In 2009 China launched an ambitious health care reform to ensure equal and affordable access to basic health care for all by 2020. The reform was not only a response to changing patterns of disease, rising health expenditures, and widening regional inequalities, but part of a wider strategy to improve the social security system covering residents in order to increase domestic consumption. Its success will be defined by the efficient use of funds in financing and delivering health care. Against this backdrop, this dissertation evaluates the importance of health insurance characteristics on measures of financial risk protection, household saving and consumption, and preference for health care providers. It uses an experimental design to study the effect of more generous outpatient coverage and a tiered reimbursement structure that sets rates higher at primary care facilities than tertiary hospitals. While middle income households benefitted most in terms of financial risk protection, poorer and sicker households increased utilization at primary care facilities and food consumption – two pathways by which health insurance can improve health outcomes. This suggests that as outpatient coverage improves those most vulnerable will increase their access to health care, where there was previous underutilization, but not necessarily see an improvement in financial risk protection. The increased cover would also offer greater protection for those already using healthcare, but on its own not necessarily change their utilization patterns or reduce household savings. Looking at the quality-price trade-off in choice of provider reveals that, while at lower levels of household consumption demand for outpatient care is elastic with respect to price, as living standards rise past subsistence, individuals begin to value other provider characteristics. Together, these findings highlight the importance of benefit design and quality improvements at lower levels of care to shift patterns of utilization and ensure health services are accessed cost-effectively.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2017-03-08T10:38:59Z No. of bitstreams: 2 Dissertação - Fabiano Calixto Fortes de Arruda - 2016.pdf: 1310988 bytes, checksum: 47a7fc51ab994e5a56cd5aec2e6f7310 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-08T11:28:50Z (GMT) No. of bitstreams: 2 Dissertação - Fabiano Calixto Fortes de Arruda - 2016.pdf: 1310988 bytes, checksum: 47a7fc51ab994e5a56cd5aec2e6f7310 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-03-08T11:28:50Z (GMT). No. of bitstreams: 2 Dissertação - Fabiano Calixto Fortes de Arruda - 2016.pdf: 1310988 bytes, checksum: 47a7fc51ab994e5a56cd5aec2e6f7310 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-12-09 / Quality of life (QoL) is the result of the individual's perception of their position in life, in the context of the culture and in the value system in which they live and their relationship with their goals, expectations, standards and concerns. It is a well-studied subject in the health area, and in 2015 alone we obtained about 25,000 publications on the subject according to PUBMED data. In its current concept it relates factors such as: health, social relations, psychological and environmental aspects of the individual with their environment and with other individuals. Plastic surgery is a medical surgical specialty that developed mainly during the great world wars, thanks to the development of anesthesia and antibiotic therapy. The surgeons in this area develop activity in the aesthetic and reconstructive area. The purpose of this dissertatio n is to describe the quality of life of the plastic surgeon in the State of Goiás. This study is about a dissertation constructed in the form of a scientific article. The first article is an integrative review of published studies on the quality of life of the physician in Brazil. Medical related studies are still scarce and do not present the same instrument in the evaluation of professionals, but indicate that the worst domains of the WHOQOL instruments are related to the environment, social and psychological relations. The second article describes the sociodemographic and professional profile of the plastic surgeon in the state of Goiás. It presents a young population, predominantly male, with a time of activity in the area of less than 10 years, with about 2 children, working more than 40 hours a week and performing Aesthetic and reconstructive surgeries. When compared in relation to the time of action, it is observed that they increase the monthly income, the number of surgeries and decrease the weekly workload. The third article reports the results found on the quality of life of the plastic surgeon in the state of Goiás relating to variables present in the sociodemographic and professional profile. The study showed that surgeons who have children, are married, have a monthly income of more than R $ 30,000.00 (about 34 minimum wages), do not perform shifts or are performed in the specialty, work up to 40 hours a week and have more