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This paper explores the economic and health needs of aging populations within a comparative perspective. The findings indicate that the cost of health care is not related to the size of the aging population. In addition, the health of a population, measured in terms of life expectancy at birth, is not influenced by the amount of money spent on health care. For many elderly, post-retirement economic needs are influenced by the reimbursement rate of the average pre-retirement income. Within these two criteria, the United States rates poorly when compared with other nations. Beyond the United States, the English-speaking world also compares poorly. The paper concludes with an analysis of of the current situation an future projections. It is argued that any discussion would be enhanced if the focus was on ensuring economic and health needs throughout the life cycle rather than limited to specific chronological periods in life. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The paper examines changing relationships between the pharmaceutical corporation, traditional psychiatry, and the bio-psychopharmacological approach to depression. It provides a political economic analysis of these changes by discussing the rise of Neoliberalist policies as they pertain to mental health. This paper then discusses changing forms of the production, distribution, and consumption of meanings and treatments of depression, focusing on the decline of talk therapy and the rise of bio-psychiatric pharmacology. Despite bringing relief from depression to many, this latter practice seeks to replace all discourse on the social causes of depression with a market driven search for its putatively biological cause. This paper assesses reductionism and essentialism in the current microbiological conceptions of depression. A closer look at the process of the changing forms of the production and consumption of depression shows how a schism in meaning making vis-୶is depression, developed between bio-psychopharmacology and the major talk therapy branches of psychiatry. This schism concerns struggles over the power to define depression in all aspects and in all institutional and public venues. This schism centers moreover on two central - problematic responses made by the Freudian and social constructionist oriented traditions in talk-based psychotherapy. They are problematic because each tradition fails to address innate biological processes in depression in a way that would challenge the pharmacological approach. The paper concludes by mentioning an evolutionary sociological and psychological approach that addresses the issues of social relations and biology in depression, and challenges bio-psychopharmacology in ways that traditional psychotherapy cannot. [ABSTRACT FROM AUTHOR]

Although there are several studies of the impact of employment of health professionals in large bureaucratic organizations, there has been significantly less research conducted that is both theoretically oriented and undertaken from an explicitly comparative perspective across professions, health care systems and cultures. In a previous paper we developed a conceptual model of the dynamic relationship between professions, organizations and clients based on an extensive review of the classic and contemporary literature on professions and organizations. In this paper we present comparative qualitative data gathered on the work experiences of health care professionals in Canadian, U.S. and French hospitals. We specifically elaborate on a typology of influence of clients on the orientation of health care providers to the community or to the bureaucracy. [ABSTRACT FROM AUTHOR]

The purpose of the paper is to provide a portrait of direct care workers who provide care to the elderly. Despite the importance of worker retention for organizations and their patients, little has been done to understand how the family and community life of the direct care worker impacts her ability to maintain her position in the workforce. Therefore, this paper is part of a larger research project that will fill a research void between characteristics of the workplace, demands placed by family responsibilities and economic stability in the lives of direct care workers. In particular, we are interested in understanding how family situations, community resources and organizational supports impact the retention of low-income female workers in direct care worker occupations. [ABSTRACT FROM AUTHOR]

The American health care system is financially inefficient, inaccessible, and administratively wasteful. Nevertheless, political and economic interests are intent on maintaining the status quo. As a result, American health care is in a perpetual state of crisis as the political process attempts to balance the economic needs of corporate stockholders with the appearance of social responsibility towards its citizens. The consequences of this political gambit (excessive costs and rising rates of uninsured) have become all too apparent. This paper identifies and analyzes a series of interrelated issues that constitute the framework of criticism associated with the American health care system. These issues include the political process, the health insurance industry, the pharmaceutical industry, and the life style of the American public. Based on the outcome of this analysis, this paper offers a pessimistic assessment of the future of the American health care system. In particular, it is argued that unless fundamental changes are made, the market-based American health care system will continue to fragment the public into categories based on their ability to access the system and ultimately their health outcomes. [ABSTRACT FROM AUTHOR]

Drawing upon the powerful role of collective protests against GMO foods and the high prices of patented drugs, this paper identifies the conditions that shape the natural and likelihood of organized voice. It identifies four kinds of ?voice? and the dimensions of ?voice?. The paper draws on the theory of A.O. Hirschman to expand his largely individual treatment of ?voice? by examining the organization of ?voice? through social movements when people perceive that markets trap or fail them. Exit, or switching, is an important form of voice at the individual level; but when people feel trapped, the ground is laid for collective behavior and the development of a social movement. Professional organizers of ?voice? have developed into a large secondary industry of its own that amplifies and orchestrates ?voice?. The paper links sociological studies of social movements to the construction, boundaries and limitation of markets. The paper enables economic sociologists and economists to study exchanges and disputes over non-monetary aspects of markets. [ABSTRACT FROM AUTHOR]

This paper examines Korean immigrants' barriers and difficulties in utilizing healthcare in the U.S. and their coping strategies for dealing with these issues. Analyzing survey data with 507 Korean immigrants and in-depth personal interviews with 120 Korean immigrants in the New York-New Jersey area, this paper finds that more than half of Korean immigrants experience difficulties in utilizing healthcare in the United States. The language barrier was the most frequent response, followed by having uninsured status. Language barrier does not simply mean linguistic difficulties in communicating with healthcare professionals in English. Rather, it has interpersonal aspects, such as a power imbalance between patients and non-Korean speaking doctors. Korean immigrants show three distinctive healthcare behaviors as coping strategies for dealing with these barriers: preference for and dependence on co-ethnic doctors in the U.S., seeking Hanbang (traditional Korean/Chinese holistic/herbal medicine) in the U.S., and medical tours to the homeland. The first two healthcare behaviors are not significantly associated with each other. However, they are significantly related to the last behavior, medical tourism. Korean immigrants who prefer to see co-ethnic doctors and to practice Hanbang are more likely to take medical tours to the home country than others. These findings contribute to the literature on immigrants' healthcare behaviors by showing that immigrants are active rather than passive agents who react to barriers to healthcare utilization in the receiving country. [ABSTRACT FROM AUTHOR]

