Dr Kithsiri Edirisinghe MBBS , MSc, MD ( Medical Administration )

• To obtain a clear picture of various social structures in the world, with a view to interact more efficiently when dealing with clients/ patients from different cultures.
Sociology for health professionals IIHS 2011

• http://www.youtube.com/watch?v=pRUGvArWXLk Sociology for health professionals IIHS 2011

OBSERVATIONS ARE CERTAINLY IMPACTED BY THE PERSONAL PERSPECTIVES THROUGH WHICH PEOPLE COME TO VIEW THE WORLD

•
http://www.youtube.com/watch?v=GG1SaSOg bXo&feature=related

• Allocated total number of hours is 45hrs • Methods of instructions - lectures, debates and group discussions • Performances are evaluated by through quizzes, assignments and visas during the sessions.
• Term exam papers include MCQ, structured essays . Sociology for health professionals IIHS 2011

• David,M.N.,Sociology-Exploring the Architecture of Everyday Life, 4 th ed, Pine Forge, 2002 • Roger, E., The ways of Religion-An introduction to the Major Traditions, Oxford, 1999 Sociology for health professionals IIHS 2011

1. Introduction to Sociology 2. Culture, Society and the Individual 3. Family 4. Marriage 5. Socialization 6. Gender and Sexuality 7. Social Interaction and Everyday life 8. Stratification and Class Structure 9. Ethnicity and Race 10. Deviance and Crime 11. Education 12. Religion 13. Population Sociology for health professionals IIHS 2011

• • http://www.youtube.com/watch?v=uPwY4TpQkLs http://www.youtube.com/watch?v=azWs-ESXZrk&feature=related • http://www.youtube.com/watch?v=E55KwzjRVBc&feature=related • http://www.youtube.com/watch?v=azWs-ESXZrk&feature=related • ttp://www.youtube.com/watch?v=NnJWv58updU&feature=related Sociology for health professionals IIHS 2011

1.
2.
3.
What is Sociology Definitions of Sociology Importance of Study Sociology
Time allocated 02hrs

• Sociology is the science (-ology) of society (socio-) “Sociology is an extended commentary on the experiences of daily life, an interpretation which feeds on other interpretations and is in turn fed into them” --Zygmunt Bauman Sociology for health professionals IIHS 2011

• http://www.youtube.com/watch?v=j geyOIMDTw&feature=related Sociology for health professionals IIHS 2011

• Sociology can help us make sense of our experiences by taking our accounts and sharing or comparing them with others.
• The sociological perspective is constituted of stories told by individuals and groups and shapes how we establish our worldviews http://www.youtube.com/watch?v=-hysCK7uHBc Sociology for health professionals IIHS 2011

• Sociology can help us make sense of our experiences by taking our accounts and sharing or comparing them with others.
• The sociological perspective is constituted of stories told by individuals and groups and shapes how we establish our worldviews •We can examine social structures (patterns of organization that constrain human behavior) by observation of the sociological perspective. •Social structures •http://www.youtube.com/watch?v=CgxM2kTw1WU&feature=re lated Sociology for health professionals IIHS 2011

• • http://www.youtube.com/watch?v=OsrXLiragCk&feature=results_main&pl aynext=1&list=PL200BE5F5424C2D6F http://www.youtube.com/watch?v=pSs6itQDZMw&feature=r elated Sociology for health professionals IIHS 2011

a. Functionalist Approach http://www.youtube.com/watch?v=_EgCBf_mrkg http://www.youtube.com/watch?v=6-p1Yvx4bPU&feature=related http://www.youtube.com/watch?v=kTNRM6XkvOs&feature=related – “Being sick” must be controlled so that not too many people are released from their societal responsibilities – Sick role: societal expectations about attitudes and behavior of a person viewed as being ill Sociology for health professionals IIHS 2011

b. Conflict Approach – Critical of growing role of medicine as major institution of social control – The Medicalization of Society http://www.youtube.com/watch?v=wdxFqVS18Qc&feature=rel ated http://www.youtube.com/watch?v=m_ISCecNBac&feature=rel ated Sociology for health professionals IIHS 2011

c. Interactionist Approach
http://www.youtube.com/watch?v=3CPIBVo2l1I
– Studies the roles played by health care professionals and patients – Asserts patients may play an active role in positive or negative health Sociology for health professionals IIHS 2011

d. Labeling Approach http://www.youtube.com/watch?v=r-UBjL1zlgM http://www.youtube.com/watch?v=830FBsmpTjg – The designations healthy and ill generally involve social definition – Disagreements continue in the medical community over whether a variety of life experiences are illnesses Sociology for health professionals IIHS 2011

