II. SOCIOLOGY, ECONOMICS, AND POLIT

II. SOCIOLOGY, ECONOMICS, AND POLITICS
A. Sociology of the medical profession
1. Professional status and autonomy
a. Ascribed status. Society has accorded the medical profession and its individual members what has been termed “ascribed status” upon the completion of the specific goals (e.g., achieving the degree of doctor of medicine, licensure to practice, board certification).
b. Autonomy. Perhaps the greatest amount of autonomy given to any professional in our society is accorded members of the medical profession. This status simultaneously gives the physician autonomy in his relationships with patients and with institutional providers (e.g., hospitals) and requires that the physician maintain professional behavior and competence.
c. Collectivity. The medical profession is characterized generally by a collegial rather than hierarchical structure.
2. Limitations on professional autonomy
a. Past experience. Limitations on the autonomy of the physician have been imposed by society only for the most pressing reasons and where there is an overriding public interest (e.g., reporting a situation that could affect public health, observing drug control laws).
b. Government-directed limitations
(1) Since 1972, federal and state governments have intruded more often into the practice of medicine and, therefore, have imposed further limits on the autonomy of the physician.
(2) Government limitations on physician autonomy are a result of efforts to control federal government expenditures for programs such as Medicare and Medicaid. Review of physicians’ activities has become an integral part of these programs.
c. Managed-care-related limitations. HMOs, PPOs, and IPAs (see I A 4), in which physicians become members of groups with specified protocols of treatment, may negatively affect the status of the physician in that he becomes an agent of the group or the employer rather than an agent and advocate of the patient. Treatment protocols associated with HMOs, PPOs, and IPAs commonly involve criteria relating to such decisions as hospital admission, duration of hospitalization, ordering of consultations, ordering of diagnostic and therapeutic procedures, and specification of particular drugs.
d. Practice variations. Studies of practice patterns over the past 20 years have been published to illustrate variations in the use of specific treatment modalities, unrelated to variations in acuteness of disease or in patient outcomes. The federal government has begun to express interest in pursuing such studies with a view to limiting reimbursement under federal programs to those procedures considered to have been proven most effective. Implementation of such regulations would serve to delimit significantly the autonomy of individual physicians.
B. Sociology of the patient
1. The patient in the sick role
a. Concept. Certain behavior is expected of patient by society in the interest of the common good. Assuming the sick role is not encouraged-it is expected that the patient will follow the physician’s direction for cure and rehabilitation in order to leave the sick (and dependent) role at the earliest possible time.
b. Changing role. The patient is encouraged increasingly to see himself as a partner, not a dependent, and the physician is expected to enable the patient to participate as actively as possible in decisions about diagnosis and care.
2. The patient as consumer
a. Choosing among health insurance plans. Increasingly, employees in the private sector have a choice among traditional fee-for-service health insurance plans, HMOs, and PPOs. Because the benefits packages, types of service, and out-of-pocket costs may differ, employees (potential patients) have incentives to become prudent buyers of health insurance for themselves and their families.
b. Choosing among alternate providers. The growing use of copayments and deductibles by health insurers, whereby the patient may pay a portion or all of the provider’s bill, has introduced price sensitivity to physician services by patients, encouraging patients to consider a physician’s fees before using his services.
(1) In recent years, Medicare has identified those physicians who have agreed to become “participating” physicians. By becoming a participant, a physician agrees to accept the Medicare Part B payment in full, without billing the patient for any balance beyond Medicare-approved deductibles or copayments. Therefore, choosing such a provider has an economic aspect for the patient.
(2) In response to the choices available to them, patients are requiring information concerning the economic implications of physician decisions. This, in turn, requires time investment on the part of the physician.
(3) In general, this new freedom of choice tends to remove the physician from the authoritative role characteristic of the ascribed status and tends to undermine her autonomy.
(4) Expectations for a successful outcome of patient care have been fostered by increasing occasions for intervention by health care providers (see II D). The inability to fulfill these expectations consistently has led to a rise in malpractice claims, with accompanying increases in the cost of insurance. The attention paid to this aspect of the health care milieu has further weakened the public’s unquestioning acceptance of physician decision-making.
C. Sociology of health care institutions
1. Organizations as open systems. Hospitals and such institutions have established sets of goals encompassing the provision of health care services, teaching health care personnel, and conducting basic and clinical research. These institutions are, in a sociological sense, “systems”, as they are goal-oriented and made up of interdependent parts. They are “open” systems because they must interact with the larger organizational, social, economic, professional, and political environments in which they operate.
2. Institutions as bureaucracies
a. Definition. A bureaucracy is a hierarchy of offices that is designed to achieve specified goals in a predictable and efficient manner. The term bureaucracy is appropriate in describing most health care institutions because these institutions have established goals and are organized into fairly rigid structures with functions specified by governing bodies.
b. Public and private bureaucracies. The term bureaucracy is equally applicable to both public and private organizations that have hierarchical structures and that operate in supposedly rational, predictable ways.

