Chapter 1 Who this book is for and who it is not for1 There are already too many books offering solutions to the problems of the health service. ...

Protection of human participants is a fundamental facet of biomedical research. We report the activities of a health service research study in which there were three institutional review boards (IRBs), three legal departments and one research administration department providing recommendations and mandating changes in the study methods. Complying with IRB requirements can be challenging, but can also adversely affect study outcomes. Multiple protocol changes mandated from multiple IRBs created a research method that was not reflective of how substance (...) use screening would be performed in a clinical setting. There was direct conflict between the IRBs' perceptions of participants' protection with the researchers' need to use research methodology that assures the clinical relevancy of results. (shrink)

To study hospital physicians’ awareness and perceptions of the legal and financial regulations, and their impact on professional discretion regarding equity in access to treatment and quality of care. A sample of 637 physicians in the Norwegian specialist healthcare services selected from a survey conducted by the Institute for Studies of the Medical Profession. The paper investigates how legal and financial policy instruments affect the application of professional discretion regarding the prioritisation of specialist health services. Descriptive statistics (...) and regressions were conducted for the analyses. Compared with financial incentives, legal regulations (laws, priority rules and guidelines) were assessed to be less negative external interventions in the exercise of medical and professional judgement. The empirical analyses revealed a positive tendency in physicians’ assessments of the impact of legal regulations on treatment equity and healthcare quality, but negative attitudes towards financial instruments. The variations revealed are attributable to various structural and epistemic features of the legal–bureaucratic and economic models of administration in this area of the welfare state. Legal and financial regulations are imposed to achieve certain social goals and values. The findings of this study can provide further insight for the health authorities in other countries concerning implementation of such regulations in the specialist healthcare services. (shrink)

Ethical decision-making is often evaluated in the literature through deontological and teleological approaches, commonly referred to as ethical positions. Ethical decision-making requires an awareness of ethical sensitivity and ethical dilemmas. It involves understanding the emotional experiences of others and assisting them. In cases of alexithymia, where there is difficulty in understanding and expressing emotional experiences, empathy may be limited, and emotions may not be effectively used. In this research, the impact of the level of alexithymia on ethical positions in students (...) of the School of Health Services, along with demographic variables, was evaluated. In this descriptive research using a quantitative research approach, data was obtained using the "Ethical Position Scale-EPQ" and the "Toronto Alexithymia Scale-TAS." Analysis was performed using the reliability testing, t-test, One-Way ANOVA Test, LSD multiple comparison test, and Pearson Correlation and Regression Analysis test were used. In ethical decision-making, it has been found that women are more idealistic than men, while men tend to be more alexithymic and deficient in outward thinking. As students' levels of alexithymia increase, they are determined to adopt a more relativistic approach. It has been observed that relativism increases and idealism decreases significantly among individuals with high alexithymia scores. These findings indicate that the level of alexithymia has a significant impact on ethical positions. The fact that individuals with high levels of alexithymia adopt a subjective position that is less concerned with the consequences of an action on others and resembles egoism suggests that these individuals may have difficulty in empathizing due to emotional inadequacy. (shrink)

Adolescent sexuality is one of the most important reproductive health issues that confronts healthcare professionals with moral dilemmas and legal issues. In this study, we aim to justify the at-risk adolescents’ regulations on access to key reproductive health services (KRHSs) based on principles of Islamic biomedical ethics and jurisprudence. Despite the illegitimacy and prohibition of sexuality for both girls and boys in Islamic communities, in this study, using 5 principles or universal rules of purpose; certainty, no-harm; necessity; (...) and custom, we argue that first, applying these principles in the context of the no-harm principle can provide the best interests of at-risk adolescents; second, it is permissible to provide KRHSs to these adolescents with their own assent, as long as necessary, only with the intention of preventing or reducing harm. In this framework, while preventing harm, it tries to provide the best interests of at-risk adolescent. Thus, the principle of no-harm requires that the government, by designating the responsibility to healthcare professionals, protects at-risk adolescents from harm, and obliges these professionals to choose and implement the option that best suits adolescents’ interests. (shrink)

The ‘managed care’ idea: implications for health service systems in Australia The growth of corporatism in health‐care in the US, and the consequences arising from US models of health‐care delivery systems provide an enormously valuable point of comparison with health systems of other developed economies, such as Australia. If lessons are to be learnt from the US, then an analysis of the structure and performance of the US health‐care system provides important background for understanding and (...) assessing contemporary policy changes to administrative and organizational designs and techniques for patient care in Australia. (shrink)

Providing a groundbreaking approach to reinventing health care, this book is a practical guide to placing patient healing back at the center of the hospital's mission. Drawing on a wealth of practical experience, the authors show health care professionals how to decrease costs and improve quality by restructuring hospital services around patients and their needs and by utilizing design and architecture to enhance the healing environment. Using the core concepts of systems theory, extensive research, and lessons from (...) pioneering hospitals, they present state-of-the-art health care practices that heal as well as cure. (shrink)

