a. I was surprised to read that increased competition among practitioners may lead to practice changes such as increased office hours, home visits, and more time spent with patients. This makes sense, but because each chapter up to this point discussed how the medical field expanded in a way that wasn't beneficial to patients always, it was interesting to learn about a shift which may occur in the opposite direction.
b. I agree that the independent small businessman is "firmly rooted in the American imagination." Many people think of this as the "American Dream." I also agree with the author that large corporations have kicked him out of the American economy, if he ever had a place in it.
c. I disagree with the author's statement that "images of the future are usually caricatures of the present." I do not think this is true. Many people extrapolate on events of the past and present to predict the future.
d. Something I have witnessed is the diminishing resources which the author discusses in this chapter. We have seen that the NC state budget has been frozen in terms of raises for several years. Programs are being cut from state colleges, and HMOs are becoming more popular as ways of managing financial expenditures.
e. I am looking forward to observing the rise of corporate enterprises in health services. In the last chapter, the author discusses how this might effect the medical field. This will likely result in savings. Corporate enterprises tend to know how to manage money, and may be a good intermediary between government programs and the health care field. This savings in money may come at a cost to other services, but there may also be a shift to saving money in the long-run, such as through preventative care.
Thursday
Chapter 10: End of a Mandate
a. I was surprised to learn that three quarters of heads of families agreed that there was a health crisis in the 70's. It seems an odd time to have a crisis, but after reading about increased costs and population growth in the rest of the chapter, it seems less surprising.
b. I agree with the sudden shift to curb the expansion of medicine's "apparently insatiable appetite for resources." The fact that a "happy sufficiency" was never reached is due to many things, not the least of which include medicine's rapid expansion, population growth, urbanization, economic growth and inflation, and transportation.
c. I disagree that the dynamics of the health care system are easy to follow. I agree with the author that people want to receive the best care possible, and that providers want to make as much money as possible, but the relationship is more complex and involve many more dynamics, such as personal lifestyle, environmental factors, socioeconomic factors, and ethical and legal decisions. I disagree with Feldstein's statement that increases in the "components" of costs related to health care were the result of and not the cause of higher prices. I don't think this makes sense, in that the market drives costs, in terms of supply and demand. The costs were more likely to be in relation to higher demand than to higher expectations, in my opnion.
d. One aspect of the book that I have witnessed is the overexpansion in some services, and the inadequate availability of others. Some fields of practice, such as specialized surgery, have an abundance of physicians, while others, such as primary care physicians in rural areas, have very little supply.
e. Something I will be aware of moving forward is the affect that public medical programs and services, such as Medicare and Medicaid, have on local and state governments. The author mentions how public funding hurt public medical services, by draining money from their budgets.
b. I agree with the sudden shift to curb the expansion of medicine's "apparently insatiable appetite for resources." The fact that a "happy sufficiency" was never reached is due to many things, not the least of which include medicine's rapid expansion, population growth, urbanization, economic growth and inflation, and transportation.
c. I disagree that the dynamics of the health care system are easy to follow. I agree with the author that people want to receive the best care possible, and that providers want to make as much money as possible, but the relationship is more complex and involve many more dynamics, such as personal lifestyle, environmental factors, socioeconomic factors, and ethical and legal decisions. I disagree with Feldstein's statement that increases in the "components" of costs related to health care were the result of and not the cause of higher prices. I don't think this makes sense, in that the market drives costs, in terms of supply and demand. The costs were more likely to be in relation to higher demand than to higher expectations, in my opnion.
d. One aspect of the book that I have witnessed is the overexpansion in some services, and the inadequate availability of others. Some fields of practice, such as specialized surgery, have an abundance of physicians, while others, such as primary care physicians in rural areas, have very little supply.
e. Something I will be aware of moving forward is the affect that public medical programs and services, such as Medicare and Medicaid, have on local and state governments. The author mentions how public funding hurt public medical services, by draining money from their budgets.
