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HSC210 | Hierarchy and Power in Healthcare Australia

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Write an essay addressing the following topic:

Hierarchy and power are intrinsic to the current health care system in Australia. Discuss this statement by drawing on sociological theories and concepts. Discuss how this may impact on you as a health practitioner.



The efficiency and effectiveness of the health care system depend on carefully established structures. It is upon these structures where the distribution of responsibilities and power are determined. Hierarchy refers to the arrangement of responsibility relationships which is set in place in organizations. Sociological theories suggest that hierarchy is crucial in the determining success of the healthcare sector. Power is described as the ability and capacity to make certain decisions and initiate action in a particular manner. Power is applied in the health sector to distribute responsibilities and determine how the health sector will be steered. Marxism states that hierarchy and social status are important in determining the success of individuals as well as organizations (Bismark, Spittal, Gurrin, Ward & Studdert, 2013). Marxism was proposed by Karl Marx for the feudal and agrarian societies. The aim of this paper is to evaluate the hierarchical and power influences in the healthcare sector in the Australian context by applying the Marxism approach. The paper will start by background information about the Marxism. The paper will also evaluate hierarchy and power in healthcare contexts on the basis of the three sociological theories of functionalism, conflict theory and the interactionist approach. Finally, the paper will make a connection between the theories and the Australian healthcare sector.

Karl Marx theory establishes that hierarchy is brought about by the role that an individual play in the production process. The Marxian theory asserts that there is awareness to politics and ideology is greatly influenced by the class position. The class is used as a reference to the group of people who share similar economic interests (Gabe & Monaghan, 2013). These classes are established at all sectors of an economy. Karl Marx theory establishes that hierarchy is inherent in the society. There are various social classes which are developed. Power is normally unequally distributed among these social classes. The healthcare sector is no exceptions in the hierarchical distribution of power. The healthcare sector in Australia is mostly provided by the private sector. This has been through the transfer of essential health care services to the hands of private organizations (Miller, 2001). The government of Australia acts as a facilitator to the sector. The specific health organizations ensure that the power is maintained at the top social classes. The healthcare sector can be evaluated from three major sociological theories. They include the functionalist, conflict and the interactionist theory.

The functionalist theory analyses the manner in which the different parts of an organization come together in order to improve on the efficiency. This theory is based on the work of Emile Durkheim. The theory focuses on the general view of the social structure by observing the specific parts of the economy (Mickan & Rodger, 2005). Other theorists who influenced the popularization of the theory include  Herbert Spencer, Talcott Parsons, and Robert K. Merton. In order to ensure that all the parts of the organization are functioning optimally, the organization has to ensure that there is a control of the work inflow and outflow in the system. A healthcare institution ensures that the level at which it is receiving patients does not overwhelm the structures which have been established in the organization (Braithwaite, Runciman & Merry, 2009). an uncontrolled flow of patients according to the facilities available at the institution will lead to hiccups in the efficiency and effectiveness of the organization.

Healthcare system in Australia is one of the best in the world. Globally, it is regarded as the second-best healthcare system in terms of facilities and expertise. The Australian healthcare system is also well recognized for the effective structure and organization which it follows. The recruitment of professionals in hospitals and other healthcare facilities followed a well-established hierarchy. The Hierarchy in the Australian healthcare sector can be viewed in the perspective of a doctor and patient divisions as well as the administrative and the lower level executives’ categorizations (Hendricks, Cope & Harris, 2010). The medical profession and the nursing profession are regarded as independent of each other in practice. This implies that doctors make their decisions while the nurses make their own decisions. However, when considering the healthcare sector in general, the medical profession is considered to be the most powerful of all the other professions in the sector. The top spot in the hierarchical structure in the Australian healthcare system is occupied by the senior medical officers. The senior medical officers are categorized into general and non-specialist medical officers. The general officers are qualified to work in a diverse array of the field in their medical practice. Non-specialist officers have not attained a qualification in a specific area. Therefore, they have to work under a specialist officer in their practice. The lower ranks in the hierarchy are usually occupied by the nurses and supporting healthcare professionals (Southon, Perkins & Galler, 2005). Researchers raise the concern that the healthcare workforce has major observable indications of gender variations. The top spots which comprise of doctors are mostly occupied by men. Females make up more than seventy-five percent of the nursing workforce.

The action to concentrate power at the top of the power hierarchy brings about the debate about the aspect of conflict theory. Karl Marx observed that the best way to understand sociological behavior was when there existed tensions in the society which were brought about by competition for the available resources (Morrow, Gustavson & Jones, 2016). This aspect comes out clear in the discussion when observing the role of doctors and nurses in the Australian healthcare system. it is the doctors who hold much of the power in the sector. They are responsible for making the majority of the major decisions which affect the entire sector. The people with the power also ensures that they stay in control. This includes controlling the amount of influence which the people on the lower ranks have.

Medical dominance within the Australian healthcare sector leads to differing professional satisfaction between higher social classes and the lower social classes. The autonomy enjoyed by the doctors in their job raises concerns about the role of the other healthcare professionals. There has been a specific focus on the perceptions of the nurses in regard to the perceived medical dominance in the sector. medical dominance has the probability to influence the satisfaction of some of the professionals in respect to their job (Benoit, Zadoroznyj, Hallgrimsdottir, Treloar & Taylor, 2010). Considering that doctors have the majority of the influence in the work, they report higher levels of job satisfaction as compared to the officials occupying the lower professional ranks. Satisfaction with their jobs can be attributed to having the autonomy to make the majority of the decision and greater autonomy over theory careers. Studies have established that nurses report dissatisfaction with their jobs. The factors contributing to the dissatisfaction include poor pay, poor working conditions, and the unfavorable working environment (Leonard, Graham & Bonacum, 2004). They believe that their professional status is not respected as they would like. Nurses also believe that doctors have a more fulfilling profession in terms of pay and autonomy in their jobs.