Reason and Rationality in Health and Human Services Delivery is the first book to discuss the topic of decisionmaking and services from a multidisciplinary approach. It uses theory and social considerations, not just technology, as a basis for improved services. Health and human service students and professionals will learn how to form rational and reasonable decisions that take their clients'cultural backgrounds into consideration when identifying an illness or appropriating any kind of intervention. With a particular (...) emphasis on theories, models, organizational settings, technologies, and practitioner training methods that lead to culturally sensitive decisions, Reason and Rationality will help you deliver efficient and improved medical and social services to clients from all ethnic backgrounds. Recognizing reason as the centerpiece of most of Western philosophy, this text reveals how our idea of truth, fact, and order are wrongly thought to be universal; yet, Western principles are continually used in the decision-making process for health and social services. Focusing on the policy implications of decisionmaking in medical and social service settings, this text works to incorporate a broad range of factors into the reasoning process, such as cultural traditions and beliefs, that will result in better treatment for patients. Giving you suggestions and strategies for upgrading reasoning and decision-making processes and applying them to every area of service, Reason and Rationality discusses different themes that will help you improve services to patients, such as: the rationale currently used to justify decision-making strategies concerning medical and human services using computer technology to make clinical assessments revising administrative structure, management theories, and organizational strategies so that decision-making processes enhance the overall quality of service delivery how the practitioner/patient relationship is important in choosing the proper treatment soliciting community-based input to assess the public's health and human service needs in order to lessen political involvement in decision-making stages In addition, Reason and Rationality provides information and examples that show why you should consider the "life-world"--the values, beliefs, and commitments of a culture's history-- as the key to understanding the powers of reasoning that specify parameters of health and illness. (shrink)

There are few industries in which decisions are so intently scrutinized by millions of Canadians as the healthcare industry. Each and every day important decisions concerning the funding and delivery of healthcare are made away from the clinic and in the offices of administrators and policy makers. This book is designed to assist the current and future healthcare administrator to render effective and ethical decisions. Health administration ethics functions as a bridge between business ethics and clinical ethics. This (...) book forges the essential link between the foundational concepts of ethics theories, principles, and codes and the science of decision making. It takes a case study approach and introduces a new, user-friendly decision-making model. There is currently no Canadian textbook designed to guide administration decisions within the Canadian healthcare system, making this textbook unique in the market. (shrink)

This column describes the history, mission, and work of Saint Louis University School of Law’s service-learning course Health Law, Policy and Advocacy: Grassroots Advocacy. Grassroots Advocacy allows law students to work with advocacy organizations on state and federal health policy initiatives, engaging in legislative and administrative advocacy and public education. The course uses community collaboration, community-led advocacy, and collaborative learning to train the next generation of health policy advocates for Missouri and the nation.

Introduction: and a pop quiz -- Administrative ethics: ideas, sources, and development -- Refining the sense of duty: responsibilities of public administrators and the issue of agency -- Reinforcing and enlarging duty: philosophical bases of ethical behavior and the ethics triangle -- Codifying duty and ethical perspectives: professional codes of ethics -- Undermining duty: challenges to the ethical behavior of public administrators -- Deciding how to meet obligations and act responsibly: ethical analysis and problem solving -- Acting on duty in (...) the face of uncertainty and risk: responsible whistleblowing -- Elevating ethical behavior in the organization -- Mandating duty: external measures to promote ethics -- Conclusion: the duties of public administrators. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of (...) health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

I Several years ago, when the Carter administration announced that it would support congressional action to end the public fund ing of abortions, the President was asked at a press conference whether he thought that such a policy was unfair; he responded, "Life is unfair." His remarks provoked a storm of controversy. For other than those who, for principled reasons, opposed abor tion on any grounds, it seemed that the President's comments were cruel, violating what was thought to be (...) an American com mitment to providing equal access to health services to all citi zens, regardless of their capacity to pay. Those sentiments had, in fact, been reflected in public opinion polls that had, for at least three decades, indicated that Americans supported the propo sition that the government should guarantee health care to all. Ultimately, those beliefs had been translated into the oft-ex 1 pressed political demand for a one-class system of health care. This commitment to equality is rather remarkable. American society evidences a striking willingness to tolerate vast inequal ities with regard to income and wealth. While it guarantees ed ucation to all children, there is not even a pretense that the children of the wealthy and the children of the poor ought to get precisely the same kind of schooling. While some commitment 'Hazel Erskine. "The Polls: Health Insurance," Public Opinion Quarterly, XXXIX (Spring, 1975), 128-143. (shrink)

Health care services today lack the resources to meet everybody's exspectations. Patients, professional workers and trade unions have legitimate but frequently conflicting claims, and so too have the different interest groups and specialties within medicine. This book provides an account of how resource allocation dilemmas appear to those confronted by them, in the hospital, on health boards and in the community, and it offers a critique of the moral and political arguments most commonly employed in discussing them.