Figure 19-1. Infant Mortality Rates in Selected Countries, 2004 Sociology for health professionals IIHS 2011 Source: Haub 2004

Table 19-1. Major Perspectives on Health and Illness Sociology for health professionals IIHS 2011

Discuss your views on sociology and its important to you and people around you !
You are requested to forward this before next Tuesday Sociology for health professionals IIHS 2011

•What is culture •Layers of culture •SEVEN Elements of Culture •Organization of a culture

• • http://www.youtube.com/watch?v=eixOqz9M tKY&feature=related http://www.youtube.com/watch?v=7VQXH0_ emEk&feature=related Sociology for health professionals IIHS 2011

• • • http://www.youtube.com/watch?v=57KW6RO 8Rcs&feature=related http://www.youtube.com/watch?v=3iCVUNGi N-I&feature=related http://www.youtube.com/watch?v=Wt2qtz0B 7mQ&feature=related Sociology for health professionals IIHS 2011

“ A system of values and norms that are shared among a group of people and that when taken together constitute a design for living.” -Hofstede, Namenwirth and Weber Sociology for health professionals IIHS 2011

• “is complex totality which includes : – Knowledge – belief – art – law – morals – custom – And any other capabilities and habits acquired by man as a member of society ." Sociology for health professionals IIHS 2011

a. Layers of culture b. Culture and Society c. Is Culture Limited to Humans?
d. Seven Elements of Culture Sociology for health professionals IIHS 2011

• Principle Cultural traditions that distinguish your specific society. – language, traditions, and beliefs that set each of these
peoples apart from others. Sinhaleese , Tamils , Muslims
• Subculture – Subculture of the main culture - their language, food, and other traditions – Tamils – Jaffna & Indians – Sinhalese – Upcountry and low country • Learned behavior Cultural universals. These are learned behavior patterns that are shared by all of humanity collectively. No matter where people live in the world, they share these universal traits.
Sociology for health professionals IIHS 2011

1. Language.
2. Norms 3. Values 4. Beliefs and ideologies.
5. Social Collectives.
6. Cultural Integration. & Statuses 7. ROLES Sociology for health professionals IIHS 2011

• http://www.youtube.com/watch?v=w5ssFOsl Bg Sociology for health professionals IIHS 2011

• Language.
• Language is a set of symbols used to assign and communicate meaning. It enables us to name or label the things in our world so we can think and communicate about them.
Sociology for health professionals IIHS 2011

• • http://www.youtube.com/watch?v=5_HrzDoS Hn4&feature=related http://www.youtube.com/watch?v=f wpN5UUxPs&feature=related Sociology for health professionals IIHS 2011

• Norms as humanly created rules for behavior . The production of norms. • The need for orderly, stable, predictable interactions . • “Social rules that govern people’s actions toward one and another” Sociology for health professionals IIHS 2011

Sociology for health professionals IIHS 2011

– http://www.youtube.com/watch?v=x4Ed2dHdznE&feature=relate • routine conventions of everyday life • actions of little moral significance • dress code, eating habits, time orientation, rituals, etc.
• violating folkways will not be considered evil or bad Sociology for health professionals IIHS 2011

• Mores are norms of morality. Breaking mores, like attending church in the nude, will offend most people of a culture. Mores, in sociology , are any given society's particular norms , virtues , or values . Sociology for health professionals IIHS 2011

• A taboo is a strong social prohibition relating to any area of human (or activity or ban ) social custom that is sacred and or forbidden based on moral judgment, religious beliefs and or scientific consensus . Breaking the taboo is usually considered objectionable or abhorrent by society .
Sociology for health professionals IIHS 2011

• A ritual is a set of actions, performed mainly for their symbolic value. It may be prescribed by a religion or by the traditions of a community . The term usually excludes actions which are arbitrarily chosen by the performers.
Sociology for health professionals IIHS 2011

• http://www.youtube
.com/watch?v=yput DOL74Mk

• Form the bedrock of a culture • Provide the context for establishing and justifying a society’s norms and attitudes toward: – individual freedom – democracy – truth and justice – honesty – loyalty – social obligations – role of women – love and sex – marriage Sociology for health professionals IIHS 2011