Sunday
Chapter 9: The Liberal Years
a. I was surprised to learn about the funding of the polio vaccine by the American people through donations. I did not know that the Salk vaccine was a "folk victory," rather, I just assumed that it had been funded by government research. I was also surprised to learn that nearly half of medical care still took place in patient's homes in 1935.
b. I agree with Starr's position that the national investment expanded and strengthened medical research and hospitals. The NIH budget increased from 81 million dollars to 400, which strengthened and increased medical research. This also helped the NIH to expand to several different institutions, becoming the National Institutes of Health. The income of medical schools also tripled, which led to their expansions into research and patient care.
c. I think that Starr's statement that when opportunities within a profession change, so do the profession is a little misleading. I believe that a profession is always changing. As we have seen throughout the book, the medical profession has been influenced by a number of factors, including political, industrial, geographical, and economical. The opportunities within a profession certainly effect the profession, but no more than many other influences.
d. One thing that I have experienced with Starr mentions is the "categorical approach" to funding of the NIH. The NIH currently has many institutions. Each institution has certain interests. For example, the National Heart, Lung, and Blood Institute is interested in heart and vascular diseases, lung diseases, and blood diseases. In order to apply for a research grant, it is a wise idea to figure out which diseases the institute you are applying to is interested in, as they preferentially apply funding to research for some diseases over others. Starr mentions that "the way to open wide the public's purse was to call attention to one disease at a time." This strategy works for the NIH when seeking government funding, as well as for those researchers hoping to be funded by the NIH.
e. Starr discusses the relationship between medical research and government funding of the NIH. The early part of this century was a time of great increases in medical research. Funding of the NIH more than quadrupled, as did the agencies within the NIH. With the recent 1.6 billion dollar funding cut to the NIH, it will be interesting to see what effect this has on research and the economy.
b. I agree with Starr's position that the national investment expanded and strengthened medical research and hospitals. The NIH budget increased from 81 million dollars to 400, which strengthened and increased medical research. This also helped the NIH to expand to several different institutions, becoming the National Institutes of Health. The income of medical schools also tripled, which led to their expansions into research and patient care.
c. I think that Starr's statement that when opportunities within a profession change, so do the profession is a little misleading. I believe that a profession is always changing. As we have seen throughout the book, the medical profession has been influenced by a number of factors, including political, industrial, geographical, and economical. The opportunities within a profession certainly effect the profession, but no more than many other influences.
d. One thing that I have experienced with Starr mentions is the "categorical approach" to funding of the NIH. The NIH currently has many institutions. Each institution has certain interests. For example, the National Heart, Lung, and Blood Institute is interested in heart and vascular diseases, lung diseases, and blood diseases. In order to apply for a research grant, it is a wise idea to figure out which diseases the institute you are applying to is interested in, as they preferentially apply funding to research for some diseases over others. Starr mentions that "the way to open wide the public's purse was to call attention to one disease at a time." This strategy works for the NIH when seeking government funding, as well as for those researchers hoping to be funded by the NIH.
e. Starr discusses the relationship between medical research and government funding of the NIH. The early part of this century was a time of great increases in medical research. Funding of the NIH more than quadrupled, as did the agencies within the NIH. With the recent 1.6 billion dollar funding cut to the NIH, it will be interesting to see what effect this has on research and the economy.
Chapter 8: The Triumph of Accomodation
a.I was surprised to learn that insurance during the Depression emerged mainly to benefit hospitals, who were struggling to fill their beds. Currently, I think of health insurance as primarily benefiting the enrollee as well as the health insurance company, with a secondary benefit to the physician or hospital, who may see more business. I also found it interesting that actuaries felt that Blue Cross would not succeed due to the difficulties in calculating risks and costs.
b. I agree with Starr's position that financial intermediaries benefit employers and insurance companies. Companies which provide health insurance impart good-will on their employees, and health insurance companies gain profit and power. I agree with several of the principles spelled out by the AMA on medical health services, namely that patients should have "absolute freedom to choose a duly qualified doctor of medicine...from among all those qualitative to practice and who are willing to give service." I believe that one should have the right to choose who they seek care from, although this is not always practical today.
c. I disagree with Starr's statement that "from these two variables alone, nearly all of their other characteristics can be derived," in reference to the type of benefits and how the plans are controlled. Private health plans may only be limited to considering two main types of variables when calculating their financial risks, but certainly financial risks are influenced by an infinite number of characteristics.
d. One element which I have seen in my own experiences is the principle addressed by the AMA that "a permanent, confidential relation between the patient and a "family physician" must be the fundamental, dominating feature of any system." This idealism holds true in my own experiences, where many people esteem to find a doctor who meets their criteria and then hope to continue seeing them as their health provider for long periods. When people see one provider consistently through time, they trust them with a variety of health issues.
e. A topic addressed in Starr's book which I am interested in learning more about is that of moral hazard. Moral hazard refers to the effect on an individual's behavior when they are buffered from a certain risk, such as through health or accident insurance. This concept has been mentioned in several courses. In Starr's example, an entity has trouble calculating risk correctly when risks are ambiguous. This has implications in our society, because there exist many types of health insurance plans, which include different physicians and types of services, and offer different solutions to health problems. Therefore, risk is difficult to determine. Starr's positions on moral risk in regards to preventing abuse, calculating risk, actuarial science, and calculation of health care costs will definitely inform my views as I continue to learn more about moral hazard in my classes.
