Health Care Analysis最新文献

{"title":"Navigating Patient-Initiated Non-Standard Care (PINSC) Requests: Applying an Ethically Coherent Framework for Shared Decision-Making.","authors":"Joshua T Landry","doi":"10.1007/s10728-026-00567-0","DOIUrl":"https://doi.org/10.1007/s10728-026-00567-0","url":null,"abstract":"<p><p>In current medical decision-making, prioritizing patient autonomy and shared decision-making has reshaped the ethical landscape. Medical decisions are no longer solely driven by a strong physician paternalism, where doctors are assumed to know best, but are increasingly characterized by a sharing of information, collaboration on decisions, and incorporation of patient values and preferences. While this shift promotes shared decision-making and patient-centered care, it has also given rise to additional ethically-complex challenges, including what will be referred to here as Patient-Initiated Non-Standard Care (PINSC) requests. PINSC requests emerge when patients or their surrogate decision-maker(s) seek interventions which fall outside accepted medical guidelines or evidence-based standards of care. This paper recounts various PINSC requests received at several hospitals in Ontario, Canada. Fundamental distinctions between PINSC requests and other cases of informed refusal are then established to highlight their novel ethical complexity, and I argue that this complexity gives rise to significant ethical and professional concerns that warrant increased attention. I then explore the reasons why clinicians often feel obligated to accede to PINSC requests, review the limitations of existing response strategies to addressing them, and propose that a model of shared decision-making called the Professionally-Driven Zone of Patient or Surrogate Discretion, or Professionally-Driven ZPSD, can be used as an ethically-defensible framework for navigating these cases. The Professionally-Driven ZPSD supports clinicians to develop a range of treatment options (\"the zone\") for decision makers to choose from that are ethically permissible, as they would fall between those treatments which cause unjustifiable harm, and those (or that) which would be in the patient's best interests to have if this can be defined.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advertising Ban in Healthcare: A Qualitative Study from the Perspective of Private Hospital Managers in Türkiye.","authors":"Tutku Ekiz Kavukoğlu, Gürkan Sert","doi":"10.1007/s10728-026-00564-3","DOIUrl":"10.1007/s10728-026-00564-3","url":null,"abstract":"<p><p>The use of advertising in healthcare is regulated strictly worldwide by ethical and legal regulations, yet its implications remain a matter of constant debate. This qualitative study examined the perceptions, approaches, and knowledge of private hospital managers in Istanbul concerning Türkiye’s healthcare advertising ban. In-depth interviews were used as the data collection method. Semi-structured, open-ended interviews were conducted with 12 managers working in private hospitals selected via purposive sampling. The participant group consisted of 4 general managers, 4 public relations managers, and 4 corporate communications and marketing manager. In terms of educational background, six participants held bachelor’s degrees, while the remaining six held postgraduate degrees. Data analysis was structured around an inductive thematic framework. As a result of the analysis, six main themes were identified: views on healthcare advertising bans; feelings about healthcare advertisements; views on healthcare advertising risks; willingness to advertise their own hospitals; knowledge of advertising regulations; comments on the distinction between promotion, information, and advertising. The findings indicated that most managers strongly support regulating healthcare advertising through legal frameworks. However, a major concern was identified as the uncontrolled rise of social media advertising and ethical breaches. Managers stressed that this trend complicates the distinction between advertising, promotion, and informational activities, thereby hindering patients’ access to accurate information. They emphasized that all hospital communication must strictly remain within ethical promotion and informational boundaries. Overall, the study highlights the critical importance of providers safeguarding patients’ right to accurate, unbiased information while avoiding misleading content. The findings offer valuable implications for policymakers to establish a more ethical and transparent healthcare communication environment.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral Challenges and Responsibilities in Caring for Relatives of Older Nursing Home Residents During the COVID-19 Pandemic in Sweden.","authors":"Pier Jaarsma, My Eklund Saksberg, Therése Bielsten, Suzanne Cahill, Tiny Jaarsma, Petra Gelhaus","doi":"10.1007/s10728-025-00551-0","DOIUrl":"10.1007/s10728-025-00551-0","url":null,"abstract":"<p><p>Caring for relatives of older nursing home residents during COVID-19 was sometimes morally challenging for nursing home nurses. We identified four moral challenges: (1) providing versus withholding information, (2) respecting relatives' wishes versus acting in accordance with professional standards, (3) acting in accordance with versus contrary to advance care plans, and (4) heeding versus ignoring visiting prohibitions. Care ethicist Margaret Urban Walker's framework of moral responsibility together with values listed in the ICN code of ethics for nurses were used as points of departure for reflection on these moral challenges. Each challenge was described, and moral responsibilities were charted and discussed in terms of moral relationships between nursing home nurses and the relatives of older residents, nurses' moral identity as a nurse, and nursing's moral values as listed in the ICN code of ethics for nurses. Nursing home nurses' moral responsibilities could be connected to many moral values of the nursing profession, such as empathy, responsiveness, caring, advocacy, equality, inclusivity, and compassion. However, these values have a limited effect on direct moral action, as different values can be addressed for opposite action alternatives.