Sociology for health professionals IIHS 2011

• Beliefs • Beliefs are the things members of a culture hold to be true. They are the "facts" accepted by all or most members. Beliefs are not limited to religious statements, but include all the things a people know and accept as true, including common sense everyday knowledge.
Sociology for health professionals IIHS 2011

• • Ideologies are integrated and connected systems of beliefs. Sets of beliefs and assumptions connected by a common theme or focus. They are often are associated with specific social institutions or systems and serve to legitimize those systems.Some prominent American ideologies.
Sociology for health professionals IIHS 2011

• • Social collectives such as groups, organizations, communities, institutions, classes, and societies are also collectively produced symbolic social constructions. Social collectives are symbolic entities. They are defined into existence when people define themselves as a group or are defined as a group by others. They can and do become reified over time, such that they are seen and treated as real objective entities. However, they remain fundamentally symbolic entities and as such can be renegotiated and redefined.
Sociology for health professionals IIHS 2011

• Cultural integration refers to how interconnected, complimentary, and mutually supportive the various elements of culture are: • Diversity, complexity, and integration.
• Variation within modern mass cultures.
• Diversity in historical and cultural traditions.
• Subcultures.
• Counter-cultures.
Sociology for health professionals IIHS 2011 • Local cultures.

• Roles are norms specifying the rights and responsibilities associated with a particular status. The term role is often used to mean both a position in society and role expectations associated with it.
• Roles define what a person in a given status can and should do, as well as what they can and should expect from others. Roles provide a degree of stability and predictability, telling how we should respond to others and giving us an idea of how others should respond to us.
• Roles are negotiated and produced during interaction, and often become reified over time. However, roles can be renegotiated and changed. Role set, role strain, role conflict, and role transition.Roles, identity, and the self.
Sociology for health professionals IIHS 2011

“Social rules that govern people’s actions toward one and another” – Mores http://www.youtube.com/watch?v=rWL_C2PWQ5w • norms seen as central to the functioning of a society • have much greater significance than folkways • violating mores can bring serious retribution • theft, adultery, incest, cannibalism Sociology for health professionals IIHS 2011

• Learned behavior through: – observation – sharing and transferring • Accumulation of solutions to common problems by: – accident – learning – borrowing ( Cultural Diffusion ) • All elements are interrelated • Composed of explicit and implicit layers • Dynamic and evolutionary 2011

http://www.youtube.com/watch?v=AKZ3K9Wfxg8&feature=related http://www.youtube.com/watch?v=KxMb6HqYh_s • Up to 90% of all cultures have their major origins from elsewhere • When two different cultures interact: – selective process – two-way process – borrowed items will be reinterpreted Sociology for health professionals IIHS 2011

• Society is a group of people who share a common culture • No one-to-one correspondence between society and a nation – nation states are political creations – many cultures can co-exist within a nation state – similarity among people is both a cause and effect of national boundaries • Nations composed of several cultures with no super ordinate and uniting values are likely to split apart • Nations break up and yield smaller units allowing national cultures to emerge and solidify 2011

• Society is a group of people who share a common culture • No one-to-one correspondence between society and a nation – nation states are political creations – many cultures can co-exist within a nation state – similarity among people is both a cause and effect of national boundaries • Nations composed of several cultures with no super ordinate and uniting values are likely to split apart • Nations break up and yield smaller units allowing national cultures to emerge and solidify 2011

Fig: 3.1
Sociology for health professionals IIHS 2011

Fig: 3.1
Sociology for health professionals IIHS 2011

• • • • http://www.youtube.com/watch?v=lNBWI_a_t10 http://www.youtube.com/watch?v=OBCN8eVV7MQ http://www.youtube.com/watch?v=CgxM2kTw1WU http://www.youtube.com/watch?v=fCALS7aaEyI Sociology for health professionals IIHS 2011

A society’s basic social organization Two Dimensions • Degree to which basic social unit is the “individual vs. the group “ • Degree to which society is stratified into “classes or castes” Sociology for health professionals IIHS 2011

• Often prevalent in Western societies • Not only reflected in the political and economic organizations • How people perceive themselves and relate to each other in social and business settings • Social status of an individual is not a function of where they work but their individual performance • Often expressed in a high degree of entrepreneurship and managerial mobility • Makes team building more difficult Sociology for health professionals IIHS 2011

http://www.youtube.com/watch?v=ljOQxDEpk-M • Often prevalent outside Western societies • Social status of an individual is determined by the standing of the group to which they belong to as much by their individual performance • Often expressed in a high degree of group affiliation and the lack of managerial mobility Sociology for health professionals IIHS 2011