b. I agree with Starr's position that financial intermediaries benefit employers and insurance companies. Companies which provide health insurance impart good-will on their employees, and health insurance companies gain profit and power. I agree with several of the principles spelled out by the AMA on medical health services, namely that patients should have "absolute freedom to choose a duly qualified doctor of medicine...from among all those qualitative to practice and who are willing to give service." I believe that one should have the right to choose who they seek care from, although this is not always practical today.
c. I disagree with Starr's statement that "from these two variables alone, nearly all of their other characteristics can be derived," in reference to the type of benefits and how the plans are controlled. Private health plans may only be limited to considering two main types of variables when calculating their financial risks, but certainly financial risks are influenced by an infinite number of characteristics.
d. One element which I have seen in my own experiences is the principle addressed by the AMA that "a permanent, confidential relation between the patient and a "family physician" must be the fundamental, dominating feature of any system." This idealism holds true in my own experiences, where many people esteem to find a doctor who meets their criteria and then hope to continue seeing them as their health provider for long periods. When people see one provider consistently through time, they trust them with a variety of health issues.
e. A topic addressed in Starr's book which I am interested in learning more about is that of moral hazard. Moral hazard refers to the effect on an individual's behavior when they are buffered from a certain risk, such as through health or accident insurance. This concept has been mentioned in several courses. In Starr's example, an entity has trouble calculating risk correctly when risks are ambiguous. This has implications in our society, because there exist many types of health insurance plans, which include different physicians and types of services, and offer different solutions to health problems. Therefore, risk is difficult to determine. Starr's positions on moral risk in regards to preventing abuse, calculating risk, actuarial science, and calculation of health care costs will definitely inform my views as I continue to learn more about moral hazard in my classes.
Chapter 7: The Mirage of Reform
a. I was surprised to learn that the original function of health insurance was income stabilization. Sick pay was provided first, and then payment for medical care came after. In our current system, sick pay and health insurance are separate entities. I was also surprised to learn that during a period of expansions in subsidization of medical care by many European countries in the early 1900s, the United States took no action, and ignored the concept entirely. While it is obvious that no compulsory insurance exists today, I was surprised to learn that such a thing was never even pursued, during a time when other developed countries were actively doing so. The author goes on to explain the different political situations, institutions, and beliefs which prevented a government sponsored program from coming to fruition, which was interesting to learn about as well.
b. I agree with the author's position that the expansion of the role of the state in health care both brought more freedom and more restriction. For example, employer provided medical care and sick pay brings freedom, in that employees are able to maintain their standard of living and keep their job during times of brief illness, but it also brings more restriction, in that they are more bound to their current company in loyalty. Starr also discusses restriction in the form of limiting the practitioners policy holders are able to use, and intrusion by the state.
c. In the last sentence of the chapter, Starr mentions that the increase in government financing did not threaten professional sovereignty. I disagree with this because the government has financed many intermediary organizations such as Medicare and Medicaid, which interfere with sovereignty of medical professionals. For example, the government determines the rates at which physicians will be reimbursed for their services. Because such programs comprise a large percentage of health coverage in the U.S., many physicians are forced to accept it. Starr does mention that sovereignty wasn't immediately threatened.
d. One aspect of this chapter that I have experienced in my own life is that of loyalty towards companies and employers due to health care. For instance, many people find their physicians through their employer-sponsored health care plan. Likewise, "good benefits," including paid sick time, and medical and dental insurance are often seen as powerful bargaining tools by employers and employees alike. Most employees consider good benefits extremely important when finding and keeping a job.
e. One aspect of this chapter that I am interested in learning more about is how illness and medical expenses affect the economy. Starr mentions the indirect costs of illness to society. While these concerns were undoubtedly important during the turn of the last century, they have become even more so recently, and will continue to do so.
b. I agree with the author's position that the expansion of the role of the state in health care both brought more freedom and more restriction. For example, employer provided medical care and sick pay brings freedom, in that employees are able to maintain their standard of living and keep their job during times of brief illness, but it also brings more restriction, in that they are more bound to their current company in loyalty. Starr also discusses restriction in the form of limiting the practitioners policy holders are able to use, and intrusion by the state.
c. In the last sentence of the chapter, Starr mentions that the increase in government financing did not threaten professional sovereignty. I disagree with this because the government has financed many intermediary organizations such as Medicare and Medicaid, which interfere with sovereignty of medical professionals. For example, the government determines the rates at which physicians will be reimbursed for their services. Because such programs comprise a large percentage of health coverage in the U.S., many physicians are forced to accept it. Starr does mention that sovereignty wasn't immediately threatened.
