Solidarity In Healthcare Research Articles

Data Solidarity Disrupted: Musings On the Overlooked Role of Mutual Aid in Data-Driven Medicine.

Several suggestions have been made to embolden and reorient the concept of solidarity given the emergence of data-driven medicine. Recently, the European Union introduced a new consent model for so-called data altruism to motivate people to make their data available for purposes such as scientific research or improving public services. Others have introduced the alternative concept of data solidarily, which assumes that people's interests in data sharing result from a collective commitment to assist others. What those perspectives have in common is a focus on top-down organizational structures to deal with data-driven medicine. In this article, I offer an alternative reading of data solidarity, drawing on anarchist theory that highlights the disposition of mutual aid as a broader characteristic of solidarity. I begin by briefly indicating how the existing approaches to data solidarity in healthcare remain legalistic and state-centered without thoroughly considering socially critical notions of solidarity that highlight the impact of structural injustices. I then sketch out how an anarchist understanding of mutual aid could inform the conceptualization of solidarity. Finally, I focus on two implications for the practice of data-driven medicine: (1) current proposals of data altruism seem to engender a form of reversed charity; and (2) data solidarity practices could arise from the bottom-up through spontaneous order and direct action.

Two Conceptions of Solidarity in Health Care

In this paper, I distinguish two conceptions of solidarity, which I call solidarity as beneficence and solidarity as mutual advantage. I argue that only the latter is capable of providing a complete foundation for national universal health care programs. On the mutual advantage account, the rationale for universal insurance is parallel to the rationale for a labor union’s “closed shop” policy. In both cases, mandatory participation is necessary in order to stop individuals free-riding on an ongoing system of mutually advantageous cooperation.

Social context matters: the role of social support and social norms in healthcare solidarity

Abstract Background In many European countries, including the Netherlands, the healthcare system is based upon solidarity. It is important that public support for solidarity-based systems is sufficient, to ensure that people remain willing to contribute to them. Although support is generally high, as indicated by high levels of willingness to pay for the healthcare costs of others, there are differences between groups. Previous research has focused on individual and institutional characteristics when explaining these differences. However, people's social context may also play a role. Little research has been conducted into this. To fill this gap, we examined the role of perceived social support and social norms in order to explain differences in the willingness to pay for other people's healthcare costs. Methods A questionnaire was sent to a representative sample of 1,500 members of the Dutch Healthcare Consumer Panel in November 2021 (56% response rate, N = 837). The relationship between the social context of people and their willingness to pay was studied via logistic regression analysis. Results Higher levels of perceived social support are associated with higher levels of willingness to pay for other people's healthcare costs (p = 0.038). We also found that willingness to pay is higher when someone's social context is more supportive of the solidarity-based healthcare system (p = 0.001). Contrary to our expectations, the effect of social norms does not differ between people who perceive low and high levels of socials support. Conclusions The degree to which people feel connected to others and the degree to which someone's social context supports the solidarity-based healthcare system affect the willingness to contribute to the healthcare system. Our results suggest that the social context of people has to be taken into account in both policy and research that addresses healthcare solidarity, next to individual and institutional characteristics. Key messages • Social support and social norms play a role in the willingness to pay for healthcare costs of others. • People's social context must be taken into account in policy and research on healthcare solidarity.

Social solidarity in healthcare: The Israeli case

While solidarity is at the basis of all social health insurance systems, little has been done to define and analyze it empirically. Equity in the delivery of medical care and progressivity of its finance are socially important, but miss the main principle of social health insurance systems – mutual help. The present study views social solidarity not as a value but as cross-subsidies among individuals, which are necessary to achieve a separation between finance and delivery of care in order to make healthcare affordable universally. A solidarity index, derived from the Kakwani Progressivity Index, is suggested and applied to the Israeli national health insurance system in 2010. The observed solidarity index for 2010 Israel is 0.242. Adjusting for possible barriers in use does not change the index. About 85% of the solidarity index originates from income solidarity. If the entire health budget was financed by the general revenue, the solidarity index would rise to 0.259. The level of solidarity in Israel is close to the one found in Canada, Finland and France. More comparative results over time and over systems will enable further insights and uses. The sustainability of solidarity requires, however, some altruism among the rich with respect to the health state of the poor.