That 4 surgeries per week, present domains with better quality of life. It is concluded that the quality of life of the Goias’ plastic surgeon is influenced by factors such as marital status,professional working time, condition of association with the SBCP, no work shifts in another specialty, weekly workload and number of surgeries performed per week. Older surgeons have better quality of life. Therefore, it is necessary to create mechanisms that can cooperate with the new specialist so that he can adapt to the market and enjoy a better quality of life. / Qualidade de vida (QV) é o resultado da percepção do indivíduo de sua posição na vida, no contexto da cultura e no sistema de valores nos quais vive e a relação destes com seus objetivos, expectativas, padrões e preocupações. É um tema bastante estudado nas áreas da saúde, daí só no ano de 2015 termos obtido cerca de 25.000 publicações sobre o tema segundo dados do PUBMED. Em seu conceito atual ela relaciona fatores como: a saúde, as relações sociais, aspectos psicológicos e ambientais do indivíduo com seu meio ambiente e com os outros indivíduos. A cirurgia plástica é uma especialidade médica cirúrgica que se desenvolveu principalmente durante as grandes guerras mundiais, graças ao desenvolvimento da anestesia e da antibioticoterapia. Os cirurgiões nesta área desenvolvem atividade na área estética e reconstrutiva. O objetivo desta dissertação é descrever a qualidade de vida do cirurgião plástico no Estado de Goiás. Este estudo trata se de uma dissertação construída na modalidade de artigo científico. O primeiro artigo é uma revisão integrativa sobre os estudos publicados sobre qualidade de vida do médico no Brasil. Os estudos relacionando médico ainda são escassos e não apresentam o mesmo instrumento na avaliação dos profissionais, porém indicam que os piores domínios dos instrumentos WHOQOL estão relacionados ao meio ambiente, relações sociais e psicológico. O segundo artigo descreve o perfil sóciodemográfico e profissional do cirurgião plástico no estado de Goiás. Apresenta uma população jovem, predominantemente masculina, com tempo de atividade na área inferior a 10 anos, com cerca de 2 filhos, trabalhando mais de 40 horas semanais e realizando cirurgias estéticas e reconstrutivas. Quando comparados em relação ao tempo de atuação é observado que estes aumentam o rendimento mensal, o número de cirurgias e diminuem a carga horária semanal. O terceiro artigo relata os resultados encontrados sobre a qualidade de vida do cirurgião plástico no estado de Goiás relacionando com variáveis presentes no perfil sóciodemográfico e profissional. O estudo mostrou que os cirurgiões que têm filhos, são casados, apresentam renda mensal superior a R$ 30.000,00 (cerca de 34 salários mínimos), não realizam plantões ou se realizam são na própria especialidade, trabalham até 40 horas semanais e têm mais que 4 cirurgias por semana, apresentam domínios com melhor qualidade de vida. Conclui-se que a qualidade de vida do cirurgião plástico do Estado de Goiás é influenciada por fatores como estado civil, tempo de atuação como profissional, condição de associação com a SBCP, não realizar plantões em outra especialidade, carga horária semanal e número de cirurgias realizadas por semana. Os cirurgiões mais antigos apresentam melhores condições de qualidade de vida. Portanto, é necessário a criação de mecanismos que possam cooperar com o especialista novo para que este possa se adaptar ao mercado e desfrutar de uma melhor qualidade de vida.

M.Com. (Business Management) / The purpose of the present study was to investigate the perceptions of medical practitioners towards managed health care and its implications for patient care. The study population was the medical practitioners in the northern suburbs of Johannesburg. A questionnaire was distributed to 224 medical practitioners in the northern suburbs of Johannesburg. The total number of the respondents was 81 with 53% being general practitioners and 47% being specialists. The findings of the study indicated that the majority of respondents perceived managed healthcare to have a negative impact on doctor-patient relationship, the ability to carry out their ethical obligations towards the patients, and that the limitations implemented by managed health care have a negative impact on the quality of care. The respondents also perceived managed healthcare to be consistent in reducing unnecessary procedures and reducing the expenditure. Recommendations made to remedy the situation include introducing a topic of managed health care as part of undergraduate studies to empower practitioners before they start a private practice. It would be advisable to include medical practitioners to help reform the strategies that will enable medical practitioners to carry out their ethical obligations towards the patients and to deliver quality care to the patients. The study concluded that medical practitioners hold negative perceptions towards managed health care and perceive managed health care to impact the quality of care negatively.