Scholars have documented the prevalence of ageism and ageist language throughout society, but ageism is of particular importance in medical settings because the elderly comprise the fastest growing patient group in the United States. Studies have shown that doctors often have negative attitudes about treating older patients and that they report having difficulty initiating conversations about age-related concerns. Even though old age is a label that is associated with many negative connotations, in this paper I will demonstrate how old age can be used to facilitate difficult discussions about the uncertainty inherent in age-related health problems. Drawing from observations of patient visits in primary care and interviews with geriatricians, I find that old age can be mobilized by both geriatricians and their elderly patients to bridge the communication gap between doctor and patient. In particular, I will show how mentioning old age enables geriatricians and their patients to a) collaboratively achieve holistic medical care that bridges the gap between the voice of medicine and the voice of the lifeworld, and b) personalize decisions about medical care. In turn, this enables geriatricians and their patients to overcome the problematization of age and aging by using it to collaboratively establish a partnership in medical interactions. [ABSTRACT FROM AUTHOR]

The amount of economic risk that Americans shoulder in the twenty-first century has increased considerably. More volatile incomes and a trend toward more neo-liberal policies have led to growing economic instability among American families. In the context of rising health care costs, particularly in the post-2000 period, this paper examines whether or not the emergent health insurance model contributes to economic instability. Considerable attention has been given to the impact of health insurance on health outcomes. The contribution of this paper is a systematic examination of the impact of health insurance on salient economic outcomes. Using longitudinal data from the National Longitudinal Study (NLSY79) collected by the US Bureau of Labor Statistics (2006), initial findings based on multinomial logistic regression suggest that a loss of health insurance coverage is positively related to downward economic mobility of families between 2000 and 2004. Interviews with a sample of twenty-five New Hampshire residents of varying economic means support the findings of the quantitative analysis and provide a more in-depth understanding of the processes involved in managing rising health care costs. [ABSTRACT FROM AUTHOR]

Health information technologies such as the electronic health record (EHR) are becoming more widely adopted by medical practices in the United States. With new technologies come new workflows and behavioral practices. Adoption of an EHR impacts medical encounters in primary care solo and small group practices. This paper includes both observational and interviewing methods of two studies to understand how the social work of primary care providers is negatively impacted when an EHR is used in solo/small group practices in the United States. Many elements of providers' work change with use of the EHR. Some notable negative changes discussed in this paper are: engaging in eye contact, dealing with lulls in the conversation while documenting in the EHR, as well as resolving the tension between the patient's logic through storytelling, the provider's personal practice of diagnosis and treatment decision-making, and the logic provided by templates in the EHR software. Hopefully, by shedding light on these issues, a conversation about the social nature of medical encounters will be at the forefront of discussion about use of an EHR. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The over-50 older adult population consistently comprises about 15% of the U.S. AIDS population; this figure is expected to increase substantially within the next few years due to rising HIV infections among this age group. HIV infection in this population is increasingly due to heterosexual transmission, with an overall increase of 94% in over-50 men and 107% in over-50 women since 1991 (www.about.com 2006); however, this age group is the least likely to be tested for HIV or seek education about prevention tactics and services. In this paper (which is part of a larger dissertation project which focuses on the Midwest--specifically Kansas, Missouri, Iowa and Nebraska's HIV/AIDS polices), I propose that the growing HIV/AIDS rate in the over-50 population is due to the failure of health promotion efforts to reach older adults; as a result of this policy failure, the infection rate among older adults will continue to increase. State HIV/AIDS directors and other officials involved with public health promotion influence public policy and financial resource distributions and help to target older adults with prevention information. Despite this potential to affect HIV/AIDS health outcomes, health workers have been slow to respond to the infection of older adults. My research will inform state-level policymakers and implementing agencies about an important and overlooked segment of the population with significant and growing HIV infection. This research has the potential to improve public health policy, public health, and reduce the cost of HIV/AIDS-related health care in the Midwest and the nation. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Health policy occupies an ambiguous position in relation to the sociology of welfare states. Most theorists assume that the provision of health care fits unproblematically within a system of broader structures and ideologies that determines the overarching shape of a nationally bounded welfare state, but empirical studies illustrate that this is not the case. Health policy research in fact exposes the diversity among welfare states that are usually lumped together in one category. This paper compares national responses to AIDS in the U.S. and the U.K. in order to explore the conditions under which policy choices are shaped by defining features of the liberal welfare state or by other competing principles or mechanisms. In particular, distinct differences between the AIDS policy trajectories in the two nations highlight the need to consider the shape of health system institutions as important determinants of policy alongside the political and cultural factors that are more routinely taken into account. I argue that the centralized and universalistic National Health Service in Britain provided relatively smooth institutional avenues along which policy responses to the AIDS crisis could be pursued, whereas the decentralized and fragmentary American health system posed an obstacle-laden environment through which policy advocates had to negotiate. My account revises the traditional story of AIDS policy by examining the ways in which different institutional precursors can mediate the effects of similar cultural and political mechanisms in the ongoing evolution of welfare states. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

