Transcript Chapter 16
Chapter 16 Health and Health Care Chapter Outline Using the Sociological Imagination Health Care as a Social Institution Theoretical Perspectives and the Health-Care System Health in the United States The Changing Health-Care System Health-Care Reform in the United States The American Health-Care System Americans spent $1.2 trillion on health care in 1999, up from $75 billion in 1970. Since 1980, total health expenditures increased nearly 400 %. Health-care expenditures account for about 14% of the GDP; the comparable figure in 1970 was about 7%. Components of the Healthcare System Physicians Nurses Hospitals patients Rising Health-Care Expenditures in the U.S. The Sick Role 1. 2. The sick are permitted to withdraw temporarily from other roles or at least reduce their involvement in them. It is assumed that the sick cannot simply will the sickness away. The Sick Role 3. 4. The sick are expected to define their condition as undesirable. The sick are expected to seek and to follow the advice of competent healthcare providers. Theoretical Perspectives: Health Care in the U.S. Theoretical Perspective Functionalism Research Topic Hypothesis Sick role Society requires (needs) a timely exit from the state of illness. Theoretical Perspectives: Health Care in the U.S. Theoretical Perspective Conflict theory Research Topic Power of physicians Symbolic Interactionism Stigmatization of illness Hypothesis Physicians repress competing approaches to health care. AIDS victims are labeled as immoral and deviant. Infant Mortality According to Race/Ethnicity of Mother Higher Incidence of Mental Illness Among the Poor: Explanations Genetic explanation •A biological tendency to mental illness within the lower social class. Social stress explanation •Lower class is more susceptible to mental disorders because of the extra stress of deprivation. Higher Incidence of Mental Illness Among the Poor: Explanations Social selection explanation •Individuals with mental disorders in other social classes tend to end up in the lower class. •The mentally healthy born into the lower class move up to higher social classes. Characteristics of Managed Care Systems Delivery of a comprehensive set of health services for a prepaid premium. Utilization and quality controls that providers agree to accept. Characteristics of Managed Care Systems Financial incentives for patients to use the provider’s facilities or designated physicians only. Assumption of some financial risk by doctors to motivate them to balance patients’ needs against the need for cost control. Negative Aspects of HMOs Coverage is restricted: Patients have to use doctors who are members of the HMO. Physicians may turn patients away because of the quota for subscribers. Physicians limit enrollment because HMO reimbursements are below other forms of insurance. Negative Aspects of HMOs Co-payment requirements discourage subscribers from visiting doctors. HMOs control referrals to more costly specialists: The primary care doctors divide referral money left over at the end of the year. Primary care doctors who fail to limit referrals are more likely to be released by HMOs. Negative Aspects of HMOs HMOs encourage doctors to keep costs low: They pay the physicians a predetermined amount annually for each patient they have. Because doctors can keep the difference between their total allocation and the actual costs of patient care, they have an incentive to under treat. Health-Care Reform The United States is the only highly developed country in the world without health insurance for all citizens. Health insurance in the United States is a privilege enjoyed, with the exception of the elderly, by those who have full-time jobs with well-established firms. Health-care Reform: Economic Motivation In 1999, health care accounted for 13% of America’s GDP ($1.2 trillion). If current trends continue, healthcare spending is expected to reach 18% of GDP early in the 21st century. Health-care Reform: Access to Medical Care Even with Medicaid, 1/2 of America’s poor are without medical coverage. In 2001, 60% of the uninsured were employed. Nearly 1/2 of uninsured children live with parents who are insured. Nearly 10% of children in the United States were without health insurance in 2001. Americans without Health Insurance, 2001 Health-Care Reform Options The “modified competitiveness” option Based on market principles such as consumer cost sharing. Depends on universal health coverage as a precondition to health-care reform. Health-Care Reform Options Managed competition A combination of free-market forces and government regulation. Health care would be structured around plans modeled after HMOs. Health-Care Reform Options Single payer approach, like the Canadian model. Government finances medical services. Canadians choose their doctors and hospitals and bill the government according to a fee structure. This approach engenders higher levels of satisfaction with patient services, and is regarded much more favorably than the U.S. system. Health-Care Reform Options Play or pay mechanism based primarily on the German model Universal coverage is provided by employers who either offer health coverage (play) or pay into a fund for covering the uninsured. Access to medical care in Germany, considered among the best in the world, is guaranteed for life.