Essay #2 - Sociology of Medicine
candi26oc
medical_sociology_chapter_8__9.pptxChapter 8
Health Care in the United States
Chapter Overview
The Birth of U.S. Health Insurance
The Crisis in Health Care Costs
The Crisis in Health Care Coverage
The 2010 Patient Protection and Affordable Care Act
Why the U.S. Lacks National Health Care
The Prospects for State-Level Reform
History of U.S. Health Insurance: 1930s
Blue Cross/Blue Shield
Designed to protect doctors and hospitals
Fee-for-service insurance
Health Maintenance Organizations (HMOs)
Designed to provide affordable health care
Salaried doctors, monitored for unnecessary care
Emphasis on prevention
The Government Steps In: 1960s
Medicare: for persons over 65 and permanently disabled
Medicaid: primarily for poor persons
Rise of Commercial Insurance
Actuarial risk rating: individual premium based on individual risk
Common in commercial insurance
Community rating: each person charged based on average risk of entire community
The Managed Care Revolution
Managed care – any system that controls costs by monitoring and controlling provider decisions
Response to increasing health care costs
Managed care itself has little impact on health care outcomes.
Significant difference between for-profits and nonprofits
Backlash against managed care
The Crisis in Health Care
U.S. health care costs have risen exponentially, and have risen far higher than anywhere else.
Myths of U.S. Health Care Costs
Myth 1: It’s the malpractice suits.
Myth 2: It’s our aging population.
Myth 3: It’s our advanced technologies.
Myth 4: We receive more and better care than do others.
Public Opinion on Health Care Systems
Source: OECD (2010).
Health Expenses and Inpatient Days in Acute Care Hospitals in 30 Nations
Health Expenses and Life Expectancy in 30 Nations
Understanding Health Care Costs
Administrative costs of fragmented system
Health care providers largely set prices
“Big Pharma” and Rising Costs
New patent regulations entice researchers and increase profits
Manipulation of drug testing and research
“Off-label” prescribing encouraged
Marketing drugs to doctors and consumers
Marketing diseases
The Crisis in Health Care Coverage
The United States is the only industrialized nation that does not guarantee health care to its citizens.
Uninsured Americans
22 percent of population under 65 are uninsured
More than half of this number have lacked insurance for at least 3 years
Low estimate (only includes those without insurance for an entire calendar year)
Figure that follows shows breakdown of this group
Percentage of Americans Under Age 65 Who Lack Health Insurance, 2010
Source: Kaiser Commission on Medicaid and the Uninsured (2010).
Underinsured and Precariously Insured Americans
Underinsured – having insurance but still being unable to pay medical bills
Precariously insured – being liable to lose insurance coverage at any time
25 million are underinsured, many more precariously insured
Others have insurance but can’t get their insurers to pay for care
What happens when people lack insurance, or lack sufficient insurance?
2010 Patient Protection and Affordable Care Act (ACA)
Establishes individual mandate rather than government provision of insurance
Employer mandate to subsidize insurance
Restrictions on insurance companies
Expected to reduce uninsured, but fundamental problems remain
Why the United States Lacks National Health Care
Numerous presidents have offered health care plans
Each proposal has been defeated through stakeholder mobilization
Stakeholders have changed, but battle hasn’t
Prospects for State-Level Reform
ACA gives states some leeway
Hawaii as a model
Strong points?
Weaknesses?
Chapter 9
Health Care Around the Globe
Evaluating Health Care Systems
Universal Coverage
U. S. neither recognizes a right to health care nor guarantees healthcare to all citizens
Portability: Coverage not threatened by work, family, or geographic changes
Geographic Accessibility: rural and urban, rich and poor areas
Evaluating Health Care Systems (con’t)
Comprehensive benefits
Affordability
Financial efficiency
Consumer choice
The Convergence Hypothesis (Mechanic and Rocheport)
Healthcare systems become increasingly similar over time
Causes include globalization, demographic changes, and economic shifts
A Look at Health Care Systems
Germany
Canada
Great Britain
China
Mexico
Democratic Republic of Congo
Germany: Social Insurance
Cities, occupations, and industries banded together to insure residents, workers, or members
These “social insurance” groups are known as sickness funds
Almost all are nonprofit
Premiums based on family income
German Health Care
Ambulatory doctors paid by capitation, hospital doctors salaried
Universal coverage
Hospitals paid by government and sickness funds
Costs lower, health outcomes better than U.S.
Canada: National Health Insurance
Single-payer system: dramatically lowers administrative costs
Primary doctors paid fee-for-service, hospital doctors salaried
Universal coverage
Hospitals paid by government
Costs lower, health outcomes better than U.S.
Great Britain: National Health Service
Single-payer system
Primary doctors paid capitation, hospital doctors salaried
Universal coverage
Hospitals paid by government
Costs lower, health outcomes better than U.S.
Privatization to lower costs
Consider: Health Care Rationing
How is health care rationed in Canada and Great Britain? Are these systems of rationing better, worse, or no different from how we ration care in the United States?
China: Promises and Perils
Model for health care in a poor country… and for how quickly gains can be lost
Special features:
Focus on improving health of masses rather than elites
Focus on prevention
Use of mass campaigns and physician extenders
Integration of traditional and western medicine
China: Good Health at Low Cost
In flux from national health system to entrepreneurial
Primary doctors paid fee-for-service, hospital doctors salaried
Access to care has diminished, especially in rural areas
Hospitals paid (poorly) by government, so forced to sell some services
Costs much lower, health outcomes almost as good as in U.S.
Mexico: Struggling to Provide Equitable Care
Three part system
Private health care
Government insurance for salaried workers (Social Security)
Government insurance for other citizens (Seguro Popular)
Almost universal coverage, but less access in rural and poor areas, and under Seguro Popular
Health Care In Mexico
Mexico is working hard to improve access to medical care across the country.
Mexican Health Care
Doctors are primarily salaried
Government pays for most primary care
Universal coverage, but with unequal services
Hospitals paid by government
Costs of care much lower than in U.S.
Life expectancy almost equals U.S., but significant infant mortality and problems in poor rural areas
Democratic Republic of Congo: Collapsed Health Care
Many doctors have fled, hospitals damaged or destroyed, reduced access to medications
Patients expected to pay for basic supplies
Doctors have not been paid by government, so they charge fees to patients
70% of citizens lack access to modern care
Very poor health outcomes
Consider: Health Care Systems
Which nation’s health care system would you prefer? Why?
