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CC2434 Sociology for Health Studies

Semester Two 09/10

Lecture 9—
Comparative Health Care Systems
Importance of the Comparative Health Care
Systems
• An understanding of the diversity of approaches that exist to
meet health care needs
• An understanding of the variety of factors that have shaped the
development of these approaches
• An understanding of the norms, values, cultural and national
outlook of those countries

Increasing Pressure of Demands Rising Costs of Providing


for Quality Health Care Health Care

To search for alternatives among both developed and


developing countries
Factors Affecting the Development of
Health Care Systems

Situational-Historical
• specific political events

Factors
• major economic
changes • the prevalence of social norms
• significant and values
technological
development

Physical Cultural
Environmental Factors Health Care System
Factors
Structural Factors

• the availability of natural • political aspect: the extent of


resources government centralization
• the presence of • economic aspect: the type of
environmental economic
pollutants system (free market or
planned)
• demographic aspect: the age
structure
Classification of Health Care
Systems

Private Public Provision


Provision different types of health
(capitalis care systems (state
m) socialism)
Types of Health Care Systems

Types of Systems
Role of Fee-for- Socialized Decentralize Socialist
Government Service Medicine d National Medicine
Health
Regulation limited direct indirect direct
Payments to limited direct indirect direct
Providers
Ownership of private private and private and public
Facilities and public public public

Public Access notguaran guaranteed guaranteed guarantee


teed d
Private Care dominant limited limited unavailabl
e
Example US Canada Japan China
Fee-for-Service: US
• Fee-for-service involves direct patient payments at the time of use
– physicians appeared as an entrepreneur in the market place
– patients' use of medical services is limited by their financial ability to pay for the service
• Supposed result: high-quality services and affordable prices
• Major characteristics of the US health care system:
– health care in the US is financed by a complex unit of private and public purchasers

National Health Expenditures in the US, 2002


• From private sources:
5.00% – employers (private health
12.70%
private insurance
insurance)
out-of-pocket – individuals and families
35.40%
medicare (health insurance and out-
medicaid
of-pocket)
other public
16.00%
other private • From the government:
– government-sponsored
health insurance
 Medicare (for the elderly)
17.20% 13.70%
Uninsured population  Medicaid (for the poor)
Socialized Medicine: Canada
• Basic elements of socialized medicine
– directly controls the financing and organization of health service in a capitalist
economy
– directly pays providers
– owns most of the facilities
– guarantees equal access to the general population
– allows some private care for patients willing to be responsible for their own expenses

• Major characteristics of the Canadian health care system:


– National Health Insurance Program
 comprehensive services (except dental care, private hospital rooms and
eyeglasses, etc)
 universal coverage (available to all)
 portable coverage
 the plans had to be publicly financed and administered by an agency accountable
to the provincial government
– relatively high income tax
– the provincial governments are the nation's purchaser of health services, paying a set
fee to doctors for patient care and providing a set budget for operating costs to
hospitals
Decentralized National Health:

Japan
Basic elements of decentralized national health
– indirectly controls the financing and organization of health service in a capitalist
economy (regulation but not operation)
– regulates payments to providers
– owns some of the facilities
– guarantees equal access to the general population
– allows some private care for patients willing to be responsible for their own expenses

• Major characteristics of the Japanese health care system:


– National Health Insurance Plan
 Japanese patients pay 30% of the cost of health services and the national plan
paying the remainder
 patients are allowed to choose their own doctors and encouraged to visit them
regularly
– private health insurance is encouraged and supported by Japanese businessmen
 normative structure of the Japanese business work to be responsible for taking
care of their own employees
 to provide security to their employees in exchange for loyalty and productivity
Socialist Medicine: China
• Basic elements of socialist medicine
– the state controls, organizes, finances, and allocates health care directly
to all citizens free of charge

• Major characteristics of the Chinese health care system:


– after 1949: Patriotic Health Movement, the revival of traditional Chinese
medicine, and the training of barefoot doctors
– The Cultural Revolution (1966-76): a serious setback of the
improvement of health care system
– before the Economic Reform: cooperative medical care system
– after the Economic Reform: dissolution of the cooperative medical care
system towards fee-for-service basis and health insurance
– the accessibility of health care is low especially in the rural areas
– a designation of a significantly revised cooperative medical care system
Implications of the Comparative Health
Care Systems
• Five criteria of assessing the quality of health services (Maxwell, 1984)
– Efficiency
 the relationship between the actual and the theoretically possible
amount of energy used to achieve a desired output
 the development of "performance indicators", e.g. average length
of hospital stay, turnover interval between cases occupying a bed
– Accessibility
 the availability of health care services
– Equity
 the equality of access: the extent to which different social groups
have access to health services
 the equality of health status: the extent to which different social
groups enjoy similar levels of health

To Strive for the Health Care


Balance between as a Right or
Efficiency and Privilege?
•Social Acceptability
the consumers' views about their health
care
•Relevance to Health Needs
the appropriateness of health care services

•Defects and solutions related to private medicine


and public medicine
private medicine: adjusted by public regulation
(equity)
public medicine: regulated by privatization
(efficiency)
Conclusion: The Convergence
• Central argument:
Hypothesis
– there is a globalization of medicine in the modern period whereby a world-
economic system has become the basis for a number of common
institutional responses to illness and mortality
– "the hypothesis does not imply that medical systems, which develop out of
the particular historical and cultural background of a nation and its dominant
ethos, will not continue to have distinct social and cultural characteristics
reflecting the ideological orientations and socio-cultural context of a country"
(Mechanic 1975)
– can be regarded as a macro-process in which a narrowing of system options
take place

• Types of convergence:
– controlling costs and increasing efficiency and effectiveness
– reducing inequalities
– initiatives to promote health
– primary health care
– patient choice and voice
– linkage between health and social services
– developing information systems to monitor and measure the activities and
outcomes of health care
Creative and Critical Thinking
創意思考與批判思考
Lecture 6
Deductive Reasoning (II)
The ambiguity of 「可能」
• 「可能」一詞是歧義的。至少可解作:
1. Possible 可能 ( 邏輯上 ) (logical possibility)
2. Probable 概然 ( 經驗上 ) (empirical probability)

• 一般人說:我不買六合彩,因為根本沒有可
能中。
其實是:有中六合彩的可能性 ( 邏輯上 ) ,
但 ( 經驗上 ) 其概然性很低 (= 機會
很微 ) 。
What strong arguments are
• A strong ( 強 ) argument:
 Invalid ( 不對確 )
 Given that the premise(s) is(are) true, it is very
likely ( 很可能 ) that the conclusion is true.
E.g.
 99.9% 的 CCT 學生都是勤奮的。
 小丙是 CCT 學生。
 所以,小丙是勤奮的。
 Peter bought one ticket in a fair lottery with ten million
tickets.
 So Peter is not going to win the lottery.
What strong arguments are
• 強的論證:
• 前提對結論不提供絕對/完全/百分百的
支持。
• 前提只在某程度上 (>50% 但 <100%) 支持
著結論。
Deductive Argument ( 演繹論
證)
• A deductive argument is an argument in which the conclusion is
claimed to be justified by (or to follow from) the premise(s) with
(logical) necessity( 必然性 ), or

• it is claimed to be (logical) necessary that the conclusion is true if all


the premises are true.

– 這是一個三角形,所以它的內角和必定是 180 度。
– All whales are mammals. All mammals are animals. Hence, all
whales must be animals.
– Alan is a father. Therefore, it is necessary that Alan is a
male.
Please note that:
• Deductive arguments ≠ valid arguments
Inductive Argument ( 歸納論證 )
• An inductive argument is an argument in which the conclusion is
claimed to be justified by (or to follow from) the premise(s) with a
certain degree of probability ( 概然性 ), namely > 0.5, or

• The conclusion is claimed to be probably true ( 大概真 ), (i.e., more


likely to be true than false) if all the premises are true.
-95% of our students wear glasses. Joe is our student.
Therefo re, Joe probably( 很可能 ) wears glasses.
– 到目前為止,所有被觀察過的烏鴉都是黑色的,所以極之可能所有
烏鴉都是黑色的。
– Mary is a six-year-old girl. Therefore, it is very likely that
Mary cannot finish 100m in 15 seconds.

