Health Care Analysis最新文献

This article examines the complex interplay of cultural practices, genetic health risks, and evolving legal frameworks surrounding consanguineous marriage, with a focus on England and Wales. Consanguineous unions, increase offspring's risk of autosomal recessive genetic disorders and congenital anomalies due to heightened homozygosity. The 'Born in Bradford' study revealed that 37% of babies in the cohort were born to related parents, with over 60% of marriages in the Pakistani-origin population being consanguineous. This was associated with a near doubling of the congenital anomaly risk (3% to 6%) and accounted for an estimated 30% of all congenital anomalies and 25% of infant mortality in Bradford. While Norway and Sweden have recently banned or are set to ban first-cousin marriages, citing public health and forced marriage concerns, England and Wales maintain a permissive stance. Proposed legislation, like the Marriage (Prohibited Degrees of Relationship) Bill 2025, aims to prohibit these unions and is argued to mitigate NHS strain. However, such proposals face significant human rights challenges (right to marry, privacy, non-discrimination) and concerns about driving the practice underground. The paper concludes by advocating for nuanced, culturally sensitive public health strategies-including enhanced genetic counselling, targeted education, and proactive screening-to empower informed choice and improve health outcomes without legal coercion, aiming to balance state responsibility with individual and cultural freedoms.

Health care price transparency tools have proliferated across the United States in recent years. While these tools are primarily intended to help control rising healthcare costs, they are also frequently described as empowering patients by providing the financial information needed to make more fully informed decisions about medical care. If these tools do empower patients, then the money and time invested in developing and maintaining them could plausibly be justified even if price transparency proves largely ineffective at cost-containment. Using Nancy Kass's public health ethics framework, I explore whether price transparency can rightly be seen as achieving the aim of empowering patients. In examining this issue, I distinguish between what I call passive price transparency initiatives (where the information is made available for patients to find, should they choose to look for it) from active price transparency initiatives (where information about costs is given directly to patients). Most existing price transparency initiatives are passive, and I argue that these programs, rather than empowering patients, instead risk increasing patient burdens in a way that is most significant for those who are already worse off. Only active price transparency (in other words, price disclosure) can be seen as empowering patients in a fair and not overly burdensome way.

Caring for relatives of older nursing home residents during COVID-19 was sometimes morally challenging for nursing home nurses. We identified four moral challenges: (1) providing versus withholding information, (2) respecting relatives' wishes versus acting in accordance with professional standards, (3) acting in accordance with versus contrary to advance care plans, and (4) heeding versus ignoring visiting prohibitions. Care ethicist Margaret Urban Walker's framework of moral responsibility together with values listed in the ICN code of ethics for nurses were used as points of departure for reflection on these moral challenges. Each challenge was described, and moral responsibilities were charted and discussed in terms of moral relationships between nursing home nurses and the relatives of older residents, nurses' moral identity as a nurse, and nursing's moral values as listed in the ICN code of ethics for nurses. Nursing home nurses' moral responsibilities could be connected to many moral values of the nursing profession, such as empathy, responsiveness, caring, advocacy, equality, inclusivity, and compassion. However, these values have a limited effect on direct moral action, as different values can be addressed for opposite action alternatives.

Experiencing meaning and fulfillment in healthcare work is recognized as important for those in nursing, medicine, respiratory therapy, social work, and other health disciplines. Critically, moral distress, compassion fatigue, staff burnout, and individual health have all been linked as related phenomena when such experiences are compromised. And yet, we may question whether we truly understand the meaning of meaningfulness and fulfillment. What calls health providers to come to work, again and again, despite the complex and difficult situations that they have to deal with? What are sources of meaning and fulfillment? How do we understand these phenomena? The context of newborn intensive care deserves special consideration as healthcare providers manage clinical acuity, respond to infant illness, support stressed families, navigate ethical decision-making, and work through complex team dynamics. In this paper, we explore and reflect on anecdotes of meaning and fulfillment as described by healthcare providers to explicate these phenomena.

China's tiered healthcare system is designed to guide patients through a two-way referral process, with primary care as the first point of contact. However, prevalent bypassing of lower-tier facilities undermines the system's effectiveness. While previous research has examined healthcare choices, the cognitive drivers of bypassing behaviour remain insufficiently understood. A case study design was employed, involving 23 semi-structured interviews with hypertensive patients in Shenzhen. Deductive thematic analysis, guided by dual process theory, explored the cognitive mechanisms underlying bypassing, focusing on intuitive (System 1) and deliberative (System 2) decision-making. Bypassing behaviour emerged from the interplay between Systems 1 and 2 processes. System 1, driven by automatic heuristics, reinforced habitual hospital use and social norms, maintaining status quo bias and the belief that tertiary hospitals offer superior care. System 2, involving reflective risk assessment, led patients to favour hospitals due to concerns over service quality and adequacy. Importantly, System 1 established bypassing as the default, while System 2 provided retrospective justifications, entrenching this decision. However, a subset of patients, influenced by health status and personal circumstances, exhibited more flexibility, opting for primary care for convenience or accessibility. This delineates the cognitive model's boundary conditions, revealing that behavioural outcomes are not deterministic but contingent on individual and situational factors. The application of dual process theory offers a nuanced understanding of bypassing behaviour within China's tiered healthcare system, emphasising the roles of both instinctive and analytical cognitive processes. Findings suggest the need for multidimensional interventions targeting both cognitive pathways to improve primary care utilisation.

