How Cultures Affect Medicine and Law - Research Paper Example

Outline I. Introduction II. Research methods III. Literature Review A. Patient’s Bill of Rights B. Healthcare Disparities C. Physician-Patient Relationship and Decision Making Rights D. Healthcare Financing E. Healthcare Policies and Cultural Influences F. Government’s Role and Power in the Protection of Public’s Health IV. Conclusion V. References Abstract This research paper hopes to examine the profound effect that culture has on medicine and on the formation of public health policies. In particular, the paper will focus on the physician-patient relationship, physician and patient decision-making rights, health care financing, and the power of the government to protect the public’s health. This will be accomplished by using comparative approaches to consider how culture structures these policies in the United States, with a comparison of minority experiences and a discussion of how the study of international examples can inform our understanding of the situation at home. In addition, the paper will focus on the implications of the Patient’s Bill of Rights, especially its influence on the treatment of minorities. By examining this historically important bill, the dissertation intends to clarify the process by which culture transforms public health, health care financing, and the very core of physician-patient interaction. Sources that will be included: (1) studies on health care disparities in the U.S., (2) health care policies, (3) Patient’s Bill of Rights, (4) studies on health-care disparities elsewhere, and (5) physicians. Data will be collected from archives, interviews, newspapers, and published reports to support my findings. Furthermore, the research hopes to show that although some view federal agencies, courts, or political parties as the agents driving institutional change these groups have acted in response to the pull of cultural movement. In order to better illustrate the “pull” the paper will include historical detail on the expansion of patient rights and gains in federal power, the diminishing of health care discrimination, and the emergence of cultural consciousness by the physician. And as the United States culture continues to evolve, so will health care policies. During the twentieth first century, both physicians and patients remain culturally ignorant of those around them. Often, minorities are not knowledgeable in the mechanics of the United States health care system, resulting in poor-quality health care for these groups. Moreover, the increasing elderly population has placed and will continue to place further constraints on the federal government. Medical staff will become in short supply and, with an already bad economy, the government is scrambling to find a solution to monetarily aid the retirement community. These events will bring about a new cultural revolution which will provide a lasting effect on the health care system. The research paper will then take a quick look at the result of such an effect on the future of US health care policies and will present an analysis of both the advantages and disadvantages of these policies. The paper will specifically look at the advantages and disadvantages of the newly signed Patient Protection and Affordable Care Act; along with an analyzation of how cultural influences brought about the recently enacted act. Such an analysis will provide the basis for further research and hopefully initiate further interest on how cultural revolutions have altered the very core of this nation’s health care policies. Proving, once more that culture has had and will continue to have a profound effect on both medicine and law. How Different Cultures Affect Both The Practice Of Medicine And Law. Focus On Laws: Public Health Policies The practice of medicine and law in public sector is greatly influenced by the existing cultural differences in the population (Kleinman, Eisenberg and Good, 1978). The way patients interact with their caregivers is influenced by the cultural factors in that community. The same thing applies to the politics of medical law. Public health policies are normally formulated with culture being a major influencing factor (Agency for Healthcare Research and Quality, 2006). As such, cultural competence has become a major concern in the public health sector in the recent years (Bradby, 2003). Medical practitioners as well as policy makers have to deal with the issue of culture as they strive to close the existing gap between people from different socio-economic and socio-cultural backgrounds. Culture in this context can be defined as the system of shared values, beliefs as well as learned patterns of behavior (Carrillo, Green and Betancourt, 1999, 829). This paper looks at the different ways in which culture affects medicine and law. Issues such as how differing cultures between a patient and his physician might affect medical care have been discussed in-depth. The way culture influence healthcare policy formulation and financing have also been discussed in the paper. The main aim of these discussions is to look at ways by which policy makers can use the cultural knowledge to come up with public health policies for the good of all, and not just a few. II. Research methods The information for my report is collected from