Anualmente são realizadas mais de 234 milhões de cirurgias no mundo com taxas de morbi e mortalidade relativamente elevadas. Os dados nacionais disponíveis de registros de operações não cardíacas são escassos e deficientes. O objetivo do nosso estudo foi avaliar o perfil epidemiológico dos pacientes submetidos a operações não cardíacas e a sua evolução nos últimos anos no Brasil. Selecionamos a partir do banco de dados de DATASUS, as informações de sistema público de saúde em caráter nacional para descrição epidemiológica de operações não cardíacas realizadas no país. As variáveis estudadas foram: número total de internações, gasto total por internação, gasto com transfusões sanguíneas, número de óbitos e tempo de internação hospitalar. O período estudado compreendeu os anos de 1995 a 2007. No período de 13 anos, foram realizadas 32.659.513 operações não cardíacas no país e houve um incremento de 20,42% no número de procedimentos realizados. De forma semelhante, os gastos hospitalares relacionados a estas cirurgias apresentaram aumento importante neste período (~ 200%), com gasto anual superior a 2 bilhões de reais. As despesas relacionadas às transfusões sanguíneas no perioperatório tiveram um aumento superior a 100%, com um gasto anual acima de 17 milhões de reais ao ano. A mortalidade hospitalar encontrada é bastante elevada no nosso país, com média de 1,77% e o aumento registrado foi mais de 30% no período. A única variável que apresentou redução ao longo dos últimos anos foi o tempo de internação hospitalar, com a média de permanência de 3,83 dias. Concluímos que há uma tendência no aumento de intervenções cirúrgicas no país. Apesar do aumento dos gastos hospitalares relacionados a estas cirurgias, a taxa de mortalidade encontrada ainda é bastante elevada. Estudos futuros são necessários para maior investigação e elaboração de estratégias complementares para melhorar os resultados cirúrgicos / Worldwide, there were performed about 234 millions of surgeries annually with a relatively high surgical morbidity and mortality. Registry and information about non-cardiac operations in Brazil are scarce and deficient. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. This is a retrospective cohort study that investigated the time-window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The variables studied were: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. There were 32.659.513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200% and the yearly cost of surgical procedures to public health system was superior to 1.2 billions of dollars (2 billions of reais). The cost of blood transfusion had an increment superior to 100% and annually approximately 10 millions of dollars (17 millions of reais) were spent in perioperative transfusion. Actually, in 2007, the surgical mortality in Brazil was 1.77% and it had an increment of 31.11% in the period of 1995 to 2007. The length of stay was the unique variable which had a reduction of its numbers in the period. In average, the mean time of surgical hospitalization was 3.83 days. We concluded that the volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil

This dissertation consists of three essays in health economics, paying special attention to neonatal care provision and newborn health outcomes in the United States. The first chapter evaluates physician productivity, focusing on the matching between physician skills and patient conditions. High U.S. spending on health care is commonly attributed to its intensity of specialized, high-tech medical care. A growing body of research focuses on physicians whose medical decisions shape treatment intensity, costs, and patient outcomes. Often overlooked in this research is the assignment of physician skills to patient conditions, which may strongly affect health outcomes and productivity. This matching may be especially important in the case of hospital admissions as high-frequency fluctuations in patient flow make it challenging to maintain effective matches between the best-suited physicians and their patients. This paper focuses on hospitals’ responses to demand shocks induced by unscheduled high-risk admissions. I show that these demand shocks result in physician–patient mismatches when hospitals are congested. Specifically, highly specialized physicians who are brought in to treat unscheduled high-risk admissions also treat previously admitted lower-risk patients. This leads to increased treatment intensity for lower-risk patients, which I attribute to persistence in physician practice style. Despite the greater treatment intensity, I find no detectable improvement in health outcomes, which prima facie could be viewed as waste. However, the mismatches observed only at high congestion levels more likely reflect hospitals’ careful assessment of costs and benefits when assigning physicians to patients – maintaining preferred physician–patient matching can be particularly costly when congestion is high. My findings highlight the need to consider both heterogeneity within patient and physician type, and furthermore show how the common phenomenon of demand uncertainty can promote mismatch between these types. The second chapter assesses hospital self-reported facility data quality using annual Institutional Cost Report (ICR). In the