A Historical View on Health Care: A New View on Austerity?
AbstractIt is an axiom of contemporary conversations about austerity and health care that the relationship between the two is essentially direct. Cutting funds damages health care systems and hurts the health of individuals who rely on them. Though this premise has provoked necessary discussion about global politics, the global economy and their impact on individual well-being, it is nonetheless intrinsically problematic. Assigning health and health care as objects of austerity not only obscures the complexity of health care systems and the opacity of health ’s definitional borders, but also misunderstands austerity, its...
Source: Health Care Analysis - June 26, 2019 Category: Health Management Source Type: research
Austerity and Professionalism: Being a Good Healthcare Professional in Bad Conditions
AbstractIn this paper we argue that austerity creates working conditions that can undermine professionalism in healthcare. We characterise austerity in terms of overlapping economic, social and ethical dimensions and explain how these can pose significant challenges for healthcare professionals. Amongst other things, austerity is detrimental to healthcare practice because it creates shortages of material and staff resources, negatively affects relationships and institutional cultures, and creates increased burdens and pressures for staff, not least as a result of deteriorating public health conditions. After discussing the...
Source: Health Care Analysis - June 4, 2019 Category: Health Management Source Type: research
Austerity or Xenophobia? The Causes and Costs of the “Hostile Environment” in the NHS
AbstractDuring the “age of austerity” the UK government has progressively limited free health services for “overseas visitors” on the grounds of fairness and frugality. This is despite the fact that the cost of the additional bureaucracy required by the new system and the public health consequences are expecte d to exceed the sums saved. In this article I explore the interaction between the discourses of austerity and xenophobia as they relate to migrants’ access to healthcare. By examining the available data and adjudicating various moral arguments, I cast doubt on the claim that the current charging r egulation...
Source: Health Care Analysis - June 2, 2019 Category: Health Management Source Type: research
Empathy and Efficiency in Healthcare at Times of Austerity
AbstractEfficiency is an important value for all publicly funded healthcare systems. Limited resources need to be used prudently and wisely in order to ensure best possible outcomes and waste avoidance. Since 2010, the drive for efficiency, in the UK, has acquired a new impetus, as the country embarked on an ‘age of austerity’ purportedly to balance its books and reduce national deficit. Although the NHS did not suffer any direct budget cuts, the austerity policies imposed on the welfare system, including social and mental healthcare, have had a direct and detrimental impact on the healthcare servic e. This paper draws...
Source: Health Care Analysis - May 30, 2019 Category: Health Management Source Type: research
Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda
AbstractPriority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to today ’s severity criteria in Norway and Sweden. The Scandinavian perspective on severi...
Source: Health Care Analysis - May 21, 2019 Category: Health Management Source Type: research
Risk, Overdiagnosis and Ethical Justifications
AbstractMany healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifiable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people ’s acceptance or otherwise of risks, and the scope individuals have to influence the practices that generate risk. This paper investigates the ethical justifia...
Source: Health Care Analysis - May 3, 2019 Category: Health Management Source Type: research
Why the Elective Caesarean Lottery is Ethically Impermissible
AbstractIn the United Kingdom the law and medical guidance is supportive of women making choices in childbirth. NICE guidelines are explicit that a competent woman ’s informed request for MRCS (elective caesarean in the absence of any clinical indications) should be respected. However, in reality pregnant women are routinely denied MRCS. In this paper I consider whether there is sufficient justification for restricting MRCS. The physical and emotive signific ance of childbirth as an event in a woman’s life cannot be understated. It is, therefore, concerning that women are having their wishes ignored, and we must ascert...
Source: Health Care Analysis - April 28, 2019 Category: Health Management Source Type: research
Perils of Professionalization: Chronicling a Crisis and Renewing the Potential of Healthcare Management
AbstractThis paper critically examines efforts to “professionalize” the field of healthcare management and its corresponding costs. Drawing upon the scholarly critiques of professionalization in medicine and the broader field of management, this paper seeks to explore the symbolic role professionalization might play in the psyche of its constit uents, and specifically its function as a defense against uncertainty and anxiety. This psychodynamic heuristic is then deployed to put forth the hypothesis that an ongoing crisis of professional identity continues to both propel and impede professionalization efforts in healthc...
Source: Health Care Analysis - March 21, 2019 Category: Health Management Source Type: research
‘Effective’ at What? On Effective Intervention in Serious Mental Illness
AbstractThe term “effective,” on its own, is honorific but vague. Interventions against serious mental illness may be “effective” at goals as diverse as reducing “apparent sadness” or providing housing. Underexamined use of “effective” and other success terms often obfuscates differences and incompat ibilities in interventions, degrees of effectiveness, key omissions in effectiveness standards, and values involved in determining what counts as “effective.” Yet vague use of such success terms is common in the research, clinical, and policy realms, with consequences that negatively affect the care offered...
Source: Health Care Analysis - March 19, 2019 Category: Health Management Source Type: research
Irresponsibly Infertile? Obesity, Efficiency, and Exclusion from Treatment
AbstractMany countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation (IVF). One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. I ultimately stop short of endorsing or rejecting such a justificati...
Source: Health Care Analysis - March 7, 2019 Category: Health Management Source Type: research
The Fundamental Importance of the Normative Analysis of Health
(Source: Health Care Analysis)
Source: Health Care Analysis - February 19, 2019 Category: Health Management Source Type: research
Are We Justified in Introducing Carbon Monoxide Testing to Encourage Smoking Cessation in Pregnant Women?
AbstractSmoking is frequently presented as being particularly problematic when the smoker is a pregnant woman because of the potential harm to the future child. This premise is used to justify targeting pregnant women with a unique approach to smoking cessation including policies such as the routine testing of all pregnant women for carbon monoxide at every antenatal appointment. This paper examines the evidence that such policies are justified by the aim of harm prevention and argues that targeting pregnant women in this way is likely to do more harm than good. Routine carbon monoxide testing is particularly problematic a...
Source: Health Care Analysis - December 5, 2018 Category: Health Management Source Type: research
Relational Ethics for Public Health: Interpreting Solidarity and Care
This article defends ‘relational theorizing’ in bioethics and public health ethics and describes its importance. It then offers an interpretation of solidarity and care understood as normatively patterned and psychologically and socially structured modes of relationality; in a word, solidarity and care understood as ‘practices.’ Solidarity is characterized as affirming the moral standing of others and their membership in a community of equal dignity and respect. Care is characterized as paying attention to the moral (and mortal) being of others and their needs, suffering, and vulnerability. The wager of re lational...
Source: Health Care Analysis - October 17, 2018 Category: Health Management Source Type: research
New Horizons for Health Care Analysis
(Source: Health Care Analysis)
Source: Health Care Analysis - October 10, 2018 Category: Health Management Source Type: research
Why We Don ’t Need “Unmet Needs”! On the Concepts of Unmet Need and Severity in Health-Care Priority Setting
AbstractIn health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria areunmet need andseverity. In this article these crucial criteria are conceptually clarified and analyzed in relation to each other. We argue that disease-severity and condition...
Source: Health Care Analysis - September 3, 2018 Category: Health Management Source Type: research
