Health Care
Chapter 15
The Components of the Health-care System
The health-care system embraces the professional services, organizations, training
academies, and technological resources committed to the treatment, management,
and prevention of disease.
1.
Physicians
– Although physicians constitute only about 10 percent of health-care workers in
the United States, they establish the working framework for everyone else.
2.
Nurses
– Possibly as a result of this initial orientation, nursing experiences frequent
controversy regarding education, professional roles, and compensation.
3.
Hospitals
– Hospitals provide specialized medical services to a variety of inpatients and
outpatients.
4.
Patients
– People usually enter the health-care system only because others defined
them as ill or injured.
Sociology and the Study of Medicine and Health
• Medicine is a society’s standard way of dealing with illness
and injury.
– Profession, a bureaucracy, and a big business
• Study how medicine is influenced by ideals of professional
self-regulation, the bureaucratic structure, and the profit
motive.
• How illness and health are related to cultural beliefs,
lifestyle, and social class.
– “Sickness” and “illness” are social labels that can stigmatize people.
Theoretical Perspectives and the Health Care
System: Symbolic Interactionism
• Health is affected by Cultural Beliefs.
– Ex. Hearing voices and seeing visions
• “Sickness” and “Health”: We are provided with guidelines to
determine whether we are healthy or sick.
• Sociologists analyze the effects that people’s ideas of health and
illness have on their lives and even how people determine that
they are sick.
– Health is a human condition measured by four components:
• Physical, mental, and social, and spiritual.
• Health is state of complete physical, mental, and social wellbeing
Theoretical Perspectives and the Health Care System:
Functionalism
Talcott Parsons first proposed a view of sickness that was
distinctively sociological rather than merely medical.
 Health problems are a threat to society.

Society must set up ways to control sickness
 If people are sick and cannot fulfill their roles, society
will not function smoothly.

Society must develop a system of medical care andmake
rules to keep too many people from “being sick”
The Sick Role
A social role that you are forced to play when you are not well.
1.The sick are permitted to withdraw temporarily from other
roles or at least reduce their involvement in them
2.It is assumed that the sick cannot simply will the sickness
away.
3. The sick are expected to define their condition as undesirable.
4.The sick are expected to seek and to follow the advice of
competent health-care providers.
Theoretical Perspectives and the Health Care
System: Conflict Theory
• The same political and economic forces that determine the
nature of capitalism determine the nature of the medical
institution.
– Primary focus is the struggle over scarce resources.
• The concerns of conflict theorists are issues of inequality
within the health care system.
• Health comes with wealth
– Globally
Conflict Perspective
High-Income Nations
• Infant mortality rate – number of babies who die in
their first year of life for each thousand births
–Low – less than 10 deaths for every 1,000
births
• Life expectancy at birth – number of years people in a
society can expect to live
–Longer - on average into their seventies or
early eighties
Conflict Perspective
High-Income Nations
• Chronic diseases – an illness that has a long-term
development
–More prevalent in high-income countries
–In U.S., a high fat diet and little physical
work result in 2/3 of adults as overweight
Conflict Perspective
Low-Income Nations
• Poverty and poor health
– Poverty and malnutrition
– Poverty and lack of safe drinking water
– Poverty and poor sanitation
• Acute disease-illness that strikes suddenly
– Infectious diseases
Focus on Theoretical Perspectives: Health Care
in the United States
Global Health Care: Health Care in the
Developed World
• Of the highly developed countries of the world, the
United States is the only one without national
health insurance for all its citizens.
• The United States has the dubious distinction of
having the most expensive health care and one of
the worst performing health-care systems in the
developing world.
An explosion in medical costs
 Medical costs continue to soar
 Americans will spend over $4 trillion on health care in 2018, up from
approximately $200 billion in 1960.
• Reasons for the explosion in costs
 Increase in the standard of living, people live longer
 Development of expensive technology
 Seek out health care after illness arises, rather than
investing time and energy in preventive care
 Corporatization of Medicine – Accepted view that medical
care is a commodity that should be sold for profit
Hospitals
Decline in not for profit
Proliferation of profit based corporate care
Global Health Care: Health Care in the
Developed World
• Americans spend over $7,000 per person for health care
annually.
