Ethical budgets: a critical success factor in implementing new public management accountability in health care

Bosa, Iris

doi:10.1258/hsmr.2009.009024

Cited by 7 publications

(9 citation statements)

References 30 publications

(47 reference statements)

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“…More fundamentally, some surveyed physicians did not seem to adhere to their assigned role regarding the development of the generics market. It is known that many GPs do not wish to exercise the economic accountability that the authorities want them to endorse [ 33 ], especially when they feel that it could contravene their own professional ethical rules [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“No generics, Doctor!” The perspective of general practitioners in two French regions

Riner¹,

Bussy²,

Hélène-Pelage³

et al. 2017

BMC Health Serv Res

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BackgroundGeneric medicines are essential to controlling health expenditures. Their market share is still small in France. The discourse and practices of prescribers may play a major role in their use. The purpose of this study was to explore the knowledge, attitudes and practices of general practitioners (GPs) toward generic medicines in two French regions with the lowest penetration rate of these products.MethodsAn observational study was carried out from October 2015 to February 2016 in Guadeloupe and Martinique. The first qualitative phase involved a diversified sample of 14 GPs who underwent semi-structured interviews. The second phase involved a random sample of 316 GPs (response rate = 74%) who were administered a structured questionnaire developed from the results of the first phase.ResultsSeventy-eight percent of the participants defined a generic drug as a drug containing an active substance identical to a brand-name drug, but only 11% considered generic drugs to be equivalent to brand-name drugs, and the same proportion believed that the generic drugs were of doubtful quality. The primary recognized advantage of generic medicines was their lower cost (82%). The main drawbacks cited were the variability of their presentation (44%), the confusion that they caused for some patients (47%), frequent allegations of adverse side effects (37%) and a lack of efficacy (24%), and frequent refusal by patients (26%). Seventy-four percent of the participants stated that they adapted their prescribing practices to the situation, and of this group, 47% prescribed the originator product simply on demand.ConclusionMost surveyed GPs were not hostile towards generic medicines. They were caught between the requirements of health insurance regimes and the opposition of numerous users and suggested that the patient information provided by health authorities should be improved and that drug composition and packaging should be made uniform.

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Section: Discussionmentioning

confidence: 99%

“No generics, Doctor!” The perspective of general practitioners in two French regions

Riner¹,

Bussy²,

Hélène-Pelage³

et al. 2017

BMC Health Serv Res

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“…One study used an action research method. 48 In some studies, 10,38,52,68 documentation was used and analysed to augment the other data collection methods. Statistical analyses were used in most of the studies (n ¼ 26).…”

Section: Study Methodsmentioning

confidence: 99%

“…37,42,51,60,73,74 High response rates were also reported ranging from 71% to 92%. 29,50,66 In some studies the sample was textual data, such as published scientific review articles (n ¼ 3 22,68,70 ), healthcare organizations' documents 38,52 or ethical codes. 10 Most of the studies were conducted in acute hospital settings (n ¼ 34).…”

Section: Informants and Settingsmentioning

confidence: 99%

“…However, some issues can be raised. Healthcare organizational ethics is concerned with many aspects of organizational life such as resource allocation, funding and priority setting, 36,38 strategic planning and value setting, 23,36,62,69,74 safeguarding justice and access to care, 33 business development and healthcare service conduct, 23,41,42 agreement over treatment decisions and care delivery processes on a broad front, 10,52 safeguarding an ethically high standard of clinical care, 27,52,57,67 disclosure of risks and complaints of misconduct, 28 and finally, workplace ethics and the ethical climate. 1,22,45,49,55,60,65 Ethics has been stated as one of the key factors that healthcare organizations address 35 having an influence on the overall success of the organization.…”

Section: Main Findings Of the Reviewed Studiesmentioning

confidence: 99%

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Organizational ethics: A literature review

et al. 2011

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The aim of the study was to report the results of a systematically conducted literature review of empirical studies about healthcare organizations' ethics and management or leadership issues. Electronic databases MEDLINE and CINAHL yielded 909 citations. After a two stage application of the inclusion and exclusion criteria 56 full-text articles were included in the review. No large research programs were identified. Most of the studies were in acute hospital settings from the 1990s onwards. The studies focused on ethical challenges, dilemmas in practice, employee moral distress and ethical climates or environments. Study samples typically consisted of healthcare practitioners, operational, executive and strategic managers. Data collection was mainly by questionnaires or interviews and most of the studies were descriptive, correlational and cross-sectional. There is need to develop conceptual clarity and a theoretical framework around the subject of organizational ethics and the breadth of the contexts and scope of the research needs to be increased.

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“…From existing empirical research we learn that organizational ethics in health care is concerned with many aspects of organizational life. The most commonly cited ethical issues are [11, 13]: resource allocation, funding, priority setting and distributive justice [14, 32, 65–67]; strategic planning and value setting [68–70]; managing the tension between budgetary constraints and providing high-quality patient care, while trying to safeguard an ethically high standard of clinical care [67, 71, 72], safeguarding justice and access to care, also for the uninsured [73].…”

Section: Introductionmentioning

confidence: 99%

‘You can give them wings to fly’: a qualitative study on values-based leadership in health care

Denier

Dhaene²,

Gastmans

2019

BMC Med Ethics

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Background Within contemporary health care, many of the decisions affecting the health and well-being of patients are not being made by the clinicians or health professionals, but by those involved in health care management. Existing literature on organizational ethics provides insight into the various structures, processes and strategies - such as mission statement, ethics committees, ethical rounds … - that exist to create an organizational climate, which fosters ethical practices and decision-making It does not, however, show how health care managers experience their job as being intrinsically ethical in itself. In the present article, we investigate the way in which ethical values are present in the lived experiences and daily practice of health care management. What does it imply to take up a managing position within a health care institution and to try to do this in an ethically inspired way? Method We carried out a qualitative study (Grounded Theory Approach) to explore the essence of values-based leadership in health care. We interviewed 15 people with extensive experience in health care management in the fields of elderly care, hospital care and mental health care in the various regions of Flanders, Belgium. Results Six predominant themes, presented as metaphors, illustrate the essence of values-based leadership in health care management. These are: (1) values-based health care management as managing a large garden , (2) as learning and using a foreign language , (3) going on a trekking with an ethical compass, (4) embodying integrity and authenticity in a credible encounter with everyone, (5) being a present and trustworthy leader during sun and storm , and (6) contributing to human flourishing by giving people wings to fly . Conclusions Notwithstanding the importance of organizing a good ethics infrastructure, values-based leadership in health care entails much more than that. It is about the co-creation of an integrated and comprehensive ethical climate of which community-model thinking and authentic leadership are essential components. As a never-ending process, the six metaphors can help leaders to take substantive proactive steps to shape a fruitful ethical climate within their organization.

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Ethical budgets: a critical success factor in implementing new public management accountability in health care

Cited by 7 publications

References 30 publications

“No generics, Doctor!” The perspective of general practitioners in two French regions

“No generics, Doctor!” The perspective of general practitioners in two French regions

Organizational ethics: A literature review

‘You can give them wings to fly’: a qualitative study on values-based leadership in health care

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