Chapter 15

Health Care and Aging

Chapter Outline Health Care as a Social Institution Theoretical Perspectives and the

Health-Care System Health in the United States Health-Care Reform in the

United States The Graying of America Health and Aging in the United

States

Health Care as a Social Institution The U.S. is the only highly developed

nation that does not provide a federally centralized, free health insurance program.

Americans spent almost $2 trillion on health care in 2005, up from $75 billion in 1970.

Since 1980, total health expenditures increased over 400%.

Health Care as a Social Institution Health-care expenditures account

for about 16% of the GDP; the comparable figure in 1970 was about 7%.

Rising Health-Care Expenditures in the U.S.

Components of the Health-Care System Physicians – constitute about 10% of

health-care workers in the U.S. Their responsibilities are matched by high levels of social prestige and monetary rewards.

Nurses – became a recognized profession in the late 19th century. Nursing has experienced frequent controversy regarding education, professional roles, and compensation.

Components of the Health-Care System Hospitals – provide specialized medical

services to a variety of inpatients and outpatients. Range from small facilities to large medical centers with long-term care.

Patients – individuals defined by others as ill or injured. People take on the sick role.

Functionalism Talcott Parsons first proposed a view of

sickness that was distinctively sociological. Health problems are a threat to society. If people are sick and cannot fulfill their

roles, society will not function smoothly. Society responds in two ways:

Society defines sham sickness as a form of deviant behavior.

Society institutionalizes legitimate patterns of behavior for a sick role.

The Sick Role – appropriate behavior patterns for people who are ill

1. The sick are permitted to withdraw temporarily from other roles or at least reduce their involvement in them.

2. It is assumed that the sick cannot simply will the sickness away.

3. The sick are expected to define their condition as undesirable.

4. The sick are expected to seek and to follow the advice of competent health-care providers.

Conflict Theory Challenges many health care practices. Success of the medical profession is

due to the power it possesses because of its alliances with the dominant capitalist class.

Rejects the functionalist explanation for the high financial and prestige rewards of physicians.

Occupational groups use various mechanisms to limit competition.

Conflict Theory Interested in the reasons minorities and

the poor have shorter life expectancies and higher incidence of certain diseases that the general American population.

Point to the role of the health-care establishment in maintaining unequal access to medical care.

Symbolic Interactionism Examines the socialization process of

physicians. Those who decide to become doctors do so early in life (many by the age of 16).

Nurses are generally more altruistic, benevolent, and generous, and are less interested in power, control, and self-advancement.

Labels and stigmas applied to people affect the way others behave toward them (“sick”, “ill”, etc.)

Questions for Consideration Do alternative methods of healing have

value in terms of true healing? Why do you think the U.S. does not seem

to embrace alternative healing methods? Do medical practices from other cultures

meet needs that what we refer to as traditional medicine cannot?

Health Care Reform in the U.S. 2003 Bush’s introduction of a new

Medicare prescription drug plan is one of the few efforts at health-care reform that has not been defeated by Congress.

If equality of health care is to become a reality in the U.S., some form of socialized medicine will be necessary. Many resist this, assuming there would be a profit reduction.

Need for Health Care Reform 60% of Americans say they are satisfied with

their health care coverage. Yet Americans identify health care as a top

domestic issue for government. ¾ of the public believes that the present

health care system is either “in a state of crisis” or “has major problems.”

Support for replacing the current system grew from 32% in 2004 to 41% in 2005.

Need for Health Care Reform Annually, America devotes a larger share of

its GDP to health care than any other nation. A substantial proportion of Americans who,

except on an emergency basis, do not have access to medical care.

Quality of life is lowered due to lack of health care or inferior health care.

The aging of the American population. As baby-boomers age, strains in the present health care system are expected to increase dramatically.

People not Covered by Health Insurance INSERT FIGURE 15.3 HERE

PERCENTAGE OF PERSONS NOT COVERED BY HEALTH INSURANCE IN THE U.S. BY AGE

Health Care Reform Options 77% of Americans support government

deregulation to create competition. 54% are in favor of a national health care

system. There are several options:

Modified competitiveness Managed competition Single payer approach Play or pay mechanism

Health-Care Reform Options The “modified competitiveness”

option Based on market principles such

as consumer cost sharing. Depends on universal health

coverage as a precondition to health-care reform.

Health-Care Reform Options Managed competition

A combination of free-market forces and government regulation.

Health care would be structured around plans modeled after HMOs.

