By: Ronald F. White, Ph.D.Professor of Philosophy

College of Mount St. Joseph

Introduction

• Health Care provision in all societies is comprised of multiple, interacting complex systems: moral, scientific, sociopolitical, and economic.

Facts and Values

• Descriptive Inquiry (Facts)– Questions of Truth and Falsity– What is a “health care system?”

• Prescriptive Inquiry (Values)– Questions of Good and Bad– What is a “good Health Care System?”

Structure of Health Care• Moral Structure (Values)

– Hippocratic– Judeo-Christian– Western Liberal

• Scientific Structure (Knowledge)– Pure Science vs. Applied Science– Biomedical Discovery – Transmission of Biomedical Knowledge

• Social and Political Structure (Power)– Human Relationships

• Professional organizations, Unions, Corporations, Government• Economic Structure (Money)

– Economic Relationships• Buyers and Sellers• professionalism

Moral Structure of Health Care

• Hippocratic Tradition– Oath

• Judeo-Christian – Charity

• Western Liberal– Rights-Based– Consequence-Based

• Individual• Collective

Scientific Structure• From Non-Scientific to Scientific Belief Systems• The Discovery and Dissemination of Scientific Knowledge• Professional Dimension

• Credentialism• Specialization• Professional Organizations

• Institutional Dimension• Educational Institutions

– Colleges and Universities– Public and Private

• Research Institutions (laboratories)– Public/Private– Professional Journals– Publishing Companies

• Hospitals– Treatment– Research– Teaching

• Clinics• Private Offices• Insurance Companies

• Technological Dimension• Patents and Licenses• Drugs and Medical Devices

Sociopolitical Structureof Health Care• Cultural Factors

– Cultural Beliefs• Health and disease

– Political Regimes• hierarchy

– Information• Dissemination of information• Mass Media

• Institutional Factors (Public and Private)– Health Care Research Institutions

• Public: Government Laboratories (NIH)• Private: Corporations

– Publishing Companies– Medical Journals

– Teaching Institutions• Colleges and Universities

– Public– Private

– Health Care Providing Institutions• Hospitals• Clinics• Doctors offices

– Health Care Financing Institutions• Health Insurance

– Private– Public

Economic Structure of Health Care

• Incentives– Why did you expend time, energy, and resources to attend MSJ in pursuit of a

career in Health Care?– Why did I agree to teach this course?

• Doctors and Patients v. Buyers and Sellers • Market Structure

– Information– Competition

• Quality• Price• Freedom

• Market Values– Don’t Steal– Don’t use Force– Tell the Truth– Keep your Promises

Role of Government• Government (Federal, State, Local)

– Discovery Function • Should government finance health care research?

– NSF• Should government conduct health care research?

– NIH

– Research Regulatory Function• Should government regulate health care research?

– FDA

– Provider Function• Should government provide health care?

– Medicare – Medicaid– Veteran’s’

– Economic Regulatory Function• Should government mediate between buyers and sellers in the health care

industry?

Summary

• Health Care involves four interacting systemic structures– Moral Structure (right/wrong)– Scientific Structure (truth/falsity)– Sociopolitical Structure (leaders/followers)– Economic Structure (buyers/sellers)

• Governments can influence all four dimensions: for better or worse.