Health System Empowerment

Individual control in the health system

empowerment: feeling of power/control

i.e. when you are in a hospital, you sense a loss of control. Thus, you feel:

1. Helplessness
2. Rules that I don’t know
3. lack of control

-->you b/c passive

-in the health system, today, one sometimes has the option of choosing what doctor\therapy\etc.--> ‘power’ of resources in order to get best treatment

-->this is all on the individual level

• physical resources
• manpower
• Technical resources
• Knowledge resources

There are really 3 types

1. individual power
2. communal power: i.e. groups w/ same prob. work together for their goals (i.e. AIDS help group)
3. professional power: 2 kinds of workers: administration, and professionals.

-->usually in our case, doctors/physiotherapist

-->each professional group will try to help the client in a way that will make them independent of this professional group (in long run it is worth it to help client in this way, even though in the short run, it is worth it to keep control over them)

sick rights law 1996:

-i.e.

• I need to give permission to be touched b/w being touched
• Need to be explained the alternatives/risks/purposes of the treatment
• You have a right for 2^nd opinion in the form of treatment

-people sue: in the short run, he will sue if he has a chance of lots of $

-->long run: defensive medicine: more tests in order to avoid being sued, sometimes to absurd levels

-->makes health system more expensive

-in caesarian birth -->Dr. earns more for less time on birth/baby has less damage.

-hard to make a new community

haskama meidait: has to explain b/f touching you

chok bruit leumi

1990 =mas bruit mamlachti = so that every one gets health

àcapitation formula = every health system gets according to # of members

-everyone gets ‘sal briyut’ = of medication/checking /hospitalization

àcan sue if he doesn’t get treatment

Avi – 037528358

053-

--

Oct. 29, 2002

Empowerment:

1. the ability to tell someone what to do despite him not wanting to do it
2. the ability to decide goals
3. the ability to achieve what to do
4. to decide what is imp. Now and what is imp. Later

ài.e. dr. is able to decide many things i.e. decide goals of direction of treatment

what gives me power? – resources:

• knowledge
• $
• physical power
• no alternatives ài.e. alternative medicine is only a helper – not a replacer
• centrality to the treatment: nurse has more power in hospital than in private practice

Theories of Empowerment

-especially after WWII

1. Weber: organizational empowerment: where one person can do his will, despite others’ objections

Sources of power:

1. Charisma:
2. Tradition
3. Rule
4. Punishment/reward – i.e. teacher – can give or take away marks

2. dahl: community empower: one forces another to do what he wants

3. bechrech/berel:
1. revealed: have decisions made
2. hidden: to stop decisions from doing
4. lukas: 3 axis:
1. revealed: have decisions made
2. hidden: to stop decisions from doing
3. Chavui: have opposing goals implanted in others in others, that work for their benefit

--

individual empowerment:

-based on everyone having the ability to control their own life:

àbased on the interaction b/w them and their environment

Process of empowerment:

-shift from passive to active [key word = active]

• Internal empowerment: psychological: belief in out ability to control
• Outside empowerment: also called political empowerments: the ability to act out the decisions/goals that we want to do

Personality factors:

1. locus of control: rotter: 2 types of people:
• internal vs. external locus of control: I vs. other people control my life
2. self-efficacy: bendura: cognitive belief in my ability to control my life

àinf. Motivation/stress situations: the more you think that you are able, the more you bother (i.e. loosing weight)

3. support groups: give motivation
4. critical awareness: the more you have knowledge of the system/problem [i.e. disease]/rules of system/etc… the more you are empowered to do something about it

050-776-217:jackline

1. dr: many pain. Dr. is too busy
2. support beka operation: h. would you choose hospital?

• Friends
• Other patients
• Its name

3. Mom @ hospital, can’t go to the washroom

1) anger/frustration regulation

2) the way you express yourself

**

Dec/3/2002

-more empowerment: better: the worse drs. Leave or improve

àthreatens the drs.’s positions!!!

