This semester I have learned so much about the US healthcare system. The weekly readings were always very interesting and applied directly to what was being discussed in class. Before taking SO215, I was aware that healthcare was extremely expensive in the US, and that millions still remain uninsured. However, I was completely unaware of the numerous issues that plague our system, such as medical underwriting, the Chargemaster, and the statistical data behind the effects of the gender gap. Additionally, I greatly enjoyed evaluating the US healthcare system through a sociological lens, especially during discussion.
One of my favorite discussion sections was when we all brainstormed factors from our regional community that may contribute to a higher or lower level of health. This discussion occurred during the week in which we were learning about the impact of SES and ones zip code on one’s health. During discussion it was intriguing to hear about the different communities that my peers grew up in and how their communities affected their health and access to resources. For example, I shared a positive aspect of my community in New Hampshire, in which there are many farmers markets for community members to utilize. Farmers markets promote local, healthy eating, as often fresh fruits and vegetables are sold. As we learned in class, the access to farmers markets, as well as additional factors such as clean air, effect the health of those in the community greatly.
Lastly, I have greatly appreciated the recent discussions about end-of-life care. While it is extremely difficult to talk about death and dying, it is a critical discussion that we all ought to have with our loved ones. Through our discussions on this topic, I am motivated to reach out to my family members and ask the type of care they would wish for themselves at their end of life. It would be horrible to be put in the position of trying guess what he/she would want, as was seen in the movie.
Overall, this semester has been very enjoyable and I will definitely use the knowledge I have gained when working in the medical field!
November Analytical Posting
Title of Article: “US Public Health Funding on the Decline” by Lisa Rapaport
In this article, Lisa Rapaport discusses the issue of a decline in funding for public health initiatives in the United States. According to the American Journal of Public Health, the expenditures spent on public health decreased by 9.3% since 2008. Rapaport writes that the Affordable Care Act, passed in 2010, stated that the healthcare funding for public health would rise by 15 billion dollars. However, laws passed beginning in 2012 cut this number down by over 6.5 billion dollars. This article utilizes statistical data to showcase the immense issue of a lack of public health initiatives that plagues the United States healthcare system.
This article directly relates to what we have learned this semester about the US healthcare system. The United States spends over 2 trillion dollars each year on healthcare, yet health outcomes are far from ideal. For example, the US is ranked 43rd in life expectancy and the infant mortality rate is not desirable either. There are many reasons that contribute to the poor health outcomes among Americans, one being the lack of public health initiatives. The medical profession is founded on curing individual patients, rather than focusing on the prevention of diseases. In the United States, we are constantly pouring money into treating patients’ acute illnesses, rather than stepping back and treating the core root of the problem. For example, the law prevents clean needles from being to given to those struggling with drug addictions. This causes a drastic increase in the prevalence of HIV among drug users due to the sharing of contaminated needles. These patients must then be treated in the hospital, which ultimately causes excess money to be spent, and a lower quality of life for the patient.
The decline in public health funding is only one manifestation of the lack of public health initiatives that embodies the US healthcare system. For example, medical school education focuses on the treatment of sick patients, rather than prevention. Therefore, the foundation of the medical profession is not founded on public health and providing equal care for all. Additionally, doctors are pressured into seeing patients for incredibly short appointments, before moving on to the next patient. This causes doctors to not have the time and necessity to promote healthy lifestyles (and thus prevention) to patients because treating the patient’s symptoms through medication has faster outcomes.
Rapaport’s article displays that the US is continuing to ignore one of the major issues regarding our healthcare system. I hope that in the coming years there is a push to increase public health funding so that the citizens of the United States can be treated equally and have a higher quality of life through disease prevention.
In “The Rise of the Modern Hospital”, Charles Rosenberg describes the growth of the modern hospital. Rosenberg states that beginning around 1910, the hospital became a national institution in which it was respected by many Americans. Previous to the 20th century, hospitals only served those who were homeless/did not have the resources to care for themselves. Rosenberg writes that the concept of a hospital flourished when new technology, such as the x-ray, were created.
To what extent does the creation of new technology still impact our view of the hospital today? Does society gain more trust/respect for hospitals and doctors when cutting edge technology is released? Is there a limit to the high-tech equipment in regards to gaining patient trust?
In Groopman’s article, he writes about the effect of marketing in medicine. In this chapter, a doctor is approached by a pharmaceutical company representative, who advertises an anti-aging drug to the doctor. The representative bribes the doctor with candy and expensive dinners, in an attempt to force the doctor to prescribe this anti-aging medication to patients.
I am wondering why pharmaceutical companies are able to pressure doctors in this way? Should there be regulations in place so that this form of bribery does not take place within the medical field?
In Allen Smith’s article, “Managing Emotions in Medical School”, the topic of the physician-patient relationship is discussed. Smith focuses on the conflicting emotions that students in medical schools must wrestle with. For example, students in the article expressed feelings of embarrassment and attraction towards some of their patients.
