Power and Hierarchy in the Australian Healthcare System
Discuss about the Power and hierarchy in Australian healthcare system.
Power may be defined as one of the most integral aspects of business and organizational life. In every sphere of organizational life, managers and employees manipulate the power available to them in order to accomplish objectives and goals and to meet job requirements (Dow et al., 2013). In fact, power is believed to strengthen positions of people as well. The manner in which a person perceives power and reacts to it would depend on how he understands power and its probable effects (Anicich et al., 2015). The term hierarchy is in turn related to power and power politics within an organization. Hierarchy may be defined as a system in which the different members of an organization would be ranked based on status and authority they exert. In the field of healthcare, the concepts of power and hierarchy come into being when members of the realm of healthcare work within the scope of medicine (Haddara & Lingard, 2013). Like every nation, Australia too has a distinct structure within the healthcare system, which is greatly steeped in power politics and hierarchy. The following essay attempts to analyze the concepts of power and hierarchy in the Australian medical system, medical dominance, the impacts of Marxism and Functionalism in healthcare and their contrast with the traditional biomedical model. The essay argues that social theories of Marxism and Functionalism have an impact on the Australian healthcare system, and offers a different perspective on healthcare from the biomedical model of health.
In the Australian healthcare system, power plays a crucial role in organizational operations. In the healthcare system, the concept of power and medical dominance cannot exist in isolation. In other words, power and hierarchy are not attributes of the individual personalities in these positions. Instead, it exists in relation to the person on whom the power is being exerted. In the medical profession, it is the obtaining, utilizing and maintaining of power that affects social relationships and attitudes of people within the organization (Stoddart & Evans, 2017). Each social relationship within the health care system (between the various employees of the organization or that between the physicians and nurses and the patients) and every interaction that takes place within the system is would be dictated by the concept of power. Within any healthcare organization, there are several units and subunits, which comprise of a number of individuals working in close accordance. All these individuals would have to controlled and regulated through the influence of power. In the healthcare organizations, more than other fields, the concept of power is closely linked to relationships between two people (Bohm et al., 2013). For instance, a physician who has been in the organization for a long period of time would be in a position to exert power over newcomers or even interns in the organization. Similarly, the system of occupational hierarchy has been present in the Australian healthcare system since time immemorial. For example, in this system, the doctors are upheld and the position of a physician is considered to be prestigious. As such, they are eligible for more rewards and recognition. According to Manners (2017), there are three factors that influence medical dominance of doctors in Australian healthcare – authority, sovereignty and autonomy.
Medical Dominance in the Australian Healthcare System
Bould et al. (2015) claim that in the Australian healthcare system, the doctors exercise a degree of autonomy in their occupation. They are not technically under the control of anyone and have complete authority over their professions. As such, the medical profession is one that comes equipped with power and hierarchy. Sovereignty refers to the fact that doctors are legitimate experts in their fields and thus are superior (Eisenberg, 2017). As a direct consequence, they have authority over other medical professions like nursing and can use their power to influence the latter’s actions and decisions (Schmidt et al., 2015). For instance, in the Australian healthcare system, medical dominance is also observed with respect to gender. Over a period of time, a majority of the doctors have mostly been male while the profession of nursing has largely been reserved for women. As a result, it can be said that the nurse is always subservient to the doctors. With respect to the concepts of power and medical dominance in healthcare, there are two theories that must be analyzed, namely Marxism and Functionalism.
Smart (2013) defines Marxism as the method concerned with socioeconomic analysis, which takes into account class relations and also social conflict. It is based on a materialistic interpretation and perception of historical development. It also has a dialectical approach towards social transformation. Friedrich Engels and Karl Marx can be called the founders of this theory, which has revolutionized the way people view materialism and the capitalist society. This theory takes into account the development of the capitalist society and also studies how cast struggles have influenced economic change. The essence of Marxism lies in the fact that there are two major classes into which the society can be divided – the bourgeoisie and the proletariat. While the former is privileged and has unlimited access to goods and luxurious amenities, the latter is usually the working class who have to struggle to even get their hands on basic amenities (Blackledge, 2017).
If one is to analyze the healthcare system in Australia from a Marxist perspective, it can be said that the theory in this case would largely deal with economic dominance and political power in the highly capitalist society. The healthcare system reflects the class structure and struggle evident in society through the control and power exercised by certain individuals in the medical system over others (Almgren, 2017). The limited mobility within the occupation of healthcare, the stratification of the healthcare professionals and the monopoly of some professions demonstrates the effect of Marxism in healthcare. For instance, the recommendations for health policies that are implemented would take into consideration the economic and political interests of various groups. Moreover, the intervention of the state into the implementation of medical policies serves the purpose of the privileged classes and would protect the economic system in the society which is capitalist by nature. Also, each healthcare organization is guided by a set of principles or medical ideology. The sole purpose of this ideology is to ensure that the patterns of medical domination and class structures and hierarchy are maintained within the organization.
