Suchergebnisse

This article aims to assess if the status of the medical profession has been reinforced or weakened with the new public management. With this purpose, it collects the opinion of two international experts regarding situation in the United Kingdom, in order to apply some lessons to the Spanish case. Both agree that, far from losing status and power with the healthcare reform, the medical profession has protected its status and autonomy against other social agents such as managers, politicians and patients. However, the maintenance of the status quo has been at the expense of an intra-professional stratification that has caused status inequalities linked to social class within the medical profession.

AbstractIt is estimated that over 50,000 individuals from the UK each year elect to fund their own treatment abroad. Such treatments commonly include cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The UK has also experienced inward flows of patients who travel to receive treatment and pay out of pocket, being treated in both private and NHS facilities.The rise of 'medical tourism' presents new opportunities and challenges in terms of treatment options for consumers/patients and health policymakers. Such developments denote a commercialization, commodification and internationalization of health care in a way that UK policy has not experienced to date.This article addresses four key issues. We explain the rise of medical‐related travel (applied to the UK), identify key policy considerations for the future, highlight important research gaps and explore conceptual frameworks which might help us understand better the observed patterns of medical tourism. Whilst the context for policy and practice is undoubtedly dynamic, we argue the need for greater clarity in understanding the emergent implications for health policy and health care delivery.

Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are also highly contextualized and are therefore of limited value when applied in different contexts. The paper then presents a new framework which, it is argued, provides a more useful way of examining centralization and decentralization by providing a way of categorizing policies and actions and avoids the problems of being contextually constrained. The paper ends with a discussion of how the framework can be applied in a health context and shows how this framework helps avoid the problems found in previous discussions of decentralization.

AbstractDespite the increasingly widespread emphasis on the need for transparency in health‐care and elsewhere, there is limited evidence regarding the consequences of disclosing medical performance data. The evidence is disparate and has not been synthesised in a coherent way. This paper focuses on surgical performance, whose measurement is generally often seen as straight forward. It begins by outlining the context for understanding the publication of such data and then presents an analytical framework as a vehicle for conceptualising the nature of disclosure in surgery and health‐care more generally. The framework addresses key dimensions concerning one surgical specialty (cardiac surgery) and its relationship with a range of stakeholders in an English context. In particular, we examine the interaction between surgeons and between surgeons, patients, managers and policy‐makers. These relationships are framed in terms of choice and calculativeness, strategies and tactics, and trust, and need to be understood at micro, meso and macro levels. We conclude by considering how this framework provides a research agenda for a sociology of disclosure.

The aim of this article is to contribute towards greater theoretical and empirical understanding about medical tourism developments globally. This evidence leads us to examine some widelyheld assumptions regarding the size and shape of global medical travel. Our paper examines three central issues: (1) Do published figures and projections 'add-up', are figures from multiple sources consistent, and what decisions and interests are involved for those compiling these statistics? (2) How should any emerging global industry be understood and explained? (3) Given this analysis and market understanding how, if at all, can national governments stimulate activity?

AbstractRecent health care reforms in England, combined with financial austerity, have accelerated both corporatization and commercialization in the English National Health Service (NHS) and this has encouraged greater public sector entrepreneurialism (PSE). We advance this argument by examining the meaning and experience of corporatization in this sector, illustrating our argument with qualitative data from a specialist hospital at the forefront of this trend. We demonstrate how the policy and practice of corporatization is entangled with increased commercialism and how this shapes more entrepreneurial conduct from staff. Framed in terms of the recursive relationship between organizational dynamics and individual behaviors, we focus empirically upon the shifting epistemic boundaries associated with increased corporatization, describing the dissonant effects of these shifts upon individuals, their attempts to compartmentalize, and the ethical dilemmas that result. Through this case we draw conclusions about the emerging impact of corporatization, commercialization, and public sector entrepreneurialism across public services.