d. One aspect of this chapter that I have experienced in my own life is that of loyalty towards companies and employers due to health care. For instance, many people find their physicians through their employer-sponsored health care plan. Likewise, "good benefits," including paid sick time, and medical and dental insurance are often seen as powerful bargaining tools by employers and employees alike. Most employees consider good benefits extremely important when finding and keeping a job.
e. One aspect of this chapter that I am interested in learning more about is how illness and medical expenses affect the economy. Starr mentions the indirect costs of illness to society. While these concerns were undoubtedly important during the turn of the last century, they have become even more so recently, and will continue to do so.
Saturday
Chapter 6: Escape From the Corporation (1900 - 1930)
a. I was surprised to learn that the railroads were the foremost industry when it came to medical care programs for their employees. However, when the author mentioned the high rate of injuries among railroad workers, this made sense. I also was surprised to learn that employee medical programs also expanded and included such services as schools, housing, and social and religious programs. The goals of such programs were two-fold; to encourage morale among workers, and to encourage loyalty to the company.
b. I agree with physicians who were reticent to accept interference or rule by private corporations and government. The idea of one's profession (be it medicine or otherwise) becoming mediated or even controlled by corporations is intimidating. Such relationships can have benefits, for both the physician and the industry or government, such as cooperative teamwork, guaranteed contract work for physicians, and decreased rates of labors for the corporation. However, other concerns, such as lowered quality of medical programs or care, and increased competition due to reduced rate services are understandable, as well. While autonomy was important, mediating corporations could also make a profit from their services, which would no doubt cut into the profits of physicians, adding to the concern.
c. I do not agree with Starr's statement, in reference to the rapid advances of medicine through new technology and antibiotics, that "the chief threat to sovereignty of the profession was the result of this success." I believe that the chief threat to sovereignty was largely due to costs. The growing population, rising costs of medicine, and new precedents of such practices as employer provided health care plans all contributed to the emergence of management organizations.
d. Something I have noticed in my experiences, which Starr mentions, is the introduction of a third party to medical care to curtail rising costs. Today, nearly 30% of health insurance coverage falls under HMOs. Starr mentions that by the second half of the 19th century, it became clear that the use of third parties in care would be unavoidable. In 1973, the Health Maintenance Organization Act was passed, which precipitated expansion of HMOs throughout the country.
e. One thing I am interested in learning more about is the shift from individual practice to mediation by corporations and the government. We have learned about HMOs in this course. In the early 1900s, physicians were hesitant to cooperate with corporations to provide care, but this attitude seems to be shifting. This is likely due to practicality, due to the large presence of HMOs and government programs such as Medicade and Medicare in medical care.
b. I agree with physicians who were reticent to accept interference or rule by private corporations and government. The idea of one's profession (be it medicine or otherwise) becoming mediated or even controlled by corporations is intimidating. Such relationships can have benefits, for both the physician and the industry or government, such as cooperative teamwork, guaranteed contract work for physicians, and decreased rates of labors for the corporation. However, other concerns, such as lowered quality of medical programs or care, and increased competition due to reduced rate services are understandable, as well. While autonomy was important, mediating corporations could also make a profit from their services, which would no doubt cut into the profits of physicians, adding to the concern.
c. I do not agree with Starr's statement, in reference to the rapid advances of medicine through new technology and antibiotics, that "the chief threat to sovereignty of the profession was the result of this success." I believe that the chief threat to sovereignty was largely due to costs. The growing population, rising costs of medicine, and new precedents of such practices as employer provided health care plans all contributed to the emergence of management organizations.
d. Something I have noticed in my experiences, which Starr mentions, is the introduction of a third party to medical care to curtail rising costs. Today, nearly 30% of health insurance coverage falls under HMOs. Starr mentions that by the second half of the 19th century, it became clear that the use of third parties in care would be unavoidable. In 1973, the Health Maintenance Organization Act was passed, which precipitated expansion of HMOs throughout the country.
e. One thing I am interested in learning more about is the shift from individual practice to mediation by corporations and the government. We have learned about HMOs in this course. In the early 1900s, physicians were hesitant to cooperate with corporations to provide care, but this attitude seems to be shifting. This is likely due to practicality, due to the large presence of HMOs and government programs such as Medicade and Medicare in medical care.