At Providence St. Joseph Health in Oregon, many factors contribute to the integration and success of the ethics services. There are three principal lenses through which one can understand the distinct way in which the ethics services are operationalized and integrated: the theological foundations of ethics as a service, the institutional ecology, and the professionalization of the field of health care ethics. The authors review key realities that have shaped their work through these three lenses and (...) then describe the activities of the Providence Center for Health Care Ethics regarding its strategic objectives and clinical and administrative integration. (shrink)

Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part (...) of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly. (shrink)

Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same‐sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a (...) narrow definition of “spouse,” “parent,” or “family.” Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the “Don't Ask, Don't Tell” policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long‐standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging.The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that “[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation.” To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves. (shrink)

There is an increasing tendency for administrators and government to expect both the health services and the education service to 'show results' for the investment of public money in them. One response to this has been the growing commitment to 'health promotion', where measurable objectives may be set in terms of desired behaviour (stopping smoking, breast self-examination, child immunisation etc) and where evaluation can be made on the evidence of statistical improvement. Health workers use the term (...) 'promotion' in a variety of ways which seem to be as confusing to them as they are to their clients --the general public. Since successful promotion is likely to depend on the 'hard sell' (and since the methodology and aims of this may be incompatible with those of health education) this paper looks at some of the questions which the customer might wish to ask the salesman before deciding whether or not to buy. (shrink)

BackgroundThe Freedom of Information Act (FOIA) provides access to unreleased government records that can be used to enhance the transparency and integrity of biomedical research. We characterized FOIA requests to Department of Health and Human Services (HHS) agencies, including request outcomes, processing times, backlogs, and costs.MethodsUsing HHS FOIA annual reports, we extracted data on the number of FOIA requests received and processed by HHS agencies between 2008 and 2017, as well as request outcomes. Processing times were reported in (...) three time increments, < 1–20, 21–60, or 61+ days, and trends in backlog status were also described. Information about costs and fees collected were aggregated.ResultsBetween 2008 and 2017, 69.6% of 530,094 HHS FOIA requests were received by the Centers for Medicare and Medicaid Services (CMS), 18.9% by the Food and Drug Administration (FDA), and 11.6% by all other HHS agencies. During this period, CMS processed 374,728 requests, FDA 114,938, and other HHS agencies 61,890. CMS and FDA reduced backlogged requests by 9396 (89.7%) and 4289 (65.3%), respectively, leaving backlogs of 1081 and 2279 requests at the end of 2017. CMS fully or partially granted 60.3% of requests whereas FDA fully or partially granted 72.4%. Of all requests to CMS, 82.0% were considered simple and 18.0% complex; 82.2% of simple requests and 54.9% of complex requests were processed in 20 days, and 5.6% and 29.9% were processed in 61+ days. In contrast, 60.2% of requests to FDA were considered simple and 39.8% complex; 28.8% of simple requests and 9.0% of complex requests were processed in 20 days, and 58.3% and 81.5% were processed in 61+ days. The costs to HHS associated with FOIA requests totaled $446.4 million ($809 per processed request), increasing from $28.1 million ($423 per request) in 2008 to $53.3 million ($1544 per request) in 2017. In total, HHS collected $8.5 million in fees (1.9% of total costs).ConclusionsFOIA is frequently used to obtain information about HHS and its agencies. With growing costs, minimal fees collected, and lengthy processing times, HHS agencies’ FOIA programs might be made more efficient through greater proactive record disclosure. (shrink)

This paper explores an approach to the implementation and evaluation of integrated health service delivery. It identifies the key issues involved in integration evaluation, provides a framework for assessment and identifies areas for the development of new tools and measures. A proactive role for evaluators in responding to health service reform is advocated.

Background Despite nurses receiving education on how to respond during crises, the stress and demands arising from unprecedented situations, such as the COVID-19 pandemic, may affect their work engagement. Aim To appraise and synthesize studies examining work engagement among nurses in the context of the COVID-19 pandemic. Methods It is a systematic review in which three databases were searched. Critical appraisal tools and PRISMA guidelines were used. Content analysis was performed. Ethical considerations Ethical approval was not required for this systematic (...) review. Findings A total of 21 studies were included. The results were classified into three categories: (1) levels and meanings of work engagement, (2) the relationship of work engagement with various factors, and (3) measures to enhance work engagement. Conclusion The review revealed that nurses’ work engagement varied from moderate to high. Factors such as education level and work schedule flexibility influenced their engagement. Positive associations were found between work engagement and job satisfaction, intention to stay, and organizational support, while stress and workload showed negative relationships. The crucial role of health policymakers, hospital administrators, and nurse managers in acting ethically, creating favorable working conditions and fostering nurses’ work engagement was emphasized. (shrink)