In this paper, we introduce the concept of clinical life to capture a form of life produced in the pursuit of medical possibility. We describe clinical life as it is expressed by aged patients and their families in the wake of receiving life-saving cardiac procedures. Clinical life is made possible as people in the more affluent sectors of U.S. society infer specific promise about lengthened, restored life from possibility, and engage easily and naturally with what the clinic has to offer in the pursuit of the opportunities, desire, and growing obligation to extend life into ever-older ages. Our notion of clinical life embodies the changed experience of and expectations about one's body and future as the transformative and restorative potential of medical technologies becomes a significant point of reference for evaluating life and its worth. Clinical life is also existentially experienced in the wake of medical intervention as aging individuals subsequently manage, negotiate, and reflect upon the contours of an acceptable relationship with the world of the clinic. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The U.S. health care financing system offers extremely uneven access to care and protection from costs to its citizens. This fact is known to have produced both negative health effects and bankruptcies for some citizens, but its overall effects have not been systematically studied. If this system exacerbates health stratification, it is likely to do so by affecting citizens? decisions about seeking care as well as by affecting providers? willingness to provide needed services. This paper reviews the historical and institutional context for such a study and reviews the literature to determine what is presently known. [ABSTRACT FROM AUTHOR]

Hundreds of studies have documented disparities in medical treatment in the US. These findings have generated research and initiatives intended to understand and ameliorate such disparities. Most approaches implicitly assume that disadvantaged patients' beliefs and attitudes toward health care are at odds with the health care system, failing consider whether patients use particular strategies to overcome providers' potentially negative perceptions of them and/or obtain quality medical care. In this paper, we examine positive self-presentation as a strategy that may be used by disadvantaged groups to improve their medical treatment. Analysis of survey data suggests that both African Americans and lower socioeconomic status persons are more likely than whites or higher socioeconomic status persons to report that positive self-presentation is important for their getting the best medical care. Based on these findings, we suggest several routes for future research that will advance our understanding of patients' everyday strategies for getting the best health care. [ABSTRACT FROM AUTHOR]

In recent years, the idea that participation in community activities may create network resources that in turn improve the health and well-being of individuals and families has gained considerable prominence among both researchers and policymakers. However, nearly all of the existing literature in this area is set in developed settings. To assess the relevance of this hypothesized pathway to health, we must establish a relationship between social capital and health in settings outside of the developed world. In this paper we assess the link between participation in community activities and health in Indonesia. Specifically, we ask whether children are healthier when their mothers are active within their communities. Panel data come from the 1997 and 2000 waves of the Indonesia Family Life Survey. Our results indicate that, in Indonesia, maternal community participation is positively related to child height-for-age in poorer households and in households with less educated mothers, mitigating the deleterious effects on health associated with low socioeconomic status. This relationship holds when community fixed effects are included in the estimations. [ABSTRACT FROM AUTHOR]

The willingness of Americans to publicly fund health care services is a long debated and perennially timely issue. We argue that public commitment to health care funding may be more extensive at the local level than previously thought. Preliminary research in the mid-1990s conducted in Kansas found between 12.1 and 13.6 percent of county budgets devoted to funding basic health care services. This paper analyzes data gathered from all county budgets in nine predominantly rural states?Georgia, Iowa, Kansas, Montana, Nebraska, New Mexico, South Dakota, Utah and West Virginia--in order to determine the extent and patterns of local spending for basic health care services in 1997, 1999 and 2001. The purpose of the study was to determine (1) the absolute amount of health care spending at the local level going to support health care services in each of these years, (2) the percent of each county budget devoted to health care expenditures throughout the nine study states in each of the three study years, and (3) county per capita spending for health care in each of the nine study states over the same three years. In addition, we wanted to examine factors that might explain variation in these three variables in a given year as well as patterns of change over time. [ABSTRACT FROM AUTHOR]

Historically, health social movements have been an important force for social change in the United States, specifically around issues of health access and quality of care. Previous research has focused on individual cases of health social movements; we consider them as a collective group that when taken together are an important force for social change. Scholars have written about individual social movements dealing with health, including such areas as occupational safety and health, the women’s health movement, AIDS activism, and environmental justice organizing. Other scholars, who do not focus on health social movements, point to the significance of these movements in medical history and health policy. Despite this significant body of research, scholars have not examined the forces that gave rise to the wide array of health social movements, nor carried out comparative analysis of these movements? different strategic, tactical, and political approaches. Generally, scholars have not examined the collective development and impact that myriad health social movements have had on public health, medical research and health care delivery. We believe that there is an analytical benefit to consider the origins and impacts of HSMs collectively, and this work is part of a larger project to integrate and synthesize this material. In this paper we focus specifically on a new type of health social movement, known as ?embodied health movements? (EHMs) whose strategies and characteristics have not previously been central to the study of health movements. [ABSTRACT FROM AUTHOR]

Health Maintenance Organizations (HMOs) have become an increasingly popular mode of health care delivery for controlling medical expenditure using different cost containment methods. However, patient advocates have long argued that the quality of health care worsens with their enrollment in HMOs. This paper studies this argument using the data from 19,914 Patient Record Forms completed for the 1998 National Ambulatory Medical Care Survey (NCHS 1998). Using the length of physician-patient encounter as an indicator of the health care quality, I hypothesize that physician-patient encounters are shorter for HMO, Medicare, and Medicaid patients, when respondent?s age, sex, and race are controlled. The results from the OLS estimates for a linear regression model show that HMOs do not necessarily lead to shorter physician-patient encounters. In addition, I suggest further research on differences in the accessibility, continuity, coordination, and comprehensiveness of health care between HMO and non-HMO patients. [ABSTRACT FROM AUTHOR]

