The implementation of European Union (EU) rules on cross-border care: moving towards convergence?

This article studies the implementation of the European Union (EU)'s Patients' Rights Directive in Germany and Norway. The objective of the Directive was to allow EU member states to have a say in the regulatory work, ensure predictability and uniformity in the application of EU rules on cross-border care, and enhance a move towards EU harmonisation in this area. So far, the implementation processes in Norway and Germany have mixed results regarding the likelihood of achieving uniformity and harmonisation. Although the Directive has had convergent effects on certain areas of cross-border care, such as setting up National Contact Points and providing patients with the basic right to treatment abroad, implementation also shows divergent patterns. In both countries, adapting to EU rules has strengthened patients' rights to choose freely among health-service providers in a wider European health-service market. However, due to legal discretion and country-specific institutions within which the new rules are applied, divergent patterns prevail.

Awareness and Observance Rate of the Patients' Rights Charter in General Hospitals; The Perspectives of Iranian Patients.

One of the most important indicators for assessing the quality of healthcare is the evaluation of patients' rights status and the interaction between patients and the healthcare providers. The patient rights charter improves communication between patients and service providers and enhances the quality of healthcare. This is a descriptive-analytic study that was performed on 500 patients referred to 25 general hospitals supervised by Tehran University of Medical Sciences. In this study, the observance rate of the patient rights charter was considered and the patient rights charter in the samples were studied based on dependency type of hospitals. The patients' opinions showed that the observance rate of the patient rights charter in the hospitals was 60.7%. Observance rate of patients' rights charter according to the dependency type of hospitals (governmental - private - public - charity) in all clauses of the patient rights charter was statistically significant (p = 0.000). The findings of this study indicate that the majority of clauses in the patients' rights charter is observed in hospitals. In the field of observing of the patient rights charter, increasing patient's awareness about their rights is a priority. And in the next step, comprehensive and assured laws are needed to observe patients' rights in healthcare centers.

Construction of patients' position in Norway's Patients' Rights Act.

BACKGROUND: Since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948, human rights as set out in government documents have gradually changed, with more and more power being transferred to individual. OBJECTIVES: The aim of this article is to analyze how the position of the patient in need of care is constructed in Norway's renamed and revised Patients' and Service Users' Rights Act (originally Patients' Rights Act, 1999) and published comments which accompanying this legislation from the Norwegian Ministry of Health and Care Service. RESEARCH DESIGN: A constructivist design was used, and Fairclough's critical discourse approach was adopted to analyze the text of the Patients' and Service Users' Rights Act and comments. FINDINGS: The analysis identified three discourses: (a) political discourse, containing ethical discourses about priority and economy, in which patients are constructed as powerless individuals; (b) expert discourse, containing a theme about patients' trust in the healthcare team and its knowledge, in which patients are constructed as helpless individuals lacking knowledge; and (c) patient participation and patient autonomy discourse, containing ethical discourses about decision-making, in which patients are constructed not only as individuals with needs and rights but also as "troublesome." CONCLUSION: Dominant paternalistic discourses in the legal text validate the power of medicine, the healthcare system, and heath personnel over the needs, rights, participation, and autonomy of the patient.

Health care reform in Iran: Implications for nurses' moral distress, patient rights, satisfaction and turnover intention.

AIM: The aim of the present study was to assess the implications of Iran's recent health care reforms on nurses' experience of moral distress, their perceptions of the respect for patient rights and the relationship of these variables to job and income dissatisfaction and turnover intention. BACKGROUND: Health systems around the world are reforming themselves to adapt to meeting the future needs of increasing patient care to an ever-growing population. METHODS: This was a cross-sectional correlational study. The participants were 276 nurses at six large private and public hospitals in Tehran, Iran. FINDINGS: Negative correlations were reported between turnover intention and respecting patient rights (r = -0.560, p < 0.001), satisfaction with job (r = -0.710, p < 0.001) and satisfaction with income (r = -0.226, p < 0.001). The correlation between moral distress intensity (r = 0.626, p < 0.001) and frequency (r = 0.701, p < 0.001) was positive with turnover intention. CONCLUSIONS: Moral distress was significantly correlated to poor respect for patient rights, poor job satisfaction and income satisfaction and was a major predictor of turnover intention. IMPLICATIONS FOR NURSING MANAGEMENT: Health system reform must take into account the concomitant increasing workload and its negative impact in order to ensure that reform does not lead to unintentional detrimental outcomes of increased moral distress, decreased satisfaction and increased turnover rates among nursing personnel.