The European Union Data Protection Regulation will have profound implications for public health, health services research and statistics in Europe. The EU Commission's Proposal was a breakthrough in balancing privacy rights and rights to health and healthcare. The European Parliament, however, has proposed extensive amendments. This paper reviews the amendments proposed by the European Parliament Committee on Civil Liberties, Justice and Home Affairs and their implications for health research and statistics. The amendments eliminate most innovations (...) brought by the Proposal. Notably, derogation to the general prohibition of processing sensitive data shall be allowed for public interests such as the management of healthcare services, but not health research, monitoring, surveillance and governance. The processing of personal health data for historical, statistical or scientific purposes shall be allowed only with the consent of the data subject or if the processing serves an exceptionally high public interest, cannot be performed otherwise and is legally authorised. Research, be it academic, government, corporate or market research, falls under the same rule. The proposed amendments will make difficult or render impossible research and statistics involving the linkage and analysis of the wealth of data from clinical, administrative, insurance and survey sources, which have contributed to improving health outcomes and health systems performance and governance; and may illegitimise efforts that have been made in some European countries to enable privacy-respectful data use for research and statistical purposes. If the amendments stand as written, the right to privacy is likely to override the right to health and healthcare in Europe. (shrink)

Next SectionBackground International and national agencies play a major role in setting HIV care-and-treatment priorities in low-income-countries. Little is known about priority setting at lower health-system levels. The objective of this article is to explore experiences of HIV priority decisions, at what levels these decisions are made and how they might influence the distribution of health benefits in a high-endemic region in Tanzania. Methods This is a qualitative study using observations, key documents and semistructured focus-group and individual interviews (...) (43) with health workers, patients and administrators at one regional and one district hospital. The analysis was based on an editing analysis style. Results Health workers did not perceive themselves as bedside rationing agents and they reported following national recommendations and felt they have little impact on important priority decisions. Health benefit distributions were largely determined by priority decisions made at a national level. External factors, such as eligibility criteria, inadequate funding and barriers to access seemed to play a major role in the actual distribution of health services and benefits in the region. Patient groups who were actually given high priority were the sickest patients, those living near a facility and those who could afford long journeys and frequent visits. Low-priority groups were those experiencing other co-morbidities or treatment failure, children, asymptomatic patients and the poorest. Conclusions/significance The interaction of priority setting across health-system levels and their impact on distribution of health outcomes in the population has been underestimated. The distributional pattern of health outcomes calls for further normative assessment. (shrink)

This article illustrates the relationships between political parties and the healthcare sector in Italy since the 1950s. The several was though which parties have "exploited" health policics are explored, ranging from the selective extension of care entitlements to the various occupational categories to the clientelistic ties with doctors, from the placement of party personnell in the various administrative posts to illegal financing. The author argues that the partitocratie exploitation of the health care sector has greatly contributed to the (...) failure of the 1978 reform establishing a National Health Service. This failure has in its turn backlashed against the partitocratic government, accellerating its demise in the early 1990s. The article concludes with some considerations on the future of Italy's health policy and, more generally, welfare state policy. (shrink)

Research has shown that paternal involvement positively impacts on child health and development. We aimed to develop a conceptual model of dimensions of fatherhood, identify and categorise methods used for linking fathers with their children in administrative data, and map these methods onto the dimensions of fatherhood. We carried out a systematic scoping review to create a conceptual framework of paternal involvement and identify studies exploring the impact of paternal exposures on child health and development outcomes using administrative (...) data. We identified four methods that have been used globally to link fathers and children in administrative data based on family or household identifiers using address data, identifiable information about the father on the child's birth registration, health claims data, and Personal Identification Numbers. We did not identify direct measures of paternal involvement but mapping linkage methods to the framework highlighted possible proxies. The addition of paternal National Health Service numbers to birth notifications presents a way forward in the advancement of fatherhood research using administrative data sources. (shrink)

