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Health Studies
R Song

10-23-2012 HLTC05H3 F Lecture 6: Doctors, Drugs, and Global Health • Martin Luther King Jr.= “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” o Health care is a significant determinant of health • Health care and managed care in the developed nations • What is the future of Medicare in Canada? o Public healthcare that is nationalized • Market-based healthcare vs public healthcare o Healthcare in the US is increasingly market-based and is shaped by the competition, commercialization, and corporatization of the health industry o Increasing growth of profit margins and economic growth and salaries of CEOs o Services outsourced to HMOs and MCOs o Running of healthcare on prevention and integrative services  Maintaining costs and spending  Sticking to a particular budget • Incentives present in HMOs and MCOs • Lower cost, greater efficiency, better quality care w/market- based health care which has not occurred in the US  With the growth of TNCs and economic growth has led to more privatized healthcare  Explicit rationing= cutting services that are considered unnecessary which is problematic because it reduces access and quality of care  Make profit • Evolved in the US around the time of welfare reforms in the late 1980s and early 1990s  Consequences opposite of the intended goal • Increase in costs and spending o Administrative costs • Resulted in poorer quality care • Widespread rationing has increased costs and fees which leads to unequal access o Important issue of noncompliance o Rising number of uninsured people  Worsening health o Medical profession that is becoming profit-driven rather than altruistic o Strain on the healthcare safety net in the US  Healthcare facilities that in a more democratic setting  Faced with public funding cuts  Process over the last 30-34 years w/the onset of neoliberal ideology • Marketization o Widening disparities across different [social] determinants of health and also different sections of the population in the US o Major mechanism of structural violence on human bodies o Consequences for the patients who become clients in the market-based medicine o HMOs generate a lot of profit while not being more efficient in their own spending vs. nationalized healthcare o Market-based healthcare in the US has driven up costs o Specialized entity= private clinics and facilities (managed medicine; concierge medicine)  Exclusive sort of clinics; for a fee, ensure access to a doctor, not including other fees • Walk-in clinics in Canada but is not exclusive in the US • Operation of private-care in Canada that follow gov’t guideline for pay for doctors and fees • Canada Health Act is thought to be very restrictive and why doctors argue that private care should be in Canada • Market-based healthcare in the US follows Neoliberal ideology for the Health Care Sector o Look @ slide 10 • Medical rationing results in how many people can doctors, nurses, administrative staff see at a given time; labeling [certain] patients as non-compliant= excluding certain people as being non-compliant which is problematic and drop off the radar for those nurses and doctors o Problem for marginalized groups of people and impoverished populations  The issue of stigma of certain diseases  Negative public opinion of certain diseases and could lead to problems in later life if added to the judgment of non-compliance • Eg. TB and HIV/AIDS patients will not come in for regular visits if there is social stigma attached to the disease o Stigma is a form of structural violence because it can be based on racial and cultural biases of diseases and/or behaviours which also can be a factor in non- compliance • Ethnographies of patient highlights individual experience of a disease and health care • Big Pharma= transnational corporations o Mechanism of TNCs o Majority of money, research, professions spent on non-communicable diseases in the developed countries vs. communicable, acute, infectious and tropical diseases; disproportionate o Repeat drugs introduced and majority of drugs are not new drugs o Increasingly today about profit-margin  Pharmaceutical profitable industry compared to fortune 500 companies which does not p
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