Subject(s)
Diabetes Mellitus, Type 2/economics , Health Services Accessibility/economics , Health Services, Indigenous/economics , Healthcare Disparities/economics , Indians, North American/statistics & numerical data , Primary Health Care/economics , Diabetes Mellitus, Type 2/epidemiology , Female , Health Services Accessibility/statistics & numerical data , Health Services, Indigenous/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Male , Manitoba , Patient Acceptance of Health Care/statistics & numerical data , Primary Health Care/statistics & numerical data , Regional Health Planning/ethicsABSTRACT
BACKGROUND: The Mental Health Commission of Canada worked collaboratively with stakeholders to create a new framework for a federal mental health strategy, which is now mandated for implementation by 2017. The proposed strategies have been written into provincial health plans, hospital accreditation standards, and the annual objectives of psychiatric departments and community organizations. This project will explore the decision-making process among those who contributed to Canada's first federal mental health policy and those implementing this policy in the clinical setting. Despite the centrality of ethical reasoning to the successful uptake of the recent national guidelines for recovery-oriented care, to date, there are no studies focused exclusively on the ethical tensions that emerged and continue to emerge during the creation and implementation of the new standards for recovery-oriented practice. METHODS/DESIGN: This two-year Canadian Institute of Health Research Catalyst Grant in Ethics (2015-2017) consists of three components. C-I, a retrospective, qualitative study consisting of document analysis and interviews with key policy-makers of the ethical tensions that arose during the development of Canada's Mental Health Strategy will be conducted in parallel to C-II, a theory-based, focused ethnography of how mental health practitioners in a psychiatric setting reason about and act upon new standards in everyday practice. Case-based scenarios of ethical tensions will be developed from C-I/II and fed-forward to C-III: participatory forums with policy-makers, mental health practitioners, and other stakeholders in recovery-oriented services to collectively identify and prioritize key ethical concerns and generate action steps to close the gap between the policy-making process and its implementation at the local level. DISCUSSION: Policy-makers and clinicians make important everyday decisions that effect the creation and implementation of new practice standards. Particularly, there is a need to understand how ethical dilemmas that arise during this decision-making process and the reasoning and resources they use to resolve these tensions impact on the implementation process. This catalyst grant in ethics will (1) introduce a novel line of inquiry focusing on the ethical tensions that arose in the development of Canada's first mental health strategy, while (2) intensifying our focus on the ethical aspects of moving policy into action.
Subject(s)
Mental Health Services/organization & administration , Mental Health/ethics , Canada , Humans , Mental Health Services/ethics , Organizational Innovation , Policy Making , Program Development , Qualitative Research , Regional Health Planning/ethics , Regional Health Planning/methods , Regional Health Planning/organization & administrationSubject(s)
Administrative Personnel/ethics , Codes of Ethics , Decision Making, Organizational , Leadership , Regional Health Planning/ethics , Resource Allocation/ethics , Canada , Communication , Humans , Politics , Regional Health Planning/organization & administration , Resource Allocation/organization & administration , Social ResponsibilityABSTRACT
Governments around the world have focused on issues of sustainability, innovations and priority setting within their health systems. Tension exists between governments' desire to increase biotechnology innovation and the need to address health system sustainability. This commentary will: (1) review government initiatives in biotechnology in health innovation; (2) discuss how innovation, specifically biopharmaceuticals, challenges health system sustainability; and (3) explore how the tension between innovation and sustainability can be addressed using fairness and legitimacy. It is evident that a uni-jurisdictional approach may not be optimal in promoting innovation while ensuring a sustainable health system. Harmonization of biotechnology policies across the federal, provincial, and territorial governments will ensure consistent policies across all branches in order to circumvent the possibility of one governmental branch refusing to reimburse the very innovations other branches are promoting.
Subject(s)
Biotechnology/economics , Diffusion of Innovation , Health Planning Councils , Health Policy/economics , Health Priorities , Insurance, Health, Reimbursement/ethics , Regional Health Planning/organization & administration , Resource Allocation/ethics , Canada , Drug Design , Government Agencies , Health Services Accessibility , Health Services Needs and Demand/trends , Humans , Orphan Drug Production/economics , Regional Health Planning/economics , Regional Health Planning/ethics , Social JusticeABSTRACT
During the 1990s priority discussions were actualized in Sweden due to increased demands on health care and limited resources. In the county of Västerbotten in northern Sweden, with large rural areas, the decision makers faced special challenges due to distances and cost. Despite discussions striving for fairness in priorities, decision makers are still dealing with limited resources and difficult priority decisions regarding different diseases and treatments. In this study we aimed at describing views on priorities in public psoriasis care and visions of a future care among politicians, administrators and professionals in the county of Västerbottten in northern Sweden. Qualitative research interviews were performed with 23 key-persons. The findings revealed priority dilemmas about issues on organization, accessibility and ethics. Visions of a future care appeared as ambitions of a more effective care with good accessibility, continued research, information and a holistic approach in priorities. We conclude that dilemmas revealed in this study were a reflection of a gap between intentions and practice. In efforts to reduce these dilemmas we suggest methods with fairness in economic planning and priority setting, with concrete, official statements about the dominating views on which the priorities are based, and public information about these statements.