Although health care spending represents one of the largest expenditure categories in all Western societies, most research on the welfare state has neglected issues related to health and health care. In this paper, we use the ISSP to evaluate the public attitudes towards health care in the United States, Australia, Germany, Great Britain, and Italy at three points in time. We find that public attitude do not cluster according to the most widely used schemes to classify welfare states which is not surprising given that these nations have often been clustered together without paying attention to health care. The results also indicate that the cleavages that are most influential in dividing individual health outcomes are an important predictor of people's attitudes towards government involvement in health care. In general, groups who have been shown to experience worse health in modern society are more supportive of government involvement in health care whereas groups experiencing better health are generally less supportive. [ABSTRACT FROM AUTHOR]

Recently, scholars and activists have focused attention on the contemporary crisis in care in the United States, particularly on the inadequacy of care resources and concomitant low wages and high turnover in care jobs. Understanding the linkages between care work and the low-wage labor market as well as gender and racial hierarchies is crucial to addressing this crisis. In this paper, the author uses Census data to demonstrate empirically the implications of using two different theoretical formulations of care to address these questions. The nurturant skill framework focuses on care as relationship while the reproductive labor framework includes both relational and non-relational jobs that maintain and reproduce daily life. The study finds that very low-wage jobs are concentrated in the reproductive labor segment, where women of color are disproportionately represented. The author concludes by suggesting several directions for integration of these two theoretical perspectives to better address both gender and race in the care sector. [ABSTRACT FROM AUTHOR]

The United States is the only nation in which health care for the majority of the population is financed by for-profit, minimally-regulated private insurance that leaves one-sixth of the population uninsured and others at risk of losing insurance as a result of such life course events as divorce, aging, widowhood or an economic downturn. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development but ignore the distinctive character of the health care financing arrangements that do exist. Medical sociologists describe the ascendance of professional sovereignty and the subsequent purchasers' revolt, but not the way this changing configuration of power was asserted in the political arena. This paper locates the political determinants of health reform within the context of the transformation of American medicine. It demonstrates that the main impediment to national health insurance has been the political mobilization of stakeholder groups against public programs that might challenge physician sovereignty, lead to increased regulation of the market or compete with private sector products. More fundamentally, it challenges the distinction social movement theorists make between the tactics and strategies of less privileged groups and normal political processes but also suggests that the institutional structure of the state channels political activities in ways that privileges stakeholder groups with ample resources. [ABSTRACT FROM AUTHOR]

African American patients are much more likely than other race patients to receive healthcare from African American physicians. Researchers have assumed that patient preferences influence the race of patients' healthcare providers, but the strength of preferences and what factors inform them have not been clarified. In this paper, I assess the extent to which 1) knowledge of historical mistreatment, 2) knowledge of current racial inequities in medical treatment, and 3) personal experiences of discrimination predict preference for same-race healthcare providers. Using national phone survey data, I find that only 1 in 5 African Americans states a preference for a same-race healthcare provider. Neither knowledge of historical mistreatment nor knowledge of current racial inequities in medical treatment are related to preferred race of healthcare providers. In contrast, I find that personal experiences of discrimination in healthcare are associated with a preference for same-race healthcare providers. The results contradict prevailing beliefs about African Americans' preference for black clinicians. They also contradict expectations about the relationship between group-level injustice and preferences. The possible explanations for these findings are reviewed. [ABSTRACT FROM AUTHOR]

In this paper, I discuss the legacy of the Women’s Health Movement in the 2000s, in restructuring health care and deinstitutionalizing medical authority through looking at the ways a feminist health collective located at the east coast of US (providing gynecological and abortion services) negotiates medical authority in (a) reducing the knowledge difference between the provider and the women, (b) challenging the license and mandate of physicians, (c) altering the size of the profession relative to clientele, and (d) transforming the clientele from an aggregate into a collectivity. Evaluated by these strategies (Ruzek, 1978), the Feminist Health Center under study was seen to alter medical authority through the first two. Efforts on the last two on the other hand, were thwarted by the male physician’s power at the center, the capitalist economy that supports medical power (through insurance policies), and the politics of abortion (the lack of support of the agency in the community and by clientele). Feminist clinics continue to be the vanguards of the women’s health movement, bridging feminist theory and practice. And through this study, it can be seen that these clinics, as Feeree and Martin (1995) claim, are hybrid organizations trying to balance feminist ideals with the realities of (mainly hostile) socioeconomic and political environments. Although the organization studied showed a change towards a more bureaucratic structure, I believe that maintaining feminist consciousness in its staff and continued efforts for community alliances will allow the agency to negotiate medical authority without compromising its egalitarian structure. [ABSTRACT FROM AUTHOR]

This paper will determine the extent to which health insurance has an impact on health, net of that of more conventional measures of socioeconomic status (SES), namely education and income, using data from the 1979 National Longitudinal Survey of Youth. As previous research indicates, a satisfactory answer to this question requires estimates of the effects of health insurance on health that are less affected by selection biases. This will be achieved by framing this question within the counterfactual account of causality and using fixed effects models with sibling clusters to corroborate -- or refute -- the results of a conventional OLS regression. Fixed effects models postulate that, by using one sibling virtually as a "control" for another one, it is possible to estimate the effects of current factors net of common family background and genetic predispositions (Guo and Van Wey 1999). Results show that, despite the inclusion of control variables antedating the measure of health insurance coverage, public insurance has in the conventional regression a strong negative association with health. However, as hypothesized, this negative relationship declines in magnitude and becomes non significant in the fixed effects regression with sibling clusters. Conversely, the effects of years uninsured, which were non significant in the OLS regression, increase in magnitude and become highly significant in the fixed effects regression. Private insurance had no significant effect on health beyond that of adult SES in either model. These results suggest that being uninsured has a strong negative impact on health, while public and private insurance may have no impact beyond that of adult SES. However, this relationship can only be observed with methods that specifically address the selection bias in health insurance allocation. [ABSTRACT FROM AUTHOR]

