Health Care and Aging

1
Chapter 15

• Health Care and Aging

2
Health Care as a Social Institution

• The American propensity for personal health is
  embedded in culture. Americans tend to respond
  aggressively to their health-care needs.

3
The Nature of the Health Care System

• The health-care system embraces the professional
  services, organizations, training academies, and
  technological resources committed to the
  treatment, management, and prevention of disease.
  
• By 2018, Americans will spend over 4 trillion on
  health care, up from approximately 200 billion
  in 1960.

4
The Components of the Health-care System

• Physicians
• Although physicians constitute only about 10
  percent of health-care workers in the United
  States, they establish the working framework for
  everyone else.
• Nurses
• Possibly as a result of this initial orientation,
  nursing experiences frequent controversy
  regarding education, professional roles, and
  compensation.

5
The Components of the Health-care System

• Hospitals
• Hospitals provide specialized medical services to
  a variety of inpatients and outpatients.
• Patients
• People usually enter the health-care system only
  because others defined them as ill or injured.

6
Theoretical Perspectives and the Health Care
System Functionalism

• Talcott Parsons first proposed a view of sickness
  that was distinctively sociological rather than
  merely medical.
• Health problems are a threat to society.
• If people are sick and cannot fulfill their
  roles, society will not function smoothly.

7
Theoretical Perspectives and the Health Care
System Functionalism

• 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.

8
The Sick Role

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.

9
The Sick Role

• The sick are expected to define their condition
  as undesirable.
• The sick are expected to seek and to follow the
  advice of competent health-care providers.

10
Theoretical Perspectives and the Health Care
System Conflict Theory

• The concerns of conflict theorists are
• an alternative explanation of the medical
  professions prestige,
• an explanation of the high income and status of
  physicians,
• the professional and economic problems of nurses,
  
• and the inequality of health care and the power
  of the pharmaceutical industry.
• The same political and economic forces that
  determine the nature of capitalism determine the
  nature of the medical institution.

11
Theoretical Perspectives and the Health Care
System Symbolic Interactionism

• The socialization process of most physicians
  begins early.
• Medical students acquire technical knowledge and
  skills and learn to diagnose and treat illness,
  as well as learning to accept the beliefs, norms,
  values, and attitudes associated with the medical
  profession.
• Sickness and illness are social labels that
  can stigmatize people.

12
Focus on Theoretical Perspectives Health Care in
the United States
13
Global Health Care Health Care in the Developed
World

• Of the highly developed countries of the world,
  the United States is the only one without
  national health insurance for all its citizens.
• (Shame on us.)
• The United States has the dubious distinction of
  having the most expensive health care and one of
  the worst performing health-care systems in the
  developing world.

14
Global Health Care Health Care in the Developed
World

• Americans spend over 7,000 per person for health
  care annually. (The total population expense
  averaged out per person)
• U.S. health-care expenditures as a share of GDP
  are the highest in the world (16 percent)
• Despite its high price tag, the United States
  finishes last on access to medical care,
  organizational efficiency, equity of treatment,
  and health results, next to last on quality care.

15
Global Health Care Health Care in the Developed
World

• The United States shows its best performance on
  preventive and patient-centered care.
• Its low scores on chronic care management and
  coordinated care drag it down to next-to-last on
  quality overall.
• Lack of insurance and cost are the biggest
  barriers to health-care access for Americans.

16
Global Health Care Health Care in the Developed
World

• The United States ranks at the bottom of the
  seven countries on efficiency of delivery, while
• the United Kingdom and Australia rank first and
  second, respectively.
• The United States performs poorly in terms of
  national health-care expenditures, administrative
  costs, information technology, re-admittance to
  hospital, and duplicative medical testing.

17
Global Health Care Health Care in the Developed
World

• The United States ranks last on almost all
  indicators of equal access to treatment.
• The United States ranks dead last on each of the
  measures of health outcomes.

18
Per Capita Health Expenditures
19
Health Care Expenditures as a Share of GDP
20
National Rankings on Key Health Indicators
21
Percentage of Persons Not Covered by Health
Insurance in the United States by Age 2009
22
The Graying of America A Global Context

• The proportion of the worlds population
  sixty-five and older is increasing at a rate of
  about 6 percent annually, whereas the worlds
  population as a whole has a growth rate under 2
  percent.
• The global population of the elderly (sixty-five
  years or over) will triple from some 516 million
  today to 1.53 billion in 2050.
• The elderly, who account for less than 8 percent
  of the population, will comprise 16 percent of
  the worlds population by 2050.

23
The Graying of America Aging in the United States

• An age cohort consists of persons born during the
  same time period in a particular population
  (example baby boomers).
• The important thing about an age cohort is that
  its members pass through life together.
• The age cohort of persons sixty-five years and
  over37 million strongcomprises 12 percent of
  the total U.S. population.

24
The Graying of America Aging in the United States

• What accounts for the rapid growth in the number
  of older Americans?
• The maximum size of the elderly population at any
  given time is due primarily to the number of
  births sixty-five or more years ago.
• Another factor in the growth of the elderly
  population is the decline in the death rate.
• Immigration has had its effect through the
  massive preWorld War I immigration into the
  United States.

25
Percentage of the U.S. Population 65 and Over
26
Projected Growth of Senior Population (2000-2030)
27
The Graying of America Aging in the United States

• The dependency ratio is the proportion of persons
  in the dependent ages (under fifteen and over
  sixty-four) in relation to those in the
  economically active ages (fifteen to sixty-four).
• A higher dependency ratio indicates that each
  worker has to support more dependent people a
  lower ratio indicates that each worker has fewer
  people to support.

28
Age Stratification

• Age stratificationthe age-based unequal
  distribution of scarce desirables in a society.

29
Age Stratification

• The poverty line is drawn at a higher dollar
  amount for the elderly than for younger
  Americans.
• Although the elderly spend proportionately more
  on health care and housing than younger people
  do, the federal government assumes a lower cost
  of living for the elderly.
• The existence of a small percentage of
  high-income older people gives the false
  impression that most elderly people are
  economically well-off.

30
Age Stratification

• The elderly who are members of racial or ethnic
  minority groups are generally in worse condition
  than older white Americans.
• Unquestionably, this disparity is intimately
  linked to the lifetime of prejudice and
  discrimination experienced by these racial and
  ethnic groups.
• Because women the world over live longer than
  males, there is a global trend toward the
  feminization of poverty among the elderly.

31
Age Stratification

• Social gerontologythe scientific study of the
  social dimensions of aginghas in the past blamed
  the elderly for their situation in much the same
  way that Americans in general have blamed the
  poor for their plight.
• Ageisma set of beliefs, attitudes, norms, and
  values used to justify age-based prejudice and
  discrimination.
• Stereotypes are ideas based on distortion,
  exaggeration, and oversimplification and applied
  to all members of a social category.

32
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.