Health Care Analysis最新文献

The ongoing war in Ukraine, which began in 2022, has displaced millions of people, creating immense challenges for healthcare systems in refugee-receiving countries. While temporary protection aims to grant refugees access to medical care, significant structural barriers and ethical shortcomings exist in refugee healthcare. To meet this challenge, the authors propose considering the integration of displaced physicians into the medical care systems of host countries. This solution not only meets the immediate healthcare demands but also leverages the expertise of Ukrainian doctors. The implementation in Germany and Poland exemplifies the current heterogeneity of regulations governing the professional practice of Ukrainian physicians, with individual workarounds such as the possibility of treating fellow Ukrainians while waiting for the approval of the license. From an ethical perspective, the dilemma between the urgent need for additional physicians and ensuring patient safety by thoroughly assessing all doctors' qualifications is a critical concern. Considering all the analyzed aspects, the authors advocate for harmonizing the regulations across the EU and removing barriers that limit healthcare access for refugees. They further stress the importance of developing comprehensive long-term strategies to ensure sustained healthcare access for Ukrainian refugees.

Despotic leadership harms both employee motivation and well-being. It has been studied using several theories, including social exchange and social learning theory, the latter suggesting learning stems from imitation. This study explores dark side of leadership, particularly in current healthcare reforms in Pakistan, such as Medical Teaching Institute (MTI). The need to review changing structural hierarchies is emphasized, as unilateral decisions often lead to defensive silence rather than workplace aggression and bullying. This study investigated the moderating role of neuroticism in the relationship between despotic leader- ship and workplace deviance, with emotional exhaustion mediating factor among healthcare sector employees. This study involved 294 professionals from public healthcare centres in Pakistan, achieving a 73% response rate. Five hypotheses were tested using Smart PLS for model testing and structural measurement along with SPSS and Preacher Hayes process models for moderated-mediation analysis. Results of linear regression analysis revealed that despotic leadership, mediated by emotional exhaustion, significantly impacts interpersonal and organizational deviance. Interestingly, neuroticism does not moderate this relationship, challenging previous literature. This study sheds light on despotic leadership's broader influence beyond personality attributes, offering new theoretical and practical implications and guiding future research directions.

In October 2024, Türkiye was shocked by the "Newborn Gang" scandal, in which a network of healthcare professionals allegedly exploited newborns for financial gain in private hospitals. The accused are charged with intentionally neglecting, mistreating or even killing of healthy infants in neonatal intensive care units to prolong their stays and maximize government reimbursements. This paper critically examines the structural and ethical failures exposed by the 2024 "Newborn Gang" scandal in Türkiye, in which healthcare professionals in private hospitals allegedly allowed or caused the deaths of newborns to profit from the state's healthcare reimbursement system. Drawing on the frameworks of neoliberal critique and medical humanities, the study argues that such extreme violations are not isolated incidents of individual misconduct, but manifestations of deeper systemic vulnerabilities fostered by the neoliberalization of healthcare. It explores how deregulation, market incentives, and the erosion of ethical values-exacerbated by Türkiye's Health Transformation Program-have created an environment where financial gain is prioritized over patient welfare. Comparative case studies are employed to contextualize these findings within broader global patterns of ethical collapse in healthcare systems influenced by market logic. The paper contends that merely strengthening oversight is insufficient; rather, a structural reorientation is needed. As a potential alternative, the study introduces Value-Based Healthcare as a model that aligns clinical outcomes with ethical imperatives. Ultimately, the paper calls for a fundamental moral recalibration of healthcare-one that affirms care, integrity, and justice as core values over profit and efficiency.