Obviously, maintaining a professional relationship is essential for the physician to do when interacting with his/her patients. However, to what degree should Goffman’s theory of dramaturgy be followed? Should the physician fully objectify his/her patient through following the “script” that is deemed appropriate by the medical society? Is it possible that the roles that the physician and patient are expected to play actually hinder the quality of treatment the patient’s receive?
Article Title: “Many Schools are Failing on Type 1 diabetes care” by Catherine Saint Louis.
In this article, Catherine Saint Louis writes about a major issue that is plaguing numerous schools across the nation. Students with Type 1 diabetes are discriminated against in public schools because of their disease. Saint Louis provides numerous examples in the article in which students with this disease are forced to switch schools because the school is unwilling to provide care. There are many cases when children have been told that they cannot come on a class field trip due to their disease as well, nor are they given the opportunity to participate in athletic activities. Some schools justify their actions towards these children by stating that they do not have the resources to help the child in the event that the child experienced extremely low blood glucose levels. School officials are neither trained nor willing to administer insulin to a child in need, and thus, the student is not allowed to attend the school.
I found this article to be extremely discouraging because innocent children are experiencing discrimination over a disease in which they have no control. Type 1 diabetes is an inherited disease in which insulin is not produced in the body. The numerous schools that force students to change to another school is not abiding by the law that protects these students, as the article suggests. This discrimination resembles the medical underwriting that insurance companies do in order to screen out “unhealthy” people. Medical underwriting ensures that insurance companies can save money by only granting health insurance to those who are healthy. Thus, the way in which schools pick and choose who can attend their institution based on a child’s medical status resembles the unjust actions of insurance companies in choosing who they wish to insure.
Saint Louis’s article also suggests the immense effect of social factors on illness. For example, the geography affects the healthcare that children receive because in some areas, children with Type 1 diabetes are able to receive adequate care at their schools. However, as the article explains, numerous schools across the United States do not provide adequate care to children with this disease, and thus, those students who live in these areas either do not have access to appropriate care, or are forced to move to a different geographic location to attain adequate care. Therefore, the child’s illness is impacted by the location in which he/she lives in, which directly affects the education the child will receive. The effect of geography on illness was also portrayed in the film watched in class, in which one’s zip code greatly affects the health of a given community member. Therefore, the children with Type 1 diabetes are only one example of the many ways that geography impacts illness of individuals.
In Barker’s article, illness is described as being socially constructed. The author explains that some illnesses are more influenced and affected by the culture while some illness are stigmatized. This stigmatization affects those who are diagnosed with the illness, because they now have to cope with both the stigmatization as well as the side effects of the particular illness.
What causes a given illness to be stigmatized by society? For those illnesses that are affected by stigma, how can we address this issue through the implementation of social policy?
In Williams article, he discusses the role that sociologists play in studying the effects of racial discrimination/inequality on a particular group’s health status. In the article, Williams explains numerous factors that affect ones’ health, such as SES or racial discrimination.
Which factor has the greater contribution to the lower health outcomes for certain racial groups? Is it SES, racial discrimination, or other factors? In what ways can these issues be addressed? (other than administering surveys by group and gender as the article suggests).
In Phelan and Link’s article, they discuss the theory of fundamental causes. This theory claims that socioeconomic status and mortality/health correlate with one another, even as intervening mechanisms change. Is it possible that a change in an intervening mechanism would be an advantage to those with lower SES? Or does this change in mechanism overtime always gives an advantage to those with higher SES?
As someone who is aspiring to be a Physician Assistant, I found that Sociology of Healthcare would be an applicable course for me to take. I think it is essential for medical professionals to understand the structure and sources of power within the healthcare system. While many of the topics discussed in lecture involve pointing fingers at the United States healthcare system, I believe it is fair to critique the system in this way. The facts/figures that we discuss in both lecture and those included in the readings all support the claim that the US healthcare system has numerous flaws.
One such flaw that has resonated with me is the issue of overtreatment. I have dealt with overtreatment in my personal life; therefore, I was able to relate when this topic was discussed heavily in class. For example, I have been ordered a few MRI’s from my doctor (due to sports injuries) in the past, in which I do not believe these tests were necessary. Despite the fact that the pain I was experiencing in my ankle had nearly subsided, my doctor wanted me to get an MRI, in which I ended up doing so. In this example, it is nearly impossible to say whether the doctor was correct in ordering the MRI, or whether this is an example of overtreatment. This surfaces another issue that plagues the healthcare system, in that it is difficult for patients to determine whether their doctor is acting out of a personal incentive (to make more money) or acting for the patient’s best interest. The physician is not at fault for the lack of trust that overwhelms most patient-doctor relationships. Rather, a systemic issue has degraded this trust, in that the healthcare system is fee-for-service, which ultimately causes the healthcare system to be a market rather than a service to help heal patients.
Overall, while many of the topics discussed in lecture are not exactly optimistic, I have enjoyed learning about the US healthcare system. It is critical to understand the sociological factors that contribute to the issues regarding US healthcare, and I am excited to learn more throughout the semester.