• All societies are stratified on a hierarchical basis into social categories (social strata) http://www.youtube.com/watch?v=LYka3NHIRf0 • Typically defined on the basis of: – family background – occupation – Income • Culture differ from each other with regard to the: – degree of social mobility between social strata – significance attached to social strata in business Sociology for health professionals IIHS 2011

The extent to which individuals can move out of the social strata into which they are born • Two Major Types – Caste System – Class System Sociology for health professionals IIHS 2011

http://www.youtube.com/watch?v=dSXCjamS_6M • Most rigid form of stratification • Closed system in which social position is determined by the person’s family • Change is usually not possible for entire life • Caste position carries with is a specific occupation Sociology for health professionals IIHS 2011

http://www.youtube.com/watch?v=_Mq0WozfMHU • Less rigid form of social stratification • Open system where social mobility is possible – both upward or downward • Person’s social position by birth can be changed through their achievements or luck • Degree of social mobility varies by society 2011

• When people tend to perceive themselves in terms of their class background which shapes their relationships with members of other classes • Where class consciousness is high, the way individuals from different classes work together may be very prescribed and strained Sociology for health professionals IIHS 2011

Fig: 3.1
Sociology for health professionals IIHS 2011

“System of shared beliefs and rituals concerned with the realm of the sacred”
• Shapes attitudes toward work and entrepreneurship • Relationship between religion, ethics and society is
subtle and complex
• Hazardous to make sweeping generalizations! Sociology for health professionals IIHS 2011

“Set of moral principles or values used to guide and shape behavior” • Can affect the cost of doing business in a country Sociology for health professionals IIHS 2011

Map 3.1
Sociology for health professionals IIHS 2011

• Christianity – “Protestant Work Ethic & the Spirit of Capitalism” • Islam – favors legitimate profit and market-based systems – important to keep one’s word or contractual
obligations
– no payment or receipt of interest (mudarabah,
murabaha)
Sociology for health professionals IIHS 2011

• Hinduism – ascetic, non-material principles inhibit entrepreneurship – caste system plays a role • Buddhism – little emphasis on entrepreneurial behavior • Confucianism – loyalty, reciprocal obligations, and honesty in dealings Sociology for health professionals IIHS 2011

Fig: 3.1
Sociology for health professionals IIHS 2011

• Can be a source of national competitive advantage – provides a pool of skilled and educated workers • Key determinant for location of FDI • Impacts the kind of products/services that are consumed and the related promotional programs • Education can be a source of social classes Sociology for health professionals IIHS 2011

Map 3.3
Sociology for health professionals IIHS 2011

Fig: 3.1
Sociology for health professionals IIHS 2011

“Enables people to communicate with each other and structures the way we perceive the world” Spoken
– verbal cues – language structures our perception of world
Unspoken
– body language – personal space

Sociology for health professionals IIHS 2011

• 70% of all communication • Nonverbal cues: – eyebrows – fingers/thumbs – hand gestures – feet – personal space – body gestures Sociology for health professionals IIHS 2011

• Study on the relationship between culture and the workplace by Geert Hofstede 1967-73 – 40 countries – 100,000 individuals

Four Dimensions of Culture A. Power Distance B. Individualism versus Collectivism C. Uncertainty Avoidance D. Masculinity versus Femininity Sociology for health professionals IIHS 2011

• Dimension focused on how a society dealt with the fact that people are unequal in physical and intellectual capabilities – High Power Cultures • societies that let inequalities (power and wealth) grow over time – Low Power Cultures • societies that tried to play down such inequalities Sociology for health professionals IIHS 2011

• Dimension focused on the relationship between the individual and his/her fellows within a culture – Individualistic Societies • loose ties between individuals • individual achievement & freedom highly valued – Collectivist Societies • tight ties between individuals • tend to be more relationship oriented Sociology for health professionals IIHS 2011

• Dimension measured the extent to which different cultures socialized their members into accepting ambiguous situations and tolerating uncertainty – High Uncertainty Cultures • job security, career patterns, retirement benefits are very important • need for rules and regulations and clear instructions and tight control from superior are important – Low Uncertainty Cultures • readiness to take risks and less resistance to change Sociology for health professionals IIHS 2011