In “The Ethics of Advertising for Health Care Services” (2014), Schenker, Arnold, and London argue that advertisements for physicians, hospitals, and other health care services are morally problematic and ought to be regulated by the Food and Drug Administration (FDA) as it regulates prescription drug ads. I argue that the regulation of prescription drug ads has been so ineffective that, if the harms of health care service ads are similar to the harms of drug (...) ads, such regulation is bound to fail. This is a major public health concern, because any good produced by these ads does not necessarily morally compensate for the harm caused. If the ads cannot be banned entirely, I propose a regulatory strategy that involves redesigning them from the ground up. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managed Health Care: New Ethical Issues for All*Martina Darragh (bio) and Pat Milmoe McCarrick (bio)Changes in the way that health care is perceived, delivered, and financed have occurred rapidly in a relatively short time span. The 50-year period since World War II encompasses enormous growth in medical technology, soaring health care costs, and significant fragmentation of the two-party patient- physician relationship. This relationship first grew to (...) include the third-party payer, the health insurance industry, and now “with great speed and relatively little public awareness, a significant change has occurred in the way some decisions are made about a patient’s medical care” (III, Institute of Medicine 1989).The new means of providing health care bring an increasing number of parties into clinical decision-making processes. With this change, ethical issues that once concerned only health care professionals, the physician or the nurse, have expanded to include the patient and the groups who “manage” care—e.g., health maintenance organizations (HMOs), preferred provider organizations (PPOs), point of service groups (POSs), independent practice associations (IPAs), insurance reviewers, hospital administrators, institutional managers, and, the most recent players, purchasers of group health care who base their decisions on competitive pricing.The term “managed care” refers to a variety of continually adapting and developing arrangements that involve four groups. These groups, which have been labeled by the world of business, not health, are the “consumer” (once the patient), the “provider” (the physician and other health care professionals), the “insurer” (the reimburser for any care), and the “purchaser of care” or the primary buyer of health services (the large employer organization). Capitation is a common way to pay for health services in managed care systems. A certain dollar amount is negotiated for health services for a specified number of patients whether the care is delivered or not; the provider shares with the [End Page 189] insurer any financial risk for the actual cost of care (III, Centers for Disease Control 1995).When the Clinton administration’s health care reform movement failed to gain support in the U.S. Congress, the use of managed care to control rising health care costs accelerated. The literature on managed care and its effect on the patient-physician relationship reflects this shift. During the era of health care reform, “debate centered on how managed care could control costs, on the use of technology and patient satisfaction, [and] on access and barriers to care” (IV, Emanuel and Dubler 1995). When managed care organizations began contracting with physicians to provide health care services subject to the plans’ provisions, these plans became agents in clinical decision making on a wide-spread basis. HMO enrollment grew to 51 million persons by 1994 (III, Centers for Disease Control 1995). This “corporatization” of health care has sparked a plethora of articles about the effects of the marketplace on the physician’s ability to do what is best for the patient, and on the patient’s ability to trust the physician to do so.Many authors make it clear that managed care itself is not the problem, but rather the development of for-profit managed care plans by “corporate conglomerates with billions of dollars in assets that compensate their executives as grandly as basketball players” (V, Kassirer 1995) “in a marketplace that is largely unregulated” (I, Zoloth-Dorfman and Rubin 1995). “Some, mostly older plans that were created when cost containment was an unexpected benefit rather than their central purpose, deliver high-quality care economically. Unfortunately, others cut costs by recruiting the healthiest patients, excluding the sickest, rationing care by making it inconvenient to obtain, and denying care by a variety of mechanisms” (V, Kassirer 1995).These cost-containment features now play an intimate role in clinical practice. When a managed care plan contracts with a physician, the doctor becomes a “double agent” with contractual obligations to the plan to provide a preset amount of services and professional responsibilities to each patient to authorize necessary treatment (V, Angell 1993). This duality can undermine the physician’s fiduciary responsibility to the patient wherein the physician “has power over the affairs of [the patient]...and is required by law to act on that person’s... (shrink)

This paper analyses social practices within public health services in Morocco, suggesting that current management orientations toward models like New Public Management obscure the social relations that often make under-resourced healthcare effective. Health policy in Morocco has increasingly adopted principles that reflect neoliberal influence in international development. Citing the work of Moroccan philosopher Mohammed Abed al-Jabri and American philosopher John Searle, the paper calls for policymakers to recognise the capacity of institutions to frame social relations. Likewise, policy (...) administration and management should be guided by reflection on the social role of institutions and related social practices at the level of service delivery. (shrink)

Starting out : ethics issues in beginning a practice -- Clinical practice -- Documentation and record keeping -- Dealing with third parties and protecting confidentiality -- Financial decisions -- Staff training and office policies -- Advertising and marketing -- Continuing professional development -- Leaving a practice -- Closing thoughts.

