Health Care Analysis最新文献

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.

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.

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.

All healthcare professionals (HCPs) have responsibilities to provide information to patients according to the duties found within UK decision-making guidance and with regards to theory about the doctor-patient relationship. While routinisation can be understood in a number of different ways, this paper is concerned with how routines might negatively affect patients in the decision-making process. Therefore, in this manuscript, medical decision making is understood as problematically routine when a medical test or procedure is framed as a standard one and-given the way options are presented-it is implied that someone can decide to use that test or treatment without being given sufficient opportunities to think through their choices. Routinisation, when understood in this way, can affect the quality and amount of information provided to patients and the ways in which patients reflect upon their choices when making decisions. With the introduction of non-invasive prenatal testing (NIPT) into the UK healthcare system, bioethicists have questioned whether this new technology will be routinised and what the implications of routinisation on the decision-making process might be. While there have been numerous studies investigating the views and attitudes of pregnant women who use NIPT, there are fewer studies that look at the views and attitudes of healthcare professionals (HCPs). This study interviewed 20 UK-based HCPs who either offer NIPT or counselled pregnant women on the use of NIPT. One important finding was that many HCPs held the attitude that the NIPT decision-making process had become routine, however there was disagreement about whether routine NIPT was problematic or not. This study provides insights about the context that surrounds decision making for NIPT, and it raises important questions about how NIPT routinisation might be evaluated.

Approximately 70% of Koreans access health and medical information online. Health information providers play a crucial role in enhancing public health by ensuring that individuals can effectively consume and utilize this information according to their information-seeking behaviors. However, existing tools for evaluating health information websites have significant limitations. These tools are often one-size-fits-all and lack strategic recommendations for delivering consumer-centered health information. There is a clear need for alternative approaches beyond merely identifying the quality factors that satisfy consumers. A Strengths, Weaknesses, Opportunities, and Threats-Analytic Hierarchy Process (SWOT-AHP) evaluates both internal and external environmental factors of a health information website, which provides strategies based on the prioritization and weighting of quality factors. Specifically, the 'National Health Information Portal,' a platform provided by the Korea Disease Control and Prevention Agency, was assessed through a comprehensive review of prior research and a SWOT analysis, followed by an AHP survey involving 15 experts specializing in health information websites. The findings of the analysis indicate that the most effective development strategy is the SO (Strengths-Opportunities) strategy. This study highlights the need to move beyond uniform evaluation tools and consider the dynamic and complex nature of the Internet, emphasizing the importance of developing prioritized strategies based on evaluations from both consumers and providers.

In many western countries informal care is conceived as the answer to the increasing care demand. Little is known how formal and informal caregivers collaborate in the context of an diverse ageing population. The aim of this study was to gain insight in how professionals' perspectives regarding the collaboration with informal carers with a migration background are framed and shaped by intersecting aspects of diversity. We used an intersectionality informed qualitative design with informal conversations (N = 12) and semi-structured interviews (N = 17) with healthcare professionals working with clients with Acquired Brain Injury. Two critical friends were involved in the analysis which was substantiated by a participatory analysis with a community of practice. We identified four interrelated themes: (a) 'The difficult Other' in which professionals reflected on carers with a migration background causing 'difficulties'; (b) 'The dependent Other' refers to professionals' realization that 'difficulties' are intensified by the context in which care takes place; (c) in 'The uncomfortable self' professionals describe how feelings of insecurities evoked by the Other are associated with an inability to act 'professionally', and; (d) 'The reflexive self' shows how some professionals reflect on their own identities and identify their blind spots in collaboration within a care network. These themes demonstrate the tensions, biases and power imbalances between carers and professionals, which may explain some of the existing health disparities perpetuated through care networks.

Research on mobile health (mHealth) applications has investigated how such technologies contribute to a responsibilisation of users/patients. This literature largely focuses on the individual responsibilities constructed by the apps and the neoliberal environments that enable the positioning of the user as responsible. With this focus, this scholarship is less attentive to the role of social relations in responsibilisation. In this article, I demonstrate how relational responsibilities are constructed in the communication of a North American self-testing app for "early changes in cognition". Through an analysis of qualitative expert interviews and images on the app's web presence, I show how social relations are, in fact, mobilised in the construction of the responsibilities to support the user in the test situation, to take the test for the sake of others, and to make others take the test. Based on this analysis, I argue that the role of social relations should receive more attention in the literature on responsibilisation, because they lead to additional, sometimes gendered responsibilities that a focus on individual responsibilities would miss.

Research on justifications has shown their significance in advice-giving, decision-making and children disputes. However, the majority of studies gloss over practical functions of justifications in patient-physician interactions as they are often expected and pursued by patients and in turn, are adopted by physicians to support their stance and authority. This study, through conversation analysis (CA), aims to explore a) what are pragmatic functions of justifications in patient-physician interaction? b) how and when do physicians unfold their justifications for treatment recommendations? c) how do physicians deal with different responses based on their epistemic and deontic domains?. A total of 32 video-recordings between postpartum women and physicians are collected and studied. Four pragmatic functions of justifications drawn upon by physicians are explored: justifications as face-saving, reassurance, risk discussion and clarification-seeking. Despite physicians' attempts to justify their positions as less challenged by patients, this is not the entire picture as they demonstrate their desire to resolve patients' concerns and coordinate their viewpoints to achieve the best practice that facilitates patients' well-being.