How Global Social and Economic Pressures Affect Medical Practices
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The trends are a reflection of increasing health care demands along with the technological advances needed to prevent, diagnose, and treat disease (IOM, 1997). Along with this increase in longevity comes the concern of finding commonalities in the treatment of health disparities for all people.
Although this framework is broad and inclusive, our national discussion about improving health outcomes tends to focus on clinical care and on individual responsibility for health behaviors; the other two modifiable health factors, social and economic factors and the physical environment, are generally not included in the conversation. This reflects a widely held belief in the United States that if an individual engages in healthful behaviors (such as exercising, eating healthfully, and not smoking) and goes to the doctor regularly, she will be healthy. However, these two factors, while certainly important, only account for at most half of what determines health outcomes.
Organisational factors include working conditions, resources and relationships with co-workers. Environmental factors consist of economic and social influences. Furthermore, the physicians’ subjective attributes, including the priority they give to medical care, would have a moderating influence on the delivery of care. A number of studies have found clear relationships between employee satisfaction, quality of care and patient satisfaction. Satisfied and com mitted employees deliver better care, which results in better outcomes and higher patient satisfaction (Is the professional satisfaction of general internists associated with patient satisfaction? Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA). Good human resource management drives employee satisfaction and loyalty (A study of the relationship between job satisfaction, organizational commitment and turnover intention among hospital employees. Mosadeghrad AM, Ferlie E, Rosenberg D Health Serv Manage Res. 2008). This study showed that physicians burdened with heavy workloads, and poor compensation packages. All of these factors have impeded the delivery of quality medical services particularly in the public health sector. Patient related factors such as socio-demographic variables (e.g., age, race, education, social class and health status), attitudes, and behaviours (e.g., moods, actions and cooperation) may act as facilitators or blockers to quality of received medical services. These findings support previous research (Ditto PH, Moore KA, Hilton JL, Kalish JR (1995). Beliefs about physicians: their role in health care utilization, satisfaction and compliance, Basic and Applied Social Psychology, 17 (1&2): 23–48.).
Current knowledge suggests ways to collaborate with others to improve health outcomes for socially disadvantaged populations.138 At a minimum, appreciation of some of the social factors that influence health-related behaviors and health status itself can help clinical providers develop more effective treatment plans.139 Clinical and public health practitioners can strengthen routine procedures to assess and respond to social needs through referrals and/or on-site social and legal services.140–142 Public health workers and clinicians also can develop health-promotion strategies that reach beyond individual clinical and social services to communities, to influence living and working conditions that are generally the strongest determinants of whether people are healthy or become sick in the first place.143 They can participate in or promote research adding to the understanding of the mechanisms by which social factors influence health, and test which strategies appear most effective and efficient. Finally, clinicians and public health practitioners can be key resources for local, state, and national policy makers on the crucial issue of health equity for all Americans, including those facing the greatest social obstacles.
Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA (2000). Is the professional satisfaction of general internists associated with patient satisfaction? Journal of General Internal Medicine, 15 (2): 122–128.
Hong SC, Goo YJ (2004). A causal model of customer loyalty in professional service firms: an empirical study. International Journal of Management, 21 (4): 531–541.
Mosadeghrad AM, Ferlie E, Rosenberg D. (2008). A study of relationship between job satisfaction, organisational commitment and turnover intention among hospital employees. Health Services Management Research, 21 (4): 211–227.