Competition between people for the few available resources leads to inequalities in the access to healthcare services by members of different social classes. The rich and powerful have better chances of getting quality treatment and other healthcare services as compared to the weak and poor. These trends are normally observed in various parts of the world. The poor have a higher probability of getting sick due to poor healthcare (Pecchia, Bath, Pendleton & Bracale, 2011). Therefore, the social hierarchies established, have an influence in the manner in which healthcare services are accessed. The inequalities in the distribution of authority in the system lead to an imbalance in the manner in which healthcare professionals dispatch their duties. This is because the professionals are bound by the power hierarchies established in the healthcare system. From the discussion on medical dominance, the lower ranking professionals are subjected to the rules and guidelines which have been established by the doctors. Because they lack autonomy, their freedom in their work is inhibited. This affects their ability to bring in ideas on their job at free will. As a result, the hierarchies and power distribution in the healthcare sector limit the level of creativity and innovation into the sector (Marmot, 2007).

Interactionist theory assumes a general view through creating the meaning between the specific interactions which happen daily. The interactionist theory would observe health and illness to be socially constructed. They exist to serve a purpose in the general existence of the society. The society draws its meaning from the interactions which take place between the members. The interactionist point of view assumes that the individuals in the healthcare sector are continuously shaped by the different people and situations who they come into contact with. Patients are assumed to be rational in their decision to seek medical attention. Interactionists are also focused on the role of doctors in the healthcare sector. They are interested in the different interactions which influence doctors to become who they are (Collins, 2011). Doctors gain comprehensive knowledge about their field by attending medical school. They also practice under supervision for a period of time in order to gain the necessary skills which they need. They encompass hard work and ethics to build a reputation which earns them the title of ‘doctor’. They are consequently respected by their workmates, subordinates and the society in general. Interactionists observe that the manner in which doctors view others plays a role in determining who they actually become. The major observation of the interactionist theory in relation to human behavior is that individuals interpret situations according to the manner in which they perceive them.

Functionalist, conflict and interactionist theories have a different approach to the healthcare system. The three approaches provide a diversified view of the healthcare system. The functionalist theory is concerned with the different aspects of the health care system and how they integrate to bring stability to the society. Functionalist theorists advance that when people get sick, they are withdrawn from their societal responsibilities (Duckett & Willcox, 2015). This causes the society to suffer instabilities in some areas. The conflict theory focuses on the inequalities which are observed in the society. The behavior of individuals is best observed when they are in competition for the few resources which are available. The interactionist approach is concerned with the different situations which shape the individuals who are observed in the healthcare sector (Julius, 2014). Healthcare professionals are influenced by the hierarchies of power which have been established in the sector.

Considering the Karl Marx theory of social hierarchy, social status and class influence the chances of success that an individual has. Marxism theory established two classes which were present in the premodern society. They include the bourgeoisie and the proletariat. The bourgeoisie refers to the people that own the own the means of production. On the other hand, the proletariat refers to individuals who sell their labor to the bourgeoisie (Cockerham & Scambler, 2010). In the Australian perspective, the government ensures that the bourgeoisie benefits. It is the responsibility of the government to keep the healthcare sector up and running (Jowsey et al., 2012). They ensure that there is no shortage of labor. Workers are motivated to work for the private owners of the healthcare sector. Despite the inequalities which exist, the employees are meant to believe that the system is just and fair. There are some Marxists who believe that the free healthcare services which are provided through various platforms are a win for the proletariat.

The structure established in the health care system influences healthcare professionals through the decisions that they make about their careers. As established by Karl Marx, social class determines the opportunities for success in social and professional life. Therefore, professionals in healthcare have the objective of working towards improving their social status. The three sociological approaches explain the manner in which an individual approach their work. The distribution of power within the organization influences the abilities of certain professionals. A health practitioner has to take into consideration the environment in order to determine how they could increase their productivity. This can be achieved if they work in an environment which they appreciate. They make decisions which they believe will result in the advancement of their careers (Turner, 2011). As a health practitioner, it is important to take into consideration the aspect of medical dominance. The medical profession is regarded as the most powerful in the healthcare sector. this is despite that it comprises less than twenty percent of the workforce. With differing incentives to pursue different careers in the sector, an individual has to consider the specific market situation.


Hierarchy and power are aspects which exert a lot of influence in the healthcare sector. From the discussion, the three sociological theories of functionalist, conflict and interactionist can be applied in the concept of the healthcare system. functionalist is concerned with the manner in which the different parts of a system cooperate to bring stability to the entire system. The sick role is addressed in this topic in that patients are not aggressive and will seek the expertise of the healthcare professionals. The conflict approach observed the competition for resources by individuals of the society which presents a great chance to understand their true behaviors. The conflict theory brings the aspect of the medical dominance. The unequal distribution of power within the health sector implies that some professions are more prestigious than others. Interactionist theory is concerned with the role of the different situations how they mold the individuals in the healthcare. Interactionists are therefore not interested in the big picture of the situation but in the finer details. Healthcare professionals should aim at understanding the different situations involved in their workplace. This will play the purpose of improving their satisfaction with their jobs. It would also present them with the opportunity to make constructive decisions about their career.


Benoit, C., Zadoroznyj, M., Hallgrimsdottir, H., Treloar, A., & Taylor, K. (2010). Medical dominance and neoliberalisation in maternal care provision: The evidence from Canada and Australia. Social science & medicine, 71(3), 475-481.

Bismark, M. M., Spittal, M. J., Gurrin, L. C., Ward, M., & Studdert, D. M. (2013). Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia. BMJ quality & safety, bmjqs-2012.

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