Capitalism, socialism and the physical quality of life.
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Economics↗
Biomedical subjects
H Waitzkin
Publications and source records attributed to H Waitzkin.
Financial barriers to medical care: a prospective study in a university-affiliated community clinic.
Access to medical care in the United States is deteriorating, particularly for the poor. The authors evaluated patients who could not afford medical care recommended by physicians in a university-affiliated clinic that serves a predominantly indigent population. The authors determined the patients' demographic characteristics, their medical problems, and the types of care for which financial barriers existed. In addition, the authors compared the patients' demographic characteristics and medical illnesses with those of a control group of patients from the clinic who did not experience financial barriers to medical care. Of the 1,950 patients evaluated, 94 (4.8%) were unable to afford care recommended by their physicians. Sixty-seven percent were US citizens, 73% were unemployed, 63% had monthly family incomes of less than $500, and only 33% had health insurance. The patients had a variety of medical problems, ranging from hearing loss, for which they could not obtain hearing aids, to breast masses, for which they could not obtain mammographies or biopsies. When compared to patients who did not experience financial barriers to recommended care, the study patients tended to be poorer, more likely to be undocumented, more likely to be uninsured, and less likely to have acute, self-limited illnesses. Our findings support the argument that the nation's current piecemeal approach to providing indigent health care may lead to serious financial barriers to access in some localities.
California↗
A critical theory of medical discourse: how patients and health professionals deal with social problems.
Criticism of social context does not generally appear in medical encounters. When contextual issues arise in medical discourse, messages of ideology and social control may become apparent, usually without the conscious awareness of the participants. By easing the physical or psychological impact of contextual difficulties, or by encouraging patients' conformity to mainstream expectations of desirable behavior, encounters with doctors can help win patients' consent to troubling social conditions. Seen in this light, doctor-patient encounters become micropolitical situations that do not typically encourage explicit statements or actions by health professionals to change contextual sources of their patients' difficulties. A critical theory influenced by structuralism suggests that the surface meanings of signs in medical discourse prove less important than their structural relationships. In addition, a theoretical approach adopting elements of post-structuralism and Marxist literary criticism emphasizes the marginal, absent, or excluded elements of medical discourse. Contextual features that shape a text include social class, sex, age, and race. Through the underlying structure of medical discourse, contextual problems are expressed, marginalized, and managed.
Communication↗
Changing the structure of medical discourse: implications of cross-national comparisons.
In the discourse of medical encounters, social problems arise frequently. Such problems typically derive from work and economic insecurity, family life and gender roles, aging, and conditions that foster substance use or other self-destructive behavior. The structure of medical discourse tends to marginalize the social issues that generate personal troubles in everyday life. Long-range strategies to alter medical discourse aim toward basic modifications of power and finance in the larger society of which medicine is a part; such strategies seek to change the contextual issues that create personal troubles on the individual level. As shown by the examples of the Soviet Union, eastern Europe, and China, social revolution does not necessarily resolve the micro-level contradictions of the doctor-patient relationship. In contrast, the Cuban revolution apparently has succeeded in transforming both the context and the structure of medical encounters. Short-range strategies in countries such as the United States involve more direct ways in which patients and doctors can alter their communication. These alterations involve reducing devices of language that maintain professional dominance, avoiding the medicalization of nonmedical problems, attempting not to marginalize contextual issues, and encouraging active attempts to change social conditions that generate personal troubles.
Adolescent↗
Why it's time for a national health program in the United States.
The United States lacks a coherent national health program. Current programs leave major gaps in coverage and recently have become more restrictive. Influential policies that have failed to correct crucial problems of the health-care system include competitive strategies, corporate intervention, and public-sector cutbacks with bureaucratic expansion. A national health program that combines elements of national health insurance and a national health service is a policy that would help solve current health-care problems. Previous proposals for national health insurance contained weaknesses that would need correction under a national program. Based on the experiences of other economically advanced countries, a national health program could provide universal entitlement to health care while controlling costs and improving the health-care system through structural reorganization. Current proposals for a national health program contain several basic principles dealing with the scope of services, copayments, financing, cost controls, physician and professional associations, personnel and distribution, prevention, and participation in policy making. Support for a national health program is growing rapidly. Such a program would help protect all people who live in this country from unnecessary illness, suffering, and early death.
National Health Programs↗
A critical theory of medical discourse: ideology, social control, and the processing of social context in medical encounters.