• Dimension focused on the relationship between gender and work roles – Masculine Cultures • sex roles were sharply differentiated and traditional ‘masculine values” were cultural ideals – Feminine Cultures • sex roles were less sharply distinguished and little differentiation was made between gender in the same job Sociology for health professionals IIHS 2011

Sociology for health professionals IIHS 2011

• Assumes one-to-one relationship between culture and the nation-state • His research may have been culturally bound • Survey respondents were from a single industry (computer) and a single company (IBM) • Findings are becoming dated (1967-1973) • Revised his initial research and included a fifth dimension “Confucian dynamism”

• Culture is not a constant; it evolves over time – American values toward the role of women – American college students values about work and careers – Japan moves toward greater individualism in the workplace and is impacted by aging society

• Effects of economic advancement and globalization – Economic progress is accompanied by a shift in values away from: • collectivism towards individualism • “traditional values” towards “secular rational values” • “survival values” towards “self-expression” and “well-being” values

Sociology for health professionals IIHS 2011

• Culture and competitive advantage – Which nations might be competitors – Which nations might be a resource (HR, R &D) – Which nations might be a market (early adopters) – Which nation might be a production site • Culture and business ethics – Many ethical principles are universal, others are
culturally bound
• Cross cultural literacy – Observe and study foreign cultures Sociology for health professionals IIHS 2011

1. Characteristics of Family 2. Family Patterns 3. Forms of Family
Time allocated 03hrs
Sociology for health professionals IIHS 2011

• http://www.youtube.com/watch?v=Lea2sY9 xX4 Sociology for health professionals IIHS 2011

• ‘A people whose marriages and families are weak can have no
solid institutions.’ Michael Novak For Functionalists such as Murdock, the Nuclear Family is a universal feature of human societies the world over. After carrying our case studies into 250 human societies for his anthropological work ‘Social Structure,’ he proposed that this family type is biologically ‘natural.’

1. Definition of Marriage 2. Forms of Marriage - Time allocated 02hrs - Sociology for health professionals IIHS 2011

1. Socialization 2. Development in children 3. Resocialization
Time allocated 04hrs
Sociology for health professionals IIHS 2011

1.
2.
3.
4.
5.
Sexual Differentiation Sex Vs Gender Gender roles over the Life span Social Inequalities between Men and Women Feminist Theories Sociology for health professionals IIHS
Time allocated 06hrs

1.
2.
3.
4.
5.
6.
Civil Inattention Non Verbal Communication Face and culture Social rules and Talk Encounters Impression managemen
Time allocated 04hrs
Sociology for health professionals IIHS 2011

1.
2.
3.
Social Stratification Basic Systems of Stratification Theories of Stratification
Time allocated 03hrs
Sociology for health professionals IIHS 2011

1. Ethnicity 2. Racism 3. Prejudice and Discrimination 4. Stereotypes and Scapegoats
Time allocated 03hrs
Sociology for health professionals IIHS 2011

1. Norms, Conformity 2. Social Control 3. Deviance 4. Crimes Time allocated 04hrs Sociology for health professionals IIHS 2011

• http://www.youtube.com/watch?v=RQ9yOE3 8-mk&feature=related Sociology for health professionals IIHS 2011

1. Development of Literacy and Schooling 2. Origins of Development of Education System 3. Functions of Education 4. Consequences of Education Time allocated 04hrs Sociology for health professionals IIHS 2011

Sociology for health professionals IIHS 2011

• Can be a source of national competitive advantage – provides a pool of skilled and educated workers • Key determinant for location of FDI • Impacts the kind of products/services that are consumed and the related promotional programs • Education can be a source of social classes Sociology for health professionals IIHS 2011

Map 3.3
Sociology for health professionals IIHS 2011

• Parsons argued that the Family acts as a ‘bridge’ between the individual and wider society.
• Within the family we gain ‘ascribed’ status- we are judged in terms of our status as brother, sister, daughter etc… • Education provides Secondary socialisation – now we are judged on ‘achieved’ status. Our conduct is measured against universal values. • Schools must operate on meritocratic principles. For Parsons, Ability + Effort = Merit.

• Schools must instil the value of achievement by rewarding those who succeed, and the value of equality of opportunity, so that all who make the necessary commitments will succeed.
• Hence, the best people will go on to fill the most important positions This represents achieved status in action.
• Can you think of any reservations you might have with Parsons?

