Process Reflection 3

As the semester draws to a close, I realize that we have covered an immense volume of topics regarding our health care system. The class was composed of fascinating, informative readings in addition to constructive discussions that no other course could possibly replicate. As a future health care provider, I feel I have grasped the fundamental ideas of the American healthcare system within these last couple months. Although there is definitely much more to learn, I firmly believe SO215 has tackled the most basic, but essential, ideas and principles of health care that all people should know. The course has encompassed all aspects of healthcare; from the early doctors and primitive forms of our healthcare system to current establishment ObamaCare, we have discussed a wide spectrum of ideas in sociology of medicine.

Additionally, Sociology of Healthcare was a course that completely shattered my naïve depiction of medicine. I had always believed that medicine was invulnerable to politically and financially driven groups that often tarnished many other professions. However, as we analyzed specific groups such as the American Medical Association and Big Pharma, I was blown away by the fact that the field of medicine was indeed susceptible to much corruption and greed. However, the course has also taught me to be hopeful as well. Rebecca has led numerous, stimulating discussions where we have discussed potential solutions to the current problems we face. Even having rudimentary knowledge of the structure of our health care system is crucial for solving problems in the future.

One of the greatest benefits of taking a course on health care is having greater understanding of how our system functions. In this health care system, we are all consumers. As consumers, we are obligated to monitor and regulate various aspects of our health care, such as medical costs or health insurance. I believe it is a civic responsibility for the American people to set standards and guidelines so that our system is safe from exploitation. For example, one of the last topics we discussed was the issue of cameras in nursing homes and the invasion privacy. We as the people must decide which situations warrant safety over privacy or vise versa. The topics also branch out to subjects like costs of health insurance, universal health care as well as much more.

All in all, I’m grateful that I took part in such an enlightening class alongside enthusiastic classmates. I hope to one day apply what I have learned inside the classroom to the health care field so that I can personally contribute to the improvement of our health care system.

Experimental Procedure

The study conducted by Dr. Harrington and his colleagues looked at various factors to assign the quality of nursing care between investor-owned homes and not-for-profit homes. However,  subjectivity and error could potentially eliminate the study as legitimate research. For example, surveyors were asked to judge nursing homes on a severity scale from A to L. The discrepancies between individual letters (ex. from E to F) could allow for inaccurate data. Also, asking surveyors to “judge” based on experience could potentially present a biased subset of data. Therefore, how could the researchers create a more objective, statistical study?

Where are the primary care doctors?

The declining salary cut for primary care physicians has snowballed into a potential healthcare crisis within the next twenty years. As medical students choose to specialize within a specific field of medicine, there has been a significant decrease of primary care doctors around the United States. In response, the federal government has provided special bonuses for these physicians in an attempt to garner more medical students. The bonuses were directed towards Medicare patients who often use primary care practitioners. In 2012, approximately $664 million was allocated among 170,000 doctors. However, as funds begin to dwindle and the bonus reward program sees its end, some doctors will likely see a small reduction in salary compared to previous years. Many are worried about the potential impact in the cutback, but others are confident the end of the program will not affect a majority of the doctors. It is believed that these primary care doctors will continue to see Medicare patients regardless of the bonuses that were enacted few years ago.

Although these salary cuts may not seem to be an immediate problem, there will certainly be long-term effects for the occupation. For example, research shows that primary care physicians earn much less than their specialist counterparts. The drop in the number of primary care physicians may cause Americans healthcare users to wait months for a simple appointment and pay much more for their medical bills. The discrepancy between primary care doctors and specialists has been known for decades, but the problem has not been tackled. The potential problem will be even worse for towns in rural areas where the number of primary care physicians is already small. The government must approach the situation as soon as possible before the shortage of primary care doctors takes a toll on the American people.

Article: http://www.npr.org/sections/health-shots/2015/11/28/457148697/end-of-medicare-bonuses-will-cut-pay-to-primary-care-doctors

Diversity in Med School Students

According to a recent study, the number of African American students applying to medical school has been decreasing within the last 40 years. This has become a concern for not only the African American community, but also the health care field. Why is it important that medical schools stress diversity of all races? What could be an explanation for the decline of African American students who apply to medical school? How could medical schools encourage more African American students to apply to medical school?