The personal troubles that patients bring to doctors often have roots in social issues beyond medicine. While medical encounters involve "micro-level" interactions between individuals, these interpersonal processes occur in a social context shaped by "macro-level" structures in society. Examining prior theories pertinent to medical discourse leads to the propositions: (a) that medical encounters tend to convey ideologic messages supportive of the current social order; (b) that these encounters have repercussions for social control; and (c) that medical language generally excludes a critical appraisal of the social context. The technical structure of the medical encounter, as traditionally seen by health professionals, masks a deeper structure that may have little to do with the conscious thoughts of professionals about what they are saying and doing. Similar patterns may appear in encounters between clients and members of other "helping" professions. Expressed marginally or conveyed by absence of criticism about contextual issues, ideology and social control in medical discourse remain largely unintentional mechanisms for achieving consent.
Adaptation, Psychological↗
Deciding against corporate management of a state-supported academic medical center.
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Academic Medical Centers↗
Economic development, political-economic system, and the physical quality of life.
This study compared capitalist and socialist countries in measures of the physical quality of life (PQL), taking into account the level of economic development. The World Bank was the principal source of statistical data for 123 countries (97 per cent of the world's population). PQL variables included: indicators of health, health services, and nutrition (infant mortality rate, child death rate, life expectancy, population per physician, population per nursing person, and daily per capita calorie supply); measures of education (adult literacy rate, enrollment in secondary education, and enrollment in higher education); and a composite PQL index. Capitalist countries fell across the entire range of economic development (measured by gross national product per capita), while the socialist countries appeared at the low-income, lower-middle-income, and upper-middle-income levels. All PQL measures improved as economic development increased. In 28 of 30 comparisons between countries at similar levels of economic development, socialist countries showed more favorable PQL outcomes.
Adult↗
Capitalism, socialism, and the physical quality of life.
This study compared capitalist and socialist countries in measures of the physical quality of life (PQL), taking into account the level of economic development. The World Bank was the principal source of statistical data, which pertained to 123 countries and approximately 97 percent of the world's population. PQL variables included indicators of health, health services, demographic conditions, and nutrition (infant mortality rate, child death rate, life expectancy, crude death rate, crude birth rate, population per physician, population per nursing person, and daily per capita calorie supply); measures of education (adult literacy rate, enrollment in secondary education, and enrollment in higher education); and a composite PQL index. All PQL measures improved as economic development increased. In 30 of 36 comparisons between countries at similar levels of economic development, socialist countries showed more favorable PQL outcomes (p less than .05 by two-tailed t-test). This work with the World Bank's raw data included cross-tabulations, analysis of variance, and regression techniques, which all confirmed the same conclusions. The data indicated that the socialist countries generally have achieved better PQL outcomes than the capitalist countries at equivalent levels of economic development.
Adult↗
Corporate interests, philanthropies, and the peace movement.
Corporate and philanthropic involvement in the peace movement is growing. In considering medical peace groups as examples, we have studied the ways that corporate and philanthropic funding have shaped the course of activism. Our methods have included: review of the Foundations Grant Index from 1974-1983; analysis of corporations' and foundations' criteria for grants in the categories of peace, arms control, and disarmament; interviews with leaders of activist organizations and with foundation officials; and our own experiences in the peace movement. Corporate interests in preventing nuclear war stem from a concern for global stability in which world markets may expand, and from a hope to frame issues posed by the peace movement in a way that will not challenge basic structures of power and finance. Several general features make peace groups respectable and attractive to philanthropies; an uncritical stance toward corporate participation in the arms race; a viewpoint that the main danger of nuclear war stems from a profound, bilateral conflict between the United States and the Soviet Union; and a single-issue focus that does not deal with the many related problems reflecting the injustices of capitalism. The two major medical groups working for peace, Physicians for Social Responsibility (PSR) and International Physicians for the Prevention of Nuclear War (IPPNW), have accomplished many goals; however, their adherence to subtle criteria of respectability and their dependence on philanthropic funding have limited the scope of their activism. The struggle for peace can not succeed without fundamental changes in the corporate system that initiates, maintains, and promotes the arms race.
Financial Management↗
The medical profession and nuclear war. A social history.
