Marketisation, Ethics and Healthcare: Policy, Practice and Moral Formation (Routledge Key Themes in Health and Society)

How does the market affect and redefine healthcare? The marketisation of Western healthcare systems has now proceeded well into its fourth decade. But the nature and meaning of the phenomenon has become increasingly opaque amidst changing discourses, policies and institutional structures. Moreover, ethics has become focussed on dealing with individual, clinical decisions and neglectful of the political economy which shapes healthcare. This interdisciplinary volume approaches marketisation by exploring the debates underlying the contemporary situation and by introducing reconstructive and reparative discourses. The first part explores contrary interpretations of 'marketisation' on a systemic level, with a view to organisational-ethical formation and the role of healthcare ethics. The second part presents the marketisation of healthcare at the level of policy-making, discusses the ethical ramifications of specific marketisation measures and considers the possibility of reconciling market forces with a covenantal understanding of healthcare. The final part examines healthcare workers' and ethicists' personal moral standing in a marketised healthcare system, with a view to preserving and enriching virtue, empathy and compassion. Chapter 4 of this book is freely available as a downloadable Open Access PDF under a Creative Commons Attribution-Non Commercial-No Derivatives 3.0 license. https: //s3-us-west-(http://2.amazonaws.com/tandfbis/rt-files/docs/Open+Access+Chapters/9781138735736_oachapter4.pdf) 2.amazonaws.com/tandfbis/rt-files/doc... Chapter 7 of this book is freely available as a downloadable Open Access PDF under a Creative Commons Attribution-Non Commercial-No Derivatives 3.0 license. https: //s3-us-west-(http://2.amazonaws.com/tandfbis/rt-files/docs/Open+Access+Chapters/9781138735736_oachapter7.pdf) 2.amazonaws.com/tandfbis/rt-files/doc... How does the market affect and redefine healthcare? The marketisation of Western healthcare systems has now proceeded well into its fourth decade. But the nature and meaning of the phenomenon has become increasingly opaque amidst changing discourses, policies and institutional structures. Moreover, ethics has become focussed on dealing with individual, clinical decisions and neglectful of the political economy which shapes healthcare.This interdisciplinary volume approaches marketisation by exploring the debates underlying the contemporary situation and by introducing reconstructive and reparative discourses. The first part explores contrary interpretations of ‘marketisation'on a systemic level, with a view to organisational-ethical formation and the role of healthcare ethics. The second part presents the marketisation of healthcare at the level of policy-making, discusses the ethical ramifications of specific marketisation measures and considers the possibility of reconciling market forces with a covenantal understanding of healthcare. The final part examines healthcare workers'and ethicists'personal moral standing in a marketised healthcare system, with a view to preserving and enriching virtue, empathy and compassion.Chapters 4 and 7 of this book are freely available as downloadable Open Access PDFs at http://www.taylorfrancis.com under a Creative Commons Attribution-Non Commercial-No Derivatives (CC-BY-NC-ND) 4.0 license. Cover 1 Title 6 Copyright 7 Contents 10 Acknowledgements 12 Contributors 13 Foreword 17 Introduction 18 PART I The place of the market 28 1 Why the economic calculation debate matters: the case for decentralisation in healthcare 30 2 The corruption of medical morality under advanced capitalism 49 3 Organisational ethics: a solution to the challenges of markets in healthcare? 66 PART II The influence of the market 82 4 Encoding truths? Diagnosis-Related Groups and the fragility of the marketisation discourse 84 5 Personal budgets: holding onto the purse strings for fear of something worse 101 6 “More than my job is worth” – defensive medicine and the marketisation of healthcare 116 7 Covenant, compassion and marketisation in healthcare: the mastery of Mammon and the service of grace 128 PART III The place of ethics 148 8 Commercialisation and the corrosion of the ideals of medical professionals 150 9 The virtuous professional and the marketplace 164 10 Empathy in healthcare: the limits and scope of empathy in public and private systems 180 11 Accounting for ethics: is there a market for morals in healthcare? 191 What next? Editors’ epilogue 211 Index 216 This chapter will take as an example a particular change in healthcare financing at the meso-level: Diagnosis-Related Groups. DRGs marked a shift in the way hospitals were oriented and were the means to operationalise the market-logic in healthcare. The DRG system is a case classification system: each hospital case is related to a 'pre-standardised product' of treatment. Depending on how a patient's case is encoded, the hospital is reimbursed for the services provided. In this way, hospital care can be matched with pre-calculated resources. Case volumes can be predetermined according to the profit needs of a hospital and an economy's 'healthcare sector' as a whole. Developed in the early 1980s by Robert B. Fetter and John D. Thompson, a management and a public health scholar at Yale, DRGs were first introduced in New Jersey, and have become the key accounting system throughout Western and increasingly LMI countries' healthcare systems. (Mathauer and Wittenbecher 2013) Here I will particularly draw on examples from Germany, Switzerland and Scandinavia, but also to the NHS in England ?No one can serve two masters ... You cannot serve God and Mammon.? Jesus? famous words, cited to different purposes by Miran Epstein and Adrian Walsh inthis volume, provide a starting point for this chapter?s constructive argument andcritical conversation with the chapters in this middle part. Epstein deploys Jesus?words to deny the possibility of any constructive reconciliation between capitalismand healthcare, contrasting Jesus? saying with the infamous words of Christian conquistadoresand with what he claims is the inherently corrupting, master-slave ethicof the Deuteronomic covenant. By contrast, Walsh cites Jesus to explain Judeo-Christian cultural suspicions about money?s place in healthcare before delineatingthe potentially, though not necessarily, corrosive effects of marketisation