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"13-27"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12920279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The High Cost of American Health Care: Understanding the Deeper Roots of the Crisis.","authors":"Cyril F Chang, David M Mirvis, Asos Mahmood","doi":"10.1007/s10728-025-00554-x","DOIUrl":"10.1007/s10728-025-00554-x","url":null,"abstract":"<p><p>The recent tragic death of UnitedHealthcare CEO Brian Thompson has renewed public scrutiny of the US health care system and reignited debate over why Americans face disproportionately high health care costs. This essay examines both the widely recognized drivers of excessive costs and the deeper systemic issues that often remain unaddressed yet continue to sustain the crisis. It highlights two critical challenges: the need to target structural barriers and misaligned economic incentives in order to design sustainable reforms, and the persistent political polarization that impedes long-term, meaningful change. The paper concludes by outlining short-term strategies that can generate immediate improvements while laying the foundation for comprehensive and enduring reform.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"1-12"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12920308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming public mental health: a review on global trends, challenges, and pathways to change.","authors":"Olalekan John Okesanya, Tolutope Adebimpe Oso, Uthman Okikiola Adebayo, Jeremiah Ayobami Obadofin, Ridhwan Opeyemi Abdulghaniy, Adebowale Alao Bamigbade, Jerico Bautista Ogaya, Ifeanyi Ngwoke, Mohamed Mustaf Ahmed, Jomar L Aban","doi":"10.1007/s10728-025-00549-8","DOIUrl":"10.1007/s10728-025-00549-8","url":null,"abstract":"<p><p>This review synthesizes global trends, persistent challenges, and actionable pathways for overhauling public mental health systems, with a particular focus on low- and middle-income countries (LMICs). Thematic analysis of our review revealed that mental health disorders now affect nearly one in eight people worldwide, yet up to 75% of those in LMICs receive no treatment due to stigma, underfunding, workforce shortages, and fragmented systems, perpetuating a widening \"treatment and care gap.\" Social inequities, harmful cultural norms, conflict, climate change, and gender disparities further amplify the risk and economic burden, projected to exceed US$6 trillion by 2030. Innovative financing approaches, including public-private partnerships and models from countries such as Norway and Australia, offer promising strategies for sustainable investments. The COVID-19 pandemic intensified mental health challenges but also raised global awareness, with leaders such as the United Nations Secretary-General and the United States Surgeon General foregrounding mental health crises in the public consciousness. Advocacy initiatives, including the FundaMentalSDG campaign, Lancet Commissions, Global Mental Health Action Network, and Global Mental Health Peer Network, have been pivotal in elevating mental health within the Sustainable Development Goals (SDGs) and linking it to social determinants. Emerging solutions include rights-based frameworks that emphasize participation and anti-discrimination, scaling up task-sharing and expanded roles for non-specialists through programs such as the World Health Organization's Mental Health Gap Action Programme, community-based interventions like Zimbabwe's Friendship Bench, and integration of mental health into primary care with dedicated counsellors, structured referral pathways, and digital innovations promising improved access and personalization. Sustained progress requires intersectoral collaboration across health, education, labor, and social sectors; embedding mental health into national health information systems; and investing in culturally adapted promotion and prevention interventions throughout the life course. Strengthening political commitment, global-local leadership, financing frameworks, and workforce capacity, particularly through continuous professional development and lived-experience participation, will accelerate progress toward the SDGs, underscoring the imperative for equitable financing and sustained political will globally.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"57-85"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tariff Conflicts and Entrenched Interests: The Deepening Deadlock of US Healthcare Reform.","authors":"Miao Wang","doi":"10.1007/s10728-025-00542-1","DOIUrl":"10.1007/s10728-025-00542-1","url":null,"abstract":"<p><p>The US healthcare system is characterized by a persistent deadlock, where high costs, low efficiency, and inequity resist fundamental reform. This stalemate is rooted in deep ideological divides, political polarization, a fragmented fiscal structure, and the power of entrenched interest groups. This article analyzes how recent trade protectionist policies, specifically tariffs on pharmaceuticals and their inputs, intersect with this domestic gridlock. It posits a central paradox: a political system incapable of enacting major domestic health reform can simultaneously deploy assertive trade interventions in the same sector. The article argues that these tariffs should not be misconstrued as flawed instruments of healthcare reform. Instead, they represent the application of a distinct sovereigntist and protectionist logic, driven by national security concerns. The consequence is not a failed attempt at a solution, but a collision of policy agendas that actively exacerbates the healthcare system's core dysfunctions. By increasing costs, destabilizing supply chains, and creating new arenas for interest group conflict, tariffs intensify partisan strife and further entrench the reform deadlock. This process, marked by the \"securitization\" of the pharmaceutical industry, signals a critical shift in global health governance, where geopolitical strategy now overrides and complicates the pursuit of domestic public health goals.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"28-42"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meaning, Fulfillment, and the Work of Healthcare.","authors":"Begoña Errasti-Ibarrondo, Gillian Lemermeyer, Michael van Manen","doi":"10.1007/s10728-025-00547-w","DOIUrl":"10.1007/s10728-025-00547-w","url":null,"abstract":"<p><p>Experiencing meaning and fulfillment in healthcare work is recognized as important for those in nursing, medicine, respiratory therapy, social work, and other health disciplines. Critically, moral distress, compassion fatigue, staff burnout, and individual health have all been linked as related phenomena when such experiences are compromised. And yet, we may question whether we truly understand the meaning of meaningfulness and fulfillment. What calls health providers to come to work, again and again, despite the complex and difficult situations that they have to deal with? What are sources of meaning and fulfillment? How do we understand these phenomena? The context of newborn intensive care deserves special consideration as healthcare providers manage clinical acuity, respond to infant illness, support stressed families, navigate ethical decision-making, and work through complex team dynamics. In this paper, we explore and reflect on anecdotes of meaning and fulfillment as described by healthcare providers to explicate these phenomena.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"43-56"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity as a Criterion for Prioritizing Diagnostic Measures.","authors":"Erik Gustavsson, Niklas Juth","doi":"10.1007/s10728-026-00561-6","DOIUrl":"10.1007/s10728-026-00561-6","url":null,"abstract":"<p><p>The extent to which a condition is severe constitutes an important part of several approaches to healthcare priority setting. For example, the Netherlands, Norway, Sweden, and the UK are all countries with explicit criteria for priority setting that apply severity as one of their considerations. However, these criteria are mainly applied to treatments rather than diagnostic measures. When the criterion of severity is applied to treatments, it is often applied as follows: the more severe the condition targeted by a treatment, the higher the cost that can be accepted per health improvement. However, applying this approach to diagnostic measures gives rise to at least three challenges. First, the issue of heterogeneity, while treatments may often be indicated for a specific patient population, diagnostic measures often target larger segments of patients. Second, the issue of secondary findings, the fact that diagnostic measures may generate secondary findings. Third, the issue of (non)-treatability, the fact that there are conditions for which there are diagnostic measures but not (yet) any treatment options. The aim of this paper is to explore these challenges. This exploration involves making sense of them from a decision-making perspective which, in turn, reveals a number of characteristic features about the notion of severity.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responsive Equanimity to Uncertainty: Towards the Construction of a Concept for Handling Medical Uncertainty in Clinical Practice.","authors":"Bjørn Hofmann","doi":"10.1007/s10728-026-00562-5","DOIUrl":"https://doi.org/10.1007/s10728-026-00562-5","url":null,"abstract":"<p><p>The objective of this study is to elaborate an overall concept of addressing uncertainty in clinical practice that covers a series of specific characteristics. To do so, a conceptual engineering approach has been applied, starting with describing the concepts that exist and are in use. Based on this description the functional quality of these concepts (representational devices) is evaluated and a series of criteria for an improved concept is developed. Four alternatives, each with special merits, are presented, suitable for different context, i.e., bearing the burdens of uncertainty, mindful adaptability, compassionate resilience, and responsive equanimity. Among these, responsive equanimity emerges as the most robust generic concept, meeting the majority of criteria at a general level. These results are open for debate and revision before implementation and evaluation.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 Pandemic on Subjective Well-Being and Quality of Life: A Comprehensive Bibliometric and Thematic Analysis.","authors":"Alper Aytekin, Rukiye Ayaz, Ahmet Ayaz","doi":"10.1007/s10728-024-00507-w","DOIUrl":"10.1007/s10728-024-00507-w","url":null,"abstract":"<p><p>This study employs bibliometric and thematic analysis to evaluate the growing body of research on subjective well-being and quality of life during the COVID-19 pandemic. The findings underscore the pandemic's profound impacts on global health, evidenced by a notable increase in studies addressing mental health and quality of life, fostered by international scientific collaboration. Keyword analysis reveals critical themes, including the pandemic's influence on mental health, physical activity, and social support systems. This research provides valuable insights into the long-term consequences of the pandemic and highlights adaptive strategies for managing future crises. By identifying key trends and research gaps, the study serves as an essential resource for academics, policymakers, and public health practitioners, offering a roadmap for future investigations.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"446-478"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}