Lecture Outline: Health and Health Care Problems
Key Overarching issue – 2 views of Healthcare
HC as Commodity to buy/sell (for Profit) Vs. HC as Human Right (Russell rdg. 43 in C&V, Mooney et al. Ch 2)
“Health Care Industrial Complex” – 5 parts / 5 different social actors. (Mooney et al. ch.2)
Related to this:, role of Hospitals (Brill web rdg.), pharmaceutical industry (Brill web rdg.), HC products manufacturers (Brill web rdg.), Insurance industry (Swartz rdg. 41 in C&V, Mooney et al. ch.2, Russel rdg. 43 in C&V), & Dr’s. (Gawande web rdg., Brill web rdg.),
Political power of this complex, Outspend other industries in lobbying govt,. for favorable policies (Brill web rdg.)
Cost of US HC system, HC Access / Coverage, & Health Status of US population (in International Rankings) US HC system is Unique Compared to all other industrialized nation’s HC systems… How is US HC system set up compared to that in all other industrialized, wealthy nations 3 models of Health Insurance in wealthy countries (Russell rdg 43 in Ch & Vig.) Govt. Run , Social Insurance, Market-driven Private sector (know or be able to define each type) & estimated 18,000 – 45,000 US deaths per year due to lack of HC coverage…. (See Mooney et al. ch.2; Russell rdg. 43 in C&V;) Health Insurance requirement in Affordable Care Act / Obamacare health insurance? (Mooney et al. Ch. 2)
Scenes from DVD “Sicko”: -- Examples of US Health Ins. Company / HMO denial of coverage (like in Brill web rdg.) Compared to Canadian and British HC systems, universal access, low-no cost to patients (though higher taxes) (as noted in Russell rdg. 43 in C&V)
This shows issue of HC as Commodity for Profit Vs. HC as Human Right (Dougherty rdg. 42 C&V)
It also shows some of hardships of lack of HC insurance coverage (Swartz, rdg. 41 in C&V, Brill web rdg.)
& Medical Bills as leading cause of personal bankruptcy – (Mooney et al. Ch. 2, Gawande web rdg., Brill web rdg.)
2 Main US govt. healthcare coverage programs ---Medicare, Medicaid (defined as to who they each cover) (Mooney et al. ch.2)
Why is the US healthcare system so expensive compared to other countries?
Prices are higher… why? 2 of 5 most profitable industries are medical (pharmaceuticals and medical devices), and no govt. regulation of prices, unlike other countries. (lecture on info ; & see also Brill web rdg.). Lack of Govt. regulation of Drug prices specifically (Brill web rdg.)
“Health Care Industrial Complex” – 5 parts / 5 different social actors. (Mooney et al. ch.2), noted above….
Non-Profit Hospitals very profitable, & where $ go…Very aggressive in billing and collecting. Emphasis on financial side as much or more as on health care side. (Brill web rdg.)
“Chargemaster” role in hospital pricing, & need to “negotiate” bills & difficulties for individuals in doing this (Brill web drg.)
Role of Drs. (Gawande web rdg.)
Overutilization / over-prescribing of procedures, pay by quantity not quality, Key role of Dr. collaboration to lessen problems,
Relationship of HC Quality to HC Spending, comparing communities on this…
Battle for the “soul of medical profession” (profit vs. healing [Also, $100 BN /year in Medicare fraud]
Pharmaceutical / Drug Industry (Brill web rdg. & Lecture)
– Spending on Research Vs. Spending on Promotion & ads, &drastic price mark-ups by drug companies and hospitals.
Increasing Obesity crisis & growth of Diabetes, role of Obesogens as well as diet and lifestyle (healthy food more costly); HC costs of obesity and Diabetes. (Ungar et al web rdg). Unhealthy food cheaper and more accessible than healthy food. [Illustrates role of social factors more than just individual decisions about diet and exercise. (Social Structure effect) (Cho et al. web rdg).
Globestiy Globalization and spread of obesity to developing nations (Mooney et al. Ch 2).
ALSO KNOW: (not covered, or not enough, in lecture)
Healthcare and Health inequalities , how much and why exist -- Race and Ethnic, Class / Socio-Economic Status, Gender (Mooney et al., Ch 2)
Theories of Health Care -- Functionalist (functions & dysfunctions of HC, etc.), Symbolic Interactionist (meanings of various labels and interactions re; HC, definitions and labels & stigmas of mental Illness, role of medicalization), Conflict Theory (inequalities & health and HC, HC Industrial Complex [covered a lot in lecture].
Various types of inequalities on access to health insurance (who is most likely to be uninsured, etc.?) (Swartz rdg.41 in C&V and Brill web rdg.)
What are key provisions of Affordable Care Act / Obamacare / Health Care Reform—esp. re: health insurance? (Mooney et al., Ch 2)
Chemicals and breast cancer and diabetes and heart disease. Prevention vs. cure. (Cho et al. web rdg).
See also HC Discussion Questions for additional key issues, but most of them were covered in lecture & Group, Disc.…