books, newspaper articles, online articles and journals. These sources cover issues such as socio-cultural healthcare disparities in the United States and in other parts of the world. The sources also cover issues in healthcare policy making as it is influenced by cultural differences and how this affects the minority members of society. Other issues covered in the literature include: patient-caregiver interactions, Patient’s bill of rights and healthcare financing. III. Literature Review A. Patient’s Bill of Rights In the United States, there is a Patient’s Bill of rights which outlines what every citizen of the country is entitles to in terms of healthcare (Bradby, 2003). The bill does not discriminate pole based on their cultural backgrounds. The bill what was passed on lays down the guidelines to be followed by medical practitioners when offering medical services to patients (Agency for Healthcare Research and Quality, 2010). Some of the individual elements of the bill include: 1. Insurance companies cannot refuse a person insurance coverage in case he becomes sick or he makes a mistake in his coverage application 2. the bill also intends to do away with the annual and lifetime limits on coverage that one is entitled to. 3. the age at which young people can remain under their parent’s medical cover has been increased to 26. 4. children with pre-existing conditions have every right to be given medical coverage. 5. Certain preventive healthcare will be offered free of charge. This care includes: colonoscopies, pre-natal care and vaccines and cholesterol screenings 6. if one happens to be in an insurance dispute, he has a guaranteed right to appeal to an independent third party 7. emergency care outside the covered jurisdiction will no longer attract higher charges. Essentially, this Patient’s Bill of Rights seeks to explain to the American citizen his basic rights as a patient. This is an important piece of legislation as it tries to bring healthcare information right at the hands of the people who have been without healthcare services for a very long time. The legislation also curtails the control that some insurance companies have been having on the provision of healthcare services for certain groups of people. B. Healthcare Disparities In the United States, there are obvious health and healthcare disparities among people from different cultures (Kahn, 2006). For instance, the black community has a different healthcare need from that of the white community. Hispanics and Asian Americans also have health disparities from their white counterparts. The issue of obesity, which has been discussed widely, is not as serious among Caucasian Americans as it is among the Black American community (Winker, 2006). Some communities in the United States have well documented proof of health disparities when compared to some of the well off communities. For instance, it is a fact that minority groups such as Latinos, Black Americans, Asian Americans and Native Americans have higher incidences of poor health outcomes and the occurrence of chronic diseases (Nazroo and Karlsen, 2002). Culture has everything to do with how certain illnesses are perceived in certain communities (Hayward, Miles, Crimmins and Yang, 2000). For instance, the Hispanic and black American community has a culture of eating too much junk food, a practice that has seen many of them develop obesity which in itself is a very serious health risk. This makes them prone to many obesity-related illnesses such as heart failure and diabetes (Carrillo, Green and Betancourt, 1999, 829). When an African-American or a Hispanic goes for medical services for diabetes, he is likely to be treated very differently from a white person who might be suffering from the same condition. This is because some of these obesity-related diseases have long been associated with laziness and a lack of interest on personal health (Kleinman, Eisenberg and Good, 1978 and Kahn, 2006). C. Physician-Patient Relationship and Decision Making Rights There are some social-cultural differences, when misunderstood, may adversely affect the interaction between a patient and his care giver. Healthcare givers need to understand their patients in order to not only make good decisions, but also form some kind of rapport to help them offer the desirable services to these patients. To do this, the caregiver will need to have a deep understanding of individual’s socio-cultural background. It is impractical to expect physicians and other health workers in the public sector to know each and everyone’s cultural inclinations. However it is possible to empathize with some of the patients who have a cultural inclination from their care givers (Carrillo, Green and Betancourt, 1999, 830). In other words, Carillo, et. al are trying to say that each medical practitioner should try to offer medical services and solve any problems that may arise on a case to case basis. While offering medical care to patients from any cultural background, the caregiver needs to understand the health needs of the patient in line with his or her cultural beliefs (Nazroo and Karlsen, 2002). This can only be done of the public healthcare sector has provisions for the right pf the patient to be heard. In any case, the caregivers do not have to be coerced into lending an ear to what their