Социология медицины: наука и практика
To compete on value providers must embrace a series of strategic and organizational imperatives. How can health care providers create more effective strategies and improve their performance? The starting point for strategy is to define the right goal. For every health care provider, the primary goal must be excellence in patient value. Value is the health outcomes achieved per unit of value compared to peers. A provider's size, range of services, reputation, and whether it earns a comfortable operating surplus are secondary. Unless a provider is delivering value to the patients it serves, it is failing at its fundamental mission even if it is financially successful. A provider that delivers superior patient results will be in a position to prosper even in the current system.Patient value can only be measured at the level of medical conditions, and assessed relative to peers. Competence alone is not enough. A provider must be able to achieve results that compare favorably to others that provide similar services.Excellent value in some services does not offset mediocrity in others. Patients, not to mention the entire health care system, are not well served if providers maintain even one service line in which they do not achieve results equal to or better than peers. In value-based competition, excellence, not breadth or convenience, should shape the choice of services by providers and the overall configuration of the health care system. While the goal of patient value may seem self-evident, goal definition in health care delivery has been clouded by a variety of factors. Financial viability often appears as an important goal. But financial results are an outcome, not the goal in and of itself. A comfortable operating surplus cannot offset mediocrity in serving patients. In a value-based system, as we will discuss, excellent results will lead to more patients, greater efficiency, and higher margins.The starting point for developing strategy in any field is to define the relevant business or businesses in which an organization competes. Health care delivery is no different. Health care providers do not think of themselves as businesses, but they are in the business of providing services to patients.
Several approaches to the concept of fatherhood present in Western sociological tradition are analyzed and compared: biological determinism, social constructivism and biosocial theory. The problematics of fatherhood and men’s parental practices is marginalized in modern Russian social research devoted to family and this fact makes the traditional inequality in family relations, when the father’s role is considered secondary compared to that of mother, even stronger. However, in Western critical men’s studies several stages can be outlined: the development of “sex roles” paradigm (biological determinism), the emergence of the hegemonic masculinity concept, inter-disciplinary stage (biosocial theory). According to the approach of biological determinism, the role of a father is that of the patriarch, he continues the family line and serves as a model for his ascendants. Social constructivism looks into man’s functions in the family from the point of view of masculine pressure and establishing hegemony over a woman and children. Biosocial theory aims to unite the biological determinacy of fatherhood with social, cultural and personal context. It is shown that these approaches are directly connected with the level of the society development, marriage and family perceptions, the level of egality of gender order.