Medical Industrial Complex
Demand for an extensive health care system created what is known today as the medical industrial complex. In the eyes of some, this complex has already begun to erode the fabric of American society in its pursuit of the economic resources it needs to sustain itself. This paper will cast a light on the American medical industrial complex, breaking down the major components of this network as well as discussing the benefits and perceptions of this concept. In doing so, the reader will glean a better understanding of the complexities of the U.S. health care system and the forces that create it.
Keywords Affect-Neutral; Generic Medication; Issue Pace Setter; Medical Industrial Complex; Profit; Proprietary Hospitals; Universal Health Care
Sociology of Health
In 1946, Congress recognized that the Great Depression and World War II had severely impacted the amount of capital available for renovations and upgrades to the primary institution used to protect the public health: the hospital. The House and Senate passed one of the most significant pieces of health care legislation of the twentieth century, the Hospital Survey and Construction Act (also known by the names of its chief architects, the Hill-Burton Act). The measure created a mechanism whereby federal grants and loans would be made available for the construction and renovation of medical centers. The law was clearly well-received — between 1946 and 1997, $4.6 billion in total grants and $1.5 billion in total loans were distributed under the program, and 6,800 health care facilities were built in 4,000 communities nationwide (US Health Resources and Services Administration, 2008).
The unprecedented attention paid to hospitals by Hill-Burton represented a national acknowledgement of the importance of such institutions as central in the administering of health care. Still, the focus on hospitals was attention paid to but one part of the heath care industry. Today, health care is a multifarious and far-reaching industry. While the hospital remains the central delivery point for care, the health care industry is a vast network, each component of which is a profit- or performance-driven entity. This network has come to be known as the "medical industrial complex."
This paper will cast a light on the American medical industrial complex, breaking down the major components of this network as well as discussing the benefits and perceptions of this concept. In doing so, the reader will glean a better understanding of the complexities of the health care system and the forces that create it.
Profit Before Care
In 1970, feminist and socialist Barbara Ehrenreich received poor care at the hands of the hospital in which her daughter was born. She and her husband, John Ehrenreich, decided to pen a critical assessment of the entire health care system, entitled The American Health Empire: Power, Profits, and Politics. In it (and in subsequent writings), she railed against what she considered the "medical industrial complex," which in her estimation put profits before care (Quinn, 2004).
Ehrenreich was by no means alone in her criticisms. Images of a "corporate" health care system driven by profit margins instead of the more noble cause of administering to the sick and injured became more prevalent in the latter twentieth century, particularly in times of economic uncertainty. It is certainly an easy target for cynics: just eight years after the Ehrenreichs wrote The American Health Empire, the New England Journal of Medicine reported that the medical industrial complex produced a gross income of $35-40 billion in 1979 (Relman, 1980).
What are the components of this vast network? How do they interact with one another?
Generally, the individual considered the primary deliverer of health care is the doctor. Doctors are invaluable components of the medical industrial complex, chiefly because of the direct relationship they share with the patient. Ideally, this relationship is built on the training of the medical doctor — in addition to biology, chemistry, anatomy and other natural sciences, the physician receives training while in medical school to avoid too strong an emotional connection with the patient. By successfully adopting this skill, doctors are able to focus on the needs of the patient instead of his or her own reactions to those needs.
One of the first sociologists to study the doctor-patient relationship was Talcott Parsons. Illness, he said, is a form of dysfunctional deviance that separates an individual from society, causing social disorder due to that person's detachment. The role of the physician is to reintegrate the individual into the social group by treating his or her medical issue. The doctor's greatest asset in this pursuit is his or her focus on the patient, as described above, to which Parsons referred as an "affect-neutral" relationship. In addition to focusing greater attention on the recovery of the patient, the affect-neutral relationship also gives a doctor a noble attribute — less focus on personal interests and more on a universal sense of egalitarianism (Hughes, 1994).
Of course, Parsons' ideal endures some adaptation in the context of the medical-industrial cost. Increasingly during the late twentieth and early twenty-first centuries, the doctor-patient relationship has been strained by government regulations, hospital protocols, and insurance guidelines. Such external factors weigh heavily on the mind of a medical practitioner, often affecting how he or she administers to the needs of a patient.
Such externalities even have an influence on how the patient might enter into a doctor-patient relationship. The strict guidelines offered by private insurance companies governing whom an individual may and may not see for medical treatment means that individuals may have to pay more for coverage that includes his or her preferred doctor. Additionally, the profit-driven mentality of pharmaceutical companies has elevated the price of prescription drug coverage, leaving patients with few affordable choices as they "shop" for medical care (Stevens & Rosenberg, 2006).
As medicine and medical care continues to evolve, so too will the doctor-patient relationship. The changes occurring as a result of the development of the medical industrial complex will also be manifest in the venues at which the care occurs: the hospital.
The Modern Hospital
Prior to the early twentieth century, hospitals and clinics were smaller and largely owned by the physicians themselves. These so-called "proprietary hospitals" were the most common of facilities until the 1920s, providing community-based medical treatment to local populations. Small, doctor-owned centers eventually gave way to larger, more sophisticated hospitals or those owned by religious and/or nonprofit institutions. In a mere forty years, the number of proprietary hospitals in the United States declined from 2,435 (36 percent of all medical facilities) to 769 (a mere 11 percent) by 1968. However, the trend began moving upward again by the latter twentieth century, this time initiated by the transfer of ownership from nonprofit groups and smaller, physician-owned facilities to corporations and for-profit entities (Relman, 1980).
Proprietary hospitals continue to operate successfully, even as much larger medical centers have become the dominant facility for the administration of health care. These smaller properties generate an average of $12 billion to $13 billion in income each year, with a growth rate of between 15 and 20 percent. Most of these hospitals are located in Europe, but some are still found in the US, including Humana and Hospital Corporation of America, which in 1980 posted revenues of $1 billion (Relman, 1980).
The diversity of health care facilities and increasing number of changes in the form of care received means an enormous complexity in the pursuit of health care at one of these facilities. An issue that has presented itself over the last few decades is the types of service available at such facilities and the ability by most patients to be able to afford the services. In many cases, patients may learn of the disparities in cost between two or more medical centers that provide the same service or...
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