• Contexts always play an important role In determining whether an


argument is inductive.
Deductive Vs Inductive
Deductive ( 演繹 ):
Alan is a father.
--------------------------------------------
Therefore, (necessarily) Alan is a male.

Inductive ( 歸納 ):

Most university students get a pass in English in A Level.


Peter is a university student.
------------------------------------------------------------
Therefore, (probably) Peter gets a pass in English in A Level.
Deductive or Inductive
What makes an argument deductive or inductive is the
type of support the premises are supposed to provide for
the conclusion.

Deductive ( 演繹的 ):
1. The conclusion is claimed to follow from its premises with (logical)
necessity ( 必然性 ).
2. This necessity is not a matter of degree. (logical  absolute)

Inductive ( 歸納的 ):
1. The conclusion is claimed to follow from its premises only with a
certain degree of probability ( 概然性 ).
2. This probability comes as a matter of degree.
Key Differences between Deductive and
Inductive Arguments
• The claimer intends to show:
Deductive Inductive

If all the premises are true, then the If all the premises are true, then the
conclusion must be true ( 必然真 ). conclusion is probably true ( 大概真 ),
i.e., more likely to be true than false.

The conclusion follows The conclusion follows probably ( 概然


necessarily( 必然地 ) from the 地 ) from the premises. i.e., the
premises. i.e., the premises premises provide good but not
provide conclusive ground for the conclusive ( 好 , 但沒有決定性 )
truth of the conclusion. evidence for the truth of the
conclusion.

If we accept all the premises, we If we accept all the premises, it is


must accept the conclusion (to more reasonable for us to accept the
avoid inconsistency). conclusion.

Prepared by Sky Lau 22


The Definitions of Good and Bad
Deductive Argument

• Generally speaking, good deductive argument =


sound deductive argument.

• Bad deductive argument = unsound deductive


argument.
Basic concepts:
Conditional Statement 條件述句
Conditional statement: Statement with the structure If
p then q
如果 p, 則 q
- "p" and "q" represent statements.
- so, conditional statement is a kind of
compound statement 複合述句 .
- p: Antecedent 前項
- q: Consequent 後項
Some Basic Valid and Invalid
Deductive Argument Forms
• The validity of a deductive argument is solely
determined by the logical form 邏輯形式 of the
argument.
• The discipline which clarifies and describes the
various logical forms of statements and
arguments is called formal logic 形式邏輯
• Now we shall introduce 2 valid and 2 invalid
deductive argument forms.
• But before that, lets clarify some basic concepts
first.
Basic concepts:
Conditional Statement 條件述句
• Conditional statement: Statement with the
structure:
If p then q
如果 p, 則 q
"p" and "q" represent statements.
- so, conditional statement is a kind of
compound statement 複合述句 .
- p: Antecedent 前項
- q: Consequent 後項
The Conditions of Truth and Falsity
of a Conditional Statement

• "if p, then q" is false when p is true and q


is false, otherwise it is true.

• E.g., "if you are pretty, I will love you" is false when "you
are pretty" is true and "I love you" is false, otherwise it is
true.
A Characteristic of Conditional
Statement
Note that:
"If p, then q" ≠ "If not-p, then not-q" .
• E.g., "If you are pretty, then I will love you" ≠ "If you are not
pretty, then I will not love you".

"If p, then q" ≡ "If not-q, then not-p"


• E.g., "if you are pretty, then I will love you" ≡ "if I do not love
you, then you are not pretty".

