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dancerjodiHere's the intro for my paper and the historical context for what I'm discussing (relationship between research and health care policy).
What I'm hoping to complete tonight will be the rest of the paper (a discussion of the theoretical concepts related to sociologically-based research, 5 research studies that are either policy-relevant or policy-oriented, a discussion on "the current state of things" and my conclusion. I'll also need to write my Bibliography and attribute things appropriately throughout the paper (I don't have the ASA specific guidelines with me at work)
If this is remotely interesting to you at all could you take a look at it? I think this is kind of long (the whole paper for this class only needs to be 8 pages and what I have done already is at 3 - though, I don't know how much what I have to say for the remaining parts will take up yet). I guess its not bad though, that I got this much done in my hour lunch break :)
Thanks in advance (and please note, formatting like tabs and Italics may not come through, and I haven't done spellcheck or printed this out and read it for grammatical issues yet)!
Linking Research and Health Care Policy
The field of medicine has experienced various changes over time that have impacted the research conducted and related health care policy activity. Political decisions are not always based on clear empirical research and research itself is not free from political bias. This paper will discuss the historic trends in the medical profession, its relationship to health care policy and some examples of research with either policy implications or that have been done on policy changes. I will conclude with some discussion about the current situation in the medical field and possible future directions for research and policy.
There have been many changes in the field of medicine over the years. According to Gray and O’Leary the American Sociological Association (ASA) first included Medical Sociology as a specialty in 1955 (Bird et al, 2000). At first health care policy was not considered in a research world where work looked at health care as a closed system involving caregivers or epidemiology. Those researchers with an applied focus worked in medical schools to help providers to “better understand how social factors effect medical care . . . medical sociology seemed to be part of the social amelioration tradition from which scientific sociology sought to escape” (Bird et all, 2000: page 260). As in other specialties of Sociology there existed a clash between the pure and applied research schools.
It is also important to note that at the time of the founding of the field of medical sociology, health-policy was stable and government was ‘unobtrusive’. Gray and O’Leary note that: “A stable policy environment is not a fertile ground for the emergence of a policy-sensitive cadre of researchers” (Bird et al, 200: page 261). Things would not remain so stable however in the health care world. Health policy was largely impacted in 1965 with the creation of Medicare and Medicaid during the ‘Great Society Period’. This was also accompanied by civil rights legislation, which resulted in no more racially segregated health facilities, and also a higher emphasis on access and equity of care (Bird et al, 2000). The late 60’s brought with it the concern of medical cost-containment and further government policies of this time period focused on this such as The HMO Act of 1973 which gave financial support for development of HMOs, set standards for community rating systems and made employers offer HMOs as an option with health benefit programs. Other changes related to health care included amendments to Medicare that created the Professional standards Review Organization who was entitled to review medical necessity of admissions and continuing length of stay and the National Health Planning and Resources Development Act which rationalized hospital construction and placed control over number of beds in facilities (Bird et al, 2000).
These historical acts had great effect on the field of Sociology (and the related sociological research conducted on health care issues). Bert Swanson wrote in the 1972 Handbook of Medical Sociology that since programs had expanded government activity and made health care a more important policy issue it was important for medical sociologists to look at these issues: “The question is no longer whether there is a ‘politics of health’ but how better to understand the political process” (Bird et al, 2000: page 263). Drastic political changes to the health care system would occur that would make the role of medical sociological research even more necessary. In the 1980’s the Regan Administration ordered many budget cuts to health services and reduced funding for research in the social sciences. There were slowings or endings of some regulatory programs while new payments systems (case rate and prospective payment system) were implemented. Emphasis continued to be on cost-containment in health care; peer review organizations were established to look for provider billing abuse, and review resulted in denials of payment. In addition to this more and more Americans were losing their health insurance. Appropriately research related to health policy issues became more widespread, as ideas from medical sociology worked their way into medical schools (Bird et al, 2000).
We are currently in a state of tight government regulation of health care services in addition to the prevalence of Managed Care Organizations as a result of growing medical costs and resource allocation issues. Many changes occurred legislatively as the Agency for Health care Policy and Research was created, great Welfare/Medicaid reform occurred and the Health Insurance Portability and Accountability Act (HIPAA) was passed (Bird et al, 2000).. Power within Managed Care Organizations and provider networks has grown as it has been crucial to merge with others and tightly managed services in order to stay in business.
