TINJAUAN YURIDIS BAGI RUMAH SAKIT YANG MENOLAK PASIEN YANG TIDAK MAMPU

ABSTRACT            The state is an organization that has a purpose. In the context of the State of Indonesia, the purpose of the State is set out in the fourth paragraph of the Opening of the 1945 Constitution of the Republic of Indonesia which identifies the State of Indonesia as a State of law aimed at realizing public welfare. Every activity also must be oriented to the objectives to be achieved must also be based on the applicable law as a rule of state activities, government, and society. To achieve these national goals, a sustainable development effort is undertaken which is a series of comprehensive, directed, and integrated development, including health development.            In matters of public health, the government is obliged to ensure that its citizens are not sick and also obliged to fulfill the rights of their people to a healthy life and the implementation of conditions that determine people's health because health has become part of the lives of citizens, and to carry out the mandate the State must fulfill the health development principle as written in Article 2 of Law Number 36 the year 2009 concerning Health.            Poor health services will adversely affect the interests of the people who need medical services. Especially if the hospital does not provide proper services according to the procedures set out in the Criminal Code, which can cause patients to suffer losses that result in disability or death, then it is a criminal offense and can be criminalized according to Indonesian law.            Based on the background description of the problem above, the problems in this paper are: (1) How is the legal protection of poor patients as consumers of services in health services in hospitals? (2) What legal actions can be taken by incapacitated patients for the patient's rejection actions carried out by the hospital?             Based on the results of the study as stated above, the following conclusions can be drawn: (1) In an emergency, health care facilities, both government and private, are prohibited from rejecting patients and / or asking for advances. " besides, the act of refusing medical treatment is also a criminal act, so that it can be prosecuted criminally by following under Articles 304 and 531 of the Criminal Code. In the case of refusing hospital medical treatment, the hospital management responsible for violating the law, according to Article 190 paragraph (1) of Law Number 36 the Year 2009 concerning Health. (2) Civil legal action that can be taken by poor patients who are refused by the hospital in an emergency is by filing a breach of tort and unlawful actions. By rejecting poor patients in an emergency, the hospital has defaulted because it did not do what was agreed to do. In this case, the hospital does not do anything in the form of providing medical treatment to poor patients who are in an emergency of course require medical treatment as soon as possible. Provisions in Article 58 Paragraph (1) of the Health Law says that poor patients who are refused a hospital in an emergency can take legal action in the form of a civil claim by demanding compensation to the hospital that committed the refusal. Keywords: Patients, Services, Hospital

The Gloucestershire Extension of Medical Services Scheme: An Experiment in the Integration of Health Services in Britain before the NHS

One of the animating beliefs of British health service reformers in the first half of the twentieth century was that delivery would improve if greater co-ordination was imposed over disparate providers. The fundamental divisions were between the voluntary, public and private sectors. Voluntary provision predominantly meant acute care hospitals, but also included a range of other therapeutic and clinical services. The public sector delivered general practitioner (GP) services to insured workers through the state national health insurance (NHI) scheme, while the remit of local government covered environmental health, isolation and general hospitals and a wide range of personal services addressing tuberculosis, venereal diseases, mental illness, and maternity and child welfare. Finally, the private sector provided nursing homes and GP attendance at commercial rates. Within each area there were tendencies towards independent rather than co-operative working. Voluntary hospitals often lacked any mechanism for conferring with neighbouring institutions and the competitive logic of fund-raising enforced an individualistic ethic. In the public sector health responsibilities were dispersed across various agencies: local authority health committees, advised by the county or borough Medical Officer of Health (MOH), oversaw sanitation, hospitals and personal health services; education committees were responsible for the School Medical Service (SMS), whose remit was the compulsory medical inspection and treatment of elementary schoolchildren; the Poor Law provided institutional care either in workhouses or separate infirmaries, although after the 1929 Local Government Act the boards of guardians were broken up; their powers were then transferred to the public assistance committees of local authorities, however these remained distinct from health committees. GP services accessed through the state NHI system were overseen by local insurance committees separate from local government. Private practice co-existed with NHI and doctors tended to prioritize fee-paying rather than panel patients.</jats:p

