1. By: Ronald F. White, Ph.D. Professor of Philosophy College of Mount St. Joseph

2. Introduction Health Care provision in all societies is comprised of multiple, interacting complex systems: moral, scientific, sociopolitical, and economic.

3. Facts and Values Descriptive Inquiry (Facts) –Questions of Truth and Falsity –What is a “health care system?” Prescriptive Inquiry (Values) –Questions of Good and Bad –What is a “good Health Care System?”

4. Structure of Health Care Moral Structure (Values) –Hippocratic –Judeo-Christian –Western Liberal Scientific Structure (Knowledge) –Pure Science vs. Applied Science –Biomedical Discovery –Transmission of Biomedical Knowledge Social and Political Structure (Power) –Human Relationships Professional organizations, Unions, Corporations, Government Economic Structure (Money) –Economic Relationships Buyers and Sellers professionalism

5. Moral Structure of Health Care Hippocratic Tradition –Oath Judeo-Christian –Charity Western Liberal –Rights-Based –Consequence-Based Individual Collective

6. Scientific Structure From Non-Scientific to Scientific Belief Systems The Discovery and Dissemination of Scientific Knowledge Professional Dimension Credentialism Specialization Professional Organizations Institutional Dimension Educational Institutions –Colleges and Universities –Public and Private Research Institutions (laboratories) –Public/Private –Professional Journals –Publishing Companies Hospitals –Treatment –Research –Teaching Clinics Private Offices Insurance Companies Technological Dimension Patents and Licenses Drugs and Medical Devices

7. Sociopolitical Structure of Health Care Cultural Factors –Cultural Beliefs Health and disease –Political Regimes hierarchy –Information Dissemination of information Mass Media Institutional Factors (Public and Private) –Health Care Research Institutions Public: Government Laboratories (NIH) Private: Corporations –Publishing Companies –Medical Journals –Teaching Institutions Colleges and Universities –Public –Private – Health Care Providing Institutions Hospitals Clinics Doctors offices –Health Care Financing Institutions Health Insurance –Private –Public

8. Economic Structure of Health Care Incentives –Why did you expend time, energy, and resources to attend MSJ in pursuit of a career in Health Care? –Why did I agree to teach this course? Doctors and Patients v. Buyers and Sellers Market Structure –Information –Competition Quality Price Freedom Market Values –Don’t Steal –Don’t use Force –Tell the Truth –Keep your Promises

9. Role of Government Government (Federal, State, Local) –Discovery Function Should government finance health care research? –NSF Should government conduct health care research? –NIH –Research Regulatory Function Should government regulate health care research? –FDA –Provider Function Should government provide health care? –Medicare –Medicaid –Veteran’s’ –Economic Regulatory Function Should government mediate between buyers and sellers in the health care industry?

10. Summary Health Care involves four interacting systemic structures –Moral Structure (right/wrong) –Scientific Structure (truth/falsity) –Sociopolitical Structure (leaders/followers) –Economic Structure (buyers/sellers) Governments can influence all four dimensions: for better or worse.