• "If not-q, then not-p" is the contraposition of "If p,


then q".
"Unless" and "Only if"
 "I won't kiss you unless ( 除非 ) you give
me a ring"
• p: I won't kiss you.
• q: You give me a ring.
• "If not-p, then q" ≡ "If not-q, then p"
• Antecedent: not-p (I will kiss you) / not-q
(You do not give me a ring).
• Consequent: q (you give me a ring) / I won't
kiss you.
"Unless" and "Only if"
• You can win the prize only if you give me
ten dollars.
• p: You can win the prize
• q: you give me ten dollars
• "If p, then q" ≡ "If not-q, then not-p"
• Antecedent: p (You can win the prize) / not-q
(You do not give me ten dollars).
• Consequent: q (you give me ten dollars)
/ not-p( you cannot win the prize)
Exercises
• 以下例子之中, (i) 哪個述句是前項,哪個述句是後
項? (ii) 它們的關係如何?
 如果這班礦場工人活了下來,便代表礦場中有足夠的氧
氣。
 若這時下起雨來,活動便必須取消了。
 除非你是香港永久居民,否則不會獲得大紫荊勳章。
 只有當你懂得使用噴筆後才能砌好模型。
 只要你懂得使用噴筆,那麼你就能砌好模型。
 You can pass the exam only if you work hard.
 You cannot pass the exam unless you work hard.
Basic concepts:
Sufficient Condition 充分條件

• P 是 Q 的充分條件 (sufficient
condition):
• 如果 P 出現,那麼 Q 必然 (一定/肯
定)也出現。
• "P" 、 "Q" 可指涉性質 (properties) 或事
態 (states of affairs)
Basic concepts:
Sufficient Condition 充分條件
In a conditional statement "If p then q":

• When p is true, q must be true.

- The truth of p is sufficient for the truth of


q.
- p is the sufficient condition for q.
Basic concepts:
Necessary Condition 必要條件
• P 是 Q 的必要條件( necessary
condition ) :
• 如果 P 不出現, Q 必然(一定
/肯定)也不出現。
Basic concepts:
Necessary Condition 必要條件
"If p then q" ≡
"If not-q, then not-p".
When q is false, p cannot be true.
E.g. "if Einstein is a man, then Einstein is mortal" ≡
"If Einstein is not mortal, Einstein is not a man"

- The truth of q is necessary for the truth of


p.
- q is the necessary condition for p.
Conditional Statement, Necessary and
Sufficient Conditions

• Accordingly, for a conditional statement,


 The antecedent is a sufficient condition for the
consequent, and
 The consequent is a necessary condition for the
antecedent.
• 據上,於條件述句中,
 前項是後項的充分條件;
 後項是前項的必要條件。
Hypothetical Syllogism ( 假設三段論 )

– Syllogism means an argument with exactly two premises and


one conclusion

– Hypothetical Syllogism is a syllogism containing at least one


if-then statement as premise.

The following are four most common hypothetical syllogisms:


1. Modus Ponens: If A then B. A. Therefore, B.
2. Modus Tollens: If A then B. Not B. Therefore, not A.
3. Denying the antecedent: If A then B. Not A. Therefore, not B.
4. Affirming the consequent: If A then B. B. Therefore, A.
Hypothetical Syllogism ( 假設三段論 )

Affirming Antecedent 肯定前項


( Modus Ponens )
If p then q
p
q Valid

e.g. If he has time, he will help you.


He has time.
He will help you.
Hypothetical Syllogism ( 假設三段論 )

Denying Consequent 否定後項


( Modus Tollens )
If p then q
Not q
Not p
Valid
e.g. If he had time, he would help you.
He does not help you.
He does not have the time.
Hypothetical Syllogism ( 假設三段論 )

Denying Antecedent 否定前項


If p then q
Not p
Not q
Invalid
e.g. If you study hard, you will pass the exam.
You did not study hard.
You did not pass the exam.
Hypothetical Syllogism ( 假設三段論 )

Affirming Consequent 肯定後項


If p then q
q
p
Invalid
e.g. If your son is naughty, he will be punished.
He is punished.
He is naughty.
References
• An Concise Introduction to Logic, Patrick
J. Hurley, 9th Edition.
• http://philosophy.hku.hk/think/arg/induction
.php