Protecting Rights of Children With Medical Complexity in an Era of Spending Reduction.

Children with medical complexity (CMC) often require multiple services across the continuum of care, such as therapies and home nursing. However, sufficient access to needed services is not assured and varies considerably by payer, many of whom who face pressures to control health spending. In this article, we review the rights of CMC in Medicaid, the Children's Health Insurance Program, and various forms of private health insurance to receive services that are necessary to promote optimal health, development, and family functioning. Controlling laws such as the Americans with Disabilities Act and the Early and Periodic Screening, Diagnostic, and Treatment provisions of the Medicaid Act are discussed, and precedential court decisions affecting CMC are reviewed. Implications for policy, advocacy, and payment model design are explored in the context of current emphasis on spending reduction.

[Patients' rights]. / I diritti del malato.

Forty years have passed since the publication of the "Patients' Rights Charter" (included in a separate section at the end of the work: "Patients' rights: a critical guide to understanding and usage of civil hospital facilities"), but it still remains remarkably topical. We here provide an analysis of the original Charter (1975) taking into consideration the changes that have occurred in sensitivity to gender, cultural as well as socioeconomic differences, the right to body privacy and to continuity of care, the key role of general practitioners, the reciprocal relations in the information and decision-making processes with shared diagnostic and therapeutic pathways and active patient participation, which mandates that adequate education in communication and care strategies be provided to all caregivers.

Financing health care in Tunisia. Current state of health care expenditure and socialization prospects, on the road to Universal Health Coverage.

CONTEXT: As part of its strategy of Universal Health Coverage (UHC), Tunisia has calculated, after its revolution, its Health Accounts (HA), in a standardized and interdepartmental way. OBJECTIVES: Describe the current structure of care financing in Tunisia, through the HA reports, from 2012 to 2014, and assess its compliance with the principles of socialization of health insurance. METHODS: Crude data on health care expenditures were collected by a multi-departmental group that is responsible for calculating health accounts, using a methodology developed by WHO. On the basis of these data, a dozen of indicators that serve to monitor the financing of care, were determined, especially the proportion of public care expenditure (state and insurance), the proportion of direct payments of households in total care expenditure. and the share of expenses of the National Diseases Insurance Fund (CNAM) in the private sector. RESULTS: During the 2012-2014 trienniums, the total health expenditure represented 7% of GDP. Public expenditure on health care did not exceed 57% of the total health expenditure, which is 4% of GDP. Households paid directly, from their pockets, 39% of current care expenditures. About half of the expenses of the CNAM, was released for the reimbursement of consultations, explorations and hospitalizations in private clinics and medical needs (drugs and medical material) in private pharmacies. CONCLUSION: The financing of the post-revolution care system in Tunisia was characterized by a dangerous triad for its survival, performance and equity: excessive spending compared to the country's growth, a very high contribution of households exceeding the cutoff of "catastrophic" spending, and a marked shift in the social policy of the CNAM, in favor of the private sector. This profile, proof of low socialization of healthcare financing, would be a limiting factor in the implementation of the CSU strategy in Tunisia.

La Persona es un fin, no un medio. ¿Estamos mercantlizando al paciente? / The Person is an end, not a means. Are we marketing the patient?

Realiza una reflexión sobre la práctica de la ética médica en la actualidad, en la cual se están perdiendo los valores y se está mercantilizando la salud de la persona...

