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Medicine, Socialized

Medicine, Socialized

BIBLIOGRAPHY

The American Heritage Dictionary (4th ed., 2001) defines socialized medicine as a system for providing medical and hospital care for all at a nominal cost by means of government regulation. This leaves room for considerable craftsmanship in the construction of socialist systems. Indeed existing socialized medical systems in, for example, Great Britain, Cuba, Finland, and Switzerland conform to this definition, but are far from monolithic.

Because every aspect of a socialized health care industry is controlled and provided by the governmentmost doctors, nurses, medics, and administrators are government employeesthe system, such as the National Health Service (NHS) in Britain, determines where, when, and how services are provided. Of course citizens may seek care outside the system, in the private sector.

Socialized medical systems are designed to eliminate the insurance industry and marginalize profit while providing health care for all. According to many recent studies, socialized systems outperform free-market profit-driven systems in terms of availability, quality, and cost of care. In addition a report from the Johns Hopkins University Bloomberg School of Public Health stated that the United Kingdoms socialized medical system outperforms the U.S. system in patient-reported perceptions (Blendon, Schoen, DesRoches, et al. 2003). In other words, the people with direct experiences report greater satisfaction with their health services under a socialized system than they do in a free-market system. These results must be considered along with the fact that the U.S. per capita health care expenditures ($4,887) are nearly triple those in the United Kingdom ($1,992). In the year 2000 the United States spent 44 percent more on health care than Switzerland, the nation with the next highest per capita health care costs. Nevertheless, Americans had fewer physician visits, and hospital stays were shorter compared with those in most other industrialized nations. The study suggests that the difference in spending is caused mostly by higher prices for health care goods and services in the United States.

The British system is probably the most instructive example for Americans to evaluate because of the similarities in economy and government structure between the two nations. According to the NHS Web site, the system was set up on the 5th July 1948 to provide healthcare for all citizens, based on need, not the ability to pay (National Health Service 2007). Originally conceived as a response to the massive casualties of World War II (19391945), the system survives and continues to evolve in the early twenty-first century. The NHS is funded by taxpayers and managed by the Department of Health, which sets overall policy on health issues. Individual patients are assigned a primary care center (with doctors, dentists, optician, pharmacist, and a walk-in center) managed by a primary care trust (PCT). The NHS explains its system of referrals this way: If a health problem cannot be sorted out through primary care, or there is an emergency, the next stop is hospital. If you need hospital treatment, a general practitioner will normally arrange it for you (National Health Service 2007).

The PCTs are responsible for planning secondary care. They look at the health needs of the local community and develop plans to set priorities locally. They then decide which secondary care services to commission to meet peoples needs and work closely with the providers of the secondary care services to agree about delivering those services.

The NHS may be the worlds most sophisticated socialized medical system, but the modern worlds first such system was established by the former Soviet Union in the 1920s. Whereas the NHS demonstrates that socialized medicine can exist within a capitalist economy, the failures of Soviet medicine demonstrated how corruption within a society can distort any system. China, Cuba, Sweden, and most of Scandinavia have successful and completely socialized health care systems.

Life expectancy and infant mortality rates are two of the best indicators of overall health. Average life expectancy in Great Britain was 77.4 years in 1998; in comparison, life expectancy for the U.S. population reached 76.9 years in 2000. Infant mortality in Finland is below 4 percent; in the United States it is 7 percent. Health services are available to all in Finland, regardless of their financial situations.

Single-payer systems such as Medicare are not socialized medicine. In socialized systems the government owns, operates, and provides every aspect of the health care services. Although it is true that in a single-payer system the government collects and disperses the capital for services rendered, its decision-making responsibilities end there. Even without socialized medicines additional powers to limit corporate profits, studies by the U.S. General Accounting Office and the Congressional Budget Office show that single-payer universal health care would save $100 to $200 billion dollars per year while covering every currently uninsured American and increasing health care benefits to those already insured (U.S. Government Accounting Office 1991; Congressional Budget Office 1993).

Outside of the United States, health care in the twenty-first century is increasingly seen as a basic human right that deserves to be protected and provided at an affordable fee to all citizens of civilized societies. This ideathat medical procedures and health care in general should not be subject to or motivated by market forces is one that, in the late twentieth century, evolved back into favor only after repeated experiments with the capitalization of health care led to systematic and catastrophic failures, resulting in grotesque profits on the supply side contrasted with the suffering of millions of disenfranchised patients on the demand side of the equation. Socialized medicine is an egalitarian system that addresses these iniquities.

SEE ALSO Egalitarianism; Human Rights; Medicine; Morbidity and Mortality; National Health Insurance; Public Health; Socialism; Union of Soviet Socialist Republics

BIBLIOGRAPHY

Anderson, Gerard, and Peter Hussey. 2001. Comparing Health System Performance in OECD Countries. Health Affairs 20 (3): 219232.

Blendon, Robert J., Cathy Schoen, Catherine DesRoches, et al. 2003. Common Concerns amid Diverse Systems: Health Care Experiences in Five Countries. Health Affairs 22 (3): 106121.

Congressional Budget Office. 1993. Single-Payer and All-Payer Insurance Systems Using Medicares Payment Rates. Washington, DC: Author.