With a limited welfare policy, the United States addresses the pressing issue of access to health care by supplementing care of the uninsured with volunteer health organizations. This paper presents a community-based research conducted with the Volunteers in Medicine (VIM) clinic in Bloomington, Indiana. The main objective of this research is to examine and evaluate the issue of access to health care in a unique context where a free health care clinic is available. Consistent with other research in this field, our findings show an association between several socio-demographic characteristics and usage of the VIM clinic. Findings also point to the importance of social capital and social networks. Based on these findings, we argue that the establishment of free health clinics like the VIM, are an example of first-order change - a response to a social problem within an existing framework. In this case it is the development of free health care clinics following the template of conventional health care clinics. However, this change does not address the underlying processes that shape actual access and usage. Hence, we highlight the need for second-order change that will include re-thinking the concept of the clinic to include more innovative strategies for patient recruitment. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

This paper reveals insights into how different players in the field of U.S. healthcare utilize the Internet to present certain conceptions about health to the public. I examine three websites sponsored by three different types of health actors. I find that the websites all present messages that on the one hand, advance the neo-liberal agenda by advocating individuals to take active control over their health, and on the other, proclaim the continued relevance and importance of mainstream western medicine as a primary distributor of care. Additionally, depending on the type of health actor operating the website the websites health messages reflected different agendas. This provides evidence that while operating within a cultural script there is room for actors to advance messages that promote their individual goals. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The unprecedented trend in demographic aging and the unmet need in health insurance coverage have a profound impact on the medical-care service utilization and quality of life of U.S. elderly. Using the 2006 Health and Retirement Study, this paper examines how marital status affects the health insurance acquisition among Medicare covered population. Outcomes of using Medicare as primary health insurance, signing up for Medicare prescription plan, being covered by Medicaid, having any private insurance, and having long-term care coverage, are investigated. Results of logistic regression analyses show that holding socio-demographic, health, economic, and social support factors constant, marriage has a beneficial effect on elder's access to health insurances. Divorce and widowhood provide a different dynamics in shaping later-life health-care strategy and therefore, influencing elder's health insurance possession. This project is concluded with a policy recommendation on how to deliver an effective intervention to reduce the insurance gap observed in the sub-population. Directions for future study are suggested. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Cancer will become the leading cause of death in the United States even as more people live with the disease. The US health care system is notorious for its institutional complexity, but there has been relatively little attention paid to the institutional contexts within which cancer care is delivered and how the social institutions of cancer care shape the experience of care. This paper examines provider-patient communication in three different types of health care delivery systems: academic centers, safety-net clinics, and private practice. I argue that these systems, which are supported by different resources and cater to different classes of patients, exhibit distinct cultural and institutional logics. In each setting the foci of provider-patient interaction are the same - disease and treatment, progress and uncertainty, side-effects and suffering - but the language and meaning of these issues vary across settings. I draw on data gathered during more than 5 years of ethnographic fieldwork in northern California to empirically describe three distinct cancer worlds: a high-tech world in academe, a market-focused world in private practice, and a resource-limited world in the healthcare safety-net. I explore theoretical and practical implications of these findings. Theoretically, what are the implications of cultural complex cancer worlds for the social process of biomedicalization, which appears to be re-shaping our contemporary understanding of bodies, risk, and suffering. Practically, can better understandings of the logics of cancer worlds help providers and patients more fully understand and negotiate their care experience. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

As the sociologist Andrew Abbott has famously observed, professional occupations form a "system," in which the fates of different professions (and hence professionalisms) are linked, sometimes competitively, sometimes cooperatively. A growing literature sheds light on the impact of information technology, qua technology, on the professionalism of medical practitioners. However, to understand the implications of the dawning "information age" for professionalism in the healthcare sector as a whole, one must look beyond the absorption of IT into the traditional healthcare professions, to consider how the introduction of clinical IT may restructure the "system of professions" that constitutes the larger healthcare enterprise. Clinical IT poses a number of significant governance challenges for healthcare relations, implicating critical issues of integrity, integration, and control. These governance challenges can -- and to some extent, perhaps, will -- be resolved by a range of essentially non-professional (or even anti-professional) social structures; however, the history and the current direction of American healthcare suggest that one likely consequence of the rising prominence of health information, health information technology, and health information technology governance will be a concomitant rise in the prominence of new "health information professions" (HIPs). This paper lays out some preliminary thoughts on what these new professions will be, who will be their members, and how those members will conceptualize their work, their workplace, and their professionalism. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Utilizing a review of relevant literature concerning complimentary and alternative medicine (CAM) and the policies of the Department of Health and Human Services (DHHS), this paper focuses on the important role that semantics play in policy decisions regarding health care. Of specific interest is DHHS' refusal to reimburse any services associated with CAM through Medicare or Medicare. This policy is justified by DHHS because the deaprtment cites a lack of evidence showing the safety and effectiveness of CAM (Kamerow 1999). In addition, physicians have been known to make attempts to limit the practice of CAM (Wolpe 1985) to protect their professional turf (Hafferty and Light 1995). However, music therapy, a popular form of therapy considered to be part of the CAM category by a number of medical institutions (National Institute of Health 2006), is reimbursable under the policy of DHHS if music therapy is classified as activity therapy. The example of music therapy illustrates that inconsistencies can exist because different labels can be applied to the same treatment. Moreover, the relationship between music therapy and DHHS shows why the label a treatment carries is significant. This observation of the importance of semantics in health care policy illustrates both challenges and opportunities for the future of CAM. [ABSTRACT FROM AUTHOR]