United States, hospital facilities are under public and government supervision. The central motivation behind this is that overbuilding and redundancy in health care facilities will lead to overutilization and higher health care costs. However, little is known about the effectiveness of these facility regulation policies. Taking certified capacities recorded by the Department of Health as reliable benchmarks, this paper presents evidence that hospitals upcode their neonatal intensive care unit (NICU) bed levels when reporting capacities in ICR. Reported NICU utilization in ICR is mostly under the top level NICU bed, which matches the bed capacity upcoding pattern. This indicates either significant overutilization which leads to NICU overcrowding, or upcoding in medical billing that results in inflated medical charges. Findings in this paper point to a potentially effective way for regulators and insurers to limit overutilization – improving hospitals’ compliance with their certified capacities. This paper also provides important guidelines for a large body of research that uses ICR data by developing an assessment of ICR data quality. The third chapter, which is joint work with Douglas Almond, measures gender inequality in perinatal health among Chinese-American newborns. The literature on “missing girls" suggests a net preference for sons both in China and among Chinese immigrants to the West. Perhaps surprisingly, we find that newborn Chinese-American girls are treated more intensively in US hospitals: they are kept longer following delivery, have more medical procedures performed, and have more hospital charges than predicted (by the non-Chinese gender difference). What might explain more aggressive medical treatment? We posit that hospitals are responding to worse health at birth of Chinese-American girls. We document higher rates of low birth weight, congenital anomalies, maternal hypertension, and lower APGAR scores among Chinese American girls – outcomes recorded prior to intensive neonatal medical care and relative to the non-Chinese gender gap. To the best of our knowledge, we are the first to find that son preference may also compromise “survivor" health at birth. On net, compromised newborn health seems to outweigh the benefit of more aggressive neonatal hospital care for girls. Relative to non-Chinese gender differences, death on the first day of life and in the post-neonatal period is more common among Chinese-American girls, i.e. later than sex selection is typically believed to occur.

With increased availability of data in various fields, researchers often need to combine efficient empirical methods with innovative analytical modeling techniques to make data-driven decisions and gain managerial insights from the large-scale raw data. In light of this, my thesis combines empirical methods and analytical modeling to study several data-related problems in the fields of financial economics and healthcare management. The first two parts of the thesis focus on two topics in financial economics: the role of dynamic information in asset pricing and the link between index-based investment and intraday stock dynamics. The last two parts of the thesis study the ICU admission decisions and cardiac surgery scheduling using data from different hospital units. The first part of the thesis focuses on the role of information in financial market. As a fundamental topic in asset pricing, information is known to play an important role in determining asset prices and market volatility. In most of the existing literature, the information environment, i.e., the amount of knowable information, is assumed to be fixed and independent of investor's choice. However, in a dynamic market, the level of available information can vary substantially due to changes in technology and regulations. On the other hand, rational news producers may respond to investors' demand for information. Such effects are commonly seen in the reality, but are less studied in the literature. To bridge this gap, we develop a model of investor information choices and asset prices where the availability of information about fundamentals is time-varying. A competitive research sector produces more information when more investors are willing to pay for that research. This feedback, from investor willingness to pay for information to more information production, generates two regimes in equilibrium, one having high prices and low volatility, the other the opposite. Information dynamics move the market between regimes, creating large price drops even with no change in fundamentals. In our calibration, the model suggests an important role for information dynamics in financial crises. In the second part of this thesis, we investigate how the growth of index-based investing impacts the intraday stock dynamics using a large high-frequency dataset, which consists of 1-second level trade data for all S&P 500 constituents from 2004 to 2018 (500GB). We estimate intraday trading volume, volatility, correlation, and beta using estimators that are statistically efficient under market microstructure noise and observation asynchronicity. We find the intraday patterns indeed change substantially over time. For example, in the recent decade, the trading volume and correlation significantly