Shifting Responsibilitiesin Medicine 4.0 – A Project Report

"In this contribution, we anticipate the results of the research project “Medicine 4.0 – the ethical basis of digitalization in healthcare” funded by the German Ministry of Health, which investigated the ethically relevant effects of digitalized medicine using mobile health (mhealth) and telemedicine as prime examples, with the final aim of deriving policy-relevant overarching recommendations. In an iterative interdisciplinary approach, we linked social science research with analytic research on the ethically relevant effects of these technologies, including on the doctor-patient relationship, the relationship between responsibility and solidarity in healthcare and on the autonomy of the individual. In both the ethical and social science research, a key focus concerned the identification and analysis of an apparent diversity of stakeholder values and perspectives. In mobile or mhealth, which we concentrate on for this presentation, technology developers, insurances, physicians and public health professionals as well as ‘patient-consumers’ need to be looked at and involved. Their outlook in turn may converge, but also be in tension or collide, e.g. regarding conditions for data access and use, liability in case of malfunction or misuse and the overall question of responsibilities in a context of shifting roles and role anticipations. The research combines ethical insight and expert stakeholder perspectives on the most pressing issues in this fast-moving field. Further, traditional issues such as informed consent, confidentiality and the role of individual autonomy, are in part redefined with the emerging role of automated or algorithmic decision-making. "

Social Solidarity in Health Care, American-Style.

The ACA shifted U.S. health policy from centering on principles of actuarial fairness toward social solidarity. Yet four legal fixtures of the health care system have prevented the achievement of social solidarity: federalism, fiscal pluralism, privatization, and individualism. Future reforms must confront these fixtures to realize social solidarity in health care, American-style.

Solidarity in the Dutch healthcare system: monitoring trends in willingness to pay

Background Increasing costs of healthcare are putting stress on solidarity principles in social health insurance in European countries. This could pose a threat to equal access to healthcare which can have negative consequences for national health. There have been policy changes to tackle rising costs which alter solidarity in the healthcare system and spark a debate on how resources should be distributed. Institutionalized solidarity principles rely on a broad societal support for equal access to healthcare. A decrease in public support might affect solidarity in healthcare systems. Aim The aim of this research is to monitor solidarity in Dutch society. The focus is on willingness to pay for healthcare costs for others through the years. Methods Questionnaires have been sent out to a random selection of the 12.000 members of Nivel’s Dutch Health Care Consumer Panel, and included, among others, questions about solidarity in healthcare. Data are available from 2013, 2015 and 2017. The response was N = 764 (51%), N = 633 (42%) and N = 668 (45%) respectively. Results In 2017 74% of the respondents stated that they were willing to pay for others, compared to 73% in 2013 and 63% in 2015. If we look at willingness to pay for certain groups the results are similar over time: people show more solidarity towards others when others experience health issues beyond their ‘control’ like a genetic disposition. People show les solidarity when others face health problems due to lifestyle choices like excessive smoking and drinking. Results show time trends, especially for certain groups that have low education or poor health. Conclusions Results show that the willingness to pay for others is high; thus reflecting a high degree of solidarity. However, there is less solidarity for certain groups and attitude is changing over time. Since social health insurance is based on a broad societal support for equal access to healthcare it is paramount to keep monitoring solidarity and see if trends continue. Key messages Willingness to pay for healthcare costs for others is high; showing high degree of solidarity over time. There are trends in willingness to pay which could affect solidarity in healthcare systems.

Solidarity in Healthcare – the Challenge of Dementia

Dementia will soon be ranked as the world’s largest economy. At present, it ranges from the 16th to 18th place, with countries such as Indonesia, the Netherlands, and Turkey. Dementia is not only a financial challenge, but also a philosophical one. It provokes a paradigm shift in the traditional view of healthcare and expands the classic concepts of human personhood and autonomy. A promising response to these challenges is the idea of cooperative solidarity. Cooperative solidarity, contrary to its ‘humanitarian’ version, promotes spontaneous teamwork and individual initiative. It obliges us not only to help 'the suffering, the troubled and the disadvantaged’, but above all to support those who already do so for spontaneous moral or affective reasons. In the field of dementia study, solidary initiatives are described within the framework of supportive care.