Using a macro level analysis and the countervailing powers framework, this paper presents a case study of an allied health occupation, certified registered nurse anesthetists (CRNAs), that succeeded in winning the right of independent practice in some US states, despite strong opposition from anesthesiologists, their physician counterparts. Two countervailing powers are examined—technology and the political-economic context. The findings demonstrate that the development of a systematic body of knowledge, which is crucial for professional power, can undermine that power, when the knowledge can be embodied in equipment and practice guidelines, as is happening in anesthesia. The alignment of this countervailing power with government initiatives to reduce health care costs opened a window for CRNAs to become independent practitioners. [ABSTRACT FROM AUTHOR]

Two major demographic trends over the past 40 years have altered the composition of the U.S. population and have a direct impact on the health care system: rapid growth of the elderly population and continued influx of immigrants from diverse regions of the world. Put simply, aging and immigration. The common denominator characterizing the growth of these populations is that they are vulnerable, or at risk, groups in terms of health care access and quality of health care, which in turn has important implications for public health and health policy. This paper draws on multiple national data sources to examine the health policy implications of these demographic realities. Our findings have implications for scholars interested in immigration, health, and gender, as well as for policy-makers. [ABSTRACT FROM AUTHOR]

The United States is facing a nursing shortage that has the potential to severely compromise our nation's health care system. In 2004, the Bureau of Labor Statistics projected that the US would be one million registered nurses (RNs) short of the national need by the year 2012. With no new evidence to suggest that the shortage is declining, the need for understanding the factors underlying the shortage has never been greater. Although the work environment is cited as the most common source of burnout, little is known about the operant mechanisms through which this environment affects nurses' well-being. Motivated by two theories of identity control (i.e., Affect Control Theory and Identity Control Theory), this paper examines the extent to which identity processes influence the experience of agitation- an emotional outcome linked to decreased well-being both on and off the job. Specifically, I hypothesize that identity salience and commitment will moderate the effect of experiencing a disconfirmation between the expected and actual identity characteristics of RNs on agitation. Results indicate that the salience of one's nurse identity is positively related to the experience of agitation, while cognitive commitment to a nurse identity is negatively associated with agitation. Although few interactions were significant, identity salience does exacerbate the effect of identity disconfirmation on agitation, but only when identity disconfirmation was operationalized as a directed construct. [ABSTRACT FROM AUTHOR]

Recent assertions that the gendered paradox in health and mortality (that men experience higher age-specific death rates and lower life expectancies than women, while women have higher rates of sickness, worse health status and more health care consumption than men) has been explained by measurement innovations are re-examined using the same source data: multiple years of the National Health Interview Survey. Procedures that help model comorbidity structures may yield more complete measures of chronic conditions; however, in explaining the paradox, alternative explanations were largely ignored. This paper explicitly tests competing hypotheses using an array of sensitivity analyses based on: sample selection; response processes (self vs. proxy reporting); alternative morbidity measures; variable mortality follow-up periods; modeling and inference specifications; and different theoretical perspectives and interpretations. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Rates of Cesarean delivery in the U.S. have increased dramatically over time, to a high of 30.4% in 2005. We argue that the organizational environment of health care - including medical malpractice suits, malpractice insurance premiums, and health insurance companies - has contributed to the escalation of "defensive medicine" and, consequently, the cesarean delivery rate. Yet no sociological research on childbirth has focused specifically on how the organizational and legal environment influences birth practices. This paper analyzes the effects of the malpractice environment on c-sections at the state level. Using publicly available data, we find that the number of obstetrical malpractice suits per 100,000 population has a strong positive relationship with state c-section rates, while caps on non-economic damages have a strong negative effect. Percent of women receiving prenatal care in the first trimester, and poverty-related variables like percent uninsured and the infant mortality rate also have significant positive effects. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

In this paper we explore the correlates of childlessness, only children, and two or more children among white and black women. Past research has either neglected racial differences among women with small completed family sizes, or attributed very low fertility to unique causes for black and white women. While white women's childlessness has been attributed to greater educational and employment opportunities that conflict with family responsibilities, black women's childlessness has been viewed as the result of inadequate health care, disease, and coercive sterilization. We re-evaluate these arguments with data from the three most recent waves of the National Survey of Family Growth (cycles 4, 5, and 6). Event history and survival analyses utilizing detailed fertility, adoption, marital, employment, and educational histories indicate striking similarities among white women and black women in how these factors relate to fertility patterns. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

During the recent public discussions of health care reform in the United States the Canadian approach to health care was both idealized as a potential model to emulate and demonized as a disastrous and un-American direction to move in. Much of the evidence used to support these positions was vague, distorted and anecdotal, leading to misconceptions about the Canadian approach to health care and how it compared with the United States. The purpose of this paper is to clear up some of the misconceptions that have emerged and provide an informed comparison of health care in both countries along multiple dimensions. Specifically this paper will look at coverage, access, cost, health outcomes and satisfaction. The potential impact of the Affordable Care Act on these comparisons will also be discussed. [ABSTRACT FROM AUTHOR]

