Facing a moral dilemma--introducing a dental care insurance within the public dental service.

Through the reform entitled "Dental care insurance-dental care at a fixed price", patients are offered a dental insurance, a capitation plan, that ensures that they can visit the dentist regularly during a period of three years at a fixed price per month (Frisktandvård).This insurance may be offered to all patients. The aim of this study was to generate a theory explaining the main concern for the staff at the public dental service when they have to introduce and advocate dental care insurance to patients. Interview data from 17 persons, representing different professions within the public dental service, were collected and analyzed simultaneously in line with guidelines for grounded theory. The results indicated that dentists/dental hygienists experienced several difficult standpoints concerning the implementation of the dental insurance, somewhat of a moral dilemma. The staff generally had a "cautiously positive attitude" to the forthcoming dental care insurance, but had perceptions how and when the patients should be offered the insurance and what that may mean to the clinic.The respondents reflected about the economic aspects for the clinic and how the oral health may be affected over time for the patients.

Unforeseen ethical/legal complications with screening tests in the capitation model of medical aid schemes.

In the South African health care system patients/consumers are divided into those who can afford private care and those who rely on state medical assistance. The system is under pressure to fund delivery of medical care to its beneficiaries. We consider the effects of different funding models on medicolegal liability of health professionals serving the private sector. Medical reasons should determine the service rendered. However, financial implications of services rendered and defensive practice of medicine also contribute to treatment received by a patient and its remuneration. Practitioners who commit to delivering a predetermined set of services within a particular time for a predetermined 'lump sum' are only paid for the service specifically requested. Should disease be found other than those contracted for, we argue that inaction with regard to that disease would be deemed to be negligent or unethical according to legal and ethical considerations.

Ethics, organ donation and tax: a proposal.

Five arguments are presented in favour of the proposal that people who opt in as organ donors should receive a tax break. These arguments appeal to welfare, autonomy, fairness, distributive justice and self-ownership, respectively. Eight worries about the proposal are considered in this paper. These objections focus upon no-effect and counter-productiveness, the Titmuss concern about social meaning, exploitation of the poor, commodification, inequality and unequal status, the notion that there are better alternatives, unacceptable expense, and concerns about the veto of relatives. The paper argues that none of the objections to the proposal is very telling.

[The bought patient : The ethical value of per capita flat rates from a medical viewpoint]. / Der verkaufte Patient : Zum ethischen Wert von Kopfprämien aus medizinischer Sicht.

Payments received by private physicians per patient sent for hospital treatment are a relatively new phenomenon in the German medical system. This practice has been made possible by the currently aggressive competition between hospitals. The practice of such regular payments has several legal as well as ethical aspects. It needs to be clarified whether and in which cases such payments constitute a justified fee for a valuable and necessary service or whether they simply represent an element of corruption which is used to generate case numbers in a competitive market situation.

[The bought patient : The ethical value of per capita flat rates from a legal viewpoint]. / Der gekaufte Patient : Zum ethischen Wert von Kopfpauschalen aus juristischer Sicht.

From the decisions of the German Medical Council for safeguarding medical independence and the new version of section 18 paragraph 1 MBO with reference to the cooperation between hospitals and physicians for patient relationship management, it can be derived that clear competitive and professional limits exist in the competition for patients within the cooperation of hospitals and physicians. The ethical and professional foundation serving the patient that physicians must make decisions regarding the patient in an independent way free from commercial influences, plays a key role for the legal assessment of models for patient allocation irrespective of the planned increased commercial and competitive nature of the service provided by social health insurance caused by the health reforms.

Informed consent, capitation, and conflicts of interest in clinical trials: views from the field.

BACKGROUND: The beliefs of research team members about informed consent practices are not well studied, especially in regard to financial aspects of research such as capitation fees. Sponsors of research offer capitation fees for the enrollment of subjects, and although this money is intended to cover the costs of the research it can sometimes be used in other ways. There is no clear consensus about whether this financial aspect of trials should be part of the informed consent process or whether it represents a potential conflict of interest. METHODS: We presented several hypothetical cases to members of the American College of Surgeons Oncology Group (ACOSOG) at a semi-annual meeting. ACOSOG is a federally funded clinical trials group evaluating surgical and adjuvant methods of cancer treatment. The meeting included surgeons, nurses, case managers, and others involved in clinical surgical trials. RESULTS: We found that most respondents believed that it would be a violation of the protocol to enroll a subject who showed lack of recall about the study. Most respondents also favored disclosure of capitation fees, especially if those fees went into discretionary accounts, but there was some disagreement about the benefit of that disclosure to potential participants. CONCLUSIONS: This study shows the need for greater work in ensuring that research team members share common understandings about informed consent. It also shows that most of these research team participants are prepared to make more disclosure about financial aspects of research than current standards in fact require.