In addition the regulatory changes described above there have also been many changes occurring in the culture of the medical profession. Donald light described how there has been a decrease in physician autonomy and power in the light of new payment systems, utilization review processes and Managed Care Organizations (Bird et al, 2000). He argues that the world of ‘corporate’ managed care has resulted in more coordinated medical care for patients and has been seen by some as “the ‘rational’ solution to the social and economic excesses and pathologies of “The Golden Age of Doctoring” (Bird et al, 2000: page 202). The impact of this system has been profound, resulting in more coordinated care, whole new industries (for example organizations that just do medical utilization review). He notes that changing technologies while they have saved lives may have put further strain on the system by creating a population of chronically ill patients (Bird et al, 2000). Other problems may occur under the current Managed Care model; Howard Waitzkin notes how the patient-practitioner relationship has been impacted by the system. Physicians experience role conflict since as Primary Care Physicians (PCPs) they are put in a position to control the care that their patient experiences. Waitzkin notes that these doctors may be ‘double agents’, “In essence, while continuing to pose as advocates for patients, physicians in actuality work as double agents for both patients and MCOs” (Bird et al, 2000: page 272). He points out that there are many more administrative workers in the field than clinicians, and that in his view much of the financial ‘waste’ in health care is from administration costs.
As you can see the historic changes in government, the medical profession and in the business world have all had a profound effect on the health care that members in a society receive. These changes have not been met with overall satisfaction - we have seen a large backlash against Managed Care Organizations and provider ‘businesses’ over the last few years with complaints regarding the restriction of patient choice, limitation of covered services and the payment incentives that are provided to doctors. Future research can be used to investigate and remedy some of these issues as well as to support policy makers so that they can make informed decisions about health related issues. Gray and O’Leary note that there are two types of research: policy relevant that can “shed light on matters that could influence or be addressed by the imaginable policy options” and policy oriented that is “driven by questions that arise from the policy environment itself and may be conducted by researchers from a variety of disciplines” (Bird et al, 2000: page 268). I will discuss some of the theories behind these types of research and provide some examples of each type below.
What I'm hoping to complete tonight will be the rest of the paper (a discussion of the theoretical concepts related to sociologically-based research, 5 research studies that are either policy-relevant or policy-oriented, a discussion on "the current state of things" and my conclusion. I'll also need to write my Bibliography and attribute things appropriately throughout the paper (I don't have the ASA specific guidelines with me at work)
If this is remotely interesting to you at all could you take a look at it? I think this is kind of long (the whole paper for this class only needs to be 8 pages and what I have done already is at 3 - though, I don't know how much what I have to say for the remaining parts will take up yet). I guess its not bad though, that I got this much done in my hour lunch break :)
Thanks in advance (and please note, formatting like tabs and Italics may not come through, and I haven't done spellcheck or printed this out and read it for grammatical issues yet)!
Linking Research and Health Care Policy
The field of medicine has experienced various changes over time that have impacted the research conducted and related health care policy activity. Political decisions are not always based on clear empirical research and research itself is not free from political bias. This paper will discuss the historic trends in the medical profession, its relationship to health care policy and some examples of research with either policy implications or that have been done on policy changes. I will conclude with some discussion about the current situation in the medical field and possible future directions for research and policy.
There have been many changes in the field of medicine over the years. According to Gray and O’Leary the American Sociological Association (ASA) first included Medical Sociology as a specialty in 1955 (Bird et al, 2000). At first health care policy was not considered in a research world where work looked at health care as a closed system involving caregivers or epidemiology. Those researchers with an applied focus worked in medical schools to help providers to “better understand how social factors effect medical care . . . medical sociology seemed to be part of the social amelioration tradition from which scientific sociology sought to escape” (Bird et all, 2000: page 260). As in other specialties of Sociology there existed a clash between the pure and applied research schools.