The public-private interface of domiciliary medical care for the poor in Scotland, c. 1875-1911

This thesis explores domiciliary medical care for the poor in Scotland. Domiciliary care is understood as medical care provided in the home by qualified medical practitioners, or medical students. The poor are understood as those simply unable to ‘pay the doctor’ for the services they received. Focus is upon service provision, and therefore this thesis is a study of the different medical agencies engaged in the visitation of patients, and of the diverse ways medical practitioners as agents of different medical services facilitated or administered treatment. The period under focus is from 1875 to the National Health Insurance Act, 1911. Particular focus falls on urban Scotland, and Glasgow and Edinburgh. The interface between public and private provision is understood as the distinction between services provided for paupers, the legal poor, and services provided for the remainder, also unable to pay, and described as occupying ‘the boundary line between self-support and parish help’. Three types of service provider are identified: the poor law, medical charity, and medical missions. The thesis is divided into four main parts, buttressed by an introduction and conclusion. Chapter One sets the parameters to study of domiciliary medical care for the poor by identifying a literature of home visitation, and by identifying pressing issues concerning treatment in the homes of the poor of Glasgow and Edinburgh, like physical structure and family. Chapter Two is comprised of eight sections and looks at public provision in the form of the poor law medical services. Of particular interest are the local management, and the medical officers who provided the service. In turn focus is put upon the role of medical relief under the Poor Law (Scotland) Act, 1911; the structure of outdoor medical services in Glasgow and Edinburgh; the role of the local medical sub-committee of the parish board; and the parochial medical officers and their work. A prosopographical approach is taken to profile the parochial medical officers. Chapter Three, comprising five sections and conclusion, looks at private provision by medical charity. At issue is the range of charity dispensaries that provided outdoor services to the poor. A prospectus identifying the range of services is provided; outdoor medical services in Edinburgh and Glasgow are detailed; the interconnection between charity dispensary, domiciliary medical care, and medical educational requirements – particularly in Edinburgh – is investigated; and new developments occurring at the start of the twentieth century in health services requiring home visits are outlined. Chapter Four is comprised of nine main sections plus conclusion and looks at private provision by home medical missions. An overview of the literature of medical missions is provided, before focus falls, in turn, on medical missions in Edinburgh; medical missions in Glasgow; the medical work of medical missions; opportunities provided for women; how medical missions work was justified against criticisms; differences between providers; the response to provision from the Catholic immigrant community, and the work of the St Vincent de Paul Society

Ethico-legal inquiry into strike action by doctors in Kenya

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfillment for the degree of Master of Science in Medicine: Bioethics and Health Law Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa. January 2017Doctors serving in public health services in Kenya under the employment of the Government went on strike in December 2011 and September 2012. The strikes were national and doctors withdrew all their services including attending to emergencies in hospitals. The reasons for the strikes were poor salaries, poor working conditions and poor state of public health services. The aim of this research was to analyse legal and ethical aspects of the strikes by doctors in Kenya and to explore ways to minimize harm to patients and society. The research examined the circumstances and contexts of the strike to enable an understanding of the status of health services and the nature of the demands by doctors. Kenyan laws relating to strikes were analysed to ascertain legal compliance or violations during the strikes. Obligations of the medical profession and ethical codes and rules of conduct for doctors were discussed in relation to the strike. Ethical theories of deontology, consequentialism and virtue ethics were applied to establish moral justification or lack thereof. Analysis of the legal provisions of the Labour Relations Act No.14 of 2007 revealed that it did not provide adequate processes for resolving trade disputes involving workers and employers in essential services. Suggestions were made on some ways to improve the conciliation process to foster appropriate resolution of disputes before strike action becomes necessary. Examination of the reasons for the strikes and status of public health services revealed that there were compelling reasons and circumstances for the strike action by doctors. It was acknowledged that harm and benefits resulted from the strikes. Some grounds for moral justification of the strikes were discussed and found valid. However, comprehensive justification of the strikes was difficult, considering the professional and ethical obligations of doctors to society and to patients. In particular the withdrawal of emergency services made it difficult to find moral justification for the doctors‟ strikes. Failure to provide emergency services expunged any moral justification for strike action.MT201

