Tailor-made finance versus tailor-made care. Can the state strengthen consumer choice in healthcare by reforming the financial structure of long-term care?

Abstract:

BACKGROUND:Policy instruments based on the working of markets have been introduced to empower consumers of healthcare. However, it is still not easy to become a critical consumer of healthcare. OBJECTIVES:The aim of this study is to analyse the possibilities of the state to strengthen the position of patients with the aid of a new financial regime, such as personal health budgets. METHODS:Data were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care institutions. RESULTS:With the introduction of individual budgets the responsibility for budgetary control has shifted from the organisational level to the individual level in the caregiver-client relationship. Having more luxurious care on offer necessitates a stronger demarcation of regular care because organisations cannot simultaneously offer extra care as part of the standard care package. New financial instruments have an impact on the culture of receiving and giving care. Distributive justice takes on new meaning with the introduction of financial market mechanisms in healthcare; the distributing principle of 'need' is transformed into the principle of 'economic demand'. CONCLUSION:Financial instruments not only act as a countervailing power against providers insufficiently client-oriented, but are also used by providers to reinforce their own positions vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care.

journal_name

J Med Ethics

authors

Grit K,de Bont A

doi

10.1136/jme.2009.030536

subject

Has Abstract

pub_date

2010-02-01 00:00:00

pages

79-83

issue

2

eissn

0306-6800

issn

1473-4257

pii

36/2/79

journal_volume

36

pub_type

杂志文章
  • When should conscientious objection be accepted?

    abstract::This paper makes two main claims: first, that the need to protect health professionals' moral integrity is what grounds the right to conscientious objection in health care; and second, that for a given claim of conscientious objection to be acceptable to society, a certain set of criteria should be fulfilled. The impo...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2011.043646

    authors: Magelssen M

    更新日期:2012-01-01 00:00:00

  • Dilemma for appeals to the moral significance of birth.

    abstract::Giubilini and Minerva argue that the permissibility of abortion entails the permissibility of infanticide. Proponents of what we refer to as the Birth Strategy claim that there is a morally significant difference brought about at birth that accounts for our strong intuition that killing newborns is morally impermissib...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2020-106781

    authors: Bobier CA,Omelianchuk A

    更新日期:2020-10-26 00:00:00

  • Multidisciplinary teaching in a formal medical ethics course for clinical students.

    abstract::A successful feature of the 4th-year curriculum in the Medical Faculty of the Queen's University, Belfast has been the development of interdisciplinary teaching in a three-week joint course to which several clinical departments contribute...Co-ordinated teaching of topics of common interest in small groups included, u...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:

    authors: Irwin WG,McClelland RJ,Stout RW,Stchedroff M

    更新日期:1988-09-01 00:00:00

  • Evolution of hospital clinical ethics committees in Canada.

    abstract::To investigate the current status of hospital clinical ethics committees (CEC) and how they have evolved in Canada over the past 20 years, this paper presents an overview of the findings from a 2008 survey and compares these findings with two previous Canadian surveys conducted in 1989 and 1984. All Canadian hospitals...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2009.032607

    authors: Gaudine A,Thorne L,LeFort SM,Lamb M

    更新日期:2010-03-01 00:00:00

  • Royal College of Nursing (Rcn) code of professional conduct: a discussion document.

    abstract::We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawy...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.3.3.115

    authors: Dawson JD,Altschul AT,Sampson C,Smith AM

    更新日期:1977-09-01 00:00:00

  • Research guidelines for embryoids.

    abstract::Human embryo models formed from stem cells-known as embryoids-allow scientists to study the elusive first stages of human development without having to experiment on actual human embryos. But clear ethical guidelines for research involving embryoids are still lacking. Previously, a handful of researchers put forward n...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2020-106493

    authors: Piotrowska M

    更新日期:2021-01-05 00:00:00

  • When four principles are too many: bloodgate, integrity and an action-guiding model of ethical decision making in clinical practice.

    abstract::Medical ethical analysis remains dominated by the principlist account first proposed by Beauchamp and Childress. This paper argues that the principlist model is unreflective of how ethical decisions are taken in clinical practice. Two kinds of medical ethical decisions are distinguished: biosocial ethics and clinical ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2011-100136

    authors: Muirhead W

    更新日期:2012-04-01 00:00:00

  • Veterinary surgeons' attitudes towards physician-assisted suicide: an empirical study of Swedish experts on euthanasia.

