Sociology - Health and Medicine - Quick Guides

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Study GuideSociology–Health and Medicine1. Medical Establishment and Professions1.1 How Health Care Looked in the PastOver the last 150 years, health care has changed in major ways. Before the early 1900s, people whowere sick did not relyonly on doctors. Instead, they could seek help from barbers, midwives,druggists, herbal healers, or even ministers. At that time, there were no national standards for medicaleducation and no official licensing system. Anyone could claim to be a doctor.Becoming a physician was also very informal. Most people learned the job through an apprenticeship,meaning they trained under someone who already called themselves a doctor. There were noconsistent rules about how long training should last or what students needed to learn.1.2 The Rise of the American Medical Association (AMA)In 1847, the American Medical Association (AMA) was created. Its goal was to regulate the medicalprofession and promote medicine based on science. At first, the AMA had limited power. However, itsinfluence increased as scientific discoveries showed thatbacteria and viruses cause disease and asvaccines became more effective.Over time, the AMA worked to set strict standards for doctors. It approved only certain medicalschools and certified only physicians who completed those programs. Doctors who used alternativetreatments, such as chiropractic care or herbal medicine, or who attended unapproved schools wereoften expelled from the organization. The AMA openly opposed alternative approaches to health care.1.3 The Flexner Report: A Turning PointA major shift in medical education occurred in 1908 with the release of theFlexner Report. Thisstudy was funded by the Carnegie Foundation for the Advancement of Teaching and led byAbrahamFlexner. Flexner examined 160 medical schools and concluded that only 82 met acceptablestandards.

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Study GuideHe found serious problems in many schools, including poor equipment, missing libraries, and trainingprograms that lasted only two years. Some schools were essentially “diploma mills,” where studentscould buy a medical degree without proper training. In other cases, doctors earned extra income bytaking on too many apprentices to teach effectively.Flexner recommended that the best medical schools—those with strong admission requirements andhigh-quality training—receive financial support. As a result, these schools remained open, while manyothers were shut down under pressure from the AMA.1.4 Professionalizing MedicineThe Flexner Report helped transform medicine into a true profession. Doctors were now expected tocomplete rigorous education, rely on scientific theory, regulate their own profession, and serve thepublic. Physicians also gained authority over patients and other health workers.This report was important because it clearly defined acceptable standards for medical education forthe first time. It exposed major weaknesses and inconsistencies in how doctors were trained andhelped eliminate unsafe or poorly run medical schools.1.5 Criticism of the AMA and Medical HierarchySupporters of the AMA argue that it improved medical care and protected the public. However, criticsclaim the AMA created a monopoly over medicine by excluding anyone who did not follow its narrowdefinition of acceptable practice.One major criticism is that nearly all medical schools that trained Black students and one school thattrained women were closed after the Flexner Report. Critics argue that this made the medicalprofession largely white and male. Doctors were often seen as all-knowing authority figures withpower over nurses, midwives, and patients.Doctors’ use of complex and technical language also reinforced this authority. Many patients feltconfused or intimidated and were less likely to ask questions or share important information.Research shows that when patients remain passive, doctors may miss key details that could changea diagnosis. According to critics, this strict hierarchy—where doctors are at the top—can negativelyaffect patient care.

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Study Guide1.6 The Return of Alternative MedicineBecause of dissatisfaction with traditional medicine, millions of Americans have turned back toalternative forms of health care. Practices such as naturopathy, herbal medicine, acupuncture, andchiropractic care have become more popular in recent years.These alternative health professions have also become more organized. Many now regulatethemselves and set professional standards. Unlike traditional medicine, most alternative practitionersaim to work in partnership with patients rather than exert authority over them.1.7 Moving Toward Patient Choice and CollaborationChiropractors, who generally receive more training than many other alternative practitioners, havegained increased recognition from the AMA. Some traditional doctors now work alongside alternativehealth professionals to treat patients. Others still strongly oppose these approaches.Overall, the trend in health care today is toward greater patient involvement. People want morecontrol, clearer information, and more choices about their treatment. This shift reflects a growingdesire for collaboration rather than authority in medical care.2. Health Care: Costs and Inequality2.1 Why Is Health Care So Expensive?Most people agree that modern health care costs a lot. The big question iswhy. Several importantfactors work together to drive these rising costs. Understanding them helps explain why medical carecan feel out of reach for many people.2.2 The HighCost of Medical TechnologyOne of the biggest reasons health care is expensive is constantly advancing medical technology. Newmachines, surgical tools, and treatment methods are often very costly. These technologies alsorequire trained specialists to operate them or additional education for doctors who already work in thefield.