Marxism and its Impact on Australian Healthcare System
Thus, it can be said that Marx’s ideas related to social class and class division are of particular importance while analyzing the systems of power and hierarchy within the medical profession. According to Marxism, it is the bourgeoisie who hold power and are able to exercise control over the others. They have the means and the access to necessary resources which offers them autonomy. However, the proletariat class is the working class who lack control or power over resources necessary for production and must work to earn a living. Yet the proletariat or the workers are always forced to remain subservient to the capitalist and would have to lose control to them (King et al., 2015). Marxism is evident both within and outside the healthcare systems of Australia. For example, the affluent upper classes have the power to exert control over the health care policies and regulations in the control. A majority of the private healthcare organizations are owned and co owned by members belonging to the bourgeoisie. This provides them with a certain level of power over how the health organizations are run. Similarly, the physicians usually hold a superior position in the society, as far as social classes and financial status are concerned (Rodon & Silva, 2015). In Australia, the physicians earn at least five to ten percent more than the average income distribution of the other working classes. This makes them the bourgeoisie within the medical community and also endows them with power and medical dominance. Class mobility in the Australian healthcare system is quite limited. In Australia, a majority of the medical students and practicing physicians belong to the upper classes. Moreover, earlier, the profession was mainly reserved for men. However, some degree of mobility has been incorporated into the medical system, with a large number of women and lower classes also being represented equally.
With respect to the Marxist view of medical systems in Australia, another concept that must be reviewed is that of the medical industrial complex (Coleman, 2013). This concept refers to the penetration of industrial models into the healthcare system. For instance, a large number of medical organizations around the world have been charged with the exploitation of the vulnerabilities of patients for personal gains and profits. In other words, there is often a tendency on the part of the medical institutions to take advantage of the illness of the patients to make profits for themselves (Renedo et al., 2015). This is one of the chief characteristics of capitalist societies. As a matter of fact, there have been several criticisms of medical organizations for resorting to marketing and advertising gimmicks in order to attract patients.
Functionalism and its Impact on Australian Healthcare System
Another theory that must be examined is that of Functionalism. According to Bowling (2014), the concept of functionalism was first applied to the medical profession in the 1950s, with the theories of Talcott Parsons (Šoltés & Gavurová, 2014). The functionalist view of healthcare stresses that an effective medical care system would be important for the society in order to sustain itself. If a majority of the people within a society is unhealthy or ill, it would adversely affect the stability and functionality of the society. Parsons was of the opinion that each individual in the society has a role to play and issues like premature death or unhealthiness and illness would prevent them from executing their assigned roles. This would in turn result in a poor return as far as the societal roles are concerned. As a result, flawed medical systems would be dysfunctional and detrimental to the society as a whole. Quality healthcare systems would ensure that each member of the society has access to decent medical care, which is also their inherent right. Based on the functionalism approach, the role of the physicians within the Australian healthcare system must be considered. In order to ensure that healthcare standards are met, physicians would have to first diagnose the person’s illness, come up with a prognosis and finally guide the patient towards recovery.
As part of the functionalist approach, the social conflict theory must also be applied to the Australia healthcare system. As mentioned in the above sections, a class struggle and social immobility is evident in the healthcare system of Australia (Lenski, 2013). The conflict theory also highlights the fact that there is an inequality in the standard and quality of medical care that is provided to patients. The Australian society is steeped in social inequality, with factors like ethnicity, race, social class and even gender affecting the delivery of medical care to patients (Hall et al., 2015). Based on the functionalism theory, the lower classes who have limited access to basic amenities for survival are more likely to be afflicted with diseases. Once ill, they have limited access to healthcare facilities that are affordable. As such, it is usually the upper classes that have access to standard health care, since they are able to afford it (Sharma & Unnikrishnan, 2013). Moreover, physicians in Australia have exerted their power and influence in the healthcare system unanimously. This is because they had the belief that they were most qualified for diagnosing problems and treating patients. Physicians also had a tendency to portray a number of social issues as medical problems. This was done so as to improve their financial status.
Contrast between Social Theories and Biomedical Model of Health
These two theories may be contrasted with that of the biomedical model of health. According to the biomedical model of health, good health may be defined as the freedom from pain, diseases and any health related defects (Deacon, 2013). The main point of difference between the biomedical model of health and that of the Marxist and Functionalist view of healthcare is the fact that the former focuses entirely on the physical aspects of disease, namely the physiology, biochemistry and pathology of diseases. On the other hand, it completely ignores the social aspects of illness. The biomedical model of health focuses solely on the biological aspects of treatment and healthcare and not the environmental or social influences. In other words, this model of health does not take into account the factors like social inequality, gender roles or class struggles which have been found to have an impact on the health conditions of patients (Farre & Rapley, 2017). However, as is evident in the Australian healthcare system, social factors do play an integral role in determining the quality of healthcare (Mosadeghrad, 2014). For instance, as the functionalism theory shows, the social stratification and the financial stability of certain social classes enable them to access better quality healthcare than others. On the other hand, the lower classes usually lack access to even the basic amenities. Similarly, the Marxist theory suggests that social factors like the superiority of doctors provides them with the power and autonomy that is usually associated with their profession. Doctors, who belong to the bourgeoisie, would have more affluence and power than other professionals in healthcare and even patients. This aspect of medical dominance and its impact on the quality of healthcare is largely ignored in the biomedical model.
To conclude, it can be said that the theories of power and hierarchy are extremely relevant within the context of the Australian healthcare system. Like other organizations, the medical institutions in Australia are dictated by norms of power politics and a rigid system of hierarchy, with doctors holding the superior position. Doctors and physicians in the medical profession usually have complete authority because they are most qualified to diagnose and treat patients. Moreover, they also have authority over the other medical professions like nursing, which is also highly gendered. As such, the thesis of the essay can be affirmed that social factors (covered in the Marxist and Functionalist approaches) are just as relevant in the healthcare system as the physiological and biological aspects of the Biomedical model of health.
Conclusion
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