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1 – 10 of over 74000Karen McKenzie, Edith Matheson, Donna Paxton, George Murray and Kerry McKaskie
This study used vignettes to examine the understanding and application of the concept of duty of care by health and social care staff working in learning disability services, and…
Abstract
This study used vignettes to examine the understanding and application of the concept of duty of care by health and social care staff working in learning disability services, and the relationship of this to promoting client choice. The study found that health care staff had a significantly broader understanding of the concept of duty of care than social care staff, and were significantly more likely to emphasise client safety. Implications of the findings are discussed.
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Douglas Amyx and Dennis N. Bristow
A 2 × 2 full factorial between subjects experimental design was used to examine how three elements of the health care experience (patients’ freedom to choose a physician; patients…
Abstract
A 2 × 2 full factorial between subjects experimental design was used to examine how three elements of the health care experience (patients’ freedom to choose a physician; patients receiving their preferred physician; health care outcome) impacted on patient satisfaction with health care service. All constructs with corresponding measurements were discussed, and their relationships with satisfaction were examined. Hypotheses were developed and tested for each relationship using a pencil and paper scenario of a patient’s first time service encounter at a health clinic. Results of the experiment indicated that given an undesirable health outcome, allowing patients a choice of physicians favorably raised patient satisfaction levels. Further, patients who were treated by a physician whom they preferred rated the health care experience more positively than did patients who received non‐preferred physicians.
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This paper has two purposes: one is to analyse how the policy of freedom of choice emerged and was formed in the Swedish health care discourse; the second is related to how free…
Abstract
Purpose
This paper has two purposes: one is to analyse how the policy of freedom of choice emerged and was formed in the Swedish health care discourse; the second is related to how free choice influences the discourse in health care and how subjects are formed within the field, i.e. what the language of choice in health care does.
Design/methodology/approach
The research strategy is inspired by a combined theoretical framework borrowed from Michel Foucault's concepts of “discursive formation” and “subjectivization” completed with Judith Butler's concept of performativity.
Findings
The language of “freedom of choice” calls to mind the rhetoric of promises, i.e. that the patient should be free and responsible, in his or her relation to health care. Since patients seem to be insufficiently informed and supported about the actual benefits of possibilities and limitations associated with the severely restricted reform of free choice, the statements concerning opportunities to make personal health decisions will lose their significance. The advocacy of discourses of freedom of choice seems therefore mostly like empty words, as they are producing weak patients instead of free and empowered people.
Research limitations/implications
As the reform was initiated in the beginning of 2000 it is rather fresh.
Originality/value
The paper produces insights into the rhetoric of political promises and the limitations of the reform dealing with freedom of choice in health care.
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Sarah Vallelly and Jill Manthorpe
In July 2007, Housing 21 began an exploration of how changes to the system of social care called personalisation might impact on specialist housing provision in England…
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In July 2007, Housing 21 began an exploration of how changes to the system of social care called personalisation might impact on specialist housing provision in England. Personalisation now forms the basis of English social care policy focusing the delivery of public services on what people might want or choose, in the context of eligibility criteria and means testing. It is designed to promote greater choice and control of the support that people receive.However, there have been concerns that the views of older people living in extra care housing settings have not been heard in the implementation of personalisation. In 2008‐09 Housing 21 engaged older people and other groups with an interest in sheltered and extra care housing to debate the implications of personalisation for current and future housing, care and support services. This article discusses what arose from this consultation and its relevance to housing providers and commissioners.
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Douglas Amyx, John C. Mowen and Robert Hamm
An experiment was conducted to examine the impact of patients’ freedom to choose a physician and health locus of control on patient satisfaction. The experiment was set within the…
Abstract
An experiment was conducted to examine the impact of patients’ freedom to choose a physician and health locus of control on patient satisfaction. The experiment was set within the scenario of a patient suffering from a lengthy viral infection after visiting a health clinic for the first time. All constructs with corresponding measurements are discussed and their relationships with satisfaction are examined. Hypotheses are developed and tested for each relationship using pencil and paper scenarios of a patient’s service encounter at a health clinic. A 2 × 2 full factorial between subjects experimental design was used with 99 subjects. Results of the experiment indicated different patterns of satisfaction among subjects based on measures of health locus of control (HLC). Individuals with an internal HLC were more satisfied with having a choice of a physician than not having a choice and were also more satisfied than external HLC individuals who had a choice. In contrast, individuals with an external HLC did not discriminate between having or not having the opportunity to choose a physician.