Process Reflection 2

I would love to think biology was the sole reason some people live longer than others. However, countless research projects and case studies reveal that there are other underlying factors at hand. The discrepancy between male and female life expectancies was not surprising to me. There exists a social stigma that men “naturally” die younger than women due to “natural” causes. For a long time, I accepted the principle as a fact and failed to question the implications of the trend.

It is true that there are many biological aspects that can explain why men die significantly younger than women. For example, genetic deficits are often the causes of many mutations that lead to lifetime diseases and cancers. The difference in chromosomes suggests men can potentially have weaker immune systems and are more vulnerable to such illnesses. Yet, what I found simply fascinating were the social reasons proposed by Professor Guseva. I was bewildered to discover the consequences of how society views men can dramatically change something as important as life expectancy. An abnormally high 15% of males who die at ages 20-24 is due to suicide. With the overall empowering feminist movement, I failed to realize there are social problems for men as well. The lectures were truly eye awakening, especially as we compared the discrepancies in developing countries and developed countries. The conclusion that male-female life expectancy gaps were smaller in poor, developing countries was completely unexpected.

As we delve deeper into the conversation and discuss what can be done, I feel much more indeed can be done in my lifetime. However, these social matters will not be recognized and accepted easily. The idea that a strong man should never get ill or be depressed has been present since the dawn of time. Even evolution explains that female look favorably upon males who are the strongest and healthiest of the breed. I believe the most efficient way to handle this social crisis would be to continue discussing the matter. In doing so, these archaic perceptions would begin to fade and the newer generations would then be responsible for how these inequalities are handled.

Punishing “Good” Hospitals

As most health experts would agree, the quality of health care is exceptionally diverse and can be characterized by many independent factors.

For example, the level of experience that doctors have at one hospital can significantly impact mortality rates in a given year. Similarly, the locations of these hospitals can also play a role in whether or not patients will receive specific treatments and medications. Hospitals on the other hand have no incentive to provide the best quality of care to its patients other than moral obligations. Therefore, the federal government has finally stepped by providing Medicare with more leverage. Medicare, which serves as a federal insurance program for people over the age of 65, introduced a value-based purchasing program (VBP), which would allow the government to pay certain hospitals for their quality of health care. However, critics have censured the program, stating that the requirements for the additional compensation are biased against hospitals in smaller, under-privileged areas. While the financial incentive may seem reasonable, the system may cause greater economic separations between hospitals.

One of the main problems with VBPs is the effect on safety net hospitals. Safety net hospitals are hospitals that provide health care to a majority of low-income families. Often times, these hospitals are financially strained because their patients cannot afford the medical bills. While the quality of care may be equivalent or even greater compared to higher-end hospitals, safety net hospitals receive poor patient satisfaction ratings because of the lack of services and facilities that other hospitals have. Therefore, the disparity between hospitals is exacerbated due to the fact that VBPs will take notice of only high rated hospitals, regardless of what particular situation some of these hospitals are in. In doing so, these programs are indirectly punishing hospitals for providing care to poorer people. Even more so, a financial incentive is created to ignore patients who are unable to pay for their hospital bills.

The intentions of the VBPs were well planned and the program was a strategic way for the government to ensure the best quality care from hospitals all across the country. By providing a financial incentive for hospitals to increase quality of care, it would potentially reduce certain problems like over and under-treatment. However, the biggest problem with the system was rewarding hospitals solely on patient satisfaction surveys. These surveys are highly vulnerable to bias and would not benefit many hospitals that actually need the additional subsidy. For instance, one aggravated patient may score a hospital low due to far less important reasons such as an unsatisfying hospital meal or the lack of television in the recovery room. These patient biases would then become poor indicators of health care quality. Some hospitals that emphasize meeting the personal patient needs rather than overall care would be unfittingly rewarded. Other hospitals that need financial aids to compensate for patients who do not pay may not receive additional grants at all even with identical quality treatment. Therefore, I believe putting more emphasis on statistical information, such as cost-efficient procedures and reductions in mortality rates, would be more appropriate. Unlike patient surveys, numbers often demonstrate the quality of health care in a much more objective perspective.