The changing purpose of mental health law: From medicalism to legalism to new legalism.

The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally.

Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country.

BACKGROUND: Patient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients' expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is currently undergoing this particular process. METHODS: Qualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final (6(th)) year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods. RESULTS AND DISCUSSION: Patient autonomy is much more than a simple notion defined as the patient's right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies. CONCLUSIONS: Knowing how to respect the various facets of patients' autonomy should be part of physician's professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia.

Crafting citizen(ship) for people with dementia: How policy narratives at national level in Sweden informed politics of time from 1975 to 2013.

This article explores how policy narratives in national policy documents in Sweden inform associated politics on people with dementia. This is disentangled in terms of how people with dementia have been defined, what the problems and their imminent solutions have been, and if and how these have differed over time. Based on a textual analysis of policy documents at national level in Sweden, covering nearly 40 years the study shows how divergent policy narratives shape the construction of citizens with dementia as policy target groups. This study shows the temporal character of people with dementia as a political problem, the implications of policy narratives on people with dementia as a citizen group, and policy narratives as something being crafted rather than shaped by fixed pre-existing "facts". Dementia, and further citizens living with dementia, does not have a once and for all stabilised meaning. Instead, the meanings behind the categories continue to evolve and to be crafted, which affects the construction of citizens living with dementia, the space in which to exercise their citizenship and further belonging to the society.

Global mental health and neuroethics.

BACKGROUND: Global mental health is a relatively new field that has focused on disparities in mental health services across different settings, and on innovative ways to provide feasible, acceptable, and effective services in poorly-resourced settings. Neuroethics, too, is a relatively new field, lying at the intersection of bioethics and neuroscience; it has studied the implications of neuroscientific findings for age-old questions in philosophy, as well as questions about the ethics of novel neuroscientific methods and interventions. DISCUSSION: In this essay, we address a number of issues that lie at the intersection of these two fields: an emphasis on a naturalist and empirical position, a concern with both disease and wellness, the importance of human rights in neuropsychiatric care, and the value of social inclusion and patient empowerment. SUMMARY: These different disciplines share a number of perspectives, and future dialogue between the two should be encouraged.

[The definition of a failure to render assistance to the patient in the forensic medical practice].

The authors consider the necessity of determining the severity of harm inflicted to human health by the inaction of the officials and other persons responsible for rendering assistance to a patient in accordance with article 124 of the Criminal Code of the Russian Federation. The absence of the normative formulation of the forensic medical criteria for the assessment of the degree of the harm to human health as a result of inaction of the subjects responsible for rendering medical aid creates difficulties for the enforcement of article 124 of the Criminal Code of the Russian Federation in its present wording. This problem awaits further studies for the possible adoption of the uniform normative and regulatory documents for the consistent application of the definition of inaction with reference to the assessment of not rendering medical assistance.

[Evolution of patients' rights at the end of life]. / Évolution des droits de patients en fin de vie.

Since the early 1999, palliative cares were legally allowed in France. The rights of end of life'patients have been reinforced by the Kouchner law in 2002 and by the Leonetti law in 2005. During the last decade, several critical conditions of end of life showed the weaknesses of the Leonetti law however different assessments of this law recently carried out by officials, revealed that healthcare providers and general population were unfamiliar with this law. Before adopting new legislation, there is a huge need to promote palliative care and to train healthcare providers and general population to manage the last moments of end of life.

Leading the way towards universal health coverage: a call to action.

Policy innovations and lessons associated with the quest for universal health coverage in Latin America are the result of a complex epidemiological transition, an extended process of democratisation, and high economic growth in recent times that has facilitated additional investments in health. The goal of universal health coverage is part of a third generation of health-system reforms, which implies a comprehensive scope of policy interventions, including the introduction of explicit ethical frameworks, the enhanced attention to financial arrangements, and the transformation of major dimensions of the organisation of health systems. The call for action emphasises the next steps that could help reach the goal of universal health coverage both in the Latin American region and the rest of the developing world.