Chapter 5: The Boundaries of Public Health
a. I was surprised to learn that the golden age of public health at the turn of the century was followed by relegation to secondary status to clinical medicine, with less financing. This seems counter-intuitive; with so many achievements in such a short amount of time, such as the development of state health departments, and the advancement of dispensaries. However, this shift is perhaps understandable, considering the ambivalence of private physicians towards public health and private dispensaries, as described throughout the chapter.
b. I agree that the maintenance of the public's health allows or even demands concern with almost every aspect of life. For example, public health involves people's diet, sleep, family life, habits, weight, mood, community, and environment.
c. I disagree with Charles V. Chapin's view that poor housing does not contribute to poor health. For examples, roaches can have implications for people with asthma, mold can cause illness, and vermin can carry diseases. Clean and safe housing has important implications for health. Further, location of housing towards trails, parks, and farmer's markets also contributes to health, as well.
d. One thing mentioned in this chapter that I have experienced is that timely medical assistance often keeps people out of poverty. Social worker Mary Richmond remarked upon this fact in Chaper 5, noting that timely medical assistance did not result in a "downward tendency." It is true that when people are able to receive treatment quickly, they can maintain their health, return to work faster, and thus stay out of poverty.
e. One aspect of the Starr book that I was interested in learning about is that of primary prevention and the role of external factors in public health, such as community and environment. In this chapter, Starr mentions that latent tuberculosis was widespread among people in the late 1800s and early 1900s, but that many were not sick. This prompted efforts at improving resistance via nutrition, housing, and working conditions. Starr notes that these interventions may be as important as preventing infection itself. This is one example of primary prevention, in that improvements in general health can help prevent specific diseases from causing illness. It is also interesting to note that the individual was not held chiefly accountable, but that aspects of the individual's environment, such as the workplace and housing, were also mentioned. Starr later notes that attention shifted from the environment to the individual, which is seen today. Currently, our country's medical system focuses on tertiary or secondary prevention. There is also an emphasis on personal responsibility. It is interesting to note that just 100 years ago, important aspects of primary prevention and external forces on health, such as workplaces and housing and communities were seen as important.
b. I agree that the maintenance of the public's health allows or even demands concern with almost every aspect of life. For example, public health involves people's diet, sleep, family life, habits, weight, mood, community, and environment.
c. I disagree with Charles V. Chapin's view that poor housing does not contribute to poor health. For examples, roaches can have implications for people with asthma, mold can cause illness, and vermin can carry diseases. Clean and safe housing has important implications for health. Further, location of housing towards trails, parks, and farmer's markets also contributes to health, as well.
d. One thing mentioned in this chapter that I have experienced is that timely medical assistance often keeps people out of poverty. Social worker Mary Richmond remarked upon this fact in Chaper 5, noting that timely medical assistance did not result in a "downward tendency." It is true that when people are able to receive treatment quickly, they can maintain their health, return to work faster, and thus stay out of poverty.
e. One aspect of the Starr book that I was interested in learning about is that of primary prevention and the role of external factors in public health, such as community and environment. In this chapter, Starr mentions that latent tuberculosis was widespread among people in the late 1800s and early 1900s, but that many were not sick. This prompted efforts at improving resistance via nutrition, housing, and working conditions. Starr notes that these interventions may be as important as preventing infection itself. This is one example of primary prevention, in that improvements in general health can help prevent specific diseases from causing illness. It is also interesting to note that the individual was not held chiefly accountable, but that aspects of the individual's environment, such as the workplace and housing, were also mentioned. Starr later notes that attention shifted from the environment to the individual, which is seen today. Currently, our country's medical system focuses on tertiary or secondary prevention. There is also an emphasis on personal responsibility. It is interesting to note that just 100 years ago, important aspects of primary prevention and external forces on health, such as workplaces and housing and communities were seen as important.
Tuesday
Chapter 4: The Reconstitution of the Hospital
a. I was surprised to learn that states actually abolished home relief, making treating the sick in one's own home against policy, except in times of economic distress. This was surprising because today, many people care for the sick in their own homes. One example is caregiving of people with dementia, which is often times done in the home (albeit, often with the help of some home modifications and health care professionals). I was also surprised to learn that attempts to build hospitals in the early 1900s were met with resistance. I understood that hospitals were seen as dirty places for the homeless and indigent, but it seems that people in the town would prefer to have these people taken care of while being partitioned in an area away from the rest of healthy society.
b. I agree that developments of the Civil war helped the medical field. This is not unprecedented, as wars have brought increases in illnesses and injuries, which forced medicine to advance in order to cope. Starr describes the Civil war as increasing cleanliness and organization. Similarly, wars in the past have resulted in or contributed to advances in surgery and medication such as penicillin.
c. I disagree that modern day hospitals are "citadels of science and bureaucratic order." For example, many hospitals today are crowded and disorganized. Many hospitals can hardly be called citadels of order, although this may be the goal.
d. Starr describes the average length of hospital stays as declining from weeks to days. I have seen this in my own experiences. With Medicare and managed care organizations, along with policy and other changes, patients have limits on the length of stay allowed or reimbursed for care. Starr discusses the average length of a hospital stay as declining from weeks to days. Today, most patients rarely spend the night. Many procedures are outpatient procedures.