-b/c of the monetary prob.s that were exaggerated after the medical laws:

• the individual pays more for services, beyond the health tax
• economic considerations increase
• save in whatever they can, sometimes disregarding consequences
• # of times/patients per dr.
• medical basket: cheaper medications
• attempt to outsource things, i.e. small operations
• attempt to make $ from the public

mashlim: **

article:

lack of knowledge: more anxiety b/f surgery, but it dep. on expose to dr. and the content of this exposure

group – national health law -1995:

-people were asked h. they perceived the new law

àmany people were satisfies: especially less education/rich/elderly

irony: most people didn’t feel any change!!!!

-most $ went to imp building/uniforms ànot services!!!

**

dec 17

-empowerment: how to get the power to enact my interests

-until now, the ‘political’ players in health system did not include the sick. Today, there is an attempt to empower the medical system.

ànecessary evil, since politics (i.e. power/interest struggle) has b/c part of the system

(**?)

system’s resources

• $$$
• medical tools/service
• values/tradition: it is traditional to go to dr. for help
• knowledge/experience
• charisma

individual’s increasing resources:

• ability to choose service/medical center
• info =>diff b/w info and knowledge (knowledge= ability to process the info)
• ability to sue à ‘sanctions’

ways to motivate the ind. to act on his rights:

• internal locus of control: the person feels the connection b/w his actions and the results
• observing others empower their rights

question: how do you choose an institution/dr.

answer:

choosing a doctor

• recommendations
• first experience =ability to maintain long-term relation
• many people go to poor dr. b/c of proximity

criterions:

1. how we’re impressed that he’s nice/competent/able to listen/diagnose (vs. just scribbling a
2. diagnosis: does he tell you what you have/explaining
3. treatment
4. results

choosing hospital

-in order to choose, you need criterions (i.e. in order to know quality)

àyou can’t always know results, but you can see the interaction

àinteraction w/ dr. has a high correlation to the quality of treatment/result

**

--

group presentation

• goals: control

-many countries made as reform in health system in 90s since they couldn’t deal w/ expenses

àdespite expenses, their service weren’t good

-the problem was that they focused on the health service givers, but not the costumers!!! You need to empower them in order to have the health [economic] reformation work

àless services/checking needed for diagnosis, i.e. by informing him of what is not necessary/unnecessary medications/hospitalization

àyet there is more compliance of the patient/more integrated service

-the point of the reformation in Israel is to make competition b/w the hospitals and thus make them more efficient

àprob: the client doesn’t have enough knowledge àyou need to know where to going order to have a good choice

asymmetry: the hospital have resources but the client doesn’t!!! (so you need to give him the knowledge resource in order to balance the asymmetry caused by the ‘economic’-style reformation.

Question: why enter patient into political game

Answer: b/c it is inevitable

test

-p.89-108 are the most imp in the obligation book -->motivation question

3 kinds of empowerment

1. individual
2. community
3. professional

àshe tries to connect b/w the micro and the micro

3 theoretic premises:

1. feministic

-there is a split b/w private/public and thus is a patrilineal power that maintains the women out àthey can’t change the system [so fast]

àif the community gets into system, the women’s status goes up, since they are now a group and not a lower-statused (woman) group

2) transactional (psychological approach)

àyou have to look at the relationship and the context that takes place b/ the patient and the Dr.

2. structural duality

àsocial structures are created by human interaction, yet they also allows for this interaction: main idea: structure and interaction are interlinked (theory of giddens)

àwhat defines those interactions

1. rules: tell us what to do
2. resources: give us the energy to act

-individual empowerment: humane interaction, yet communal empowerment changes the rules!!! /professional empowerment: humane interaction from w/I the institutionalized system that allows for community and ind. empowement

community:

-people try to change by grouping themselves into large groups: i.e. in self-help groups

-->individuals might not be able to do so by themselves, or be motivated to do so.

Professional empowerment: (not workers empowering) the professionals help both the community and ind. to empower themselves: i.e. nurse teaching ind. of their medical rights