• U.S. health-care expenditures as a share of GDP are the
highest in the world (16 percent)
• Despite its high price tag, the United States finishes last
on access to medical care, organizational efficiency,
equity of treatment, and health results, next to last on
quality care.
• Lack of insurance and cost are the biggest barriers to
health-care access for Americans.
Global Health Care: Health Care in the
Developed World
• The United States ranks at the bottom of the seven countries on
efficiency of delivery, while
• the United Kingdom and Australia rank first and second,
respectively.
– The United States performs poorly in terms of national healthcare expenditures, administrative costs, information technology,
re-admittance to hospital, and duplicative medical testing.
• The United States ranks last on almost all indicators of equal
access to treatment.
• The United States ranks dead last on each of the measures of
health outcomes.
Per Capita Health Expenditures
Health Care Expenditures as a
Share of GDP
Progress on Key Health Indicators
Socialist Systems
The People’s Republic of China
• Government administers health care
• Barefoot doctors
• Modern scientific medicine
• Traditional forms of medicine
– Acupuncture
– Medicinal herbs
Capitalist Systems
Sweden
• Government run health care system
• Funded through taxes
• Physicians are government employees
• Health care a basic right
• Form of socialized medicine
Capitalist Systems
Great Britain
• Socialized system of health care since 1948
• Dual system
• National Health Service – funded by tax dollars
and covers all British citizens
• Private health care for those that can pay
Capitalist Systems
Canada
• Not state controlled but managed system of
health care
Japan
• Physicians and hospitals operate privately in a
market system
• Government programs and private insurance
pay the majority of health care costs
Health Care in the United States:
A system in Crisis?
U.S. Health Care System
• Direct-fee system – medical care system in
which patients or their insurers pay directly
for the services of physicians and hospitals
• Obama wants to overhaul health care system
• Issues are access and soaring costs
• Medicine for profit: a two-tier system of medical care
 Medicine for profit is also known as a fee-for-service
system.
 Two-tier system of medical care: one for those who can
afford insurance, and another for those who cannot
• The Haves
Can afford individually, or through employer provided
health plans, insurance adequate to meet demands of
system
• The Have Nots
Cannot either individually, or through employment,
afford adequate insurance
The Cost Problem
Health care costs were 2.2 trillion in 2007
• Six reasons behind the soaring cost:
1. Spread of private insurance
2. Specialization of doctors
3. More high technology
4. Lack of preventive care
5. Aging population
6. More lawsuits
7. *Corporate Greed
Health Care Reform in the United
States
• A large majority of Americans believe that the
U.S. health-care system requires reform.
• Moreover, almost three-fourths of Americans
approve of a government-backed healthcare
program for children, and almost 60 percent
prefer a universal health-care system.
Why is there a need for health-care
reform?
1. Too expensive
2. Limited access to medical care
3. Quality of life
4. Aging population
Percentage of Persons Not Covered by Health
Insurance in the United States by Age: 2009
What are the health-care reform
options?
There are a few basic options to delivering health-care services:
1. Modified competitiveness bases its approach on market
principles such as consumer cost sharing.
2. Managed competition is combination of free market forces
and government regulation.
3. Single payer approach is a model where the government
finances medical services.
4. Play or pay mechanism where employers either offer
employees health coverage (play) or pay into a public fund
for covering the uninsured.
The Health Reform Road Taken
• Obama 2010 Health Reform
– requires most citizens and legal residents to purchase
health insurance
– penalizes employers with more than fifty employees
who do not offer some form of health coverage
– extends coverage to some 32 million uninsured
people through Medicaid, particularly providing health
coverage for all uninsured children
– includes subsidies for purchasing health insurance
provided by the government to lower-income families
– establishes health-insurance exchanges designed to
promote more competitive insurance coverage rates