3. The information in the Starr book may influence my view on the idea of hospital privileges for doctors. Starr explains that hospital privileges were given to doctors as a way to feed patients into the hospital system, in order to benefit the hopsitals financially. I had always thought that hospital privileges were something which physicians primarily sought out, due to convenience, necessity, and prestige
b. I agree that developments of the Civil war helped the medical field. This is not unprecedented, as wars have brought increases in illnesses and injuries, which forced medicine to advance in order to cope. Starr describes the Civil war as increasing cleanliness and organization. Similarly, wars in the past have resulted in or contributed to advances in surgery and medication such as penicillin.
c. I disagree that modern day hospitals are "citadels of science and bureaucratic order." For example, many hospitals today are crowded and disorganized. Many hospitals can hardly be called citadels of order, although this may be the goal.
d. Starr describes the average length of hospital stays as declining from weeks to days. I have seen this in my own experiences. With Medicare and managed care organizations, along with policy and other changes, patients have limits on the length of stay allowed or reimbursed for care. Starr discusses the average length of a hospital stay as declining from weeks to days. Today, most patients rarely spend the night. Many procedures are outpatient procedures.
3. The information in the Starr book may influence my view on the idea of hospital privileges for doctors. Starr explains that hospital privileges were given to doctors as a way to feed patients into the hospital system, in order to benefit the hopsitals financially. I had always thought that hospital privileges were something which physicians primarily sought out, due to convenience, necessity, and prestige
Chapter 3: The Consolidation of Professional Authority (1850 - 1930)
a. I was surprised to learn of the mutual hostility among practitioners. I suppose this should not be surprising, given the competition of the time, and the surplus of practitioners, but it does offer a contrast to today's world where many practitioners work with one another and benefit from networking, coordinating care, and making and receiving referrals.
b. One point that I agree with is that the structure of society does not remain fixed throughout time. Most aspects of society are dynamic, and experience changes, whether cyclical or linear in direction. This has been seen in professions other than medicine. The rise of the technology boom along with the internet in the late 90s resulted in growths in the industry, which experienced rapid decline in the early 2000s, with the dot-com crash. While more sudden in growth and more extreme in its rapid decline, it provides one example of how professions and social structures are constantly evolving. I also agree that common identity is imparted along with prolonged training, as this is certainly true among other professions and training.
c. One point I disagree with is the author's statement that "internally divided, it was incapable of mobilizing its members for collective action." I do not think it is necessary or even ideal for all members of a profession or group to agree on everything. Internal division can actually help mobilize members. Indeed, internal division is what initiated the medical community to make many changes, including the formation of authoritative medical associations, which also brought important organizational changes. Even today, there is some division among the medical community, such as the division of specialties into emerging specialties or sub-specialties, which can drive change and even collective action.
d. Reading about how inequalities among doctors parallel class structure applies to an experience I have had as a patient, because wealthier doctors tend to live in areas where wealthier people in general live. For example, there are not very many physicians or health care professionals in rural areas, which tend to be poorer. In this way, the social class structure of the two groups parallel one another.
e. One way the Starr book will influence my view on a topic is when thinking about interest groups. For example, in another public health course on politics and policy development, we are learning about interests (as in interest groups). The Starr book discusses how interest group organizations tend to produce generalized benefits. This is somewhat different than what I have learned in my other class, in that interest groups don't necessarily. For example, highway development interest groups, which are focused on building, expanding, or improving roads, may not necessarily strive to build roads which the general public needs. The Starr book specifically mentions organizational benefits in the form of "selective incentives" for participants in professional organizations. This is a new type of interest group which we have not studied, and it will be interesting to apply the concept of selective benefits to other types of interest groups.
b. One point that I agree with is that the structure of society does not remain fixed throughout time. Most aspects of society are dynamic, and experience changes, whether cyclical or linear in direction. This has been seen in professions other than medicine. The rise of the technology boom along with the internet in the late 90s resulted in growths in the industry, which experienced rapid decline in the early 2000s, with the dot-com crash. While more sudden in growth and more extreme in its rapid decline, it provides one example of how professions and social structures are constantly evolving. I also agree that common identity is imparted along with prolonged training, as this is certainly true among other professions and training.