Public health agencies undertake a broad range of health promotion and injury and disease prevention activities in collaboration with an array of actors, such as the community, businesses, and non-profit organizations. These activities are “multisectoral” in nature and centered on public health agencies that oversee and engage with the other actors. Public health agencies can influence the hazardous activities in the private sector in a variety of ways, “ranging from prohibition and regulation to volunteerism, and from (...) cooperation to cooption.” Hence, a public health agency that possesses the necessary administrative resources and authority is vital to the effective implementation of health policies and regulations.In the developing world, however, many state health agencies lack these basic capacities in dealing with critical health threats, including their ability to avert epidemics of communicable diseases arising from poor sanitary conditions. A serious constraint is the shortage of public health funding for health agencies in the developing world for typical agency functions. This is often aggravated by the transaction-intensive demands entailed in enforcing regulations among an array of private and public sector actors including individuals, businesses, and local bodies responsible for providing civic services. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medical Tourism:Crossing Borders to Access Health CareHarriet Hutson Gray (bio) and Susan Cartier Poland (bio)Traveling abroad for one's health has a long history for the upper social classes who sought spas, mineral baths, innovative therapies, and the fair climate of the Mediterranean as destinations to improve their health. The newest trend in the first decade of the twenty-first century has the middle class traveling from developed (...) countries to those with emerging economies to avoid treatment delays, prohibitive costs for life-saving procedures, or simply high costs for elective surgery. Others leave to have access to assisted suicide in countries that have legalized it: Belgium, The Netherlands, and Switzerland. This new era of globalization in health care has arrived without the benefit of international standards, government oversight, or ethical and legal review.Howard Staab, a self-employed carpenter from North Carolina, flew to India for his medically necessary heart surgery, scheduled a side trip to the Taj Mahal, and returned home to work in North Carolina. He spent a total of less than $10,000, instead of the $200,000 required from the local hospital (I, Milstein and Smith 2006).At first blush, the outsourcing of medical care to India seems to be a particular solution for a particular problem. However, the particularity of Mr. Staab is not unique. His experience is emblematic of those patients in the United States with a medical need for major and elective procedures, but who also must bear the total cost of these procedures. These middle-class, under-insured Americans go abroad.In tandem with increasingly aggressive marketing campaigns, American hospitals and companies have begun to leverage their connections in Asia to grow the medical tourism business into a major economic force. What are the consequences of this?Several authors point to the effect on the host country's population, particularly the poor, to be pushed farther down the queue to receive adequate, affordable care. Resources are applied to the foreign trade instead of building the local [End Page 193] medical infrastructure. Another potential problem is the obligation of the home-country physician to provide follow-up care. What are the legal ramifications when the procedure was illegal to begin with? Are there opportunities for redress for medical errors?These factors may be converging into a "perfect storm" for health care in the U.S., in which the potential participation of the major insurance companies in promoting offshore care will be the tipping point in the precarious structure that represents the economic currents in health care. Third-party administrators and self-funded employers may be on the cutting edge in 2009 by providing incentives to employees to travel overseas for care.I. Economic ConsiderationsConnell, John. Medical Tourism: Sea, Sun, Sand and... Surgery. Tourism Management 27: 1093–1100, 2006.As evidence of the interest of traditional tour operators in this newer twist on the industry, the author explores medical tourism as an element of the growth of world tourism. In promoting medical tourism, he urges consideration of such issues as the privatization of health care, the foundational role of technology, and uneven access to health resources.Dunn, Philip. Medical Tourism Takes Flight. H and HN: Hospitals and Health Networks: 40–44, November 2007.Writing for U.S. health care executives, Dunn emphasizes that the reality of medical tourism competes with the local medical center for patients and their insurance dollars in a significant way. He examines the possibility that U.S. insurance plans soon may offer to pay for what is currently a cash only business and that the economic impact to the local medical center could be significant or even devastating.Frontiers of Health Services Management [Selected Articles] 24 (2), Winter 2007.In "Managing Healthcare Services in the Global Marketplace" (pp. 3–18), Bruce J. Fried and Dean M. Harris consider legal, ethical, and financial implications of the international workforce. In "Globalization of Health Care" (pp. 19–30), Lynn Schroth and Ruthy Khawahja point out that the transfer of comprehensive management expertise and intellectual property from U.S. medical centers to international sites is driving the success of collaboration between U.S. and foreign health care centers. In "Is... (shrink)

A romance with the concept of community has long characterized activist healthcare movements and has more recently been taken up by academic medical centers as a sign of virtuous civic engagement. During the late 1960s, the word community, as deployed by administrators at prestigious AMCs, became increasingly politicized, commodified and racialized. Here, we analyze how the concept of community was initially framed in the 1963 Community Mental Health Centers Act, the first legislation to establish community mental health centers (...) in America. We then examine the Health Policy Advisory Center’s analysis of the proposed Washington Heights Community Mental Health Center to be run by Columbia University’s College of Physicians and Surgeons, an institution that had historically neglected residents’ health needs. Community pushback against Columbia’s plan to build a multi-block center, amplified by medical students and residents critical of the professionalized community mental health movement, escalated in the late 1960s, leading the city’s planning board to reject Columbia and approve a community council’s plan for preventive and rehabilitative local services. These conflicting overtones of “community” still inform understandings of the word in medicine today; thus, a critical historical analysis of “community” is warranted. (shrink)

This book prepares readers to recognize and respond to the ethical dilemmas they will encounter on a regular basis during their career in healthcare management. Through cases, exercises, and self-quizzes, readers can apply the theories and tools presented in the text to actual situations they may find themselves facing.

What are the moral challenges that confront doctors as they manage healthcare institutions? How do we build trust in medical organisations? How do we conceptualize moral action? Based on accounts given by senior doctors from organisations throughout the UK, this book discusses the issues medical leaders find most troubling and identifies the moral tensions they face. Moral Leadership in Medicine examines in detail how doctors protect patients' interests, implement morally controversial change, manage colleagues in difficulty and rebuild trust after serious (...) medical harm. The book discusses how leaders develop moral narratives to make sense of these situations, how they behave while balancing conflicting moral goals and how they influence those around them to do the right thing in difficult circumstances. Based on empirical ethical analysis, this volume is essential reading for clinicians in leadership roles and students and academics in the fields of healthcare management, medical law and healthcare ethics"--Provided by publisher. (shrink)

Partially because of the high cost of developing and maintaining cold chains, systems needed to keep heat-labile vaccines under adequate refrigeration from their points of manufacture to their administration in the field, the Joint WHO/FAO Expert Committee on Zoonoses (i.e., the approximately four fifths of all described human infections that people share with other vertebrate animals) recommended in 1982 operation of common cold chains by health and veterinary services in rural areas. Following this recommendation, a 1984 pilot (...) level initiative in medical-veterinary intersectoral cooperation should be regarded as a practical way to deliver human primary health care to currently neglected African pastoralists, and as a potential core program for development efforts overall within arid and semiarid areas of the African continent. (shrink)

