PART 1 – this part looks at some of the ways in which health care is provided. The key question is,
who should provide health care?
CHAPTER 1 – HEALTH AND HEALTH POLICY
What is health? health is difficult to categorize since it is transformed by people’s own experiences,
and the view of our health changes as we move through the various stages of our life. Therefore we
do not need to categorize it, but we have to understand it.
Health could be seen in terms of the ability of the individual to perform its social functions,
and people all perform different functions (working, raising a family). Our health could be seen in
terms of the ability we have to fit in and live in accordance with the expectations placed upon us by
other members of society. Since health and illness have serious social consequences.
What are health policies? They are illustrating different philosophies of life rather than dry policy
documents.
Health can be viewed negatively (in terms of the absence of something) or positively ( as possessing
something). If health consists in the absence of disease, people could be seen as being healthy if they
do not have a disease. But this definition causes problems, because if we are unaware that we have a
disease, does it then mean that we are healthy? Health can also be characterized as the absence of
illness. Illness is experienced and consists in the unpleasant feelings that often accompany a disease.
The problem with this view is that it deals with subjective experience. Illness (experience) thus differs
from sickness (diagnosed).
The positive view of health emphasizes the value of things we possess. The WHO declared a
definition of health: ‘a state of complete physical, mental and social well-being and not merely the
absence of disease’. The positive view encourages us to find ways to improve or promote good
health rather than always think in terms of responding to illness or disease.
There are two main models that can be used to discuss issues of health:
1. The bio-medical model of health
This model gained prominence during the 19 th century and still has power. It looks for ways to
identify the cause of an illness and seems to assume that illnesses can b classified and treated in an
objective way. This model tends to view health in terms of freedom from a clinically ascertainable
disease. One of the main problems with this approach is that it can lead to prioritizing the treatment
of short-term acute illnesses rather than long-term chronic conditions.
2. The social model of health
This model rejects the neutrality and scientific ideas of the bio-medical model. And regards reliance
upon the scientific method as merely one way to measure health. The social model acknowledges
that health and illness are created socially, and health has an historical, cultural and social context.
3. The bio-medical model of disability
The model with respect to disabilities, portrays people with disabilities as problems and attempts to
exert control over their lives. Using this model, it is assumed that if we could treat all forms of illness,
we could do away with disability. This rests upon the belief that disabled people are both ill and
inferior.
4. The social model of disability
,They say that disability is not a medical problem, but one stemming from material and cultural
forces. The social model of disability sets out to undermine self-blame and hate among people with
disabilities and urges us to value the abilities they do have.
Although the state is one of the main players in the development of health policy, we should
recognize that health care is often formulated and delivered through partnerships with a variety of
groups in the community. This means that the development of health policy and the delivery of
health initiatives often involve a process of negotiation with key stakeholders, each of which may
have its own agenda to promote.
PART 1 – CHAPTER 2 – THE STATE
One of the key aims of this chapter is to outline some of the conflicting views of how far the state
should intervene in health care.
Arguments for state intervention:
Those who argue in favor often do so in the belief that health should be viewed in its social context.
There are multiple views:
Egalitarian
State involvement in health care could be seen as a means by which the state can enhance equality
or at least compensate for some of the inequalities that arise due to capitalism. Egalitarians believe
in the essential equality of human beings and argue that policies should be developed to enable
people to become as equal as possible. because of this, they claim that society should aim to
establish equal health status and grant equal access to healthcare.
Civic
They say that arguments in favor of health care intervention do not have to be tied to broader social
change, but can be defended on the grounds that health care intervention is essential for our
maintenance as individuals. And we all have the right to individual freedom in healthcare.
Social
This view says that individuals are tied to others in society and that this creates a series of
responsibilities towards each other. No one is sure of their health, and it makes sense to pool risks
and share the costs of health care together. And that what is good for the community is also good for
individuals since everyone is tied to each other.
Arguments against state intervention:
Arguments against state intervention in health care tend to proceed from the assumption that health
is a possession for which we are responsible as individuals. Then the state has thus no
duty/obligation to increase our health. Different views:
Neo-liberalism
they believe that the state should avoid being too entangled in the direct provision of health care
and leave most of it to the private practice. This view started to develop after WW2. Neo-liberalists
defend the capitalist system and their world is based upon individual achievement and on keeping
the government as small as possible. They say that we ourselves are responsible for our health and
healthcare. And the state’s intervention would give the state too much power and this could be used
to coerce citizens.
, Relieving the tax burden
This view says that state intervention in healthcare will increase the tax burden upon society. This
decreases freedom of individuals to make decisions about how to dispose of their own income.
The third way: mixing both streams
Many people are willing to pick and mix from both streams (of arguments for and against state
intervention) in an attempt to devise a third way of looking at how much the state should intervene
in health care. Advocates of this ‘third way’ recognize that health is influenced by social factors, so
the state should have some part to play in the provision and direction of health care. The third way
involves the creation and maintenance of a mixed economy of care. Rather than rely primarily on the
state, the private sector, or the voluntary sector, it is believed that these providers can work together
as long as the health care they provide is coordinated by the state.
Policy developments around state and healthcare
Britain
Labor party = the state needs to do more. Conservative party = the state needs to reduce it’s role.
New labor party = seeks middle way (third way).
US
Governments in the US tend to have relatively little to do with the provision of healthcare. But
maybe their government should at least provide a minimum safety net? The democratic part has
tried to increase the role of the state in health care. The republicans are less convinced of the
benefits of health care.
Professionals who have worked in both countries point out that the US system is often far more
advanced in terms of the facilities, but that the extent to which it can provide healthcare for all
citizens does not fare so well. Are superior facilities more important than access to healthcare?
Countries that also rely heavily upon state intervention (as Britain does) are Sweden and Canada.
While there are also countries that rely on an insurance-based system. In this insurance-based
system, individuals have more responsibility for their own health.
PART 1 – CHAPTER 3 – THE PRIVATE SECTOR
If we are not willing to trust the state to organize and provide health care, then we need to identify
some alternatives. Those who argue against the state having a major role, are often supporters of the
private sector.
The private sector includes independent practitioners and those who supply the public sector with a
vast array of products and services. But public and private is sometimes hard to divide, because they
can also coexist in the same location and with the same staff. What separates these two sectors is
who pays the bill. For the public sector, often the taxpayers pays for the bill. In the private sector, it is
often paid by individuals and/or their insurance companies.
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