Subject(s)
Attitude to Health , Health Priorities/classification , Health Services Accessibility/standards , Psoriasis/therapy , Regional Health Planning/ethics , Resource Allocation/ethics , Rural Health Services/supply & distribution , Social Justice , Forecasting , Health Planning Guidelines , Health Priorities/ethics , Health Services Accessibility/ethics , Humans , Intention , Interviews as Topic , Policy Making , Psoriasis/economics , Qualitative Research , Social Responsibility , State Medicine , SwedenABSTRACT
BACKGROUND: In order to maintain both quality and efficiency of health services in a small country with a scattered population, Norway established a monopoly system for 38 highly specialized medical services. The geographical distributions of these services, which are provided by one or two university hospitals only, were analysed. METHODS: The counties of residence for 2,711 patients admitted for the first time in 2001 to these 31 monopolies and 7 duopolies were identified. RESULTS: The general tendency observed was that with increasing distance from residential home to monopoly hospitals there was a declining coverage of these health services. The same pattern was found even with regard to explicit diagnoses or treatments such as organ transplantations (except renal transplantations). Duopolies seemed to yield a more even geographical distribution of the services. CONCLUSION: Monopolies may serve as a useful means for maintaining quality in highly specialized medical services, but seem to have an inherent tendency to do this at the expense of geographical equality.
Subject(s)
Health Services Accessibility/statistics & numerical data , Hospitals, University/organization & administration , Medicine/organization & administration , Regional Health Planning/ethics , Social Justice , Specialization , Specialties, Surgical/organization & administration , Catchment Area, Health , Geography , Health Services Research , Hospitals, University/statistics & numerical data , Hospitals, University/supply & distribution , Humans , Medicine/statistics & numerical data , Norway , Odds Ratio , Patient Admission , Regional Health Planning/methods , Socioeconomic Factors , Sociology, Medical , Specialties, Surgical/statistics & numerical dataABSTRACT
Health research in Bangladesh is increasing and hence there is a need to consider the ethical issues with regard such research. This paper describes the measures being taken in Bangladesh to address research ethics, such as the bioethics educational programmes and the ethics review committees functioning within the country. The role and work of the Central Ethics Review Committee and the regulatory guidelines are outlined. The paper also discusses the situation regarding research ethics within the South Asia region.
Subject(s)
Ethics Committees, Research/organization & administration , Ethics, Research , Regional Health Planning/organization & administration , Academies and Institutes/organization & administration , Bangladesh , Developing Countries , Drive , Education, Medical/organization & administration , Ethics Committees, Research/ethics , Guidelines as Topic , Health Services Needs and Demand , Human Experimentation/ethics , Humans , Models, Psychological , Organizational Objectives , Regional Health Planning/ethicsSubject(s)
Ethics Committees, Clinical/standards , Genetic Counseling/ethics , Regional Health Planning/ethics , Rural Health Services/ethics , Rural Health , Vulnerable Populations/statistics & numerical data , Black People , Canada , Genetic Testing/ethics , Health Planning Organizations/ethics , Health Services Accessibility/ethics , Humans , Nova Scotia , Poverty/ethnology , Poverty/statistics & numerical data , Regional Health Planning/organization & administration , Rural Health Services/standards , Social Environment , Vulnerable Populations/ethnologySubject(s)
Ethics Committees, Clinical/organization & administration , Ethics, Institutional , Regional Health Planning/organization & administration , Rural Health Services/organization & administration , Alberta , Canada , Ethics Committees, Clinical/ethics , Health Planning Organizations/ethics , Health Priorities , Health Services Accessibility/organization & administration , Humans , Regional Health Planning/ethics , Resource Allocation/ethics , Rural Health , Rural Health Services/ethics , Social EnvironmentSubject(s)
Ethics, Institutional , Health Care Rationing/ethics , Regional Health Planning/economics , Regional Health Planning/ethics , Rural Health Services/economics , Rural Health Services/ethics , Canada , Health Care Rationing/economics , Health Planning Organizations/ethics , Health Services Accessibility/economics , Humans , Newfoundland and Labrador , Organizational Culture , Organizational Objectives , Resource Allocation/ethics , Rural Health , Social EnvironmentSubject(s)
Ethics Committees, Clinical/organization & administration , Ethics, Institutional , Health Planning Organizations/ethics , Regional Health Planning/ethics , Rural Health Services/ethics , Social Justice , Canada , Health Planning Organizations/standards , Humans , Nova Scotia , Organizational Objectives , Regional Health Planning/organization & administration , Rural Health , Rural Health Services/standards , Social Environment , Urban HealthSubject(s)
Ethics Committees, Clinical/organization & administration , Ethics, Institutional , Health Planning Organizations/ethics , Regional Health Planning/ethics , Rural Health Services/ethics , Canada , Humans , Manitoba , Organizational Culture , Organizational Innovation , Organizational Objectives , Program Evaluation , Quality Assurance, Health Care/ethics , Regional Health Planning/organization & administration , Rural Health , Rural Health Services/organization & administrationSubject(s)
Bioterrorism , Civil Defense/ethics , Health Care Rationing/ethics , Resource Allocation/ethics , Triage/ethics , Bioethical Issues , Biological Warfare , Chemical Warfare , Disaster Planning/standards , Ethics, Medical , Humans , Organizational Case Studies , Regional Health Planning/ethicsABSTRACT
The authors were involved in developing an ethical framework to assist the Queens Region Board (Prince Edward Island, Canada) set priorities in health and health care. Two and one half years after the adoption of this framework, the authors undertook an evaluation of the framework. This paper will discuss: (a) the historical background of regionalization in Canada, and in particular the circumstances leading up to the institution of regional boards in Prince Edward Island; (b) the sorts of ethical issues facing the Queens Regional Board; (c) issues arising in connection with the use and development of ethics frameworks for managing ethical issues in priority setting; (d) the framework adopted by the Queens Board and the process that led to its development; (e) issues arising as concerns implementation of the framework; (f) questions and issues pertinent to other boards and bodies considering similar initiatives.