The production of critical theories in Health Systems Research and Education. An epistemological approach to emancipating public research and education from private interests

2019

Int J Health Serv

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Just as with burnout in other social sectors, burnout among physicians is acquiring epidemic proportions. After describing the pathology, this article covers the multidisciplinary aspects of its clinical management. As for prevention, the article describes the importance of the socially motivated, professionally oriented management of health care services, courts, universities, and schools for preventing burnout and contrasts such features with the characteristics of their industrial and commercial management.

“…In the particular case of public universities, this privatization is functional but not statutory: it concerns the production of knowledge but not the property of the institution. 15…”

Section: Burnout and Political Economy Of Carementioning

confidence: 99%

Physicians’ Burnout (and That of Psychologists, Nurses, Magistrates, Researchers, and Professors) For a Control Program

2019

Int J Health Serv

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“…These health system, cultural, economic, and/or policy facilitators and obstacles can best be studied with repeated tests. Contextualisation ought also to be studied with interdisciplinary methods and be open to political scientists [ 38 ] – yet another sizeable challenge for academia [ 39 ].…”

Section: Formulating Strategies and Theories For Clinical And Public mentioning

confidence: 99%

Medical heuristics and action-research: professionalism versus science

Morales

Paepe

2020

BMC Health Serv Res

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Background Professional knowledge aims at improving practice. It reduces uncertainty in decision-making, improves effectiveness in action and relevance in evaluation, stimulates reflexivity, and subjects practice to ethical standards. Heuristics is an approach to problem-solving, learning, and discovery employing a practical methodology that, although not optimal, is sufficient for achieving immediate goals. This article identifies the desirable, heuristic particularities of research in professional, medical practice; and it identifies what distinguishes this research from scientific research. Main text We examine the limits of biomedical and sociological research to produce professional knowledge. Then, we derive the heuristic characteristics of professional research from a meta-analysis of two action-research projects aimed at securing access to essential generic drugs in Senegal and improving physicians’ self-assessment and healthcare coordination in Belgium. To study healthcare, biomedical sciences ignore how clinical decisions are implemented. Decisions are built into an articulated knowledge system, such as (clinical) epidemiology, where those studied are standardisable - while taking care of patients is an idiosyncratic, value-based, person-to-person process that largely eludes probabilistic methodologies. Social sciences also reach their limits here because descriptive, interpretative methods cannot help with gesture and speech quality, while the management of the patient’s suffering and risks makes each of them unique. Research into medical professionalism is normative as it is intended to formulate recommendations. Scientific data and descriptions are useful to the practitioner randomly, only from the similarities in the environment of the authors and their readers. Such recommendations can be conceived of as strategies, i.e., multi-resource and multi-stage action models to improve clinical and public health practice. Action learning and action-research are needed to design and implement these strategies, because their complexity implies trial and error. To validate a strategy, repeated experiences are needed. Its reproducibility assumes the description of the context. To participate in medical action-research, the investigator needs professional proficiency - a frequent difficulty in academic settings. Conclusion Some criteria to assess the relevance of publicly funded clinical and public health research can be derived from the difference between scientific and professional knowledge, i.e. the knowledge gained with real-life experience in the field.

“…The authors approached qualitative research in medical care and public health policies by making use of the concept of praxeology that Bourdieu developed and adapted to sociology in his “Outline of a Theory of Practice.” [ 7 ] They took this approach because both medicine and public health, like sociology research, are combinations of practice and theory [ 8 ]. They believed that the failure to connect them was a frequent weakness of contemporary medical and public health research.…”

Section: Main Textmentioning

confidence: 99%

Objectives, methods, and results in critical health systems and policy research: evaluating the healthcare market

Morales

Paepe

2020

BMC Health Serv Res

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Background Since the 1980s, markets have turned increasingly to intangible goods – healthcare, education, the arts, and justice. Over 40 years, the authors investigated healthcare commoditisation to produce policy knowledge relevant to patients, physicians, health professionals, and taxpayers. This paper revisits their objectives, methods, and results to enlighten healthcare policy design and research. Main text This paper meta-analyses the authors’ research that evaluated the markets impact on healthcare and professional culture and investigated how they influenced patients’ timely access to quality care and physicians’ working conditions. Based on these findings, they explored the political economic of healthcare. In low-income countries the analysed research showed that, through loans and cooperation, multilateral agencies restricted the function of public services to disease control, with subsequent catastrophic reductions in access to care, health de-medicalisation, increased avoidable mortality, and failure to attain the narrow MDGs in Africa. The pro-market reforms enacted in middle-income countries entailed the purchaser-provider split, privatisation of healthcare pre-financing, and government contracting of health finance management to private insurance companies. To establish the materiality of a cause-and-effect relationship, the authors compared the efficiency of Latin American national health systems according to whether or not they were pro-market and complied with international policy standards. While pro-market health economists acknowledge that no market can offer equitable access to healthcare without effective regulation and control, the authors showed that both regulation and control were severely constrained in Asia by governance and medical secrecy issues. In high-income countries they questioned the interest for population health of healthcare insurance companies, whilst comparing access to care and health expenditures in the European Union vs. the U.S., the Netherlands, and Switzerland. They demonstrated that commoditising healthcare increases mortality and suffering amenable to care considerably and carries professional, cultural, and ethical risks for doctors and health professionals. Pro-market policies systems cause health systems inefficiency, inequity in access to care and strain professionals’ ethics. Conclusion Policy research methodologies benefit from being inductive, as health services and systems evaluations, and population health studies are prerequisites to challenge official discourse and to explore the historical, economic, sociocultural, and political determinants of public policies.