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Micol Bronzini and Benedetta Polini
Illness narratives provide a useful lens for analysing neoliberal citizenship at a micro level, from the point of view of patients, family caregivers and healthcare professionals…
Abstract
Illness narratives provide a useful lens for analysing neoliberal citizenship at a micro level, from the point of view of patients, family caregivers and healthcare professionals. Indeed, they reveal how people think about and act on their health and disease; they also tell us something about the social context in which illness is experienced, thereby illuminating dominant discourses.
According to Mol (2008), health and illness can be thought about and acted on according to two logics: the logic of choice and the logic of care. The logic of choice entails the neoliberal principle that people should be allowed to make their own autonomous choices. The logic of care implies an interpersonal process of co-responsibility over one’s health and illness.
Drawing on Mol’s work, the chapter presents a thematic content analysis of 20 illness narratives of patients with multiple sclerosis and their caregivers, questioning whether these two logics conflict with each other or whether they are intertwined.
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This paper describes major trends in the health care market. They include increased health care costs, the growth of managed care, emphasis on quality of care, consumer choice and…
Abstract
This paper describes major trends in the health care market. They include increased health care costs, the growth of managed care, emphasis on quality of care, consumer choice and the growth of the elderly and uninsured populations. The relationship between cost, quality, managed care and choice are explored in the Medicare and Medicaid programs. A clearer understanding of these trends enables managers in health care organizations to make strategic decisions resulting in organizations' survival and growth.
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– The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare.
Abstract
Purpose
The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare.
Design/methodology/approach
The paper uses a mixed-method research methodology to analyse two primary healthcare ADs in two Swedish regions. In total, 19 interviews were conducted with actors involved in the creation and use of such documents.
Findings
This paper points to the crucial role of ADs in the identification of quality differences that influence the competition in primary healthcare. This finding contrasts with the commonly held laissez-faire idea that competition causes providers to develop their own service concepts and where the invisible hand creates quality differences. The paper adds to the discussion with its detailed description of how ADs create competition among primary healthcare providers through selection processes, quality differentiation, and ranking.
Research limitations/implications
The paper does not explore quality differences in the medical treatment of patients in primary healthcare centres.
Practical implications
The paper provides insights for politicians on how to use ADs to control competition and regulate choice.
Originality/value
The paper takes an innovative approach to the examination of how ADs increase the competition in primary healthcare choice.
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This chapter addresses the grand challenge of an aging society and the subsequent growing demand for in-home care for the elderly – often referred to as homecare. It examines how…
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This chapter addresses the grand challenge of an aging society and the subsequent growing demand for in-home care for the elderly – often referred to as homecare. It examines how emergent homecare models in England differ from the “time and task” model and how they are shaping the care market. These models offer new approaches regarding what, how, and when care is delivered at home. Homecare providers face rising demand driven not only by population aging but also by market demand for personalized care, choice, continuity of care, and real-time availability. The landscape presents an opportunity for innovative models to become established, by offering a more inducing service design and value propositions that respond to customers' needs. Using the “business model canvas” to guide data collection, this study presents an ethnographic case analysis of four homecare organizations with distinct emergent homecare models. The study includes 14 months of field observation and 33 in-depth interviews. It finds that providers are becoming increasingly aware of evolving customer needs, establishing models such as the “uberization,” “community-based,” “live-in,” and “preventative” described in the chapter. These models are becoming more pervasive and are mostly market-driven; however, some of their innovations are market shaping. The major innovations are in their value propositions, partnership arrangements, and customer segments. Their value propositions focus on well-being outcomes, including choice and personalization for care users; their workforces are perceived to be a major stakeholder segment, and their networks of partners offer access to complementary services, investments, and specialist knowledge.
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Douglas Amyx, John C. Mowen and Robert Hamm
An experiment was conducted to examine the relationship between patient satisfaction and patients’ freedom to choose a physician and the outcome of a health service encounter…
Abstract
An experiment was conducted to examine the relationship between patient satisfaction and patients’ freedom to choose a physician and the outcome of a health service encounter. Each construct with corresponding measurements is discussed and their relationship with satisfaction is reviewed. Hypotheses were developed and tested for each relationship using pencil and paper scenarios of a patient’s service encounter at a health clinic. The study yielded four major findings. First, patients who experienced a good health outcome were significantly more satisfied than patients who received a bad health outcome. Second, patient satisfaction ratings differed significantly only in the bad outcome condition, suggesting an outcome bias. Third, patients who were given the freedom to select a physician but did not receive their chosen physician were least satisfied. Fourth, there was no difference in satisfaction between patients who had a choice of physician and those who did not.
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