Ethics in contemporary health care management and medical education

Abstract

Rationale:The health care landscape is changing: it has become the largest part of the economy and changes in public management systems will greatly affect how we practice medicine in the future. Medical education will be more important than ever to ensure patients get the best care with empathy. However, new public management systems implemented without thorough analysis might challenge medical education. An increasing number of public health care institutions provide services based on competitive market rules and express their goals in financial terms and have set financial gains as their main goal, which contradicts the fundamental nature of medical ethics and practice. Aims and objectives: To explore new public management to identify potential problems and offer possible solutions for medical education and health care institutions. Methods: A scoping review of the literature on public administration, hospital management, professionalism, ethics, and medical education was undertaken to map evidence on the topic and identify main concepts and knowledge gaps in the influence of management systems on the quality of medical educational practices.Results: If the accelerating changes in public management are cursorily analysed, medical education may lose the esteem in which it has long been held globally. Without precautions, the so-called new public management medical faculties will-at best-generate economic benefit, following a business model with strict quality rules, regulations, standardized products, and complex analysis and measurement systems.However, these faculties will function at a level far below the ideal of teaching institutions distinguished for their outstanding components, creativity, and ambience.Conclusions: Patients and teaching values are not reducible to financial terms only and the acknowledgement of non-financial values is fundamental to achieve quality in health care and education. The most essential step could be selecting managers who will implement public management principles while taking into account both business requirements and medical ethics. K E Y W O R D S health policy, health care, medical education, medical ethics, philosophy of medicine Abbreviations: NPG, new public governance; NPM, new public management; PA, public administration.

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“…As Balak et al describe, there are many potential adverse outcomes of prioritizing financial imperatives over those related to professionalism. 1 First, the disconnect between institutional mission and professionalism may have unintended negative consequences on efforts to enhance diversity, equity, and inclusion. For example, a financially focused business model does not serve to bridge the gender wage gap that has been well-documented in the literature, even after adjusting for potentially confounding factors.…”

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We read with great interest the article entitled "Ethics in contemporary health care management and medical education" by Balak et al which discusses the ethical challenges associated with an increasing trend towards prioritization of fiduciary interests and their potential impact on patient outcomes and trainee education. 1 We agree that systems which are focused on productivity and profitability dilute the focus on the mission of medicine and its tenets of professionalism. At a minimum, institutions need to give equal consideration to professionalism and education priorities that are not fiscally driven.How does an institution formalize the adoption of professionalism values?

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