patients have to say (Kahn, 2006). The role of gender as well as family dynamics are some of the cultural aspects that come into play in any physician-patient encounter (Carrillo, Green and Betancourt, 1999, 829). Women from the more conservative communities such as the Hispanic and muslim communities are normally wary of going through physical examinations. Therefore diseases such as cancer may be more prevalent among these individuals than other members of the community. This affects the patient-physician interaction and hence might lead to a wrong conclusion on the care giver’s part. This misunderstanding may be replicated in the formulation of healthcare policies. This can have adverse effects on the provision of basic healthcare since the needs of certain groups of people will not have been met (Winker, 2006). The physicians should not be the only ones making decisions regarding their patient’s healthcare needs (Kleinman, Eisenberg and Good, 1978). Even if this has been the trend for a long time, it needs to change. The medical fraternity has for a long time been operating on the assumption that people from specific cultures lack basic medical and health knowledge to make any substantive decisions for themselves. The patients need to know exactly what kind of services are being given to them. In formulating healthcare policies, the government needs to take this issue into consideration. The policies should enable the patients to make healthcare decisions that will help them in the long run. This will definitely make healthcare more accessible to all (Feinberg, nd). D. Healthcare Financing For a long time, healthcare financing has been based in the assumption that physicians are the ones who control how healthcare policies are formulated (Carrillo, Green and Betancourt, 1999). This is because they are the major source of information regarding the healthcare needs of the communities where they work. Healthcare financing is mainly the duty of the federal government (Kleinman, Eisenberg and Good, 1978). Other financing normaly comes from insurance companies (Kahn, 2006). Culture of a certain community or group in the United States plays a big role in the kind of insurance cover that the members of that particular community get (Hayward, Miles, Crimmins and Yang, 2000). Most minority groups normally have problems with their insurance covers due mainly to a lack of awareness on what is entitled to them. Healthcare financing should be done in a way that no one feels unfairly treated (Nazroo and Karlsen, 2002). There have been complaints that the government is targeting income earners to finance the healthcare sector while the people who should be benefiting form the services are not required to contribute anything (Sack, 2008). Everyone who is a beneficiary of the public healthcare services should make an effort to contribute to its sustenance. E. Healthcare Policies and Cultural Influences Healthcare policies in the United States are normally passed by politicians, most of whom do not have an inkling of what the public health sector is like (Kleinman, Eisenberg and Good, 1978). Therefore, most of them normally rely on the information they get from medical practitioners and healthcare organizations that work in different communities to formulate these policies (Nazroo and Karlsen, 2002). This information is normally collected among different communities, and therefore, the needs of one community may not necessarily be the needs of another community. For instance, most non-Caucasian Americans do not face as many challenges when seeking medical services as other ethnicities (Nazroo and Karlsen, 2002). This might be to some traces of racism and cultural superiority among some white medical practitioners. It could also be due to the fact that many people in the public healthcare sector work on the assumption that culture cannot make medical decisions since they are properly educated in medical issues. To avoid these occurrences, it is important for the patient to know what his rights as a patient are in the constitution (Carrillo, Green and Betancourt, 1999, 829). F. Government’s Role and Power in the Protection of Public’s Health The government of the United States has been tasked with the duty of ensuring that all American citizens can access basic healthcare regardless of their cultural background. There have been numerous cases of people lacking basic health services because of their cultural background (Kleinman, Eisenberg and Good, 1978). Misinformation about the medical needs of people from different ethnicities is rife. This leads to the formation and implementation of healthcare policies that end up helping very few people while those who need the services the most are left unattended to. The healthcare policies and legislations that the government makes should be guided by what every citizen of America needs in terms of healthcare (Kleinman, Eisenberg and Good, 1978). Many people in the US use the public healthcare scheme and this is under government regulation. It is up to this government to ensure that everyone has access to affordable healthcare services (Hayward, Miles, Crimmins and Yang, 2000). Anti-discriminatory laws in the health sector should be implemented in order to ensure that everyone enjoys the same level of healthcare (Nazroo and