The Veil of Ignorance and Solidarity in Healthcare: Finding Compassion in the Original Position

In this paper I will juxtapose the concept of the veil of ignorance – a fundamental premise of Rawlsian justice as fairness – and solidarity in the context of the organisation of a healthcare system. My hypothesis is that the veil of ignorance could be considered a rhetorical tool that supports compassion solidarity. In the concept of the veil of ignorance, I will find some crucial features of compassion solidarity within the Rawlsian concept of “reciprocity” (actually, not being reciprocity at all) – located between “impartiality” and “mutual advantage”. I conclude that, even behind this “thick” veil, some essential, yet “particular” facts on health and wealth redistribution are available to decision makers. Lastly, I discover that by means of the assumption of self-interest in the original position the veil aims to convert egoism into empathy, thus invoking the solidarity of compassion that in turn could be translated into principles of the organisation of a healthcare system.

Medical innovation and age-specific trends in health care utilization: Findings and implications

Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981–2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology.

Impact of Poll Results on Personal Opinions and Perceptions of Collective Opinion

Whether, and to what degree, the publication of poll results might influence the opinions of the public is a much-debated subject. While many effect-studies of polls have looked at the voting context, this study is an empirical investigation into the effects of poll information on personal opinions and perceptions of collective opinion on five nonelectoral, though politically relevant issues (independence of the Flemish region in Belgium, retirement income, immigration policy, purchasing power, and health-care solidarity). An experimental study was conducted in which poll information was integrated into a survey of a randomly selected group of respondents in order to test the overall impact of poll results on opinions, as well as the differential effects depending on individual characteristics, such as opinion strength, political interest, and perceived poll influence. Furthermore, a two-wave panel design was used to investigate the duration and repeatability of the poll effects. It was successively found in both waves and consistently for all issues that exposure to poll information primarily affected the perceptions of collective opinion, while the personal opinions on political issues remained unaffected. This poll effect on the perceptions of collective opinion was observed not only shortly after being exposed to the poll information, but also three months later.

Mutuality and solidarity in healthcare in South Africa

This paper uses Wilkie's definitions of mutuality and solidarity to review the history of private healthcare in South Africa. The vision for a future unified national healthcare system is given and the phases of reform are outlined. The first phase of reforms has been completed and these are contextualised in terms of a return to solidarity principles. The elements of a planned social healthinsurance system are described and it is shown how income cross-subsidies will further entrench the principles of solidarity. In the past, healthcare actuaries largely supported mutuality principles. The implications for the actuarial profession are suggested. Keywords: healthcare, medical schemes, social solidarity, community rating, minimum benefits, social health insurance, risk equalisationSouth African Actuarial Journal Vol. 5 2005: 135–167

Solidarity and the role of the state in Italian health care.

The article deals with the issue of solidarity in health care, with particular reference to the Italian context. It presents the difficulties of the Italian NHS and assesses the current proposal to counter the crisis of the Welfare State by giving up institutional arrangements, in order to favour the so-called 'social private'. Moreover, it addresses the question of prioritization and targeting in the context of health care, arguing for the insufficiency of the standard approach of neutral liberalism, and showing how the concept of solidarity might help to develop a different account. Lastly, it discusses the case of organ transplantation in Italy, as an example of solidarity-inspired health care policy.

Philosophy and Medicine.

The Philosophy and Medicine series is dedicated to publishing monographs and collections of essays that contribute importantly to scholarship in bioethics and the philosophy of medicine. The series addresses the full scope of issues in bioethics, from euthanasia to justice and solidarity in health care. The Philosophy and Medicine series places the scholarship of bioethics within studies of basic problems in the epistemology and metaphysics of medicine. The latter publications explore such issues as models of explanation in medicine, concepts of health and disease, clinical judgment, the meaning of human dignity, the definition of death, and the significance of beneficence, virtue, and consensus in health care. The series seeks to publish the best of philosophical work directed to health care and the biomedical sciences. Since its appearance in 1975, the series has created an intellectual and scholarly focal point that frames the field of the philosophy of medicine and bioethics. From its inception, the series has recognized the breadth of philosophical concerns made salient by the biomedical sciences and the health care professions. True to its original commitment, the series publishes monographs and collected works addressing issues ranging from bioethics to the philosophy of science focused on medicine. Its subseries include Asian Studies in Bioethics and the Philosophy of Medicine, Catholic Studies in Bioethics, and Classics of Medical Ethics and the Philosophy of Medicine. With over one hundred volumes in print, no other series offers as substantial and significant a resource for philosophical scholarship regarding issues raised by medicine and the biomedical sciences.