Since World War II, individual physicians and medical organizations in the United States have cooperated with the federal government in preparing for nuclear war. While most physicians have maintained a neutral stance, a minority have resisted federal policies. Health professionals participated actively at the wartime laboratories that developed the atomic bomb and in the medical research that followed Hiroshima and Nagasaki. Professional organizations helped with civil defense planning for nuclear conflict during the Cold War of the late 1950s and early 1960s. Medical resistance to nuclear war began in the same period, gained wide attention with the growth of Physicians for Social Responsibility in the early 1960s, declined during the Vietnam War, and vastly increased in the early 1980s. Activism by health professionals usually has responded to government policies that have increased the perceived risk of nuclear conflict. The recent return of civil defense planning has stimulated opposition in medical circles. Ambiguities of medical professionalism limit the scope of activism in the nuclear arena. These ambiguities concern the interplay of organized medicine and government, tensions between science and politics, and the difficulties of day-to-day work in medicine while the arms race continues.
American Medical Association↗
The return of two-class medicine--ill effects of Medi-Cal reform.
California's drastic Medi-Cal reforms have created great difficulties in health care for the poor. Patients' clinical problems seldom are apparent in descriptions of changes in public insurance programs. Rapidly escalating costs of Medi-Cal led to irresistible pressures for reform, especially from the business community. The new Medi-Cal regulations provide for prospective contracts with hospitals for inpatient services, the transfer of "Medically Indigent Adults" to the responsibility of county governments and various other straightforward funding cutbacks. Confusion, disruption of services and adverse health outcomes have accompanied the Medi-Cal reforms.
Adult↗
Information giving in medical care.
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Adult↗
Two-class medicine returns to the United States: impact of Medi-Cal reform.
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Adult↗
Doctor-patient communication. Clinical implications of social scientific research.
Research in the social sciences has clarified the nature and problems of doctor-patient communication. The development of adequate communication skills is now a goal of training programs in the primary-care specialties. Social structural barriers impede effective communication, however, and information giving remains problematic. Doctors tend to underestimate patients' desire for information and to misperceive the process of information giving. The transmission of information is related to characteristics of patients (sex, education, social class, and prognosis), doctors (social-class background, income, and perception of patients' desire for information), and the clinical situation (number of patients seen). Doctors' nonverbal communication abilities are associated with outcomes of medical care such as satisfaction and compliance. Regarding the sociolinguistic structure of communication, doctors often maintain a style of high control, which involves many doctor-initiated questions, interruptions, and neglect of patients' "life world." Training programs and standards of clinical practice should emphasize that improved doctor-patient communication is both desirable and possible.
Attitude of Health Personnel↗
California's cutbacks in public-sector medicine: two-class health care returns to the United States?
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Adult↗
The micropolitics of medicine: a contextual analysis.
Certain features of the doctor-patient encounter "medicalize," and thereby depoliticize, the social structural roots of personal suffering. The critique of medicalization holds that medicine has become an institution of social control, that the health care system helps promulgate the dominant ideologies of a society, and that the doctor-patient relationship is a major site where these developments occur. This paper presents a contextual analysis of medical encounters, drawn from a sample of tape-recorded doctor-patient interaction in medical practice. The doctor-patient relationship manifests problems that arise despite the best conscious intents of well-motivated participants. Conveying the symbolism of scientific medicine, messages of ideology and social control reinforce current relations of economic production and reproduction in work, the family, leisure, pleasure, sexuality, and other areas of social life. Ambiguities within the doctor-patient relationship both reflect and help reproduce broader social contradictions and structures of oppression. The medical encounter is one arena where the dominant ideologies of a society are reinforced and where individuals' acquiescence is sought. A vision of a progressive doctor-patient relationship must include a conception of how that relationship contributes to fundamental social change.
Adult↗
Community-based health care: contradictions and challenges.
Social contradictions, including uneven economic development and the private-public duality, make community-based provision of health care difficult. The unrestricted expansion of private medical centers has been criticized from several perspectives including inadequate coordination of services, high costs, and negative effects on urban housing and living conditions. Corporate and professional control over health policy, monopolization, and public subsidization foster expansion of private institutions. While private facilities enlarge, public health-care institutions deteriorate, close, or shift to private management. Many clients eligible for care at public hospitals do not receive adequate attention in the private sector. Despite their achievements, community clinics have problems that threaten their survival. The financial insecurity of community clinics is an inherent feature of the private-public duality that affects the entire health-care system. Community clinics and public hospitals offer a potential for broader organizing and empowerment.
California↗