Health 10/25/05 care and health care delivery Healthcare as a social problem-is adequate healthcare a human right, ex: should everyone be entitled to it? (social compact) Healthcare as a commodity- "the US has the best health care that MONEY can buy" Should healthcare delivery be "for-profit" enterprise? Factors that contribute to good health: Adequate diet manageable levels of stress Exposure to pollution work conditions
shelter exercise healthcare-preventable, treatment
Morbidity and mortality not randomly distributed- consequences of dominant/subordinate relations. Race Class Gender Sexual orientation Health care crisis Cost rising health care costs The US spends a larger % (>15%) of GDP than any other industrialized country. Lower return (as measured by life expectancy, infant mortality, years spent in poor health) Why is health care so expensive? Little on prevention Fee for service 3rd party pay fraud-fee splitting Privatization AIDS Drugs Access 45 M are uninsured >50M more are underinsured Health insurance is tied to employment Medicare/Medicaid (govt safety net for uninsured) Related problems (structural discrimination- occurring across social institutions) Real income dropping- health care rising (most bankruptcies due to medical expenses) Growth of contingency (no workers benefits) Dual labor market (primary/secondary) Unemployment/underemployment Welfare reform *Caveat emptor- buyer beware Prescription drug costs have risen 2x the rate of healthcare and 5x the rate of inflation. Costly for insured - Extremely costly for the uninsured More ppl taking medicines (chronic diseases Advertising) Research & Development (R&D) Aging population Shift from surgical to drug therapy Prescription drugs are not competitively priced/purchased PBMs (Prescription Benefits Managers)-negotiate prices betw. Pharmacetical companies, insurers (conflict of interests?) **AWP (Average Wholesale Price)-sticker price-the base from which discounts for bulk buyers are calculated. Determines the much higher price the uninsured are paying. 1. 2. 3. 4. Is the phr. Industry organized in the most effective way for the best health care delivery? What mechanisms are used that are consistent with the phr. Industry being a profit driven industry? How do you balance the need for affordable drugs with incentives for the industry to continue R&D. What keeps the costs of prescription drug high? And patients from buying low cost alternatives (generics)?
Aging population Artificial physician shortage unnecessary hospital stay Patient dumping
*Interest in profit, not health.