Health-care systems and ethics: What can we learn?

Health Care Analysis

Volumn 7, Issue 4, 1999, Pages 309-320

  Loewy, Erich H ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Community; HMO; Managed care; Market; Single versus multiple tiered systems; Solidarity

Indexed keywords

CULTURAL FACTOR; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HEALTH MAINTENANCE ORGANIZATION; MEDICAL ETHICS; REVIEW; SOCIAL STRUCTURE;

EID: 0033401152     PISSN: 10653058     EISSN: None     Source Type: Journal    
DOI: 10.1023/A:1009472415941     Document Type: Review

References (16)

1. The distortion of language and its results (especially with reference to Nazi Germany is beautifully discussed in Klemperer, V. (1975) LTI (Lingua Tertii Imperii). Leipzig, Germany: Reklam Verlag.
2. The fact that practicing ethically within an unethical system or building a just institution within an unjust society is, at the very least, extremely difficult if not virtually impossible, should be obvious. Examples abound. See: Loewy, E.H. (1998) Justice and Health-care Systems: What Would an Ideal Health-care System Look Like? Health Care Analysis 6, 185-192.
3. This analysis of choosing among differing values is one based on the Rawlsian idea of justice as fairness. In it, Rawls proposes that the various goods and stations should be distributed in a way which would safeguard everyone's (egoistically and individually made) choice. While neither agreeing with the egoistically base and certainly not with the individualistically made choice, Rawls veil of ignorance offers an excellent heuristic device and is used here. See - Rawls, J. (1971) A Theory of Justice. Cambridge, Ma: Harvard University Press.
4. This anaylsis is taken from Loewy, E.H. (1998) Justice and Health-care Systems: What Would an Ideal Health-care System Look Like? Health Care Analysis 6, 185-192.
5. A poor law model (in which persons are entitled to certain goods because certain criteria -poverty, for example) are met can be contrasted with the welfare model in which entitlement is a result of membership in a given community. Most societies have a mixture of these - fire and police protection, for example, is given to all whereas in many societies child support depends upon one's level of income. See: Barry, B. (1990) The Welfare State vs the Relief of Poverty. Ethics 100, 503-529.
6. A study of the waiting period from tentative diagnosis of coronary disease to cardiac catheterization and from cardiac catheterization to (if necessary) by-pass surgery) not only was drastically different between the National Health Service and the private sector in one area studied in the UK but - and more distrubingly - had greatly increased in the ten year interval studied. See Marber, M., MacRae, C. and Joy, M. (1991) Delay to Invasive Investigation and Revascularization for Coronary Heart Disease in South West Thames Region: A Two Tiered System? British Medical Journal 302, 1189-1191.
7. Loewy, E.H. (1998) Justice and Health-Care Systems: What Would an "ideal" Health-care System Look Like? Health Care Anaylsis 6, 185-192.
8. Moreno, J. (1992) The Social Individual in Clinical Ethics. Journal Clinical Ethics 3(1), 53-55.
9. Loewy, E.H. (1993) Freedom and Community: the Ethics of Interdependence. Albany, NY: State University of New York Press.
10. Navarro, V. (1989) Why some Countries Have National Health-insurance, others have a National Health Service and the U.S. has neither. Social Science and Medicine 28(9), 887-898.
11. There are several studies to support this point of view. Among others see: Helman, A.L., Pauly, M.V. and Kerstein, J.J. (1988) How do Financial Incentives Affect Physicians' Clinical Decisions and the Financial Performances of Health-maintainance Organization? New England Journal of Medicine 321(2), 86-92; Ware, J.E. et al. (1996) Differences in 4 Year Health Outcomes for Elderly and Poor, Chronically Ill Patients Treated in HMO and Fee for Service Systems. Journal American Medical Society 276(3), 1039-1053; Goldzweig, C.L. et al (1997) Variations in Catarct Extraction Rates in Medicare Prepaid and Fee for Service Settings. Journal American Medical Association 277(22): 1765-1768.
12. There are several studies to support this point of view. Among others see: Helman, A.L., Pauly, M.V. and Kerstein, J.J. (1988) How do Financial Incentives Affect Physicians' Clinical Decisions and the Financial Performances of Health-maintainance Organization? New England Journal of Medicine 321(2), 86-92; Ware, J.E. et al. (1996) Differences in 4 Year Health Outcomes for Elderly and Poor, Chronically Ill Patients Treated in HMO and Fee for Service Systems. Journal American Medical Society 276(3), 1039-1053; Goldzweig, C.L. et al (1997) Variations in Catarct Extraction Rates in Medicare Prepaid and Fee for Service Settings. Journal American Medical Association 277(22): 1765-1768.
13. There are several studies to support this point of view. Among others see: Helman, A.L., Pauly, M.V. and Kerstein, J.J. (1988) How do Financial Incentives Affect Physicians' Clinical Decisions and the Financial Performances of Health-maintainance Organization? New England Journal of Medicine 321(2), 86-92; Ware, J.E. et al. (1996) Differences in 4 Year Health Outcomes for Elderly and Poor, Chronically Ill Patients Treated in HMO and Fee for Service Systems. Journal American Medical Society 276(3), 1039-1053; Goldzweig, C.L. et al (1997) Variations in Catarct Extraction Rates in Medicare Prepaid and Fee for Service Settings. Journal American Medical Association 277(22): 1765-1768.
14. Loewy, E.H. and Loewy, RS (1998) Ethics and Managed Care: Reconstructing a System and Refashioning a Society. Archives Internal Medicine 158, 2419-2422.
15. See: Loewy, E.H. (1994) Of Markets, Technology, Patients and Profits. Health Care Analysis 2(2), 101-110; and Loewy, E.H. (1998) Justice and Health-care Systems: What Would an Ideal Health-care System Look Like? Health Care Analysis 6, 185-192.
16. See: Loewy, E.H. (1994) Of Markets, Technology, Patients and Profits. Health Care Analysis 2(2), 101-110; and Loewy, E.H. (1998) Justice and Health-care Systems: What Would an Ideal Health-care System Look Like? Health Care Analysis 6, 185-192.