Article:

http://www.forbes.com/sites/peterubel/2015/10/16/paying-for-patient-satisfaction-harms-hospitals-that-care-for-poor-people/

Role of Medical Schools

By law, all physicians must be certified from an approved medical school, whether it be allopathic, osteopathic, or naturopathic. Each year, thousands upon thousands physicians obtain their licenses as they finish their final years of medical school and enter their residency. As these doctors gain notable experience, they become aware of the flaws and internal complications of the American healthcare system. For one, many doctors are able to see the enormous differences in income among their patients. Yet many do not advocate or publicize these economic differences that are crucial factors in a failing health care system. What can doctors and medical schools do to bring attention to these matters? What other issues should they address with their expertise and media power?

National Healthcare Unconstitutional?

Brill calls attention to the method in which our healthcare prices are set. He states healthcare consumers are “powerless buyers in a sellers’ market where the only consistent fact is the profit of the sellers”. It is a fact that prices and rates in our system vary immensely throughout the country. Many parties, such as the pharmaceutical market, have taken advantage of how the system has been set. Interestingly, the difference in prices does not significantly affect the quality of healthcare at all. While a national healthcare system has been proposed in the past, the Supreme Court has regularly called it unconstitutional. Therefore, how could our system be reformed so that healthcare prices are similar nationwide while still being constitutional?

Process Reflection

I don’t get it. I don’t get how the United States, a country full of world-renowned economists, doctors, and politicians, is unable, maybe even unwilling, to establish an affordable healthcare system. We have identified the problems: a muddle of unnecessary expenses for consumers, power struggles between doctors and administrations, and an overall lacking quality of healthcare. Sociologists have been studying the ordeal for decades from various perspectives. Physicians have attempted to provide insight into the internal complications within the system. Yet, any solution that is proposed seems to dissatisfy one or more groups, and further prolong the issue.

In my opinion, the healthcare dilemma is a social and political problem. The disproportionate distribution of wealth segregates many Americans, even those in the same state. For this reason, the cost of healthcare is unfavorable for Americans who live in poverty-stricken regions of the country. Consequently, I believe the reconstruction of the healthcare system is only possible through social and economic reform. These concerns are not being addressed at this time because financial complications have not resonated to the higher income class. The problem has taken its largest tolls on those who are unable to acquire healthcare because they simply cannot afford it. Therefore, one of the biggest solutions for people in the middle and lower income bracket is to become more knowledgeable consumers. By getting involved and learning about how the current healthcare system works, people will be able to set their own healthcare and pharmaceutical prices.

Americans today protest high costs and rates, but are unwilling to take action. The problems in the healthcare system have been established and studied. Now, it is time to shift our focus to creating solutions and putting those plans into motion. As problems remain unresolved, more and more people will die unnecessarily because their country has failed them.

Doctor vs. Guardian: Who Should Have More Power?

When addressing sociology in medicine, statistical evidence is a useful tool in identifying specific problems in our healthcare system. While these “numbers” may give us a general, objective perspective, medicine is often not an objective subject. Medical treatment deals with the emotions and relationships between doctors and patients that cannot be overlooked. Within these relationships, there is also a struggle for power between the two parties. For example, in the video “Money and Medicine”, a son looks over his dying mother who is unable to do anything independently. She must be fed, bathed, and watched at all times by either the son or medical staff. She is unable to breathe on her own and her condition has been worsening for the past 8 months. The doctors have advised the son to “pull the plug” and let the mother pass in peace. However, the son’s religious beliefs and confidence in miracles have compelled him to continue his mother’s treatment. The hospital bills have summed up to $5 million. In this situation, the doctors have no power unless they are able to persuade the son that keeping his mother in a minimal conscious state would be undesirable. At what point should the doctor’s decision override the guardian’s? Should the doctor have any power to override the decision at all?