1. What is Religion 2. Characteristics of Religion 3. Major Religions of the World
Time allocated 03hrs
Sociology for health professionals IIHS 2011

“System of shared beliefs and rituals concerned with the realm of the sacred”
• Shapes attitudes toward work and entrepreneurship • Relationship between religion, ethics and society is
subtle and complex
• Hazardous to make sweeping generalizations! Sociology for health professionals IIHS 2011

“Set of moral principles or values used to guide and shape behavior” • Can affect the cost of doing business in a country Sociology for health professionals IIHS 2011

Map 3.1
Sociology for health professionals IIHS 2011

1. Statistical measures 2. Agriculture & Industrial revolution 3. The third world, developing world 4. Population Growth, Environment and Poverty
Time allocated 04hrs
Sociology for health professionals IIHS 2011

Table 19-1. Major Perspectives on Health and Illness

– Social epidemiology: study of distribution of disease, impairment, and general health status across a population – Incidence: number of new cases of a specific disorder occurring within a given population during a stated period of time, usually a year – Prevalence: number of cases of a specific disorder that exist at a given time

• Social Epidemiology and Health – Morbidity rates: disease incidence figures presented as rates or number of reports per 100,000 people – Mortality rate: incidence of death in a given population

• Social Class – Studies show people in lower classes have higher rates of mortality and disability • Crowded living conditions • Substandard housing • Poor diet • Stress • Unable to afford quality health care

• Race and Ethnicity – Health profiles of racial and ethnic groups reflect social inequality in U.S.
• Poor economic and environmental conditions manifested in high morbidity and mortality rates • Gender – When compared with men, women live longer

Figure 19-2. Percentage of People without Health Insurance, 2001 Source: Haub 2002:23

• Age – Most older people in U.S. have at least one chronic illness • Older people vulnerable to certain types of mental health problems • Older people use more health services than younger people

• A Historical View – During the 1830s and 1840s, “self-help” was emphasized • Strong criticism of “doctoring” – Eventually, medical profession controlled the market for its services and the various organizations that govern medical practice, financing, and policymaking

• Physicians, Nurses, and Patients – Physicians have position of dominance in dealing with nurses and patients • Alternatives to Traditional Health Care – Holistic medicine • Therapies that consider the person’s physical, mental, emotional, and spiritual characteristics

• The Role of Government – In 1965, government subsidized health care programs • Medicare for the elderly • Medicaid for the poor – Medicare had huge impact on health care system • Some hospitals “dumped” unprofitable Medicare patients until practice was banned in 1987

Figure 19-3. Availability of Physicians by State Source: Bureau of the Census 2004:101

Figure 19-4. Total Health Care Expenditures in the United States, 1970— 2014 (projected) Sources:Center for Medicare and Medicaid Services 2005 (2005—2014 data); Health Care Financing Administration 2001 (1970—1990 data)

• Mental illness – Brain disorder that disrupts a person’s thinking, feeling, and ability to interact with others – People in U.S. traditionally maintained a negative and suspicious view of those with mental disorders

• Theoretical Models of Mental Disorders – Medical Model: Mental illness rooted in biological causes that can be treated through medical intervention – Labeling Theory: Mental illness is not an “illness” since the individual’s problems arise from living in society and not from physical maladies • Devalues mentally ill patients

• Patterns of Care – Historical confinement of the insane or mentally ill to public institutions – Community-based outpatient care most prevalent now • Legislation has made it easier to commit mentally-ill homeless involuntarily

• Financing Health Care Worldwide – The Issue • Industrialized nations face issues related to the accessibility and affordability of health care – The Setting • The U.S. is the only Western industrial democracy that does not treat health care as a basic right

• Financing Health Care Worldwide – Sociological Insights • Conflict theorists suggest health care system resists basic change – Those who receive substantial wealth and power through an existing institution have strong incentive to keep things as they are • Health care system undergoing “corporatization”

• Financing Health Care Worldwide – Policy Initiatives • Major reforms occurring in U.S. without legislative reform – As of 1997, managed care plans enrolled 85% of all workers, up from 52% in 1993 – There are growing concerns about the quality of health care provided by managed care plans

Figure 19-5. Government Expenditures for Health Care, Selected Countries Source: World Bank 2005a:100--102

Sociology for health professionals IIHS 2011