It is also important to note that at the time of the founding of the field of medical sociology, health-policy was stable and government was ‘unobtrusive’. Gray and O’Leary note that: “A stable policy environment is not a fertile ground for the emergence of a policy-sensitive cadre of researchers” (Bird et al, 200: page 261). Things would not remain so stable however in the health care world. Health policy was largely impacted in 1965 with the creation of Medicare and Medicaid during the ‘Great Society Period’. This was also accompanied by civil rights legislation, which resulted in no more racially segregated health facilities, and also a higher emphasis on access and equity of care (Bird et al, 2000). The late 60’s brought with it the concern of medical cost-containment and further government policies of this time period focused on this such as The HMO Act of 1973 which gave financial support for development of HMOs, set standards for community rating systems and made employers offer HMOs as an option with health benefit programs. Other changes related to health care included amendments to Medicare that created the Professional standards Review Organization who was entitled to review medical necessity of admissions and continuing length of stay and the National Health Planning and Resources Development Act which rationalized hospital construction and placed control over number of beds in facilities (Bird et al, 2000).
These historical acts had great effect on the field of Sociology (and the related sociological research conducted on health care issues). Bert Swanson wrote in the 1972 Handbook of Medical Sociology that since programs had expanded government activity and made health care a more important policy issue it was important for medical sociologists to look at these issues: “The question is no longer whether there is a ‘politics of health’ but how better to understand the political process” (Bird et al, 2000: page 263). Drastic political changes to the health care system would occur that would make the role of medical sociological research even more necessary. In the 1980’s the Regan Administration ordered many budget cuts to health services and reduced funding for research in the social sciences. There were slowings or endings of some regulatory programs while new payments systems (case rate and prospective payment system) were implemented. Emphasis continued to be on cost-containment in health care; peer review organizations were established to look for provider billing abuse, and review resulted in denials of payment. In addition to this more and more Americans were losing their health insurance. Appropriately research related to health policy issues became more widespread, as ideas from medical sociology worked their way into medical schools (Bird et al, 2000).
We are currently in a state of tight government regulation of health care services in addition to the prevalence of Managed Care Organizations as a result of growing medical costs and resource allocation issues. Many changes occurred legislatively as the Agency for Health care Policy and Research was created, great Welfare/Medicaid reform occurred and the Health Insurance Portability and Accountability Act (HIPAA) was passed (Bird et al, 2000).. Power within Managed Care Organizations and provider networks has grown as it has been crucial to merge with others and tightly managed services in order to stay in business.
In addition the regulatory changes described above there have also been many changes occurring in the culture of the medical profession. Donald light described how there has been a decrease in physician autonomy and power in the light of new payment systems, utilization review processes and Managed Care Organizations (Bird et al, 2000). He argues that the world of ‘corporate’ managed care has resulted in more coordinated medical care for patients and has been seen by some as “the ‘rational’ solution to the social and economic excesses and pathologies of “The Golden Age of Doctoring” (Bird et al, 2000: page 202). The impact of this system has been profound, resulting in more coordinated care, whole new industries (for example organizations that just do medical utilization review). He notes that changing technologies while they have saved lives may have put further strain on the system by creating a population of chronically ill patients (Bird et al, 2000). Other problems may occur under the current Managed Care model; Howard Waitzkin notes how the patient-practitioner relationship has been impacted by the system. Physicians experience role conflict since as Primary Care Physicians (PCPs) they are put in a position to control the care that their patient experiences. Waitzkin notes that these doctors may be ‘double agents’, “In essence, while continuing to pose as advocates for patients, physicians in actuality work as double agents for both patients and MCOs” (Bird et al, 2000: page 272). He points out that there are many more administrative workers in the field than clinicians, and that in his view much of the financial ‘waste’ in health care is from administration costs.
As you can see the historic changes in government, the medical profession and in the business world have all had a profound effect on the health care that members in a society receive. These changes have not been met with overall satisfaction - we have seen a large backlash against Managed Care Organizations and provider ‘businesses’ over the last few years with complaints regarding the restriction of patient choice, limitation of covered services and the payment incentives that are provided to doctors. Future research can be used to investigate and remedy some of these issues as well as to support policy makers so that they can make informed decisions about health related issues. Gray and O’Leary note that there are two types of research: policy relevant that can “shed light on matters that could influence or be addressed by the imaginable policy options” and policy oriented that is “driven by questions that arise from the policy environment itself and may be conducted by researchers from a variety of disciplines” (Bird et al, 2000: page 268). I will discuss some of the theories behind these types of research and provide some examples of each type below.