Compliance and regulatory bodies often encourage health care providers' disclosure of and apologies for wrongdoing. Patients may perceive that forgiveness is expected and feel pressure to grant it. However, forgiveness carries consequences, which can bring limits to forgiveness. Understanding these limits is crucial for understanding when forgiveness can either heal or add to trauma. This paper explores 10 context-dependent limits to forgiveness across four categories. The first category outlines conceptual limits: not all harm requires forgiveness, some evil acts may be beyond human forgiveness, and blame can be incompatible with forgiveness. Secondly, moral and ethical limits result from how accountability strains forgiveness, how moral absolutism can hinder it, and how proxy forgiveness may lack moral legitimacy. The third category identifies relational and social limits. Forced reconciliation can undermine forgiveness. System negligence diffuses culpability, hindering individual forgiveness, and requires prioritizing the victim's healing and benefit despite the diluted accountability. Finally, the fourth category highlights temporal and process-related limits. It emphasizes that ongoing or unaddressed harm can obstruct forgiveness, while variations in healing trajectories may delay or complicate it. Updating current understanding, this framework adds insight into when forgiveness may be inappropriate. It offers providers ethical guidance in navigating this terrain through a person-centred approach balancing empathy and accountability. The framework aims to facilitate healing for the patient and provider, regardless of whether forgiveness occurs.

About one-third of Australians use the services of complementary and alternative medicine (CAM); but debate about the role of CAM in public healthcare is vociferous. Despite this, the mechanisms driving CAM healthcare choices are not well understood, especially in rural Australia. From 2016 to 2018, 2,679 persons from the Goulburn Valley, northern Victoria, were surveyed, 28% (755) of whom reporting visiting CAM practitioners. A Generalized Linear Mixed Model was used to assess associations between various socio-demographic variables and the use of CAM services. The strongest significant inverse (p < 0.05) association with CAM use overall was being unemployed, with markedly lower odds of using CAM than those employed full-time (OR 0.22 [0.12, 0.41]). The next strongest inverse relationship was being retired (OR 0.44 [0.30, 0.65]). The strongest positive associations were with English spoken at home (OR 2.38 [1.34, 4.24]), private health insurance (hospital cover) (1.57 [1.28, 1.91]), being Australian born (OR 1.61 [1.14, 2.28]), and female sex (1.25 [1.02, 1.52])). Females had significantly higher odds of using osteopathy than males (OR 1.98 [1.33, 2.96]) but there were no significant sex differences for chiropractic or massage. This is the first such study conducted solely for a rural Australian population. The drivers of CAM use differed from previous nation-wide studies and they varied across modalities. The factors identified here as being associated with CAM use could be used by CAM practitioners in developing person-centred services. Similarly, the findings are relevant to primary-care services in understanding what sectors of society might eschew conventional health care for CAM in rural regions, where health services are often limited.

Publicly-funded health systems have traditionally been presumed to be underpinned by solidarity among the users. To which extent such solidarity presents and associates with what factors is understudied in the non-western countries. This article explores the distribution of health sector solidarity and its relationships with sociopolitical factors in Taiwan. Data was collected in 2021 through a national representative, cross-sectional survey with a sample size of 1272 included in the final analysis. The survey shows that solidarity regarding the National Health Insurance in Taiwan was prevalent in 2021, with 76.6% of Taiwanese willing to carry the cost to enhance the quality of care through the system, while ten years ago, in 2011, that figure was only 49.1%. Nationalist sentiments, belief in differentiated social responsibility, and political partisanship are found to be the main factors associated with this supportive attitude, while familial values are not. The supportive attitude toward the health system remains strong and has increased during the past ten years, implying that the clinical and social effectiveness of the system itself may help further forge health sector solidarity in Taiwan.