The Law and Poor People’s Access to Health Care

Many companies today, in different fields of operations and sizes, have access to a vast amount of data which was not available only a couple of years ago. This situation gives rise to questions regarding how to organize and use the data in the best way possible. In this thesis a large database of pricing data for products within various market segments is analysed. The pricing data is from both external and internal sources and is therefore confidential. Because of the confidentiality, the labels from the database are in this thesis substituted with generic ones and the company is not referred to by name, but the analysis is carried out on the real data set. The data is from the beginning unstructured and difficult to overlook. Therefore, it is first classified. This is performed by feeding some manual training data into an algorithm which builds a decision tree. The decision tree is used to divide the rest of the products in the database into classes. Then, for each class, a multivariate time series model is built and each product’s future price within the class can be predicted. In order to interact with the classification and price prediction, a front end is also developed. The results show that the classification algorithm both is fast enough to operate in real time and performs well. The time series analysis shows that it is possible to use the information within each class to do predictions, and a simple vector autoregressive model used to perform it shows good predictive results

Allies Not Adversaries: Teaching Collaboration to the Next Generation of Doctors and Lawyers to Address Social Inequality

Recent reports from the Carnegie Foundation for the Advancement of Teaching, as well as from other medical and legal educators, stress that professional training of doctors and lawyers focuses too narrowly on knowledge-based learning, and not enough on context-based problem solving, professionalism, and ethics. Tracing recent calls from both legal and medical educators to increase the teaching of ethics, social responsibility, the lawyer-client and doctor-patient relationship, and holistic problem-solving, this article offers a model of interdisciplinary medical-legal education focused on developing practitioners sensitive to the needs of diverse and disenfranchised clients and patients. It highlights a burgeoning medical-legal partnership model, now in nearly eighty sites across the country, which partners lawyers and doctors to address the underlying social determinants of health for poor children and their families. The medical-legal partnership model, which increasingly includes medical school and law school partners, provides a unique opportunity to engage law and medical students in interdisciplinary problem-solving and ethical reflection, while also expanding their understanding of complex issues of social justice and inequality in our legal and health care systems. An interdisciplinary course offered by Brown Medical School and Roger Williams University School of Law is offered as a model

Securing Health or Just Health Care? The Effect of the Health Care System on the Health of America

The author first analyzes why the prevention of illness and promotion of health provide the leading justification for the government to act for the welfare of the population. His analysis focuses principally on the foundational importance of health for human happiness, the exercise of rights and privileges, and the formation of family and social relationships. He explains why health care, although critically important; is not the only, nor even the most important, determinant of health. Most morbidity and mortality in the United States is attributable to environmental conditions, pathogens, and human behavior, which are all more responsive to population-based interventions than to medical treatment. Secondly, the author explores the importance of universal access to health care in achieving the health of populations. The number of persons in the United States without health insurance or with inadequate insurance is extraordinarily high and increasing, and this fundamentally inadequate access to health care services results in unnecessary sickness and death among large sectors of the population. Universal access to health care is justified not only by greater vitality among the currently uninsured, but also by social and economic benefits for all of society. Third, he examines the importance of equitable access to health care. The distribution of health care services is highly inequitable, with persons in lower socio-economic classes and ethnic minorities receiving substantially inferior care. The author states that the inequity in the distribution of health care services not only lowers the quality of life among those receiving inferior services, but also renders them poorer and more dependent on society. Inequitable access to health care extends the already wide gap between rich and poor in the United States, with worrying social implications. Fourth, the author explores the applicability of market theory and competition to health care services, stating that market theorists have the burden of demonstrating why a theory developed for consumer goods and services generally is applicable to health services that are essential to human flourishing. This burden is particularly strong when the empirical evidence shows that increased cost and inaccessibility have occurred in spite, and perhaps because, of competition in health care