Since 1965, federally subsidized community health centers (CHCs) have played a key role in the health safety net in the United States. More than 1,200 CHCs receive more than $2 billion to operate in community settings, migrant worker facilities, public housing, and homeless shelters, serving nearly 20 million people. CHCs have a distinctive governance system, mandated by federal law, that differs from most other publicly funded health care facilities. The centers are governed by local boards of directors, of which at least 51 per cent must be patients or consumers of the health center, and that are representative of the people served by the centers in terms of ethnicity, race, gender, and socioeconomic status. This paper examines the role, history, and governance structures of CHCs and discusses the implications of persistent community control for their operation and community impact. The paper concludes by proposing a research agenda to better understand the governance of CHCs and its implications for health care services to indigent and underserved populations. [ABSTRACT FROM AUTHOR]

A major objective of the Affordable Care Act passed in March 2010 is to ensure access to care for millions of uninsured Americans. This paper expands on existing work, which finds differential patterns of insurance coverage and access to healthcare based on race and ethnicity or nativity. I examine inequities in health access for children across immigrant generations for four major U.S. racial/ethnic groups, testing explanations of racial differences, generational differences and the interaction of the two. Using data from the 2007 National Survey of Child Health, I discuss patterns of health care access among children that differ by race/ethnicity and immigrant generational status. More time in the country (across generations) does not mean equal increases in likelihood of access for the children of all groups. Multivariate regression models test to what extent these patterns may be explained. This paper expands on factors that may account for differences in access starting with characteristics commonly assessed in the literature such as: age, income, parents education, language spoken in the home, family structure, work status, and adding receipt of government aid. With the growing number of children of immigrants in the United States, this project establishes a crucial baseline on equity of access by which to evaluate implementation of future health care reform. [ABSTRACT FROM AUTHOR]

Basing health insurance on the economic productive value of human beings, on a career job, or on having a partner with insurance are disadvantages for women with lower career opportunities. Although employment-based health insurance has become recognized as a factor relevant to remaining in the labor force, the dynamics surrounding gender differences are not well-examined by the large body of mostly economic insurance-retirement research which mainly works from the rational-choice angle. Other fields including sociology and life course literature have only very inconsistently included health insurance when looking at labor force patterns. None of these studies has examined and theorized gender to the extent that it could fully explain complex gendered labor force patterns which are likely to be exacerbated by employment-based health insurance in the United States. A sufficient account for gender can only be accomplished when taking marital status and health insurance combined into account, looking at married/divorced/widowed women and men with insurance separately, and in placing much emphasis on spousal insurance and individual income. This paper theorizes for the first time gender in this particular strand of research which largely did not differentiate gendered labor force patterns. This paper is theoretically informed by the doctrine of separate spheres including breadwinning, organizational power structural theories, gender and the life course perspective, and the gender and the social constructionist perspective. [ABSTRACT FROM AUTHOR]

The shift of high-tech medical care from hospital to home has been one of the most pronounced trends in health care over past two decades. Patients discharged "sicker and quicker." Further, most families must perform complex nursing tasks without visiting nurse support. Because of these policy shifts, caregiving families must rely on support from informal networks to meet care demands. Based on an in-depth, one-year ethnographic study of thirty families caring for Bone Marrow Transplant patients at home, this paper analyzes how social class shapes the "cultural capital" (medical literacy and the sense of entitlement required to use it), and the "social capital" (informal networks) on which patients and informal caregivers depend for assistance. Unexpectedly, working-class networks were large, diverse and multiplex compared to middle-class networks, providing higher quality patient care and preventing caregiver burnout. Middle class networks, while benefitting from high cultural capital, had almost nonexistent informal networks due to geographic mobility, lack of contact with neighbors, and unwillingness to incur reciprocity demands. By contrast, working-class families have dense social networks and ongoing reciprocity norms. They received the most frequent and the most varied forms of assistance of the three groups. They also compensated for low medical literacy in the nuclear family unit by drawing on "pockets of expertise" in extended family and community networks. This paper will discuss the sources of these differences in informal support. [ABSTRACT FROM AUTHOR]

As we follow the HIV epidemic and the phenomenon of ?mass incarceration? into the 21st century, mounting statistical evidence clearly indicates three sides of an injurious triangle. One, we cannot talk about HIV/AIDS without talking about communities of color. Two, we cannot talk about communities of color without talking about incarceration. And three, we cannot talk about incarceration without talking about HIV/AIDS. This paper examines each of these connections in detail and argues that in contemporary American society experiences of incarceration (on both individual and social levels) play important roles in the context of HIV/AIDS within communities of color and must be considered in the development of prevention and treatment efforts. In addition, a stronger understanding of the links between incarceration, HIV transmission risk, and inconsistent or even harmful health care for sero-positive people of color highlights the pressing need for advocacy around issues of the nation?s over-reliance on incarceration, standards of care for the medical treatment for inmates, and the lack of universal access to health care for U.S. residents. [ABSTRACT FROM AUTHOR]

This paper examines the arguments used to legitimize the use of medical imaging technologies in current medical practice. Specifically, accounts presented by the American Medical Association, the press, and the Food and Drug Administration are examined to understand how imaging technology is positioned as a necessary medical intervention in the United States. Two case studies"-Magnetic Resonance Imaging (MRI) and mammography"-are used to illustrate these claims. The analysis of these imaging technologies illuminates the rhetorical strategies used to legitimize and justify contemporary imaging practices in the United States and Canada and, in the case of mammography, demonstrates how recent attempts to delegitimize these techniques were quickly stabilized and silenced. [ABSTRACT FROM AUTHOR]