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan (...) and Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)

The authors conducted a baseline survey of baccalaureate and graduate degree health humanities programs in the United States and Canada. The object of the survey was to formally assess the current state of the field, to gauge what kind of resources individual programs are receiving, and to assess their self-identified needs to become or remain programmatically sustainable, including their views on the potential benefits of program accreditation. A 56-question baseline survey was sent to 111 institutions with baccalaureate programs and (...) 20 institutions with graduate programs. Respondents were asked about three areas: (1) program administration (managing unit, paid director, faculty lines, paid staff, funding sources); (2) educational program (curricular structure, CIP code usage, completion rates); and (3) views on accreditation for the field. A clear majority of respondents agreed that some form of accreditation or consultation service could address resource and sustainability issues. Overall, the survey responses to staffing, curricular structure, and support suggest the need for developing a sustainable infrastructure for health humanities. (shrink)

The federal government has a generally unquestioned obligation to provide health care to veterans for diseases or disabilities acquired during military service. Much argued, however, is the government's obligation to offer care for nonservice‐connected disorders. The Reagan administration has sharpened the debate recently by attempting to impose a means test on veterans over sixty‐five who are seeking such care. But the controversy focuses on the wrong issue. Society has a moral obligation to provide adequate health care to (...) all citizens but has no special obligation to care for nonservice‐connected health problems of veterans. (shrink)

Through a series of essays and cases based on real-life experiences, this book explores the interrelatedness of ethics and management and helps healthcare professionals at all levels of an organization overcome barriers to ethical decisions.

It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (2) (...) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector’s reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards’ assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors’ reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine. (shrink)

'Trade in Health is a timely reflection on the interface of economics with the ethics and public policy facets of the international movement of patients. Health issues such as these are at the forefront of modern political economy."National" health is increasingly less so. Reisman's previous scholarship in this area is brought to bear in an insightful and eminently readable and engaging fashion. In an area where uncovering the facts is more difficult than "decyphering the Dead Sea Scrolls", (...) such a reflective work on the critical aspects of political economy helps to fill a void in considering whether such trade is likely to be in the interests of patients, nations and the global community. In addition to the rosy picture of healthy and wealthy tourists having a sojourn for medical care during a vacation, Reisman is not afraid to tackle the thorny issues concerning trade in organs, eggs and even death, in this sobering and comprehensive volume. It is a rare skill to bring the luminaries of Smith, Marshall, Mill and Confucius to bear on such a contemporary tale! International travel by patients is at the nexus of a revolution in global health. It is driving and affecting aspects of foreign investment, health worker migration and e-health provision. Reisman skilfully links these foundations of health care, and as such provides critical text for consideration by those seeking to build and strengthen future health systems. Trade in Health is an excellent overview. It provides critical insights for those new to the area as well as new information and challenges for those of us involved for a number of years.' - Richard Smith, Professor of Health Ssytem Economics and Dean of Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK. Once exports and imports meant agriculture and industry. In the global economy and the electronic age, trade is also expanding into the service sector. This timely book closely examines trade in health. It documents the growth of a cross-national service that in the past was mainly consumed at home. Following from his highly successful book Health Tourism, Professor David Reisman offers a comprehensive and searching multidisciplinary account of the way in which medical services, patients, capital and professionals are making up a global healthcare economy that crosses borders. He reflects on their pursuit of lower prices, better quality and a differentiated product, and suggests that public policy is essential if the ethical capital of interdependent societies is not to be eroded by the international market in health and care. Written in a concise and lucid form, this original book will be of great interest to all people interested in the internationalization of health care. Combining theory and empirical evidence from economics, tourism and medical care, scholars involved in health policy and social administration will find much of significance in this authoritative study. (shrink)

The budget battles have hit the Indian Health Service hard: sequestration forced a 5 percent reduction in funds, followed by an additional 0.2 percent rescission in the recently passed Consolidated and Further Continuing Appropriations Act. Exempted from sequestration (and rightly so) were other very important health care programs such as the Veterans Administration Health Programs, the State Children's Health Insurance Programs, and Medicaid. Medicare has been reduced by only 2 percent, with that cut targeted to (...) provider reimbursement so as to avoid a reduction in service to beneficiaries. In March 2013, Representatives Betty McCollum, Tom Cole, and Michelle Lujan Grisham introduced a bill to reduce the impact of sequestration on the IHS to 2 percent (H.R. 1371). This bill was referred to the Committee on the Budget, but to date, there has been no movement on it.Why was the IHS susceptible to sequestration? Why is it considered a “discretionary” line item in the federal budget? Why is there not parity for Indians, whose health status remains far below that of mainstream America? As a matter of legal requirement, social contract, and moral obligation, the United States should fundamentally change how Indian Health is funded. (shrink)

The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether (...) or not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties. (shrink)