National Health Service. 2007. NHS in England. http://www.nhs.uk.

U.S. Government Accounting Office. Canadian Health Insurance: Lessons for the United States. Document GAO/HRD-91-90. Washington, DC: Author.

Woolhandeler, Steffie, and David Himmelstein. 1991. The Deteriorating Administrative Efficiency of the U.S. Health Care System. New England Journal of Medicine 324: 12531258.

World Health Organization. 2000. The World Health Report 2000: Health Systems Improving Performance. Geneva: Author.

Eugene Straus

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medicine, sociology of

medicine, sociology of A field of sociology that focuses on medicine as a set of ideas and practices. However, exact delineation of the field is problematic. In the first place, there is disquiet about identifying a field of sociology in terms of its relation to another profession. This issue has often been raised by drawing a contrast between sociology in medicine and the sociology of medicine. Sociology in medicine, it is argued, works within the constraints and parameters of medicine, accepting its objectives and priorities. Sociology of medicine adopts a more detached, critical approach, in which the sociological enterprise has priority over the medical. According to this argument, the sociology of medicine is consequently a legitimate field of sociology, whereas sociology in medicine is not. However in both cases the field is still defined in relation to medicine. Other writers prefer a broader designation of the territory, such as the sociology of healing or of healers, or the sociology of health-care systems, in order to make it clear that doctors are not the only group involved in healing or the only components of the health-care system. There are a range of health carers such as nurses and physiotherapists, as well as informal carers, whose work needs to be examined and should not be subsumed under the umbrella of medicine. A further problem with the delineation of the field concerns the relation of the sociology of medicine to the sociology of health and illness. Many would argue that the sociology of medicine necessarily embraces the sociological study of health and illness, since these are the core of medicine's concern; others would argue that the focus should be rather narrower and concentrate on medicine as a profession, and that the sociology of health and illness should be treated as a separate field of study.

Notwithstanding these territorial difficulties, the sociology of medicine, broadly defined, has flourished since the 1950s. Although its roots lie in part in the social medicine of the inter-war years and earlier, its sociological impetus came primarily from Talcott Parsons's influential work on the medical profession and the sick role, which put medicine and illness into the mainstream of sociology.

Leaving aside the questions concerning health and illness, the sociology of medicine in its narrower definition focuses on two major issues. A first and dominant concern is to analyse the nature, extent, and origins of the power of the medical profession, and the relation of the medical profession to other allied professions. The work of Eliot Freidson in The Profession of Medicine (1971), with his emphasis on autonomy as the defining feature of a profession, exemplifies this tradition. It has been further developed by a number of feminist writers, such as Ann Oakley, who have examined the exclusionary tactics deployed by the medical profession in the medicalization (a term particularly associated with Ivan Illich's study Medical Nemesis, 1976) of events such as childbirth–a medicalization that not only excludes the female midwife but also increases the powerlessness of women who are giving birth.

Doctor-patient relationships constitute the second major focus of the sociology of medicine, with work ranging from in-depth studies of doctor-patient interactions, including analyses of tape-recorded doctor-patient exchanges, to large-scale surveys of doctor-patient satisfaction, the time spent with patients, and so forth. The care of the dying has received especial attention, as has the socialization of medical students. Ruth Laub Coser's Life in the Ward (1962) illustrates this tradition.

However, whilst these two areas will no doubt remain at the core of the sociology of medicine, it seems likely that the activities of the medical profession will be increasingly located within the context of the study of other health workers and the wider health-care system (see U. Gerhardt , Ideas about Illness: An Intellectual and Political History of Medical Sociology, 1989). Emily Mumford 's Medical Sociology (1983)
is one of the many textbooks dealing with this specialism.

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socialized medicine

socialized medicine, publicly administered system of national health care. The term is used to describe programs that range from government operation of medical facilities to national health-insurance plans. In 1948, Great Britain passed the National Health Service Act that provided free physician and hospital services for all citizens. The system was later amended, now charging a small fee for the filling of prescriptions and the purchasing of eyeglasses and dentures; it is funded jointly by a health-insurance tax and by the national treasury. Doctors are salaried by the government and receive an additional allotment per patient and for the performance of special services. Sweden maintains a compulsory health-insurance plan that provides for income compensation, hospital treatment, most of the physician's fee, and part of the cost of medicines. Maternity benefits are provided for expectant women. A large percentage of Israel's medical care is provided by the Histadrut, the national labor union. A number of private welfare organizations also provide care, and the armed forces maintain a number of military hospitals whose services are widely used since many citizens of Israel are military veterans. Canada has a federally sponsored system of medical insurance with voluntary participation on the part of each province; the system is funded by taxes and contributions from the government. The United States is the only major Western country without some form of socialized medical care. However, it does sponsor Medicare, a federally administered program for those over 65, and Medicaid, a federally funded program of medical care for the poor that is administered by the individual states. Veterans have access to Veterans Health Administration facilities; care is free or partially subsidized, depending on whether injuries and disabilities are service connected.

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public health medicine

public health medicine (pub-lik) n. the speciality concerned with preventing disease in populations as distinct from individuals. Formerly known as community or social medicine, it includes epidemiology, health promotion, health service planning, health protection, and evaluation.

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