Health Care Analysis最新文献

Patent-based intellectual property (IP) has come under progressively substantiative attack in the peer-reviewed literature as many studies have shown it retards innovation. In addition, the monopoly period no longer fits the innovation cycle. Although the vast majority of patents are not useful, patent proponents argue monopoly-based economic incentives are specifically necessary to fund medical technologies. Rather than use simple economics, quantifying human deaths has also been proposed as a means to guide public policies. Such an approach can be applied to patents by investigating the lives saved by patents as well as those lost in the current IP systems. This study is the first to provide such a theoretical approach to quantifying human mortality costs of patent-based IP systems. To illustrate the mechanism by which patents are responsible for premature deaths, a case study of the 100-year-old innovation of insulin is provided. The U.S. and Canada were selected to compare because the approach to drug costs in the two countries allows for a fraction of the additional costs of IP to be quantified. By comparing the different death rates of diabetics in U.S. and Canada, it was found that insulin-related patents result in over 94,000 American premature deaths annually (in 2021). The results also make it clear that many human deaths are related to price increases and lack of accessibility to needed medications due to the current monopolistic IP system. These findings require patent proponents to defend the continued existence of patents in the medical innovation space.

In recent years, artificial intelligence (AI) has become more important in healthcare. It has the ability to completely change how patients are diagnosed, treated, and cared for. To make sure AI is properly supervised in healthcare, many problems need to be solved. This calls for a broad approach that includes policy, technology, and involving important people. This study investigates the governance of AI within healthcare, highlighting the importance of policy, technology, and stakeholder engagement. Adopting a mixed-methods research design, the study encompasses surveys, interviews, and document analysis to comprehensively explore diverse perspectives on AI governance. Purposive sampling techniques were employed to gather 897 valid samples, ensuring diversity across stakeholder groups. Surveys gathered quantitative data on demographic characteristics and attitudes toward AI governance, while interviews provided deeper insights into stakeholders' experiences and recommendations. Document analysis supplemented data collection by reviewing policy documents, guidelines, and academic literature related to AI governance. This study merges quantitative and qualitative data to thoroughly investigate AI governance, enabling the identification of policy implications and actionable recommendations. This study contributes novel insights by adopting a comprehensive approach to AI governance in healthcare, integrating policy, technology, and stakeholder engagement perspectives. Unlike previous studies focusing solely on individual aspects of AI governance, this research provides a holistic understanding of the complex dynamics involved. This research offers important insights into AI governance by investigating the impact of stakeholder engagement, ethical considerations, digital health disparities, governance structures, and health communication strategies on AI integration in healthcare, ultimately aiding in policy development and implementation.

In this paper we discuss whether effective public health interventions and policies are environmentally sustainable. First, we suggest that the environmental impact from public health interventions and policies should be considered in the perspective of a human lifecycle. Second, we spell out in greater detail what we take it to mean for a public health intervention or policy to be environmentally sustainable. Third, environmental sustainability regards not only environmental impact, but also shares of our environmental "budgets", also referred to as environmentally safe operating spaces. Such budgets represent the limits of the sustainability of a group of individuals, e.g. a population. Each individual is assigned a share of the budget for each category of environmental impact, which represents how much the individual may impact the environmental category in question without doing so unsustainably. We discuss whether individuals ought to have a larger share of these budgets as a function of their ongoing life as this would make a better case for thinking that public health interventions and policies are environmentally sustainable. But we argue that this is incompatible with maximizing health within our environmental budgets and therefore mistaken. Instead, individuals ought to be ascribed a share of these budgets for life, a share that does not increase as individuals get older. We conclude that while some public health interventions and policies might be environmentally sustainable, we cannot merely assume that public health and sustainability are win-win; indeed, we have positive reason to think that some interventions and policies are not environmentally sustainable. Finally, we elaborate on how we ought to think about and react to this conclusion.

This paper questions the conventional wisdom that physicians must suppress anger in response to patient misbehaviour. It distinguishes the emotion of anger from its expression, which leans toward concerned frustration and disappointment for the sake of professionalism in patient care. Drawing on the framework of person-centred health care as a virtue ethic, the paper first suggests four reasons why and when physician anger toward patient behaviour may occasionally be appropriate: the inevitability of sometimes feeling angry, anger as a cognitive and behavioural resource, physician well-being, and potential patient benefit. The paper then proposes five conditions under which physician anger displays may be prudent as a measured response that balances emotional expression with professional conduct: ethical intention, rational justification, proportionality, problem-focused constructive expression, and precision. Potential benefits of this conceptualization of prudent anger include improved physician wellbeing, enhanced communication, and patient education to address perceived patient misbehaviour. The paper advocates for a cultural shift in health care environments to help allow for more authentic expression of physician frustration, aiming to harness prudent anger as a catalyst for positive change in patient-physician relationships and systemic improvements in health care delivery.