The study of racial attitudes and public opinion in the U.S. has largely focused on white attitudes toward African Americans. We go beyond this black-white dichotomy by focusing on Latino/a perceptions and experience with discrimination, both individualized and structural, and how this links to evaluations of health care access, education and employment opportunities. Data from the 2002 National Survey of Latinos (Pew Hispanic Center/Kaiser Family Foundation) are used to test the socio-economic and cultural effects (e.g., race, ethnicity, education, age, gender, occupation, nativity, language proficiency, and length of time in the U.S.) in shaping respondent's understanding of discrimination at the individual level and group level. Our study exclusively focuses on Mexican origin respondents (N=1059), the nation's largest Latina/o population in the United States, to capture varying degrees of discrimination and their relative impacts in structuring attitudes on key issues. Preliminary analyses of the descriptive statistics indicate higher levels of discrimination experienced at the group level in schools and employment with lower levels of discrimination experienced at the individual level. We perform logistic regressions to measure the cumulative effects of the independent variables on the dependent(s) for both individual and group level discrimination. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The management of uncertainty is a fundamental aspect of the organization of healthcare. The integration of new medical technology into medical practice can create a variety of forms of uncertainty in the delivery of healthcare. Much has changed in the organization of healthcare in the U.S. since the 1900s with the advent of new forms of government oversight, the decline of medical authority, and the rise of evidence-based medicine all of which have helped standardize medical practice. When taken at face value, standardization appears to decrease uncertainty in disease management. A comparison of the early twentieth century case of syphilis with the contemporary case of HIV/AIDS illustrates a central paradox of standardization in the treatment of sexually transmitted disease: that is, technological solutions to old problems generate additional uncertainties. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Fundamental cause theory suggests that because persons of higher socioeconomic status have a broad range of flexible and multi-purpose resources that can be used to the advantage of their health, including knowledge, money, power, and social connections, they hold an advantage in warding off whatever particular threats to health exist at a given time (Link and Phelan 1995). Therefore as proximal risk factors that stratify health along socioeconomic lines are eliminated, socioeconomic disparities in health remain strong rather than weakening. To test the theory, it has been hypothesized that SES should be more strongly associated with diseases that are more highly preventable than with diseases that are less preventable. I use data from Canada and the United States, two countries that share many similarities but are also very different in terms of health-related social policy and in levels of inequality, to establish the relative impact of socioeconomic status as a "fundamental cause" of health disparities in the two countries. The results of this analysis suggest that SES as a fundamental cause of disease operates similarly in Canada and the U.S., despite Canada's lower overall inequality and universal health care. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Mindfulness meditation, a practice that originated in Buddhism, has grown exponentially over the past thirty years both in the U.S. and across the globe. This growth is due, at least in part, to scientific studies documenting the health effects of meditation including positive effects of meditation on brain function. As a result of this research, medical practitioners are increasingly encouraging their patients to explore mindfulness meditation practice to help with a variety of physical and mental ailments. The new mindfulness courses have roots in Tibetan Buddhist traditions, but are wholly secularized treatments of meditation that are advertised through health care providers and covered by many insurance plans. My research will document and discuss the significance of the rising popularity of mindfulness meditation in the U.S., and will explore how this trend highlights growing tensions at the boundaries of science and religion. My core theoretical questions investigate how Buddhist contemplatives and scientists who are studying meditation negotiate the tensions between spirituality and rationalism. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The United States has experienced four waves of health care reform during the twentieth century. Beginning with the first wave between 1910 and 1920, other waves occurred between 1935-50; 1965-80; and the fourth wave approximately 1991-1994. During the first three waves, health care reformers advocated national health insurance as an alternative to the current system. The fourth wave however, argued in favor of a broadly constructed, yet less focused public/private partnership. Although reform efforts were defeated during all four waves, the fourth wave experienced increased fragmentation of system-level options along with multiple voices advocating a range of reform options. Focusing on the fourth wave, this research examines how national news programming used three specific health reform terms on their newscasts and by whom. Utilizing Lexis-Nexis, this research analyzed news transcripts of ABC, CBS, NBC, Fox, and the McNeil-Lehrer News Hour. This research categorized who and how the following three terms were used on the newscasts: universal coverage, national health insurance, and single-payer. The findings indicate that health caree reform terminology on network newscasts was primarily given as a statement rather than within the context of health policy and that the television anchors/reporters were more likely to use the terms rather than politicians or health policy experts/advocates. It is argued that national news programming presented health reform as having limited significance because it was not considered within the context of broader health policy. The implications associated with media usage of these health reform terms are presented. [ABSTRACT FROM AUTHOR]

The purpose of this research is to examine differences in access to and sources of health care for children among major Hispanic sub-populations of the United States in comparison to non-Hispanic Whites and Blacks, while considering the influences of mother's nativity, citizenship and the length of time lived in the United States. Using the National Health Interview Survey from 1999-2001, logistic regression and multinomial logistic regression models are estimated to compare Mexican Americans, Puerto Ricans, Cubans, Other Hispanics and non-Hispanic Blacks with non-Hispanic Whites. Only Mexican American children are significantly different from the reference, as they are less likely to report access to a regular source of care in comparison to Non-Hispanic whites. In sources of medical care, Mexican Americans and Other Hispanics are all less likely to report relying on a private doctor's office than other types of care in comparison to Non-Hispanic whites. The models illustrated the role immigration plays in influencing access to and sources of a regular medical care. As the duration of the mother in the United States increases and naturalization occurs, the odds of reporting clinic, emergency room and other medical facility relative to the use of a private doctor's office between race/ethnic groups declines. As immigration status variables are taken into account, Hispanic sub-groups will have decreases in the inequality in sources of care between themselves and Non-Hispanic whites. [ABSTRACT FROM AUTHOR]