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Study GuidePatients are more informed than ever. With easy access to medical information online, many peopleexpect the newest technology to be used in their care. Doctors and researchers also want to use thelatest tools to explore every possible treatment option. All of this increases demand—and cost.2.3 Physician Salaries and the Growth of SpecializationAnother major contributor to rising health care costs is the cost of physician services. As medicaltechnology advances, the number of medical specialties continues to grow. Specialists usually chargemore than general practitioners, family doctors, or internal medicine doctors.For example, surgeons, radiologists, and endocrinologists can earn up to$80,000 more per yearthan general practitioners. Cardiologists, gynecologists, and anesthesiologists earn about$30,000more per year. Some specialists, such as pathologists, oncologists, and pediatricians, actually earnless than general practitioners.Even with these differences, physicians as a group earn very high incomes. They consistently fallwithin thetop 1 percentof earners and typically earn more than the rate of inflation.2.4 The Rising Cost of Malpractice InsuranceMalpractice insurance is another factor driving up health care costs. Between the 1980s and 1990s,the cost of malpractice insurance doubled or even tripled, depending on the specialty. Specialistsusually pay higher insurance rates than general doctors, and these costs are often passed on topatients.2.5 Expensive Prescription DrugsNewer prescription drugs also play a major role in rising health care costs. This is especially true foradvanced antibiotics and treatments for AIDS. Some medications can costover $100 for a singledose.Because of these high prices, the cost of medicine has become a serious social and public policyissue. Many people must choose between paying for medication and covering basic needs like foodor housing. This problem is especially common among older adults who do not have prescription drugcoverage.

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Study Guide2.6 The Bigger PictureTogether, expensive technology, high physician salaries, malpractice insurance, and costlymedications make modern health care increasingly unaffordable. These rising costs deepeninequality, leaving many people struggling to access the care they need.3. Managed Care as a Means of Cost Control3.1 Why Managed Care DevelopedAs health-care costs continue to rise, insurance companies have looked for ways to control spending.For many years, health care followed afee-for-servicemodel. In this system, doctors, hospitals, andlaboratories charged a fixed fee for each service they provided.Patients either paid these fees themselves or shared the cost with a private insurance company.Typically, the patient and their employer also split the cost of insurance premiums. However, thesetraditional plans often did not fully cover serious illnesses. When they did, insurance companiesusually responded by raising premiums for both the individual and the employer.3.2 Traditional Insurance CoverageUntil fairly recently, most insurance plans focused on covering serious illness, not routine care. Forexample, Blue Cross once offered separate plans—one for doctor visits andanother for hospital care.Regular checkups, preventive screenings, and minor illnesses were usually paid for by patients out ofpocket.Insurance coverage typically began only after a disease was diagnosed or when hospitalization wasrequired. Some highly generous plans—often called “gold-standard” plans, such as those negotiatedby auto and steel workers—covered almost everything.Most insured patients had partial coverage, usually about80 percent paid by insurance and 20percent by the patient, up to a certain limit. However, this system discouraged preventive care.Many people skipped regular checkups or screenings because they had to pay the full cost. Forexample, if a woman did not already have a lump, insurance often would not pay for a mammogram,making the test too expensive for many patients.

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Study Guide3.3 A Shift Toward WellnessHealth Maintenance Organizations (HMOs) were created to focus onwellness rather than disease.The idea was simple: regular checkups and early treatment could save both money and lives.Treating illness early is usually cheaper and leads to better outcomes.Supporters believed that covering preventive care would reduce long-term costs. Critics, however,argue that when insurance covers both wellness and illness, patients may visit doctors for minorproblems they would otherwise handle on their own—raising costs instead of lowering them.At the time, most hospitals were nonprofit or not-for-profit. While they did earn money, profits wererequired to be reinvested into new programs, equipment, or expanded facilities rather than distributedto shareholders.3.4 The Rise of Managed Care OrganizationsManaged care organizations developed in response to these challenges. Originally nonprofit, theseorganizations aimed to lower costs while expanding coverage. Managed care systems consist ofnetworks of doctors, specialists, and often hospitals that work together to provide care for afixedmonthly fee.These systems tightly control patient access to medical services. Patients must use approveddoctors, specialists, laboratories, and hospitals. In many managed care systems, physicians are paidasalaryrather than being paid per service. Clinics receive the same amount of money no matter howoften patients visit.Because payment is not tied to the number of services provided, the system encourages keepingcosts low. Critics argue that this can lead to situations where non-medical administrators overruledoctors’ medical decisions in order to save money.3.5 Problems and Public DissatisfactionAlthough the number of HMOs grew rapidly, many experts now predict their decline due towidespread dissatisfaction and concerns about patient care. HMOs are only one type of managedcare; other models includePreferred Provider Organizations (PPOs).While many managed care systems began as nonprofits, most are nowfor-profit, and many hospitalshave also become for-profit. This has introduced a strong profit motive into health care—not just costcontrol. Patients often distrust systems where financial incentives may influence medical decisions.

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