Medical Sociology and Health Services Research: Past Accomplishments and Future Policy Challenges

Headnote

Abstract

The rising costs and inconsistent quality of health care in the United States have raised significant questions among professionals, policy makers, and the public about the way health services are being delivered. For the past 50 years, medical sociologists have made significant contributions in improving our understanding of the nature and impact of the organizations that constitute our health care system. In this article, we discuss three central findings in the sociology of health services: (1) health services in the U.S. are unequally distributed, contributing to health inequalities across status groups; (2) social institutions reproduce health care inequalities by constraining and enabling the actions of health service organizations, health care providers, and consumers; and (3) the structure and dynamics of health care organizations shape the quality, effectiveness, and outcomes of health services for different groups and communities. We conclude with a discussion of the policy implications of these findings for future health care reform efforts.

Keywords:

health services, health care delivery, health care organizations, health care quality

Public and professional interest in health services has increased dramatically over the last two decades driven primarily by persistent and growing frustrations with the cost and quality of care. Medical sociologists have been interested in the structure, organization, dynamics, and impact of health services for well over 50 years. Our health care system has evolved and changed dramatically over the same period, shifting from one focused on providing acute care for immediate and emergent health problems to a more diffuse system struggling to support individuals with chronic and longterm conditions while also controlling costs (Wholey and Bums 2000). Not surprisingly, medical sociological interest in health services has followed suit and expanded to examine a wider variety of settings, conditions, and processes within the formal health care delivery system. Scholarship initially focused largely on understanding the structural and institutional underpinnings of health care systems, and later on exploring the variability in access to health care across social groups. More recently, sociological health services research has concentrated on the structure of and dynamics within health service organizations and how these factors shape both access and clinical outcomes for different groups and communities.

In this essay, we highlight three key findings that summarize the most important contributions of medical...