Medizin: Ihr Geld und
ihr Leben – Karl Kraus
(“Medicine: Your money AND your life.”)
What is Medical Sociology
Levels of Analysis
Micro
Meso
Macro
Health Care in the United States
International Comparisons
Major Theorists Major Paradigms
Emile Durkheim
Max Weber Structural
Karl Marx Functionalism
George Herbert Mead
Georg Simmel
Conflict
Talcott Parsons
Eliot Freidson
Erving Goffman Symbolic Interactionism
Anselm Strauss
Michel Foucault
Structural-Functionalism (Struktureller Funktionalismus)
Society (Gesellschaft) seen as an organism or a machine, all
the parts working together, defending against attack or
decay. Equilibrium is the goal. (Das Gleichgewicht ist Die
Ziege.)
Conflict (Konflikt)
Society seen as an arena of competing forces. Eqilibrium is
usually achieved at the expense of some interests. True
equilibrium also means equality of interests.
Symbolic Interaction (Symbolisch Interaktion)
Society reality is a constructed reality. Things are as they
are because they are socially defined that way.
For Talcott Parsons
Sickness = Deviance
(Krankheit = Abweihung)
In order for the social order to protect
itself from the possible disorder
created by people not playing their
normal roles, they are given a sick role
to play. It is a role that should be
temporary and its purpose is restoring
the sick to health.
There are two benefits (zwei vorteilen) and
two obligations (zwei verpflictungen):
Benefits (Vorteilen):
1. Person is not blamed for being sick
2. Person is released from normal social roles.
Obligations (Verpflictungen):
1. Person cannot like being sick.
2. Person must seek out and cooperate with
caregivers.
It is useful only for explaining acute
illnesses rather then chronic illnesses
Freidson added the dimensions of
legitimacy and severity
It is a reflection of middle-class values
It does not apply well to mental illness
It does not apply well to disability
It is extremely physician oriented
It does not recognize cultural variation in
defining and explaining illness
Anselm Strauss and Barney Glaser discussed awareness
contexts in their work Awareness of Dying. When a
person is dying, the fact of their dying may be kept from
someone in the situation. They noticed the following
possibilities:
1. Open (Offen) Awareness Context
2. Closed (Geschlossen) Awareness Context.
3. Pretense (Vortäuschung) Awareness Context.
4. Suspicion (Verdacht) Awareness Context.
Truth Telling
Pain Management
Obligation to Treat
Right to Refuse to Treat
Spending Time
Talking to the Patient
Assisted Suicide
Sexual/Reproductive Issues
Others
Middle-level Institutions
Medical Schools (Boys in White)
Nursing Schools
Research Centers
Clinics
Hospitals
Outpatient Facilities
Doctors’/Nurses’ Offices
Government Bureaucracies
Insurance Companies and HMOs
System-wide analysis – It is this level of analysis
which takes into account the nature of health
care systems, level of care, extent of coverage,
epidemiological data, government involvement,
and other related issues.
Structural/Functionalism – Health care systems
respond to basic needs for social order.
Conflict – Health care systems are expressions of
the class relationships in a particular society.
Symbolic Interaction – Health care systems are a
result of the definition of the situation made by
people in that society.
IF PEOPLE TREAT SITUATIONS
AS REAL, THEN THEY (THE
SITUATIONS) HAVE REAL
CONSEQUENCES.
The gentleman in the
picture is Glen Beck, an
American talk show
host, (Dampfplauderer)
who had a very bad
experience in an
American hospital
during routine surgery.
He complained most
about the lack of caring
(caritas).
American health care is a nightmarish
(alptraumisch) combination of private, public
and personal efforts.
It is not a national system.
14% or 45 million people have no health
care coverage at some time during any year,
many are children.
People without coverage visit hospital
emergency rooms when they get sick creating
dangerous hospital conditions.
Preventive medicine is not often practiced.
The most important national program,
Medicare (Part A – hospital coverage
[Versicherungschutz] for the elderly) will not
be able to pay full benefits after 2019.
Medicaid, the state/federal health program
for poor people, is being seriously cut. In
some states, people who earn more than
$1,700 per year cannot qualify.
The U.S. spends more than 16% of its GDP
on health care -
Hospitals engage in “patient dumping.”
Health care/hospital corporations engage
in “cream-skimming.”
Doctors are very highly paid – median is
over $200,000 per year.
Malpractice insurance rates are very high –
for example, $75,000 for ob/gyn.
Physicians and nurses practice “defensive
medicine.”
The bottom line results of the “system”
are not good – U.S. does not have the highest
life expectancy and has poor infant mortality.
Managed care has been a financial failure.
All signs are things are getting worse.
Health care has become big business –
Arnold Relman described the “medical-
industrial complex.”
IS THIS A GOOD MODEL FOR
YOUR COUNTRY TO COPY?
Please refer to the handout which compares
various simple measures between selected
nations. It is obvious that there is little
relationship between amount spent on health
care and resulting demographics, at least in
developed nations. Greece spends a fraction
of what the U.S. spend or even Germany for
that matter and has a higher life expectancy
than either nation. American health care is
expensive and profitable but it is not friendly
to those in the U.S. who are in need of care
and have no financial resources.
Sociology has an important role to play in
increasing understanding of the health care
sector within and between nations.
Unfortunately, it is not as widely
disseminated (übergetragen) as it should be.
Vielen dank für ihre Aufmerksamkeit!