Advances in Medical Science

Answers to Chapter 3 Questions

1. Why did the professionalization of medicine start later in the United States than in some Western European nations?

Advances in medical science, experimental research, and medical education in the United States had lagged far behind advances taking place western European nations. American attitudes about medical treatment placed a strong emphasis on natural history and on conservative common sense.

2. Why did medicine have a domestic, rather than professional, character in the preindustrial era? How did urbanization change that?

(1) In rural and small-town communities, there was a strong orientation toward self-reliance.

(2) The market for physicians’ services was limited by economic conditions.

(3) Personal health services had to be purchased without the help of government or private insurance.

(4) There was often little that a physician could do for a patient that the patient’s family could not do.

With the growth of urbanization, telephones and mechanized transportation reduced the cost of time and travel, making medical care more affordable for most people. Urbanization also spread family members further and women entered the workforce so that they could no longer care for sick members of the family.

3. Which factors explain why the demand for the services of a professional physician was inadequate in the preindustrial era? How did scientific medicine and technology change that? A LOT LIKE QUESTION 2

Advancement in science and technology was one reason for the increased demand of medical services. Advances in bacteriology, antiseptic surgery, anesthesia, immunology, diagnostic techniques, and new drugs gave medicine an aura of legitimacy and complexity. Scientific medicine and technology increased people’s reliance on physician’s professional judgment. Laypeople were no longer competent to provide medical care. Professional help was likely to do more for the patient than what folk remedies could do.

4. How did the emergence of general hospitals strengthen the professional sovereignty of physicians?

The rise of hospitals was a key precondition for the formation of a sovereign profession. As hospitals expanded, their survival became increasingly dependent on physicians to keep the beds filled. Hence, it became important for hospitals to keep the physicians satisfied, which enhanced physicians’ professional sovereignty. Affiliation with establishments symbolizing the scientific cutting edge of medicine lent power and prestige to the medical profession.

5. Discuss the relationship of dependency within the context of the medical profession’s cultural and legitimized authority. What role did medical education reform play in galvanizing professional authority?

The medical profession’s cultural authority is grounded in scientific knowledge, and its authority is legitimized when society accepts its competence in delivering specialized judgments. The profession’s cultural authority is derived from the physician’s superior knowledge and expertise in medicine. The patient becomes dependent on the medical profession’s judgment and assistance. Advanced graduate medical education was instrumental in establishing the profession’s cultural authority because it gave physicians a superior base of knowledge and skills.

6. How did the organized medical profession manage to remain free of control by business firms, insurance companies, and hospitals until the latter part of the 20th century?

The structure of medical practice in the United States has been based on private enterprise. Once the medical profession became organized, it was in a much better position to resist control from outside entities.

7. In general, discuss how technological, social, and economic factors created the need for health insurance.

Medicine offered new and better treatments. Because of its well-established healing values, medical care was regarded as socially desirable. The value placed on medical services by individuals and society created a growing demand for medical services. Increasing cost of health care made it less affordable.

8. Which conditions during the World War II and postwar period lent support to private health insurance in the United States?

During the World War II period, Congress implemented wage freezes. Hence, it became popular to offer group health insurance.

The US Supreme Court ruled that employee benefits, including health insurance, were a legitimate part of the union-management bargaining process. Health insurance then became a permanent part of employee benefits in the postwar era.

Revision to the tax code also had a profound effect. Employer contributions toward the purchase of health insurance became exempt from taxable income for the employee.

9. Discuss, with particular reference to the roles of (a) organized medicine, (b) the middle class, and (c) American beliefs and values, why reform efforts to bring in national health insurance have historically been unsuccessful in the United States.

The concerted activities of physicians have been represented by the AMA. The AMA has typically opposed national health insurance by labeling it “government interference in the practice of medicine” and “socialized medicine.” For instance, in 1949, the AMA spent $1.5 million in a successful lobbying effort to defeat President Truman’s proposal because the AMA viewed national health insurance not only as a threat to the individual practitioner but also as a threat to the hard won solidarity of the medical profession.

The American middle class has been averse to increased taxes to pay for national initiatives to expand health insurance coverage. In polls, middle-class Americans have expressed support for government programs to help people pay for the medical care they need. But when the same people have been asked about higher taxes to extend health insurance to the uninsured, there has been a dramatic fall in support.

American beliefs and values emphasize the principles of market justice. Individualism and self-determination, distrust of government, and reliance on the private sector to address social concerns are typically American ideologies that run against the principles of social justice.

10. Which particular factors that earlier may have been somewhat weak in bringing about national health insurance later led to the passage of Medicare and Medicaid?

Medicaid and Medicare were designed to cover only the most vulnerable populations. The proposals did not reengineer how the majority of the Americans would receive health care. The growing elderly population was becoming a politically active force among middle-class Americans.

11. On what basis were the elderly and the poor regarded as vulnerable groups for whom special government-sponsored programs needed to be created?

The poor and the elderly generally could not afford the increasing cost of health care. The health status of these population groups was significantly worse than that of the general population, and they required a higher level of health care services.

12. Explain how contract practice and prepaid group practice were the prototypes of today’s managed care plans.

Industries operating contract practice plans either hired physicians on salary or contracted with independent physicians and hospitals at a flat capitated rate per worker per month. These features are found in certain managed care plans today. Prepaid group practice also provided comprehensive services for a capitated fee. Later, health maintenance organizations were modeled after prepaid health plans. Managed care organizations today attempt to combine the efficiencies of contract and group arrangements with the objective of delivering comprehensive healthcare services at predetermined costs.

13. How has the information revolution affected the practice of medicine?

Telecommunication systems, such as videoconferencing, have been integrated into the delivery of medical care through telemedicine. Health care can be provided at a distance with or without actual physician-patient interactions. Telemedicine has also increased the delivery of specialized care in rural and remote areas.

E-health has been driven by consumer demand for health care information and services offered over the Internet. This revolutionary change is characterized by patient empowerment. Access to expert information is no longer strictly confined to the physician’s domain.