There are numerous ways to improve the quality of healthcare services, and Quality Improvement (QI) tools play a central role in this. These tools are essential for identifying problems, reducing errors and costs, modifying practices, generating innovative ideas, acquiring and analysing data, visualising issues, and supporting decision-making. Using them effectively promotes healthcare quality, patient safety, and optimal resource utilisation. Despite the importance of QI tools, the lack of systematic and comprehensive data on the frequency and purpose of their use in healthcare facilities constitutes the main problem area of this study. This descriptive and cross-sectional study examines the frequency and purpose of QI tool usage among quality managers in hospitals across Türkiye. The study population comprised quality managers from 248 hospitals who fully completed the survey. It focused on the use of 18 widely recognised QI tools, including Brainstorming, Fishbone Diagram, Five Whys, Flowchart, Control Chart, PDCA Cycle, FMEA, Histogram, Scatter Diagram, Process Mapping, and others. The results indicated that the least known tools were the Swiss Cheese Model, Spaghetti Diagram, Six Thinking Hats, House of Quality, Mapping the Last Ten Patients, Tree Diagram, and Pareto Chart. Conversely, Brainstorming, Fishbone Diagram, Five Whys, and Flowcharts were the most frequently used. QI tools were primarily used for generating ideas, visualisation, identifying problems, and analysing them. Significant differences in tool usage were observed based on experience in healthcare and quality roles. The findings underscore the complementary nature of QI tools and the need for enhanced training and awareness.

Cost-effectiveness analysis (CEA) is a mainstay of contemporary health care priority setting. However, priority setting in reference to cost-effectiveness may discriminate against people with disabilities. The ethical literature on priority setting suggests that the permissibility of such discrimination varies with the reason why people with disabilities receive lower priority. In a vignette-based survey experiment (N = 1100) in the UK, we tested whether five justifications for prioritizing people without disabilities affect the views of the broader public on priority setting based on CEA. In our vignettes, a hospital denies a person with a disability treatment for a disease based on CEA, and respondents were asked to assess the moral permissibility of this. The vignettes varied in terms of the reason the hospital emphasized in the decision. We tested vignettes emphasizing lower expected lifespan, lower quality of life, higher costs of treatment due to disability, less efficient treatment due to disability, and lower productivity due to infrequent labor-market participation. Our study is an initial exploratory survey experiment, exploring participant's responses to CEA with respect to disability. Discrimination against the patient with a disability was deemed impermissible across all experimental conditions, and there were no significant differences between the various reasons. This suggests a discrepancy between folk intuitions and those of many ethicists.

Integrating artificial intelligence (AI) in healthcare has sparked innovation but exposed vulnerabilities in regulatory oversight. Unregulated "shadow" AI systems, operating outside formal frameworks, pose risks such as algorithmic drift, bias, and disparities. The Comprehensive Algorithmic Oversight and Stewardship (CAOS) Framework addresses these challenges, combining risk assessments, data protection, and equity-focused methodologies to ensure responsible AI implementation. This framework offers a solution to bridge oversight gaps while supporting responsible healthcare innovation. CAOS functions as both a normative governance model and a practical system design, offering a scalable framework for ethical oversight, policy development, and operational implementation of AI systems in healthcare.

'Positive Health' and 'recovery' seem to cover similar multidimensional health perspectives focussing on capabilities instead of incapabilities. The My Positive Health questionnaire and Individual Recovery Outcomes Counter were initially developed as dialogue tools, but nowadays also used as self-reported questionnaires. Structural validity of these dialogue tools was assessed in earlier research resulting in the 42-items Positive Health questionnaire (PH42) and 12-items Individual Recovery Outcomes Counter (I.ROC12). As a next step, we investigated their construct validity. An observational cross-sectional study was conducted in a representative general Dutch population (LISS-panel) determining (1) Coherence between the PH42 and I.ROC12 using correlation coefficients; (2) Convergent validity by testing hypotheses for PH42 and I.ROC12 with external health-related questions using correlation coefficients; (3) Discriminative validity for subgroups gender, age, educational level and healthcare use. (1) Nine out of twelve correlations between PH42 and I.ROC12 factors were substantial (> 0.5). (2) Hypotheses for PH42 and I.ROC12 factors with health-related questions were confirmed for 80% and 75%, respectively. (3) Scores on all factors increased (i.e., better health) from low to high educational level and decreased from no healthcare use to healthcare received from (medical) specialists. Only the factor physical health and functioning showed a continuous decrease in scores with increasing age. Women scored lower only on physical health and functioning. Convergent validity is adequate and discriminative validity is adequate for educational level and healthcare use supporting the conclusion that the PH42 and I.ROC12 are useful instruments to measure Positive Health in a general population.