are its foundations:
Patients are people.
Responsibility, not dependency.
Personal treatment.


Medicine Paying for medical care



The United States. Ours is a direct-fee system or a medical care system in which patients pay directly for the services of physicians and hospitals.
Medical bills are paid three ways:
Private insurance programs (Indidual and employer/group plans)
Public insurance programs, such as Medicare and Medicaid.
Health Maintenance Organizations, organizations that provide comprehensive medical care to subscribers for a fixed fee.


Medicine Supply of Providers

Another issue in medical care is the shortage of some medical professionals in some parts of the United States
Especially in disadvantaged parts of large cities and in Rural areas
Nurses are in short supply in some place
Some places do not have enough doctors
some places have too many hospital beds and some not enough

Availability of Physicians by
State, 2005
Medicine In other Cultures
Capitalist Societies:
The Swedish system is often described as socialized medicine, a medical care system in which the government owns and operates most medical facilities and employs most physicians.
Great Britain. The British created a “dual system” of medical service.
The National Health Service pays 100% of medical costs
The Private system is very expensive
Medicine In other Cultures
Japan. Physicians in Japan have private practices, but a combination of government programs and private insurance pays medical costs.
Canada. Canada has a “single payer” model of health care. But Canada also has a two-tiered system like Great Britain’s, with some physicians working outside the government-funded system and setting their own fees.

Medicine

Theoretical Analysis of Medicine
Structural-functional analysis views illness as a social dysfunction.
Talcott Parsons suggests that people often respond to illness by assuming the sick role, patterns of behavior defined as appropriate for people who are ill.
The sick role has three characteristics:
Illness exempts people from routine responsibilities.
A sick person must want to be well.
A sick person must seek competent help.
The physician’s role. Parsons saw the doctor-patient relationship as hierarchical. Yet this pattern varies from society to society.
Critique: Parsons’s work links illness and medicine to the broader organization of society, but it also supports the idea that doctors, rather than patients, bear primary responsibility for health.

Theoretical analysis of Health Care
Symbolic-interaction analysis.
The social construction of illness. How people define a medical situation may actually affect how they feel.
The social construction of treatment. Understanding how people construct reality in the examination room is as important as mastering the medical skills required for treatment.
Critique: This paradigm reveals the relativity of sickness and health, but seems to deny that there are any objective standards of well-being.

Social-conflict analysis.
Access to care. The access problem is more serious in the United States than in other industrialized societies because our country has no universal medical care system.
The profit motive. Some conflict analysts argue that the real problem is the character of capitalist medicine itself.
Medicine as politics. Scientific medicine frequently takes sides on significant social issues.
Critique : This perspective minimizes the improvements in health brought about by the present system.

Social Epidemiology
Social Epidemiology
Social Class
Percentage of People
Without Health Insurance, 2006
Race and Ethnicity
Infant Mortality Rates in
the United States, 2002–2004
Race and Ethnicity
Mexican Americans and other Latinos interpret illness according to curanderismo: Latino folk medicine, a form of holistic health care and healing
Latinos are likely to wait to receive treatment
Gender
Smoking Rates by Gender,
1965–2005
Age
Health Insurance Rates by Age, 2006