Medicine is practiced in a social, economic, and political context. It takes more than excellent medical care to improve the health of patients because many of the determinants of the health of individuals and populations lie outside traditional clinical activity.
By contrast, 40% of premature deaths are attributed to personal behaviors, including patterns of eating and physical activity and decisions about smoking, drinking, illicit drug use, and sexual behavior...
[...] By contrast of premature deaths are attributed to personal behaviors, including patterns of eating and physical activity and decisions about smoking, drinking, illicit drug use, and sexual behavior Social Issues Socioeconomic status, which is determined by a person's income, education, and occupation, also exerts a strong influence on health status, in part by influencing patterns of behavior. In the United States, people in lower socioeconomic groups have higher rates of smoking, and there is a continuous gradient between health and socioeconomic status that persists well above the poverty line. [...]
[...] In contrast to the linear association between health and social class, however, there seems to be little health difference between individuals with moderate compared with high levels of social support. What can physicians do with this information? First, they can look for ways to encourage healthy behavior. Second, at key times of transition, such as during discharge planning for hospitalized patients, physicians should be attentive to the patient's social circumstances. For patients who are likely to be socially isolated, clinicians should encourage or arrange interactions with family, neighbors, religious organizations, or community agencies to improve the likelihood of an optimal outcome. [...]
[...] This slowing in the growth rate was accomplished under the general strategy of managed care, which includes reductions in reimbursement rates, decreases in in-hospital capacity, controls over usage, and administrative delays in processing payments; little actual managing of care occurs. A public backlash against the perceived constraints on access to desired medical services has led insurance companies to weaken their usage controls, and as a result, large increases in annual insurance premiums are occurring. The reason that the United States leads the world in medical care expenditures can be found in a potent combination of supply and demand. [...]
[...] Political pressures currently exist to reduce taxes, to avoid budget deficits, to add a prescription drug benefit to Medicare and other benefits to private insurance coverage, to increase spending for the military and for homeland security, and to contain medical costs. Recommendations It is not clear how these conflicting pressures will be resolved. It is likely that physicians will become more involved in issues of medical economics. As pressures for cost containment force patients to assume more of the expense of their care, patients will become more cost conscious and more demanding about the value and price of services. Informed [...]
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