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Lecture 6

Lecture 6

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Health Studies
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Lecture 6 06/12/2012 22:48:00 ← Doctors, Drugs and Global Health ← ← Current health care issues: widening racial, ethnic and class disparities in access to care and health outcomes, uninsured vs. insured, questionable quality and safety of services, rising health care and drug costs, critical hospital bed shortages, inability to fill prescriptions, chronic nursing shortages, ER overloads, ambulance inefficiency…..future of Medicare/Medicaid? ← ← Market-Based Medicine ← •Transformation into a market-based system (service industry?) shaped by forces of competition, commercialization and corporatization ← •Manifest in growth of managed care, drug and biotechnology industries ← •HMOs (health maintenance organizations) ← •MCOs (managed care organizations) ← ← Market-based Health Care (Rylko-Bauer and Farmer 2002) ← •Emphasis on prevention and integrated services for enrolled individuals, with the goal of controlling costs through prospective financing of a preset, limited budget ← •lower cost, greater efficiency, better quality care ← •Early HMOs largely local and not-for-profit ← •MCOs evolved that placed increasing financial pressures on providers they contracted - through increasing consolidation (mergers, acquisitions) and integration of health care services and products, providing these corporations with major economic and political clout in the health care sector ← •Accompanied by privatization of health care services (profit) ← ← Market-based Health Care (Rylko-Bauer and Farmer 2002) ← •Introduced “explicit rationing”: by limiting unnecessary use of services (determined by evidence-based guidelines), efficiency in delivery of care is maximized, patients are better off and money is saved ← •Patients and physicians are managed through cost-containment techniques that put strict controls on use of medical services and patients’ choice of doctors & medical options… and offer financial incentives to doctors/hospitals to cut costs, services ← •Controlling costs, increasing efficiencies, making profits ← •N.B.: in US, evolved amidst welfare reforms (1996) that cut into Medicaid coverage and spending ← ← Consequences of the Marketization of Medicine ← •Increase in health care costs/spending, yet poorer quality care ← •Widespread rationing of care based on ability to pay (“non- compliance”, Brenda, AIDS case study) ← •Rising number of uninsured (unequal access) ← •Worsening health status for many ← •Ethical dilemmas regarding care ← ← Greater strain on the ← “health care safety net” ← (public hospitals, emergency rooms, community health centers, local health departments, community and teaching hospitals, private physicians who give charity care, school-based health clinics) ← – which also faced public funding cuts ← ← Consequences of the Marketization of Medicine “managed care”… ← •Widening disparities in access to care, particularly along race, sex, SES/class lines ← •Uninsured/inadequately insured: . children, un/underemployed, minorities, elderly, women, rural populations, disabled, homeless ← •In US: at least 30% of population lack ready access to health care ← •Has become a major mechanism of structural violence (racism, sexism, social inequality, poverty) ← ← “boutique medicine” “concierge medicine” A new “policy environment” that emphasizes (Navarro 2009): ← ← Neoliberal Ideology and the Health Sector ← 1.the need to reduce public responsibility for pop. health ← 2.the need to increase choice and markets ← 3.the need to transform national health services into insurance-based health care systems ← 4.the need to privatize medical care ← 5.a discourse in which patients are referred to as clients and planning is replaced by markets ← individual’s personal responsibility for their health ← 7.understanding of health promotion as behavioural change ← 8.the need for indi
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