Health-Care Reform Options Single payer approach, like the

Canadian model. Government finances medical services. Canadians choose their doctors and

hospitals and bill the government according to a fee structure.

This approach engenders higher levels of satisfaction with patient services, and is regarded much more favorably than the U.S. system.

Health-Care Reform Options Play or pay mechanism based primarily

on the German model. Universal coverage is provided by

employers who either offer health coverage (play) or pay into a fund for covering the uninsured.

Access to medical care in Germany, considered among the best in the world, is guaranteed for life.

Aging of the World’s Population The proportion of the world’s population

sixty-five and older is increasing at a rate of about 6% annually, yet the world’s population has a growth rate under 2%.

Percent increase in those over the age of 65 in China is expected to increase by over 238% by 2025.

Questions for Consideration What images do the media present

of the elderly? What are the stereotypical images

that we have regarding the elderly? Have images of the elderly, as seen

in the movies, changed over the past 60 years?

Aging in the United States Due to the baby-boom generation (cohort

between 1946 & 1964), there will be an increasing proportion of elderly in the advanced age cohort.

Number of Americans 65+ will increase to 82 million (20% of the population) in 2040.

Number of Americans over age 85 will increase to about 8 million in 2010 and to over 17 million by 2050.

Percentage of the U.S. Population 65 and Over

U.S. Elderly Population 1990–2050

Reasons for the Growth in the Number of Older Americans Between 2010 and 2030, those born

in the post-World War II baby boom will dramatically increase the pool of the elderly.

Then the rate will fall as those born in the 1960s and 1970s reach retirement age, and then in 2045 another increase as children of the baby boomers reach retirement age.

Decline in the death rate.

Reasons for the Growth in the Number of Older Americans

Immigration has also had an effect through the massive pre-World War I immigration into the U.S. Most of those immigrants were young with a high fertility rate.

Dependency Ratio Dependency ratio - the proportion of

persons in the dependent ages (under 15 and over 64) in relation to those in the economically active ages (15 – 64)

For less-developed countries, a high youth dependency means that the national income must be diverted from savings to take care of its large population of children.

Dependency Ratio In more developed countries rising old-

age dependency creates a challenge (e.g in the U.S. every 2 working Americans support one elderly person).

New View of Retirement Baby boomers may have a different view of

retirement than previous generations. 51% of baby boomers want to alternate periods

of work and leisure by working part-time. Only 12% want to work full-time past 64. Baby boomers are healthier, more educated, and

living into their 80s. Baby boomers find enjoyment through

employment. They are worried about not having enough

money due to health care costs and diminishing pensions.

Age Stratification Age stratification – age-based unequal

distribution of scarce desirables in society based on chronological age.

The social inequality reflected in age stratification is always justified socially and culturally.

This form of stratification affects more and more people.

Economic Condition of the Elderly Economic condition of elderly has

improved since 1960. Poverty rate for Americans over 65

has declined from 35% to 10%. There are factors of race, ethnicity,

and gender that also impact the true economic situation of the elderly.

Measurement of Poverty among the Elderly Measurement of poverty among older

people distorts reality: The poverty line is drawn at a higher

dollar amount for the elderly than for younger Americans.

Elderly spend more on housing and health care than younger people do.

Official statistics do not include “hidden poor” who live in either institutions or with relatives because they cannot afford to live independently.

Measurement of Poverty among the Elderly Diversity is another factor complicating

an evaluation of the economic situation of the elderly.

Most elderly do not have sources of income beyond Social Security benefits.

The existence of a small percentage of high-income older people gives the false impression that most elderly are economically well-off.

Measurement of Poverty among the Elderly Elderly who are members of racial

or ethnic minority groups are generally in worse condition than older white Americans.

The disparity is intimately linked to a lifetime of prejudice and discrimination experienced in society.

Measurement of Poverty among the Elderly There is a global trend toward the

feminization of poverty among the elderly since women generally live longer than males.

Elderly women constitute one of the poorest segments of American society.

Average income of elderly women is about 60% that of elderly males.

Consequences of gender inequality are compounded by the inequalities of age.

Ageism and Health Care Stereotypes are ideas based on distortion,

exaggeration, and over simplification applied to all members of a category. Most elderly people are not senile. Old age is not a sexless period for the majority

of those over 65. There are few age differences in job-

related challenges. Most elderly people are able to learn

new things and can enthusiastically adapt to change.

Questions for Consideration Do you think that the U.S. health-care

system will be reformed in the next 10 to 15 years? Why or why not?

What factors have led to the graying of America? What societal impacts beyond health care and economics do you think this will have on the U.S.?