c. One point I disagree with is the author's statement that "internally divided, it was incapable of mobilizing its members for collective action." I do not think it is necessary or even ideal for all members of a profession or group to agree on everything. Internal division can actually help mobilize members. Indeed, internal division is what initiated the medical community to make many changes, including the formation of authoritative medical associations, which also brought important organizational changes. Even today, there is some division among the medical community, such as the division of specialties into emerging specialties or sub-specialties, which can drive change and even collective action.
d. Reading about how inequalities among doctors parallel class structure applies to an experience I have had as a patient, because wealthier doctors tend to live in areas where wealthier people in general live. For example, there are not very many physicians or health care professionals in rural areas, which tend to be poorer. In this way, the social class structure of the two groups parallel one another.
e. One way the Starr book will influence my view on a topic is when thinking about interest groups. For example, in another public health course on politics and policy development, we are learning about interests (as in interest groups). The Starr book discusses how interest group organizations tend to produce generalized benefits. This is somewhat different than what I have learned in my other class, in that interest groups don't necessarily. For example, highway development interest groups, which are focused on building, expanding, or improving roads, may not necessarily strive to build roads which the general public needs. The Starr book specifically mentions organizational benefits in the form of "selective incentives" for participants in professional organizations. This is a new type of interest group which we have not studied, and it will be interesting to apply the concept of selective benefits to other types of interest groups.
Wednesday
Chapter 2: The Expansion of the Market
a. I was surprised to learn that medicine in England was largely regarded as philanthropic. For a time, physicians were assumed to be "above" material gains, due to the nature of their work, as well as their social status. I was surprised to learn this because my view of physicians is that most of them do not come from elite backgrounds, and must do some kind of work. Further, it does not seem a coincidence that the highest paid specialties are also among the most popular and competitive in medical practice today.
b. One point that I agree with is the author's statement that limited training was more a response to effective demand, rather than ignorance. This is evident when you take into consideration the fact that during this time, medicine was only just emerging as an economic institution, and was mostly limited to the realm of family and home. There simply was not enough demand to justify the necessary level of training and education, yet.
c. The author states that "the social history of medicine in the nineteenth century is a history of both the extension of the market and its restriction," noting a "double movement." I would disagree that there was double movement. It seems as though there was clear movement in one direction, with merely a certain amount of reticence acting against it. Medicine in the 19th century was definitely expanding its presence in the market, and did not seem to retract during this time. The author even states that "the market expanded continuously."
d. Much of medical care was provided on credit, and substantial amounts of money were lost through unpaid bills. This applies to an aspect of the health care system that I have had experience with in that many times, a patient seeks care and is not able to pay when they are treated, or in a timely manner, or perhaps ever. The difference is that hospitals are now the ones losing money, while physician salaries are fixed.
e. The information on the Starr book has influenced my view on medicine in that I am now beginning to see how medicine exists as a market. I am also beginning to see how economic patterns influence the dispersion of physicians in urban and rural areas. For instance, easy entry into medical practice and a surplus of physicians meant that physicians often had to travel to remote or "frontier" areas and to under charge for their services in order to set up a practice. This resulted in dispersion among rural areas. The transportation revolution and emergence of medicine as a market helped to drive physicians out of rural areas, and into cities, where they could see more patients. The effects of this migration are seen today, with critically low numbers of health care professionals in rural areas, such as the Missisipi Delta region.
b. One point that I agree with is the author's statement that limited training was more a response to effective demand, rather than ignorance. This is evident when you take into consideration the fact that during this time, medicine was only just emerging as an economic institution, and was mostly limited to the realm of family and home. There simply was not enough demand to justify the necessary level of training and education, yet.
c. The author states that "the social history of medicine in the nineteenth century is a history of both the extension of the market and its restriction," noting a "double movement." I would disagree that there was double movement. It seems as though there was clear movement in one direction, with merely a certain amount of reticence acting against it. Medicine in the 19th century was definitely expanding its presence in the market, and did not seem to retract during this time. The author even states that "the market expanded continuously."
d. Much of medical care was provided on credit, and substantial amounts of money were lost through unpaid bills. This applies to an aspect of the health care system that I have had experience with in that many times, a patient seeks care and is not able to pay when they are treated, or in a timely manner, or perhaps ever. The difference is that hospitals are now the ones losing money, while physician salaries are fixed.
e. The information on the Starr book has influenced my view on medicine in that I am now beginning to see how medicine exists as a market. I am also beginning to see how economic patterns influence the dispersion of physicians in urban and rural areas. For instance, easy entry into medical practice and a surplus of physicians meant that physicians often had to travel to remote or "frontier" areas and to under charge for their services in order to set up a practice. This resulted in dispersion among rural areas. The transportation revolution and emergence of medicine as a market helped to drive physicians out of rural areas, and into cities, where they could see more patients. The effects of this migration are seen today, with critically low numbers of health care professionals in rural areas, such as the Missisipi Delta region.
