Health care analysis : HCA : journal of health philosophy and policy
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Progress in medicine and the subsequent extension of health coverage has meant that health expenditure has increased sharply in Western countries. In the United States, this rise was precipitated in the 1980s, compounded by an increase in drug consumption which prompted the government to re-examine its financial support to care delivery, most notably in hospital care and emergencies services. In California for example, 50 emergency service providers were closed between 1990 and 2000, and nine in 1999-2000 alone. ⋯ Alternative providers such as walk-in clinics are increasingly common. EDs also attempt to reengineer their operations to curb costs. While the data are mostly applicable to a private health care system (e.g. the US), the article, using a critical assessment of the existing literature, has implications for other EDs generally, wherever they operate, since every ED faces similar funding problems.
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This article provides an understanding and defence of 'best interests'. The analysis is performed in the context of, and is informed by, English law. ⋯ It is accepted that some commentators are cynical of best interests in practice. Following an assessment of some of their principal concerns, it is suggested that best interests in fact provides a construct that is both defensible and desirable.
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In this article I will show that 'best interests' is a concept that fits nicely with many of the features of pragmatism--Holm and Edgar's rejection of the principle in favour of pragmatism it will be suggested is misplaced. 'Best interests' as a principle may be considered an embodiment of the ideals of pragmatic adjudication. The paper starts by briefly introducing the concept of 'best interests' and theories of judicial and legal 'pragmatism'. This article will examine the role of the rational decision-maker in medical law and argue that this role is limited. The paper concludes by suggesting how we view the relationship between 'best interests' and 'pragmatism'.
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This paper is a response to a paper by John Coggon 'Best Interests, Public Interest, and the Power of the Medical Profession'. It argues that certain legal judgements in relation to best interests seek to change and curtail the role of the medical profession in this arena while simultaneously extending the jurisdiction of the courts. It also argues that we must guard against replacing one professional standard, that of the medical profession, with another, that of the judiciary in this area.
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Health care systems throughout the developed world face 'crises' of quality, financing and sustainability. These pressures have led governments to look for more efficient and equitable ways to allocate public resources. ⋯ Priority setting at the macro level has yet to demonstrate real successes. This paper describes international approaches to explicit prioritisation at the macro-governmental level in the six experiences most published in the English literature; analyzes the ways in which values, principles and other normative concepts were presented in these international priority setting experiences; and identifies key elements of a more robust framework for ethical analysis which could promote meaningful and effective health priority setting.