    abstract:AIM:To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. DESIGN:A questionnaire about attitudes towards PAS, including prioritization of arguments pro and contra, was sent to Swedish veterinary surgeons. The results w...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2010.038901

    authors: Lerner H,Lindblad A,Algers B,Lynöe N

    更新日期:2011-05-01 00:00:00

  • Changing practice on confidentiality: a cause for concern. Commentary 2: Confidentially speaking.

    abstract::Elaborating on the concept of confidentiality of medical records and interdisciplinary communication discussed in earlier articles by D.J. Kenny and Derek F.H. Pheby, the author expresses concern about written communications to professional colleagues and verbal revelations to colleagues or to persons outside the ther...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.8.1.21

    authors: Green M

    更新日期:1982-03-01 00:00:00

  • How physician executives and clinicians perceive ethical issues in Saudi Arabian hospitals.

    abstract:OBJECTIVES:To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN:Self-completion questionnaire administered from February to July 1997. SETTING:Different health regions i...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.25.1.51

    authors: Saeed KS

    更新日期:1999-02-01 00:00:00

  • Thinking clearly about the FIRST trial: addressing ethical challenges in cluster randomised trials of policy interventions involving health providers.

    abstract::The ethics of the Flexibility In duty hour Requirements for Surgical Trainees (FIRST) trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trial...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2017-104282

    authors: Horn AR,Weijer C,Hey SP,Brehaut J,Fergusson DA,Goldstein CE,Grimshaw J,Taljaard M

    更新日期:2018-09-01 00:00:00

  • Further clarity on cooperation and morality.

    abstract::I explore the increasingly important issue of cooperation in immoral actions, particularly in connection with healthcare. Conscientious objection, especially as pertains to religious freedom in healthcare, has become a pressing issue in the light of the US Supreme Court judgement in Hobby Lobby Section 'Moral evaluati...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2016-103476

    authors: Oderberg DS

    更新日期:2017-04-01 00:00:00

  • The placebo effect in psychiatry: problem or solution?

    abstract::This opinion piece aims to situate the placebo effect within the field of psychiatric treatment. To accomplish this, the placebo is explored at the centre of an often heated debate between three discrete perspectives: the clinical trial researcher, the placebo researcher and the clinician. Each occupational perspectiv...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101410

    authors: Huculak S

    更新日期:2014-06-01 00:00:00

  • Artificial nutrition and hydration in the patient with advanced dementia: is withholding treatment compatible with traditional Judaism?

    abstract::Several religious traditions are widely believed to advocate the use of life-sustaining treatment in all circumstances. Hence, many believe that these faiths would require the use of a feeding tube in patients with advanced dementia who have lost interest in or the capacity to swallow food. This article explores wheth...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.27.1.12

    authors: Gillick MR

    更新日期:2001-02-01 00:00:00

  • Patients' ethical obligation for their health.

    abstract::In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.10.3.138

    authors: Sider RC,Clements CD

    更新日期:1984-09-01 00:00:00

  • Issues of consent and the primary-school medical.

    abstract::This article discusses what level of consent is needed from a child or parent before a primary-school medical can take place (i.e. where children are aged under 12). It also considers whether there are occasions when a doctor can see a child if the parents have failed to give consent or have explicitly refused consent...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.26.6.469

    authors: Bradley P

    更新日期:2000-12-01 00:00:00

  • Doctors and torture: the police surgeon.

    abstract::Much has been written by many distinguished persons about the philosophical, religious and ethical considerations of doctors and their involvement with torture. What follows will not have the erudition or authority of the likes of St Augustine, Mahatma Gandi, Schopenhauer or Thomas Paine. It represents the views of a ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.6.3.120

    authors: Burges SH

    更新日期:1980-09-01 00:00:00

  • Developing a culturally relevant bioethics for Asian people.

    abstract::Because of cultural differences between East and West, any attempt at outright adaptation of Western ideas in Asia will undoubtedly encounter problems, if not rejection. Transferring an idea from one place to another is just like transplanting an organ from a donor to a recipient--rejection is to be expected. Human cu...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.27.1.51

    authors: Tai MC,Lin CS

    更新日期:2001-02-01 00:00:00

  • Analogy in moral deliberation: the role of imagination and theory in ethics.

    abstract::This paper develops themes addressed in an article by Eric Wiland in the Journal of Medical Ethics 2000;26:466-8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel u...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/jme.28.4.244

    authors: Smith B

    更新日期:2002-08-01 00:00:00

  • Testing relationships: ethical arguments for screening for type 2 diabetes mellitus with HbA1C.

