A Conflict Perspective: Inequalities in Health and Health Care
Unlike the functionalist approach, conflict theory emphasizes the political, economic. and social forces that affect health and the health care delivery system.
Among the issues of concern to contlict theorists arc the ability of all people to obtain health care; how race, class, and gender inequalities affect health and health care: power relationships between doctors and other health care workers; the dominance of the medical odel of health care; and the roll! of profit in the health care system.
Who is responsible for problems in the U.S. health care system? According to many contlict theorists, problems in U.S. health care delivery are rooted in the capitalist economy, which views m edicine as a commodity that is produced and sold by the medicalindustrial complex. The medlcal-lndustrial complex encompasses both local physicians and hospitals as well as global health-related industries such as insurance companies and pharmaceutical and ‘medical supply companies (Relman; 1992). Tho: United States is one of the few industrialized nations that rely almost exclusively on the ‘medicalindustrial complex for health care delivery and do not
have universal health coverage, which provides some level of access to medical treatment for all people. Consequently, access to high-quality medical can: is linked to people’s ability to pay and to their position within the class structur e. Those who are affluent or have good medical insurance may receive high-quality, state-of-the-art care in the medical-iudustnal complex because of its elaborate technologies and treatments. However, people below the poverty level and those just above it have greater difficulty gaining access to medical care. Referred to as the medically indigent, these individuals do not earn enough to afford private medical care hut earn just enough money to keep them from qualifying for Medicaid (Weiss and Lonnquist, 2009). In the profit-oriented capitalist economy, these individuals arc said to “jail between the cracks” in the health care system. Who benefits from the existing structure of medicine? According to conflict theorists, physics-who hold a legal monopoly over medicine-benefit from’ the existing structure because they can charge inflated fees. Similarly, clinics. pharmacies, laboratories, hospitals, supply manufacturers, insurance companies, and many other corporations derive excessive profits from the existing system of payment ill medicine. In recent.
years, large drug companies and profit-making hospital corporations have come to occupy a larger and larger part of health care delivery. As a result, medical costs have risen rapidly, and the federal government and many insurance companies have placed pressure for cost containment on other players in the medical industrial complex complex (Tilly and Tilly, 1998). Theorists using a r dical conflict framework for their analysis believe that the only way to reduce inequalities in the U.S. health care structure is to eliminate capitalism or curb the medical-industrial complex. From the approach. capitalism is implicated in both the rates of illness and how health care is delivered. An example of how rates of illness are related to
capitalism is the predominance of workplace hazards and environmental pollution that are dangerous hut are often not corrected because corrective measures would be too costly, reducing corporate profits. Conflict theorists increase our awareness of inequalities of race. class, and gender as these statuses influence people’s access to health care. They also inform us about the problems associated with health care becoming “big business.” However, some analysts believe that the conflict approach is unduly pessimistic about the gains that have been made in health status and longevity-gains that are at least partially due to large investments in research and treatment by the medical-industrial complex.