Change agents and service providers? User organizations in the German healthcare system

Journal of Integrated Care

2016

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Purpose – Integrated health care lacks a theoretical concept of the user figure that is appropriate to reflect users’ various claims and multi-dimensional interrelations in the care process. The paper aims to discuss this issue. Design/methodology/approach – Key goals of integrated health care, such as a continuity of care, seamless services and better health outcomes depend strongly on users’ capabilities to engage themselves in the care process. These goals are hardly reachable if integrated health care schemes operate with a one-dimensional understanding of users’ identity. Findings – The suggested concept of users’ identity facets suggests that users draw from different sources while receiving integrated health care. Thus, users are patients, co-producers, citizens, consumers and community members in one person and at the same time. Each facet of the user identity gains or loses relevance depending on health care contexts, health statuses, personal values and the design of service arrangements. As demonstrated by the example of disease management programmes (DMPs), care schemes for chronically ill persons, users have to apply different facets of their identities in order to benefit best from service provision. Moreover, addressing users’ identity may facilitate the extent of integration in DMPs. Originality/value – Integrated health care schemes are challenged to invent strategies that facilitate and support coherence among users’ diverse identities in the process of service provision. Lessons could be learned from small-scale and localized integrated health care networks.

Section: Discussionmentioning

confidence: 99%

Patient, co-producer and consumer in one person

Journal of Integrated Care

2016

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“…This smaller part of the law deviates from the previous points since it leaves the meaning of prevention and the implementation of preventive policies to nongovernmental and nonmedical organizations. Thus, it breaks, to some extent, with the rule according to which “doing prevention” is a privilege of governments and policy makers; however, self‐help organizations that receive state subsidies are in an uneasy situation where they have to fulfill a double role of being service providers as well as critics of the health system (Ewert 2015).…”

Section: Preventive Health Policy In Germanymentioning

confidence: 99%

Citizenship as a Form of Anticipatory Obedience? Implications of Preventive Health Policy in Germany

2021

Politics & Policy

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This article scrutinizes citizenship implications in the field of preventive health policy in Germany. While at first glance prevention policies seem fairly uncontroversial, they have intricate links concerning the impact on preventive policies to social citizenship and to the notion of the “good” citizen. I argue that prevention is a future‐oriented permanent task that requires constant alertness and the commitment of responsible citizens to being “ahead of time.” Although originally based on the principles of voluntary compliance and self‐responsibility in Germany, preventive policies are likely to become more compulsory in the aftermath of the COVID‐19 pandemic that has, in effect, been a collective crash course on the importance of prevention and its range of policy tools. Under the prevention paradigm, active citizenship requires anticipatory action—that may turn into obedience—due to the imminent danger of assumed health risks. Related Articles in this Special Issue Barrault‐Stella, Lorenzo, and Thomas Douniès. 2021. “Introduction to the Special Issue: Citizenship as a Tool of Government in Europe.” Politics & Policy 49 (4). Haapajärvi, Linda. 2021. “On the Importance of Playing House: Belonging‐Work and the Making of Relational Citizens in Finnish Immigrant Integration Policies.” Politics & Policy 49 (4). Mioni, Michele. 2021. “The ‘Good Citizen’ as ‘Respectable Worker:' State, Unemployment, and Social Policy in the United Kingdom and Italy, 1930 to 1950.” Politics & Policy 49 (4).

“…As a result, health activists and emancipated patients challenged the supremacy of healthcare professionals, leading to decreasing levels of trust in the ‘healthcare state’ (Moran, 1999). For example, patient organisations and self-help movements sought to civilise healthcare systems that were perceived as rigid and inhumane through collective voice (Ewert, 2015; Mold, 2011). In the light of fairly standardised and impersonal services, individual choice in health behaviour came to be perceived as a form of resistance for ‘self-caring, self-medicating patients who took increasing responsibility for their own treatment’ (Armstrong, 2014: 169).…”

Section: Health Policymaking and The Meaning Of Health Citizenship: Amentioning

confidence: 99%

From entitled citizens to nudged consumers? Re-examining the hallmarks of health citizenship in the light of the behavioural turn

Public Policy and Administration

2018

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Behavioural Public Policy seeks to produce behavioural change by altering people's choice architecture. As exemplified in the field of health, this behavioural turn in public policy comes at a cost since policymakers ('nudgers') tend to disregard the historical policy legacies and policy rationales that have shaped the notion of health citizenship. Behavioural interventions challenge the traditional hallmarks of health citizenship, such as trust in providers and professionals, lifestyle as a matter of individual choice, and healthcare provision and voice within healthcare governance arrangements. As demonstrated in the areas of health promotion, health insurance provision and the doctor-patient relationship, nudge tactics make state-citizen relations more patchy and inconsistent. This calls for a behaviourally informed citizenship model, which accommodates human flaws and the inevitability of systematic exploitation, offers a way to explore new forms of protecting individuals from coerced behavioural change strategies, and helps to maintain the collective engagement of citizens in the process of public policymaking.