    abstract::Since the 1990s, glycated haemoglobin (HbA1C) has been the gold standard for monitoring glycaemic control in people diagnosed as having either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Discussions are underway about diagnosing diabetes mellitus on the basis of HbA1C titres and using HbA1C tes...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2011-100086

    authors: Degeling C,Rock M,Rogers WA

    更新日期:2012-03-01 00:00:00

  • Fair subject selection in clinical research: formal equality of opportunity.

    abstract::In this paper, I explore the ethics of subject selection in the context of biomedical research. I reject a key principle of what I shall refer to as the standard view According to this principle, investigators should select participants so as to minimise aggregate risk to participants and maximise aggregate benefits t...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2015-103311

    authors: MacKay D

    更新日期:2016-10-01 00:00:00

  • Advance directives are the solution to Dr Campbell's problem for voluntary euthanasia.

    abstract::Dr Neil Campbell suggests that when patients suffering extremes of protracted pain ask for help to end their lives, their requests should be discounted as made under compulsion. I contend that the doctors concerned should be referred to and then act upon advance directives made by those patients when of sound and calm...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/jme.25.3.245

    authors: Flew A

    更新日期:1999-06-01 00:00:00

  • Disclosure of individual research results in clinico-genomic trials: challenges, classification and criteria for decision-making.

    abstract::While an ethical obligation to report findings of clinical research to trial participants is increasingly recognised, the academic debate is often vague about what kinds of data should be fed back and how such a process should be organised. In this article, we present a classification of different actors, processes an...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2009.034041

    authors: Kollek R,Petersen I

    更新日期:2011-05-01 00:00:00

  • Publication ethics and the research assessment exercise: reflections on the troubled question of authorship.

    abstract::The research assessment exercise (RAE) forms the basis for determining the funding of higher education institutions in the UK. Monies are distributed according to a range of performance criteria, the most important of which is "research outputs". Problems to do with publication misconduct, and in particular, issues of...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.26.6.422

    authors: Sheikh A

    更新日期:2000-12-01 00:00:00

  • AIDS legislation--turning up the heat?

    abstract::This paper is not about the medical condition of AIDS. Nor is it about the history of the condition since it was first reported in Atlanta, Georgia in 1981. It looks rather, at the catalogue of legislative and other legal responses to the spread of AIDS. The paper analyses the AIDS condition in its historical context....

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.12.4.187

    authors: Kirby MD

    更新日期:1986-12-01 00:00:00

  • Balancing urgency, age and quality of life in organ allocation decisions--what would you do? A survey.

    abstract:PURPOSE:Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions. BACKGROUND:The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this c...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2006.018291

    authors: Stahl JE,Tramontano AC,Swan JS,Cohen BJ

    更新日期:2008-02-01 00:00:00

  • Interests.

    abstract::Explorations of bioethical issues frequently raise the question of an entity's "moral standing," or its right to moral consideration by rational agents. Many contemporary philosophers subscribe to Leonard Nelson's view that only beings that have interests have moral standing. Kuhse attempts to define interests and t...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.11.3.146

    authors: Kuhse H

    更新日期:1985-09-01 00:00:00

  • Compensation and hazard pay for key workers during an epidemic: an argument from analogy.

    abstract::The COVID-19 pandemic has created unusually challenging and dangerous workplace conditions for key workers. This has prompted calls for key workers to receive a variety of special benefits over and above their normal pay. Here, we consider whether two such benefits are justified: a no-fault compensation scheme for har...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2020-106389

    authors: McConnell D,Wilkinson D

    更新日期:2020-05-28 00:00:00

  • Agency, duties and the "Ashley treatment".

    abstract::In 2006, a paper in the journal Archives of Pediatric and Adolescent Medicine described a novel case of growth attenuation therapy and other treatments carried out on Ashley, a severely cognitively, neurologically and physically disabled 6-year-old girl. Some of the moral arguments that have sprung up in respect of th...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2009.029934

    authors: Tan N,Brassington I

    更新日期:2009-11-01 00:00:00

  • Scientific misconduct from the perspective of research coordinators: a national survey.

    abstract:OBJECTIVE:To report results from a national survey of coordinators and managers of clinical research studies in the US on their perceptions of and experiences with scientific misconduct. METHODS:Data were collected using the Scientific Misconduct Questionnaire-Revised. Eligible responses were received from 1645 of 530...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2006.016394

    authors: Pryor ER,Habermann B,Broome ME

    更新日期:2007-06-01 00:00:00