Healthcare choice: Discourses, perceptions, experiences and practices

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, primarily in the Global North. This special issue aims to explore how choice is perceived and utilised in the context of different systems of healthcare throughout the world, where choice, at least in policy and organisational terms, has been embedded for some time. The articles are divided into those emphasising: embodiment and the meaning of choice; social processes associated with choice; the uncertainties, risks and trust involved in making choices; and issues of access and inequality associated with enacting choice. These sociological studies reveal complexities not always captured in policy discourse and suggest that the commodification of healthcare is particularly problematic

Development of bookkeeping exercises to supplement the textbook in beginning bookkeeping classes.

Thesis (Ed.M.)--Boston Universit

Strict Liability and the Liberal Justice Theory of Torts

Ask a group of tort scholars to explain the relationship between fault and strict liability and the responses are likely to be sharply split. An economist might reply that strict liability—assigned on the basis of efficiency—should be the rule and fault, if it is to apply at all, but a reluctant and occasional exception. A moralist, however, would likely give the opposite opinion—that fault, defined as deontological culpability, should be the rule and strict liability the exception. Ironically, both economists and moralists often base their views on liberal principles. Economists rely on the political dimension of liberalism, arguing that government generally should not intervene in free market transactions, but if it must, it should do so only with clear tort rules that minimize accident costs. Not surprisingly, moralists rely on the moral dimension of liberalism, contending that tort law should promote private rights and freedoms by creating and enforcing personal responsibilities. Both views, however, share the same three flaws. Methodologically, they are one-dimensional in outlook (focusing on either the moral or the political, but not both) and unilateral in objective (seeking to either punish or deter injurers while virtually ignoring the injured). Substantively, they are strangely illiberal (promoting either social welfare or some particular conception of the Good). In this article, I offer a liberal justice tort theory that avoids these pitfalls. It is holistic, encompassing both sides of tort law’s dual personality; relational, invoking justice concepts that illuminate the bilateral aspects of all torts; and classic, adopting a longstanding and mainstream perspective that seeks only to protect and promote individual liberty. After recapturing and redefining strict liability, I demonstrate how that ancient concept can lay the groundwork for a new metatheory of torts. My thesis, in short, is that strict liability is both a moral-political and a substantive-procedural concept that must be implemented in a two-step process. The first step determines whether the parties’ encounter and its effects were consensual. If consent exists, the consenter is held strictly liable for her own loss, irrespective of the fault of her counterpart. If no consent is found, or if it is not an issue, liberal justice theory then implements a scheme of reasonableness, grounded in concepts of strict law and equity, to determine the actor’s liability. Strict law creates substantive rules that forbid, inhibit or sanction certain people, activities or relations that pose the greatest and surest threats to freedom and equality. However, even when a person, activity or relationship is not covered by a strict substantive rule, equity may episodically impose strict procedural requirements on actors who hold an unfair advantage in the trial of their actions. Because litigation itself is a threat to the freedom of the loser, the ad hoc adjustment of procedural burdens serves to correct an important imbalance between the parties and restores them to a state of moral and political equality

Registration and ranking of company charges in Zambia

Copyright @ School of Oriental and African Studies.This article discusses the effect of the registration requirements under the Zambian Companies Act on the rules for determining priority among company charges in Zambia. In light of the Supreme Court decision in Zambia National Commercial Bank Ltd v Mwila, the article also analyses the scope for applying common law rules on the ranking of charges, vis-à-vis section 101 of the Companies Act

Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture

Still elegantly muddling through? NICE and uncertainty in decision making about the rationing of expensive medicines in England

This article examines the “technological appraisals” carried out by the National Institute for Health and Care Excellence as it regulates the provision of expensive new drugs within the English National Health Service on cost-effectiveness grounds. Ostensibly this is a highly rational process by which the regulatory mechanisms absorb uncertainty, but in practice, decision making remains highly complex and uncertain. This article draws on ethnographic data—interviews with a range of stakeholders and decision makers (n = 41), observations of public and closed appraisal meetings, and documentary analysis—regarding the decision-making processes involving three pharmaceutical products. The study explores the various ways in which different forms of uncertainty are perceived and tackled within these Single Technology Appraisals. Difficulties of dealing with the various levels of uncertainty were manifest and often rendered straightforward decision making problematic. Uncertainties associated with epistemology, procedures, interpersonal relations, and technicality were particularly evident. The need to exercise discretion within a more formal institutional framework shaped a pragmatic combining of strategies tactics—explicit and informal, collective and individual—to navigate through the layers of complexity and uncertainty in making decisions

Routine use of a standardised assessment instrument for measuring the outcome of social care

This study had as its primary aim determining the extent to which standardised assessment can contribute to monitoring the outcomes of social care. It also addressed the comparison of resource use between individual clients, groups of clients with similar characteristics and between Social Service Departments (SSD's). An important part of the study was exploring the views of Social Workers and Care Managers on assessment in general and standardised assessment and the MDS-HC in particular. It has succeeded in achieving the majority of its goals and its findings have been incorporated into a revised MDS-HC assessment system including the development of a simplified screening assessment. It has also identified how attitudes to assessment, the manner in which assessment is done, and the organisation of assessment and on going management of services provided was significantly different between the two social service departments that took part in the study. Some of the issues identified are important for the development of policy on assessment in community care. It is likely that the findings are widely generalisable

The Health and Social Care Act for England 2012: The extension of ‘new professionalism’

The 2012 Health and Social Care Act, introduced by the coalition government, has been seen as fundamentally changing the form and content of publicly funded health care provision in England. The legislation was hugely controversial and widely criticized. Much of this criticism pointed to the ways in which the reforms undermined the funding of the National Health Service, and challenged the founding principle of free universal provision. In this commentary we take issue with the argument that the Act represented a radical break with the past and instead suggest that it was an extension of the previous Labour government’s neo-liberal reforms of the public sector. In particular, the Act invoked the principles of ‘new professionalism’ to undermine professional dominance, and attract private providers into statutory health care at the expense of public providers. In turn, this extension of new professionalism may encourage public distrust in the medical profession and absolve the state of much of its statutory health care obligation. </jats:p