One of the most controversial issues in many health care systems is health care rationing. In essence, rationing refers to the denial of - or delay in - access to scarce goods and services in health care, despite the existence of medical need. Scarcity of financial and medical resources confronts society with painful questions. Who should decide which medicine or new treatment will be covered by social security and on which criteria such decisions must be based? (...) Can age, for example, be justified as a selection criterion? Should decision-making be left to health care policymakers, hospital administrators, or rather, to treating physicians? And finally: is there a role for individual patients? These are difficult questions that suggest the need for transparent and democratic decision-making. In reality, however, the rationing debate occurs in a sub rosa world, based on imperfect information, distorted interpretations of effectiveness, and hidden cost concerns. This book explores these and other questions from various perspectives. Each of the book's contributors analyzes the debate from a different angle, in search of fair and just rationing decisions. (shrink)

At the end of last year, President George Bush implemented a smallpox vaccination plan covering military operatives, health care workers, and “first-responders”. The program is administered by the federal Department of Health and Human Services in conjunction with the states and follows the smallpox vaccination guidelines established by the Centers for Disease Control and Prevention in September 2002. While inoculation is mandatory for military personnel, health care workers and first-responders are vaccinated on a voluntary basis. The (...) Administration had hoped that 450,000 health care workers would be inoculated within the first month of the program. Toward the end of February, however, only about 1 percent of the anticipated recipients had been inoculated. In Connecticut, which was the first state to begin the nonmilitary component of the program, only three people received vaccinations on the first day. (shrink)

This Open Access book about the Zadeh Project demonstrates and explores a core question in clinical ethics: how can ethics consultants be accountable in the face of a robust plurality of ethical standpoints, especially those that underwrite practices and methods for doing ethics consultation as well as those viewpoints and values encountered in daily clinical ethics practice? Underscoring this question is the recognition that the field of clinical ethics consultation has arrived at a crucial point in its maturation. Many efforts (...) are underway to more formally “professionalize” the field, with most aimed toward stabilizing a specific set of institutional considerations. Stretched between these institutional and practical initiatives resides a crucial set of of ethical considerations, chief among them the meaning and scope of responsibility for clinical ethics consultants. Developed around a long-form case scenario, the Zadeh Project provides a multi-layered series of “peer-reviews”: critique of the actions of the case scenario’s ethics consultant; reflection on clinical ethics method; examination of the many ways that commitments to method and practice can, and do, intersect, overlap, and alter one another. The design and format of this book thus models a key element for clinical ethics practice: the need and ability to provide careful and thoughtful explanation of core moral considerations that emerge among diverse standpoints. Specifically designed for those studying to become and those who are ethics consultants, this book, with its innovative and multi-layered approach, allows readers to share a peer-review-like experience that shows accountability to be what it is, an ethical, not merely procedural or administrative, undertaking. (shrink)

The vulnerability of participants in Substance Abuse and Mental Health Services Administration (SAMHSA) programs is a consequence of the illnesses that they are experiencing; ethical guarantees must be in place that ensure the dignity of the persons involved in such programs. Dignity is more than an individual concern; it has individual, institutional, and societal dimensions. An ethical framework is proposed that involves the interrelated vulnerabilities and needs of individuals and communities and our societal response to them. Among (...) the issues given particular attention are individual and community stigmatization, target population involvement in program planning, balance with regard to confidentiality and privacy, the place of proportionality grounded in a rich sense of community as a guiding ethical principle, and guidelines for SAMHSA programs. (shrink)

Health Maintenance Organization (HMO) administrators have been accused of engaging in selective marketing. That is, through such strategies as tailoring the benefits package of the program or advertising in styles or in media that do not appeal to certain undesirable audiences, the administrator can minimize the percentage of persons in the HMO who are heavy users of health care services.By means of analyzing what insurance is (philosophically) and what it means for something to be a free market (...) commodity, the author argues that, as long as American society chooses to regard health insurance as a commodity or service of the free market, the use of such strategies is within the moral rights of health administrators. (shrink)

Nursing staff plays a key role in the public health response to the COVID-19 pandemic, being in the front line of care. This study sought to synthesise the qualitative literature on care experiences of frontline nurses during the COVID-19 pandemic. A search was conducted on five databases in January 2021. Fifteen qualitative studies met the inclusion criteria and were included in the research, being submitted to interpretive meta-synthesis according to the eMERGe guide. The final synthesis included a line of (...) argument that shows the experiences of frontline nurses during the COVID-19 pandemic, divided into three major themes: ‘Instability on the edge of a cliff: unpredictable and unknown context,’ ‘The price of walking the tightrope: the uncertainty surrounding care,’ and ‘Finding the balance to reach the other side: dealing with the emotional demands of care.’ Although essential in the health response to the COVID-19 pandemic, nurses experienced an emotional impact arising from the hampered care provision. Our results point to need for strengthening the training of nurses and future nurses, creating and promoting measures that contribute to their psycho-emotional well-being, ensuring a safe environment for their clinical practice, and promoting their participation in decision-making processes. (shrink)