Monday
Chapter 1: Medicine in A Democratic Culture (1760 - 1850)
a. I learned several things which surprised me. I was surprised by John C. Gunn's comment that Latin names for medical terminology were "originally made use of to astonish the people." I found this idea interesting, and in keeping with the last sentence of the chapter, which explains that "the democratic interregnum of the nineteenth century was a period of transition, when the traditional forms of mystification had broken down and the modern fortress of objectivity had not yet been built." John C. Gunn and other practitioners of the time, such as William Buchan, advocated to make medicine less "mystical," and more accessible to the public. Using common names, rather than Latin, which most people did not speak, would help to accomplish this by making medicine easier to understand by lay people.
b. The author states that "A profession, by its nature, is an inegalitarian institution; it claims to enjoy a dignity not shared by ordinary occupations and a right to set its own rules and standards." I agree with the author's statement that professions are inegalitarian. People who are less privileged may not have access to education. Professions require education and specialized training, separating professionals from those who don't have access to the same opportunities.
c. I don't agree with Gunn's statement that using Latin names for diseases and medicines were meant to contribute to confusion and fraud. For example, Latin has been considered a universal language in the Western world. The Latin word for an herb is the same among physicians who speak different languages and live in different parts of the world. Latin is also the mother language for all of the Romance languages, including English. Therefore, physicians in England would have used Latin. Doctors in colonial America used the social structure of medicine in eighteenth-century England as a model; early physicians in the U.S. were likely simply copying what physicians in England did, out of practicality due to its establishment as a common language.
d. One thing I have read which applies to an experience I have had with an aspect of the healthcare system is that "much treatment of the sick takes place outside of the doctor's sphere in the home or under alternative practitioners." This is still true, as most people will self-diagnose and self-treat a wide range of illnesses, such as colds, flu, stomach viruses, and cuts. Most illnesses do not require a visit to the doctor, and even when they do, most of the treatment, such as rest, and taking medication, takes place at home. Only more serious illnesses require stays in a hospital or observation of a physician.
e. I expect that the information in the Starr book will influence my view on how physicians and medical schools operate today. It provided me the opportunity to learn how the medical education and physician licensing practicing existed before its current state. I had never thought of medical education and practice as evolving in the way described by Starr in Chapter 1. Because of this knowledge, I have come to think of our current system as also in development, and have started thinking about ways in which it too, may develop.
b. The author states that "A profession, by its nature, is an inegalitarian institution; it claims to enjoy a dignity not shared by ordinary occupations and a right to set its own rules and standards." I agree with the author's statement that professions are inegalitarian. People who are less privileged may not have access to education. Professions require education and specialized training, separating professionals from those who don't have access to the same opportunities.
c. I don't agree with Gunn's statement that using Latin names for diseases and medicines were meant to contribute to confusion and fraud. For example, Latin has been considered a universal language in the Western world. The Latin word for an herb is the same among physicians who speak different languages and live in different parts of the world. Latin is also the mother language for all of the Romance languages, including English. Therefore, physicians in England would have used Latin. Doctors in colonial America used the social structure of medicine in eighteenth-century England as a model; early physicians in the U.S. were likely simply copying what physicians in England did, out of practicality due to its establishment as a common language.
d. One thing I have read which applies to an experience I have had with an aspect of the healthcare system is that "much treatment of the sick takes place outside of the doctor's sphere in the home or under alternative practitioners." This is still true, as most people will self-diagnose and self-treat a wide range of illnesses, such as colds, flu, stomach viruses, and cuts. Most illnesses do not require a visit to the doctor, and even when they do, most of the treatment, such as rest, and taking medication, takes place at home. Only more serious illnesses require stays in a hospital or observation of a physician.
e. I expect that the information in the Starr book will influence my view on how physicians and medical schools operate today. It provided me the opportunity to learn how the medical education and physician licensing practicing existed before its current state. I had never thought of medical education and practice as evolving in the way described by Starr in Chapter 1. Because of this knowledge, I have come to think of our current system as also in development, and have started thinking about ways in which it too, may develop.
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