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Sociology - Health and Medicine

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    Study Guide Sociology – Health and Medicine 1. Medical Establishment and Professions 1.1 How Health Care Looked in the Past Over the last 150 years, health care has changed in major ways. Before the early 1900s, people who were sick did not rely only 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 medical education 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 no consistent rules about how long training should last or what studen ts 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 medical profession and promote medicine based on science. At first, the AMA had limited power. However, its influence increased as scientific discoveries showed that bacteria and viruses cause disease and as vaccines became more effective. Over time, the AMA worked to set strict standards for doctors. It approved only certain medical schools and certified only physicians who completed those programs. Doctors who used alternative treatments, such as chiropractic care or herbal medicine, or wh o attended unapproved schools were often expelled from the organization. The AMA openly opposed alternative approaches to health care. 1.3 The Flexner Report: A Turning Point A major shift in medical education occurred in 1908 with the release of the Flexner Report . This study was funded by the Carnegie Foundation for the Advancement of Teaching and led by Abraham Flexner. Flexner examined 160 medical schools and concluded that only 82 met acceptable standards.

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

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    Study Guide 1.6 The Return of Alternative Medicine Because of dissatisfaction with traditional medicine, millions of Americans have turned back to alternative forms of health care. Practices such as naturopathy, herbal medicine, acupuncture, and chiropractic care have become more popular in recent years. These alternative health professions have also become more organized. Many now regulate themselves and set professional standards. Unlike traditional medicine, most alternative practitioners aim to work in partnership with patients rather than exert author ity over them. 1.7 Moving Toward Patient Choice and Collaboration Chiropractors, who generally receive more training than many other alternative practitioners, have gained increased recognition from the AMA. Some traditional doctors now work alongside alternative health professionals to treat patients. Others still stron gly oppose these approaches. Overall, the trend in health care today is toward greater patient involvement. People want more control, clearer information, and more choices about their treatment. This shift reflects a growing desire for collaboration rather than authority in medical ca re. 2. Health Care: Costs and Inequality 2.1 Why Is Health Care So Expensive? Most people agree that modern health care costs a lot. The big question is why . Several important factors work together to drive these rising costs. Understanding them helps explain why medical care can feel out of reach for many people. 2.2 The High Cost of Medical Technology One of the biggest reasons health care is expensive is constantly advancing medical technology. New machines, surgical tools, and treatment methods are often very costly. These technologies also require trained specialists to operate them or additional edu cation for doctors who already work in the field.

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    Study Guide Patients are more informed than ever. With easy access to medical information online, many people expect the newest technology to be used in their care. Doctors and researchers also want to use the latest tools to explore every possible treatment option. A ll of this increases demand — and cost. 2.3 Physician Salaries and the Growth of Specialization Another major contributor to rising health care costs is the cost of physician services. As medical technology advances, the number of medical specialties continues to grow. Specialists usually charge more than general practitioners, family doctors, or int ernal medicine doctors. For example, surgeons, radiologists, and endocrinologists can earn up to $80,000 more per year than general practitioners. Cardiologists, gynecologists, and anesthesiologists earn about $30,000 more per year . Some specialists, such as pathologists, oncologists, and pediatricians, actually earn less than general practitioners. Even with these differences, physicians as a group earn very high incomes. They consistently fall within the top 1 percent of earners and typically earn more than the rate of inflation. 2.4 The Rising Cost of Malpractice Insurance Malpractice 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. Specialists usually pay higher insurance rates than general doctors, a nd these costs are often passed on to patients. 2.5 Expensive Prescription Drugs Newer prescription drugs also play a major role in rising health care costs. This is especially true for advanced antibiotics and treatments for AIDS. Some medications can cost over $100 for a single dose . Because of these high prices, the cost of medicine has become a serious social and public policy issue. Many people must choose between paying for medication and covering basic needs like food or housing. This problem is especially common among older adult s who do not have prescription drug coverage.

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    Study Guide 2.6 The Bigger Picture Together, expensive technology, high physician salaries, malpractice insurance, and costly medications make modern health care increasingly unaffordable. These rising costs deepen inequality, leaving many people struggling to access the care they need. 3. Managed Care as a Means of Cost Control 3.1 Why Managed Care Developed As health - care costs continue to rise, insurance companies have looked for ways to control spending. For many years, health care followed a fee - for - service model. In this system, doctors, hospitals, and laboratories 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, these traditional plans often did not fully cover serious illnesse s. When they did, insurance companies usually responded by raising premiums for both the individual and the employer. 3.2 Traditional Insurance Coverage Until fairly recently, most insurance plans focused on covering serious illness, not routine care. For example, Blue Cross once offered separate plans — one for doctor visits and another for hospital care. Regular checkups, preventive screenings, and minor illnesses were usually paid for by patients out of pocket. Insurance coverage typically began only after a disease was diagnosed or when hospitalization was required. Some highly generous plans — often called “gold - standard” plans, such as those negotiated by auto and steel workers — covered almost everything. Most insured patients had partial coverage, usually about 80 percent paid by insurance and 20 percent 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. For example, if a woman did not already have a lump, insurance often would not pay for a ma mmogram, making the test too expensive for many patients.

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    Study Guide 3.3 A Shift Toward Wellness Health Maintenance Organizations (HMOs) were created to focus on wellness 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 minor problems they would otherwise handle on their own — raising cos ts instead of lowering them. At the time, most hospitals were nonprofit or not - for - profit. While they did earn money, profits were required to be reinvested into new programs, equipment, or expanded facilities rather than distributed to shareholders. 3.4 The Rise of Managed Care Organizations Managed care organizations developed in response to these challenges. Originally nonprofit, these organizations aimed to lower costs while expanding coverage. Managed care systems consist of networks of doctors, specialists, and often hospitals that work t ogether to provide care for a fixed monthly fee . These systems tightly control patient access to medical services. Patients must use approved doctors, specialists, laboratories, and hospitals. In many managed care systems, physicians are paid a salary rather than being paid per service. Clinics receive the same amount of money no matter how often patients visit. Because payment is not tied to the number of services provided, the system encourages keeping costs low. Critics argue that this can lead to situations where non - medical administrators overrule doctors’ medical decisions in order to save money. 3.5 Problems and Public Dissatisfaction Although the number of HMOs grew rapidly, many experts now predict their decline due to widespread dissatisfaction and concerns about patient care. HMOs are only one type of managed care; other models include Preferred Provider Organizations (PPOs) . While many managed care systems began as nonprofits, most are now for - profit , and many hospitals have also become for - profit. This has introduced a strong profit motive into health care — not just cost control. Patients often distrust systems where financial incentives may influence medical decisions.

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