The Future of Medical Sociology
The Health Insurance Experiment and many of the studies that followed point to the extent to which the course of disease and the behavior of patients and health professionals are governed by noneconomic factors. The uncontrollable costs of medical care will continue to occupy a central place on the health policy agenda.
Inequities have increased in access to care and in quality of service, and significant proportions of our population are under‐ or uninsured. Encouragement of competitiveness has basically demolished our system of community rating, making it difficult for those who most need health insurance to obtain it. Tax subsidies for insurance give substantial entitlements to the most affluent, encouraging over insurance and overuse among those who need care the least. We lack a viable strategy for organizing or paying for long‐term care, despite the growing size of the elderly population and the old‐old subgroup. Care for chronic illness–particularly for the stigmatized chronically mentally ill, alcohol and chemical abusers, and people with AIDS– is fragmented and in disarray. In the face of galloping medical technology, we lack standards of care and waste enormous resources through unnecessary and inappropriate procedures. Administrative costs are extraordinarily high. And, we have yet to effectively engage the tough ethical issues that biomedical advances make inevitable. Examination of the future health care agenda makes it abundantly clear that if we didn’t have sociology of health we would now have to invent one. The influences affecting health and the provision of services are largely social, and the way we address problems of illness and care reflects our values and the arrangement of powerful interests within our social system. In a recent volume issued by The Henry J. Kaiser Family Foundation, Pathways to Health: The Role of Social Factors, substantial documentation is again presented,illustrating the pervasive influence of socioeconomic factors on disease processes, health status, longevity, and access to medical care. The integrity of our health care system requires that we address questions relating to such broad influences as well as to the more technical immediate ones and that we critically examine our goals and initiatives in the light of the best scientific knowledge of the determinants of health and welfare. There is little doubt that the powerful interests in our health care system, and our political processes of decision making, create serious obstacles to fundamental change. Nevertheless, a clear view of our goals, and the structures necessary to implement them, is an essential basis for constructive advancement.
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