Journal of health and social behavior
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Review
Medical sociology and health services research: past accomplishments and future policy challenges.
The rising costs and inconsistent quality of health care in the United States have raised significant questions among professionals, policy makers, and the public about the way health services are being delivered. For the past 50 years, medical sociologists have made significant contributions in improving our understanding of the nature and impact of the organizations that constitute our health care system. ⋯ S. are unequally distributed, contributing to health inequalities across status groups; (2) social institutions reproduce health care inequalities by constraining and enabling the actions of health service organizations, health care providers, and consumers; and (3) the structure and dynamics of health care organizations shape the quality, effectiveness, and outcomes of health services for different groups and communities. We conclude with a discussion of the policy implications of these findings for future health care reform efforts.
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After struggling as a surgical specialty, obstetrics and gynecology initiated its "women physician" program in the 1970s. This program officially defined the mostly male obstetricians and gynecologists at that time as women's primary care physicians. ⋯ Whatever else it was intended to be, the women's physician program, in its most developed form, aimed to galvanize the various interests within obstetrics and gynecology behind a strategy to restructure the medical division of labor serving women so that obstetricians and gynecologists controlled both the upstream positions responsible for their own case referrals and the downstream positions to which they referred their difficult cases. The article illustrates the importance of integrating insights from both macro-institutional and intra-occupational explanatory frameworks in accounting for significant developments in medicine.
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We investigate positive effects of volunteering on psychological well-being and self-reported health using all four waves of the Wisconsin Longitudinal Study. Confirming previous research, volunteering was positively related to both outcome variables. Both consistency of volunteering over time and diversity of participation are significantly related to well-being and self-reported health. ⋯ Mattering appears to mediate the link between volunteering and wellbeing. Controls for other forms of social participation and for the predictors of volunteering are employed in analyses of well-being in 1992. We find volunteering effects on psychological well-being in 2004, controlling for 1992 wellbeing, thus providing strong evidence for a causal effect.
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This study describes depressive symptoms among caregivers following bereavement and connects these trajectories to earlier features of caregiving using life course and stress process theory. Data are from a six-wave longitudinal survey (five years) of spouses and adult children caring for someone with Alzheimer's Disease. The analytic subsample (N = 291) is defined by death of the care-recipient after the baseline interview. ⋯ These results demonstrate that caregivers are not uniform in their emotional responses to bereavement, but follow several distinct trajectories. These trajectories are linked to their previous experiences as caregivers, in particular exposure to stressors and access to resources. These findings suggest that intervention during caregiving may facilitate adaptation following death of a loved one.
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In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. ⋯ International financial institutions and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector