Health Care Politics, Policy and Services: A Social Justice Analysis

417 Pages·2012·6.941 MB·English

by  Gunnar Almgren

H C P , P ,
EALTH ARE OLITICS OLICY
S
AND ERVICES
GunnarAlmgren,PhD,isanAssociateProfessorintheSchoolofSocialWorkatthe
University of Washington. He is also a Faculty Affiliate of the West Coast Poverty
Center and a Faculty Research Associate at the Center for Studies in Demography
andEcology.Hisprofessionalinterestsincludehealthcarepolicyandthesocialdeter-
minantsofhealth.Hisresearchinterestsincludethestudyoftheeffectsofracialsegre-
gation and economic disadvantage on urban mortality trends, and the health care
policyeffectsonthehealthcaresafetynet.
H C P , P ,
EALTH ARE OLITICS OLICY
S
AND ERVICES
A S J A
OCIAL USTICE NALYSIS
S E
ECOND DITION
Gunnar Almgren, PhD
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Almgren,GunnarRobert,1951–
Healthcarepolitics,policy,andservices:asocialjusticeanalysis/GunnarAlmgren.—2nded.
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ISBN978-0-8261-0887-6—ISBN978-0-8261-0888-3(e-book)—ISBN978-0-8261-9929-4(instructor’smanual)
I.Title.
[DNLM:1.DeliveryofHealthCare—UnitedStates.2.HealthServices—economics—UnitedStates.3.Health
Services—history—UnitedStates.4.HealthcareDisparities—UnitedStates.5.SocialJustice—UnitedStates.
6.SocioeconomicFactors—UnitedStates.W84AA1]
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2012023132
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To my wife Linda, in loving gratitude for the nearly
four decades of life we have shared together.
The best is yet ahead of us my love.

C
ONTENTS
Foreword EdwardF.Lawlor,PhD xi
Preface xiii
Acknowledgments xv
Chapter1 APrimeronTheoriesofSocialJusticeandDefiningthe
ProblemofHealthCare 1
DefiningtheProblemofSocialJustice 1
AlternativeTheoriesofSocialJustice 2
ConcludingComments:AlternativeTheoreticalPerspectiveson
“theRighttoHealthCare” 31
Notes 41
References 45
Chapter2 HistoricalEvolvementoftheU.S.HealthCareSystem 49
HistoricalEvolvementoftheBasicComponentsoftheHealth
CareSystem:Hospitals,Doctors,Nurses,andHealthInsurance 50
TheHistoricalEvolvementoftheFederalGovernmentin
HealthCare 64
ConcludingComments:ProspectsforAchievingHealth
CareReform 100
Notes 101
References 105
Chapter3 TheContemporaryOrganizationofHealthCare:HealthCare
Finance 109
HealthCareExpenditures 110
AnOverviewofHealthCareSystemFinance—Employment-Based
HealthInsurance 118
AnOverviewofHealthCareSystemFinance—PublicFinancingof
HealthCare 139
ConcludingComments:TheLargePresenceofPublicDollarsin
theFinancingofHealthCare 153
vii
VIII CONTENTS
Notes 154
References 157
Chapter4 TheContemporaryOrganizationofHealthCare:HealthCare
ServicesandUtilization 161
TheMixedPublic/PrivateStructureoftheU.S.HealthCare
System 161
TheResourcesoftheU.S.System:Facilities,Technology,and
HumanResources 164
TheHealthCareSystemSafetyNet 188
ConcludingComments:TheParadoxicalUnderachievementof
theU.S.HealthCareSystem 200
Notes 201
References 203
Chapter5 Long-TermCareoftheAgedandDisabled 207
TheLong-TermCareServicesSystem 208
TheSustainabilityofResourcesforLong-TermCare:Caregiving
LaborandPublic/PrivateFinancing 225
DirectionsforLong-TermFinancingPolicy 232
ConcludingComments:ASocialJusticePerspectiveonthe
FinancingofLong-TermCare 237
Notes 238
References 239
Chapter6 DisparitiesinHealthandHealthCare 243
ConceptualizingDisparitiesinHealthandHealthCare 243
MeasuringDisparitiesinHealthandHealthCare 252
SocialCharacteristicsAssociatedWithDisparitiesinHealthand
HealthCare 262
DisparitiesinHealthandBurdenofDisease:General
Findings 263
ConcludingComments:TheDeepRootsofDisparitiesinHealth
Care 277
Notes 278
References 281
Chapter7 SocialEpidemiology:UnravelingtheSocialDeterminantsof
DisparitiesinHealth 285
TheDisciplineofSocialEpidemiology 286
The“FundamentalSocialCauses”Hypothesis 294
IncomeInequalityasaSocialDeterminantofHealth 304
CONTENTS IX
TheoreticalDebatesConcerningIncomeInequalityEffects 306
ConcludingComments:SocialEpidemiologyasaTool
ofSocialPolicy 317
Notes 318
References 321
Chapter8 ProspectsforJustHealthCareSystemReform:APolitical
andPrincipledAnalysis 327
TheSocialandPoliticalContextofHealthCareReform 327
ThePatientProtectionandAffordableCareAct(PPACA) 342
ConcludingComments:TowardaProgressiveVisionof
UniversalHealthCare 367
Notes 370
References 376
Glossary 381
Index 391