Karlsen, 2002). IV. Conclusion Medical practitioners in the public healthcare sector have to deal with the challenge of offering the required healthcare to people from different cultures (Agency for Healthcare Research and Quality, 2006). Policy makers also have to face the challenge of coming up with public health policies that are relevant to the needs of all these culturally diverse people (Aspinall, 1997). From the research done in his paper, it is quite certain that there exists wide disparities in the provision of healthcare services among different members of society, not just in the US alone, but also in many other parts of the world as well (Bradby, 2003). Although the constitution of the US outlines the rights of the patient, not all Americans enjoy good healthcare services in their country (Kleinman, Eisenberg and Good, 1978). Culture is an important factor in the in determining the popper medical care and policies that will enhance the health of everyone on the United States (Aspinall, 1997). Policy makers need to take cultural factors into consideration when formulating laws that are meant to impact the lives of Americans. No one should be made to feel like they do not deserve medical attention when they need it. The government should have strong mechanisms to ensure that everyone has equal access to Medicare, regardless of his or her cultural background. The current Health Bill was one of the policies that were meant to have brought some kind of sanity and equality in America’s healthcare sector (Helman, 1994. However, due to the swiftness with which it was formulated, there are many issues that it does not cover. It is true that more people on social security register will now be able to access health services, but at what cost? There are a group of people who are unhappy with the current health policies because they are not all inclusive (Agency for Healthcare Research and Quality, 2006). To ensure that this problem ends, there is need for further research on the different cultural factors that might help in the formulation of medical laws that will encompass the needs of everyone, both the majority and minority (Sack, 2008). With the enactment of the Healthcare Bill, 2010, there is hope that Americans will not have to suffer from lack of healthcare services based on their ethnicity or cultural backgrounds. More people will be able to access insurance coverage without being turned away for fear that they might not be able to pay for the medical services that they will get. Although this legislation has been long overdue, it has given hope to many people who would never have dreamt of enjoying the same level of public health services as their more privileged counterparts. It is clear that the policy adopted by the present government took into account some of the cultural factors that have been previously ignored, such as the fact that some communities are at a disadvantaged economic situation as compared to others. For this group of people, the legislation has provided the necessary measures to ensure that they get all the healthcare that they need, whenever they need it. References Agency for Healthcare Research and Quality. (2006). National Healthcare Disparities Report. Rockville, MD. Retrieved 1 October 1, 2010, http://www.ahrq.gov/qual/nhdr06/nhdr06.htm (Agency for Healthcare Research and Quality, 2006) Aspinall, P. (1997). The conceptual basis of ethnic group terminology and classifications. Social Science & Medicine. Vol. 45(5): 689 – 698 (Aspinall, 1997) Bradby, H. (2003). Describing Ethnicity in health research. Ethnicity and Health. Vol. 8(1): 5 – 13. (Bradby, 2003) Carrillo,J.E., Green, A. R. and Betancourt, J.R. (1999). Cross-cultural primary care: a patient –based approach. Annals of Internal Medicine. Vol. 130 (10): 829 – 830 (Carrillo, Green and Betancourt, 1999, 829). Feinberg, S. (nd). Race, ethnicity, cultural factors and chronic pain in injured workers. Retrieved 30 September, 2010, http://spinalmedicine.com/articles/ethnicity_and_pain_CWCE.pdf Helman, G. (1994). Culture, Health and Illness: An introduction for health professionals, ed. Boston, Mass: Butterworth-Heinemann. (Helman, 1994) Hayward, D., Miles, P., Crimmins, M. and Yang, Y. (2000). The significance of socioeconomic status in explaining the racial gap in Chronic health conditions. American Sociological Review, Vol. 65: 910 – 930 (Hayward, Miles, Crimmins and Yang, 2000) Kahn, J. (2006). From disparity to difference: how race-specific medicines may undermine policies to address inequalities in health care. Southern California Interdisciplinary Law Journal, Vol. 15: 105 – 130 (Kahn, 2006) Kleinman, A., Eisenberg, L. and Good, B. (1978). Culture, illness and care. Annals if Internal Medicine, Vol. 88: 251-258. (Kleinman, Eisenberg and Good, 1978) Nazroo, Y. and Karlsen, S. (2002). Relation between racial discrimination, social class and health among ethnic minority groups. American Journal of Public Health, vol. 92: 624-631 Sack, K. (2008). Research finds wide disparities in healthcare by race and region. The New York Times. Retrieved October 1, from: http://www.nytimes.com/2008/06/05/health/research/05disparities.html Winker, M. (2006). Race and ethnicity in medical research: Requirements meet reality. Journal of Law, Medicine & Ethics. Vol. 34(3): 520 – 525 Read More