Medicine has always existed in a marketplace, and there have been extensive discussions about the ethical implications of commerce in health care. For the most part, this discussion has focused on health professionals' interactions with pharmaceutical and other health technology industries, with less attention given to other types of commercial influences, such as corporatized health services and fee-for-service practice. This is a significant lacuna because in many jurisdictions, some or all of healthcare is delivered in the private sector. Using the exemplar of Assisted Reproductive Technologies (ART), this paper asks: what, if any, responsibilities do doctors have to challenge the distorting influence of commerce in healthcare, other than those arising from their own interactions with health technology companies? ART provides a good focus for this question because it is an area of practice that has historically been provided in the private sector. First, we describe a range of concepts that offer helpful heuristics for capturing how and when doctors can reasonably be said to have responsibilities to resist commercial distortion, including: complicity, acquiescence, wilful ignorance, non-wilful ignorance, and duplicity. Second, we present ways that individual doctors can act to stop questionable behaviour on the part of their colleagues, clinics/corporations, and their profession. Third, we note that there are many situations where change cannot be achieved by individuals acting alone, and so we consider the responsibilities of health professionals as collectives as well as the role that professional bodies and regulators should play.

A few months after national vaccination campaigns were initiated around early 2021, the discussion regarding the mandatory vaccination of healthcare workers started gaining ground in most European states and also in the United States. The debate on whether healthcare workers should be required to be vaccinated has been fueled by three main reasons: the high transmissibility rate of the Delta variant, which posed a significant risk to national healthcare systems across Europe and the Americas, as well placing high pressure on intensive care units even in the summer months (a); states' inability to impose general lockdowns and social distancing measures during the 2022 winter due to financial hardship and fears of an ongoing recession (b); and governmental unwillingness to implement restrictive measures, having in mind their populations' tiredness from previous lockdowns (c). This paper will explore the legal and managerial implications of mandatory vaccination among healthcare workers and will argue that it has the capacity to be a successful part of effective national healthcare systems in the search for responsible professionals to staff them. It will argue that national vaccination strategies are dependent on states' national healthcare models. It will show how the major difference in healthcare models of the two states chosen as examples have affected their vaccination policies and their reception by healthcare personnel. Finally, it will prove that the advantages of mandatory vaccination for healthcare personnel outweigh prospected disadvantages, irrespective of ethical, or legal justification is applied. This research will go through the key points of the legislative provisions of the two states (a); it will delve into their legal (b) and managerial implications (c); and finally, it will go through the policy questions which arose (d). It will prove how selective mandatory vaccination policies may be applied to national healthcare systems with foundational differences in their conception. Thus, it will demonstrate that selective mandatory vaccination is a viable option both for models approaching health from a societal perspective, and from the liberal ones.

This essay places contemporary efforts to understand and respond to the crisis of physician burnout in historical perspective, proposing that the origins of such efforts lie in nineteenth century concerns over "nervous exhaustion," well before the term "physician burnout" was coined by social scientists in the early 1970s. Only very recently, however, have physician-scholars started to bring more sophisticated tools to bear in conceptualizing the problem, moving from a "systems approach" to the most recent efforts to frame the issue as a problem of corporate culture. The essay proposes that these different approaches to physician burnout illustrate the changing self-images of the medical profession over the last century and a half. Because such self-images are embedded in normative assumptions, contextualizing physician burnout in these terms reveals the crisis to be as much social and political as professional.

The pervasive effects of increasingly restrictive migration policies on the health of immigrant populations in the U.S. have been well-documented, but not so much concerning the unique experiences of Brazilian immigrants, a subgroup of the Latino/a/x population. Considering that, this narrative review article employs a research design that is both conceptual and exploratory-to understand the possible connections and associations between restrictive immigration policies and negative health outcomes among Brazilian immigrants in the U.S. Findings indicate that Brazilian immigrants in the U.S. face an array of health and non-health related challenges, including racism and poor working conditions, with undocumented individuals experiencing worse outcomes. Studies highlight the complex relationship between immigration policies and health and emphasize the detrimental effects of deportation fear, healthcare access obstacles, and mental health repercussions due to hostile immigration policymaking and generalized anti-immigrant sentiment. More research is needed to understand the unique challenges faced by the Brazilian immigrant population concerning several mental and physical health outcomes.

Historically, the transgender population has faced prejudice and discrimination within society. The purpose of diagnostic terms is to direct clinical care and facilitate insurance coverage. However, the existence of a medical diagnosis for gender nonconformity can exacerbate the stigmatization of transgender people with adverse consequences on their emotional health and social life. Whether transgenderism and gender dysphoria are indeed a psychopathological condition or even any kind of nosological entity is a contested issue. Many advocates of human rights, trans activists, social scientists, and clinicians support either the removal of gender incongruence from the list of mental disorders or at least its transfer to a separate category. Reforming the classification is an intermediate step toward depathologization and permits access to transgender-related care. Nonetheless, it partly preserves the stigma associated with abnormality and puts the availability of psychiatric care at risk. A more radical approach dictates that the classification of diseases serves exclusively medical purposes and must be dissociated from the respect for the legitimacy of one's autonomy and dignity. In the long term, only a swing in societal values can detach stigma from mental and physical illnesses. Enhancing collective respect for life, human rights, and diversity is the best way to achieve cohesion and well-being among members of society. Health professionals can be pioneers of social change in this field.