Kết quả (Việt) 1:

II. SOCIOLOGY, ECONOMICS, AND POLITICSA. Sociology of the medical profession1. Professional status and autonomya. Ascribed status. Society has accorded the medical profession and its individual members what has been termed “ascribed status” upon the completion of the specific goals (e.g., achieving the degree of doctor of medicine, licensure to practice, board certification).b. Autonomy. Perhaps the greatest amount of autonomy given to any professional in our society is accorded members of the medical profession. This status simultaneously gives the physician autonomy in his relationships with patients and with institutional providers (e.g., hospitals) and requires that the physician maintain professional behavior and competence. c. Collectivity. The medical profession is characterized generally by a collegial rather than hierarchical structure.2. Limitations on professional autonomya. Past experience. Limitations on the autonomy of the physician have been imposed by society only for the most pressing reasons and where there is an overriding public interest (e.g., reporting a situation that could affect public health, observing drug control laws).b. Government-directed limitations(1) Since 1972, federal and state governments have intruded more often into the practice of medicine and, therefore, have imposed further limits on the autonomy of the physician.(2) chính phủ hạn chế về quyền tự chủ của bác sĩ là một kết quả của những nỗ lực để kiểm soát chính phủ liên bang chi tiêu cho các chương trình như Medicare và Medicaid. Nhận xét của bác sĩ hoạt động đã trở thành một phần không thể thiếu của các chương trình này.c. quản lý chăm sóc-liên quan đến những hạn chế. HMO, PPO, và IPAs (xem tôi A 4), trong đó bác sĩ trở thành thành viên của nhóm với các giao thức được chỉ định điều trị, có thể ảnh hưởng đến tình trạng của các bác sĩ trong đó ông trở thành một đại lý của nhóm hoặc nhà tuyển dụng thay vì một đại lý và người biện hộ của bệnh nhân. Giao thức điều trị kết hợp với HMO, PPO, và IPAs thường liên quan đến tiêu chí liên quan đến quyết định như vậy là bệnh viện nhập học, thời gian nằm viện, đặt hàng tham vấn, đặt hàng của thủ tục chẩn đoán và điều trị, và đặc điểm kỹ thuật của các loại thuốc cụ thể.Các biến thể thực hành mất. Các nghiên cứu về các hình thức thực hành trong quá khứ 20 năm đã được công bố để minh họa cho các biến thể trong việc sử dụng phương thức điều trị cụ thể, không liên quan đến biến thể acuteness của bệnh hoặc bệnh nhân kết quả. Chính phủ liên bang đã bắt đầu để thể hiện sự quan tâm theo đuổi các nghiên cứu với mục đích hạn chế hoàn trả chi phí theo các chương trình liên bang để những thủ tục xem xét để có được chứng minh hiệu quả nhất. Thực hiện các quy định như vậy sẽ nhằm mục đích delimit đáng kể quyền tự trị của bác sĩ cá nhân.Xã hội học sinh của bệnh nhân1. The patient in the sick rolea. Concept. Certain behavior is expected of patient by society in the interest of the common good. Assuming the sick role is not encouraged-it is expected that the patient will follow the physician’s direction for cure and rehabilitation in order to leave the sick (and dependent) role at the earliest possible time.b. Changing role. The patient is encouraged increasingly to see himself as a partner, not a dependent, and the physician is expected to enable the patient to participate as actively as possible in decisions about diagnosis and care.2. The patient as consumera. Choosing among health insurance plans. Increasingly, employees in the private sector have a choice among traditional fee-for-service health insurance plans, HMOs, and PPOs. Because the benefits packages, types of service, and out-of-pocket costs may differ, employees (potential patients) have incentives to become prudent buyers of health insurance for themselves and their families.b. Choosing among alternate providers. The growing use of copayments and deductibles by health insurers, whereby the patient may pay a portion or all of the provider’s bill, has introduced price sensitivity to physician services by patients, encouraging patients to consider a physician’s fees before using his services.(1) In recent years, Medicare has identified those physicians who have agreed to become “participating” physicians. By becoming a participant, a physician agrees to accept the Medicare Part B payment in full, without billing the patient for any balance beyond Medicare-approved deductibles or copayments. Therefore, choosing such a provider has an economic aspect for the patient.(2) In response to the choices available to them, patients are requiring information concerning the economic implications of physician decisions. This, in turn, requires time investment on the part of the physician.(3) In general, this new freedom of choice tends to remove the physician from the authoritative role characteristic of the ascribed status and tends to undermine her autonomy.(4) Expectations for a successful outcome of patient care have been fostered by increasing occasions for intervention by health care providers (see II D). The inability to fulfill these expectations consistently has led to a rise in malpractice claims, with accompanying increases in the cost of insurance. The attention paid to this aspect of the health care milieu has further weakened the public’s unquestioning acceptance of physician decision-making.C. Sociology of health care institutions1. Organizations as open systems. Hospitals and such institutions have established sets of goals encompassing the provision of health care services, teaching health care personnel, and conducting basic and clinical research. These institutions are, in a sociological sense, “systems”, as they are goal-oriented and made up of interdependent parts. They are “open” systems because they must interact with the larger organizational, social, economic, professional, and political environments in which they operate.2. Institutions as bureaucraciesa. Definition. A bureaucracy is a hierarchy of offices that is designed to achieve specified goals in a predictable and efficient manner. The term bureaucracy is appropriate in describing most health care institutions because these institutions have established goals and are organized into fairly rigid structures with functions specified by governing bodies.b. Public and private bureaucracies. The term bureaucracy is equally applicable to both public and private organizations that have hierarchical structures and that operate in supposedly rational, predictable ways.