Medical Sociology Chapter 16 Book Notes Introduction Medical care and health services are acts of political philosophy In Europe, the provision of health services became an important component of government policy in the last half of the nineteenth century. Entitlements based on citizenship are aimed at providing people with welfare and health benefits, regardless of their class position. The social welfare systems of Europe are more advanced in this direction than in the United States.. It wasn’t until 1965 and the passage of Medicare and Medicaid that the United States provided health care benefits for some Americans – the aged and the poor. Americans have historically been less committed to government welfare programs and more in favor of private enterprise in dealing with economic and social problems. Americans who do receive welfare tend to be stigmatized and have low social status. In Europe, providing welfare and social security for the general population, not just the poor and elderly, is a normal feature of the state’s role. The United States have a higher level of private financing and spends more on health than any other county in the world. The American health care delivery system is the most expensive in the world Socialized Medicine: Canada, Great Britain, and Sweden Socialized medicine refers to a system of health care delivery in which health care is provided in the form of a state – supported consumer service There are five things common in all systems of socialized medicine: The government directly controls the financing and organization of health service in a capitalist economy The government directly pays providers The government owns most of the facilities (Canada is an exception) The government guarantees equal access to the general population The government allows some private care for patients willing to be responsible for their own expenses Canada Americans like the Canadian health care system because it is the system most often discussed as a future model for the United States Canada does not have a single health care delivery system Canada essentially has a private system of health care delivery paid for almost entirely by public money They publicly financed health care system is supported by taxes and premiums collected by the federal and provincial/territorial governments The major problem facing Canada with respect to health care delivery is its rising costs Canadian health care is essentially free at the point of service in that patients never see a bill, it is not free for the taxpayer. Virtually all Canadian doctors participate in provincial health plans and have no other major source of payment for most medical procedures Major reasons why Canadians are satisfied with their health care delivery system are its quality and lower cost. The essential difference between the United States and Canada in health spending is that the Canadian system combines universal comprehensive coverage for the population combined with cost controls The largest drawback to the Canadian system is long waits for some medical procedures The most significant recent change in Canada’s public health care delivery system occurred when the Supreme court ruled in 2005 that Quebec’s ban on private health insurance was unconstitutional Great Britain Britain had inaugurated a national health insurance program between 1911 and 1943, but it provided limited benefits and covered only manual workers The National Health Service (NHS)takes responsibility for the country’s health care The NHS is now Britain’s largest employer with over one million employees in 2005 Germany was the first country to enact national health insurance Britain established the first health care system in any Western society to offer free medical care to the entire population The NHS Act of 1948 reorganized British health care into three branches: Executive Councils Branch Local Health Authority Services Branch Hospital and Specialist Branch The first line of medical care in Great Britain remained the general practitioner (GP) Specialists (called “consultants” in the British system) are the only physicians who treat patients in hospitals and are paid a salary by the government The advantage of being a private patient is less time spent in waiting rooms, obtaining appointments, and more privacy Conflict and problems concerning health care delivery in Britain are largely between health care providers and the government The central problem faced by the British NHS is its lack of financial resources The most important measure that Britain did when responding to patients needs was the enactment of the NHS and Community Care Act of 1990 This gave more power and responsibility down to local health districts and hospitals. Sweden The Swedish National Health Service is financed through taxation Taxes in Sweden have been the highest in the world Sweden, along with the other Nordic countries, has the lowest proportion of poor people in Europe Swedes is considered one of the worlds’ healthiest populations overall The Swedish National Health Services is the responsibility of the Ministry of health and Social Affairs Only particularly important health issues are decided by the ministry Most decisions pertaining to health policy are made by the National Board of Health and Welfare A major characteristic of the NHS in Sweden is that general hospitals are owned by county and municipal governments It would be somewhat misleading to consider the funding of Sweden’s health care delivery system as an example of national health insurance because most of the revenues come from county councils. Decentralized National Health Programs: Japan, Germany, and Mexico Decentralized national health programs government control and management of health care delivery is more indirect Japan Japan has a national health insurance plan but its benefits are relatively low by Western standards About one-third of Japanese doctors are in private practice and are paid on a fee-for-service basis All the rest are full time, salaried employees of hospitals The government fee schedule is the primary mechanism for cost containment The Japanese national health insurance plan does not cover all Japanese The entire Japanese population is covered by some type of health insurance plan, and the average Japanese has a greater