Download 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.