This study aimed to compare how healthcare professionals and laypeople from the UK engaged with and confronted misinformation about masks on social media and some of the barriers encountered, applying connectivism as a theoretical lens to interpret findings. Using thematic framework analysis, 12 in-depth interviews were conducted with participants consisting of seven healthcare professionals and five laypeople who actively use the social media website Twitter (now known as X). Interviews were recorded, transcribed verbatim and analysed iteratively using constant comparison and line-by-line coding. After coding of the first few interviews a working analytical framework was developed by comparing codes and grouping them together into categories. This was later applied to the subsequent interview transcripts. Analysis revealed six key categories: social capital (e.g., celebrity status), emotion (e.g., fear, anger, and burnout), culture (e.g., politics and toxic social media culture), social media dynamics (e.g., information overload), communication (e.g., managing cognitive load), and belief (e.g., beliefs being fixed and difficult to change). Our study suggests that healthcare professionals must actively engage with the public on social media by providing clear, evidence-based information, correcting false claims, and fostering trust through transparent communication. Interpreting our findings through a connectivist perspective highlights how digital networks shape trust and learning in online health discourse. Wider society, including tech companies and policymakers, should implement stronger fact-checking mechanisms, promote digital literacy, and support regulations that curb the spread of harmful health misinformation.

Non-invasive prenatal testing (NIPT) is offered on a user-pays basis in Australia, with a range of providers and services available. A key concern raised about NIPT provision is the impact on informed consent of possible routinization of testing. Given these concerns, the documents, forms and informational material used in clinical practice are of critical importance. Test-specific request forms produced by commercial providers are frequently used in Australia, but there is a lack of clarity about the function or role of these forms. Some are labelled as "request forms", while others include references to "informed consent". Our aim in this study was to assess the range of functions that these forms may serve. We performed an online search for forms available from Australian providers in 2024 and applied a modified version of the Evaluative Linguistic Framework to a final list of eight forms. Our findings indicate significant heterogeneity and ambiguity in the function of these forms. We suggest these forms play a role in the performance of informed consent as a clinical ritual. Documents and forms can play a supportive role in counselling related to NIPT, but this supportive role should be recognized and articulated. These findings can inform the way healthcare professionals in Australia and other settings approach NIPT provision.

Voice biomarker research is fueling a growing health-tech market, largely driven by start-ups. Yet, there is limited scholarship on how start-ups navigate the legal uncertainty surrounding voice data protection and the rising expectations for responsible AI. This study reviews the ethical, legal and regulatory practices as stated on the websites of 27 start-ups using voice as a biomarker in health-tech. The review reveals substantial disparities in the availability, readability and content of the information disclosed, especially regarding privacy policies, with only a few websites offering product-specific, transparent, and comprehensive privacy policies. Significant differences also emerged in the start-ups' terms of use and regulatory compliance statements, likely reflecting the novelty of the field, disparity in legal and regulatory requirements, and the absence of sector-specific ethical guidance. For example, while most start-ups reference compliance with data protection frameworks (e.g., HIPAA, GDPR), many fall short of best practices for transparency, accountability, and user-centered communication. We argue that the success of start-ups in health-tech depends on their capacity to capture and retain the attention of potential end-users and investors. By adopting accessible, transparent and forward-looking communication on how they frame their legal and ethical responsibilities in practice, start-ups can not only ensure legal and regulatory compliance but build trust and support sustainable innovation. This work identifies key best practices for voice AI start-ups to consider and lays the foundation for future research, including surveys and longitudinal tracking, to better understand the evolving landscape of ethical and legal practices in voice biomarker and voice AI health-tech.

The US healthcare system is characterized by a persistent deadlock, where high costs, low efficiency, and inequity resist fundamental reform. This stalemate is rooted in deep ideological divides, political polarization, a fragmented fiscal structure, and the power of entrenched interest groups. This article analyzes how recent trade protectionist policies, specifically tariffs on pharmaceuticals and their inputs, intersect with this domestic gridlock. It posits a central paradox: a political system incapable of enacting major domestic health reform can simultaneously deploy assertive trade interventions in the same sector. The article argues that these tariffs should not be misconstrued as flawed instruments of healthcare reform. Instead, they represent the application of a distinct sovereigntist and protectionist logic, driven by national security concerns. The consequence is not a failed attempt at a solution, but a collision of policy agendas that actively exacerbates the healthcare system's core dysfunctions. By increasing costs, destabilizing supply chains, and creating new arenas for interest group conflict, tariffs intensify partisan strife and further entrench the reform deadlock. This process, marked by the "securitization" of the pharmaceutical industry, signals a critical shift in global health governance, where geopolitical strategy now overrides and complicates the pursuit of domestic public health goals.