measure of security concerning health care than the average American The excellent health of the Japanese population and relatively low medical costs are more a reflection of lifestyles and economic conditions than the health care delivery system. Overcrowding has become common in most Japanese hospitals The proportion of people living to old age is increasing in Japanese society faster than in any other country in the world Germany The structure of health care delivery in the Federal Republick of Germany has not changed significantly since 1883 and the reforms instituted by Bismark’s administration in imperial Germany Germanys largest public health insurance organization is the Allgemeine Ortskrankenksassen (AOK) The AOK originally insured only blue-collar workers but broadened its membership base to include the general population Bismark’s welfare measures in the late nineteenth century were both a response to democratization and an attempt to suppress it Public health insurance plans are coordinated by the National Federation of Health Insurance The German government does not play a major role in the financing of health services The government’s primary function is one of administration Most German doctors practice medicine in private offices or clinics on a solo basis The 2007 Strengthening of Competition in Legal Health Insurance Law made having health insurance mandatory for all Germans and extended insurance options Germany has the lowest birthrate in Europe Mexico Mexico has a decentralized national health system covering most of the general population through a variety of programs that fall into one of three broad categories First, there are the public social security organizations that provide both health insurance and old-age benefits for specific groups of private and government employees. Second is the health care provided through the government’s Secretariat of Health and Welfare or Secretaria de Salubridad y Asistencia (SSA) It is the primary source of care for the majority of persons not covered by a social security organization – especially the poor Third, there is the private health care system The largest health plan in Mexico covers workers in the private sector and is administered by the Mexican Social Insurance Institute or Instituto Mexicano de Seguro Social (IMSS) The Secretariat of Health and Welfare (SSA) is responsible for Mexico’s overall health policy and provides health care directly to the urban poor through its own hospitals and clinics In theory, Mexico has a national health system; yet in reality, not everyone has access to it Mexico has a serious problem of maldistribution of services The overall health of the Mexican population is improving Significant problems in the Mexican Health delivery system remains: Most importantly, a significant segment of the population in rural areas lacks access to modern health services Health care for the urban poor seems to be Mexico’s highest priority at this point in the development of its health care delivery system Socialist Medicine: Alterations in Russia and China The socialist model of health care delivery features central government ownership of all facilities, employment of workers, and free universal care paid out of the national budget. Russia The Russian Federation passed legislation establishing a system of health insurance, consisting of compulsory and voluntary plans The compulsory social health insurance plan is financed by central government subsidies for pensioners and the unemployed Health insurance is mandatory for all employees Prior to the collapse of communism, the health care delivery systems in the former Soviet Union and Eastern Europe were philosophically guided by Marxist-Leninism programs for reshaping capitalism into socialism The ultimate goal was the establishment of a classless society However, Marxist-Leninist ideology pertaining to health was never developed in depth Russia has more doctors per capita than any major nation and most are women However, men hold the majority of academic positions in medicine and medical posts in the Ministry of Health Serious problems remain as the Russian Federation’s new insurance-based structure has come into existence, including low financing and declining life expectancy Russian demographers credit Russia’s brief rise in male longevity to Gorbachev’s anti-alcohol campaign in the mid-1980s The decline of life expectancy in Russia and elsewhere in the old Soviet bloc countries was one of the most significant developments in world health in the late twentieth century Nowhere else has health worsened so seriously and for so long in Peacetime among industrialized nations than in Russia. The rise in mortality was greatest in Russia and came very late to East Germany, but virtually all former soviet bloc countries were affected to varying degrees The death largely stemmed from higher rates of heart disease and to a lesser extent from alcohols abuse and alcohol related accidents The Soviet system lacked the flexibility to adjust to chronic health problems that could not be handled by the mass measures successful in controlling infectious ailments China The Chinese health care systems is financed largely by fees paid by patients, employers, and health insurance companies Improvement in health became one of the major goals of the Communist Chinese government after it came to power following the civil war with Nationalist forces China is the only country that consistently treats traditional and scientific medicine equally Two measures were important during the Communist improvement of health: First traditional Chinese medicine was revived Second the bare-foot doctors movement begun Through this movement the majority of the population was able to have at least some routine access to basic health care A health reform plan has been introduced to provide universal insurance coverage with comprehensive benefits in the cities and later in the country side The central government provides less than 1 percent of all health expenditures. The responsibility for health services was delegated to provincial and county governments Heart disease and cancer are the major health problems in most of China The Chinese government is faced with an important dilemma: if smoking declines, its greatest single source of income will be reduced.