increase at the end of trading session; the betas of different stocks start dispersed in the morning, but generally move towards one during the day. Besides, the daily dispersion in trading volume is high at the market open and low near the market close. These intraday patterns demonstrate the implication of the growth of index-based strategies and the active-open, passive-close intraday trading profile. We theoretically support our interpretation via a market impact model with time-varying liquidity provision from both single-stock and index-fund investors. In the third part of the thesis, we study the intensive care units (ICUs) admission decisions in a large hospital system. In the case of ICUs, which provide the highest level of care for the most severe patients, it is known that admission rates of some patients decrease as occupancy increases. It is also known that, for at least some conditions, ICU admission is not just a function of patients’ illness, and that a significant proportion of the variation in ICU admission rates is due to hospital, not patient, factors. To understand such variation, we employ two years of data from patients admitted to 21 Kaiser Permanente Northern California ICUs from the ED. We quantify the variation in ICU admission from the ED under varying degrees of ICU and ED occupancy. We find that substantial heterogeneity in admission rates is present, and that it cannot be explained either by patient factors or occupancy levels alone. We use a structural model to understand the extent that intertemporal externalities could account for some of this variation. Using counterfactual simulations, we find that, if hospitals had more information regarding their behaviors, and if it were possible to alter hospital admission processes to incorporate such information, hospitals could reduce their ICU congestion in a safe way. The last part of the thesis focuses on the impact of system workload on service time and quality in the context of cardiac surgeries. Using a detailed data set of more than 5,600 cardiac surgeries in a large hospital, we quantify how surgeon's daily workload level (e.g., number of surgeries) affects surgery duration and patient outcomes. To handle the endogeneity of surgeon's daily workload, we construct instrument variables using hospital operational factors, including the block schedule of surgeons. We find high daily workload of surgeons is associated with longer incision times and worse patient outcomes. Specifically, increased daily workload of surgeons leads to longer post-surgery length-of-stay in ICU and hospital, as well as higher likelihoods of reoperation and readmission for their patients. These results highlight the potential negative impact of surgeon's fatigue under long working hours. We then develop a surgery scheduling model that incorporates the effects of surgeon's daily workload levels.

No description available.

Lam Siu Kuen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 77-79). / Abstracts in English and Chinese. / Acknowledgments --- p.ii / English Abstract --- p.iv / Chinese Abstract --- p.vi / Table of Contents --- p.vii / List of Tables --- p.x / List of Figures --- p.xii / List of Appendices --- p.xiv / Chapter Chapter 1. --- Introduction --- p.1 / Chapter Chapter 2. --- Research Background --- p.7 / Chapter 2.1 --- Epidemiology of Hepatitis B Virus (HBV) --- p.7 / Chapter 2.2 --- The prevalence of HBV around the world --- p.12 / Chapter 2.3 --- The prevalence of HBV in Hong Kong --- p.16 / Chapter 2.4 --- Standard medical treatment --- p.17 / Chapter Chapter 3. --- Literature Review --- p.20 / Chapter Chapter 4. --- Data compilation --- p.31 / Chapter 4.1 --- Prince of Wales Hospital's Dataset --- p.31 / Chapter 4.2 --- Expert Opinion and other published data --- p.35 / Chapter 4.3 --- Definition of health states under study --- p.36 / Chapter Chapter 5. --- Empirical Findings I --- p.39 / Chapter 5.1 --- Estimation of disease costs from Department of Hepatology --- p.39 / Chapter 5.1.1 --- Methodology and sample size --- p.39 / Chapter 5.1.2 --- Summary of costs included in the analysis --- p.42 / Chapter 5.1.3 --- Descriptive analysis --- p.43 / Chapter 5.1.4 --- Calculation method --- p.44 / Chapter 5.1.5 --- Empirical results --- p.47 / Chapter 5.2 --- Estimation of direct medical cost from the Department of Oncology --- p.51 / Chapter 5.2.1 --- Methodology and sample size --- p.51 / Chapter 5.2.2 --- Summary of Costs included in the analysis --- p.52 / Chapter 5.2.3 --- Descriptive analysis --- p.52 / Chapter 5.2.4 --- Calculation method --- p.54 / Chapter 5.2.4 --- Empirical results --- p.58 / Chapter 5.3 --- Kernel estimators --- p.61 / Chapter 5.4 --- Sensitivity to cost variations in medical procedures --- p.63 / Chapter Chapter 6. --- Empirical Findings II --- p.65 / Chapter 6.1 --- Estimation of indirect medical costs --- p.65 / Chapter 6.1.1 --- Methodology --- p.65 / Chapter 6.1.2 --- Calculation method --- p.67 / Chapter 6.1.3 --- Empirical results --- p.68 / Chapter 6.2 --- Estimation of indirect cost (HCC-deceased) --- p.70 / Chapter 6.3 --- Premature death --- p.71 / Chapter 6.4 --- Limitation --- p.72 / Chapter Chapter 7. --- Conclusion --- p.75 / Bibliography --- p.77 / Tables --- p.80 / Figures --- p.120 / Appendices --- p.128

Abstract not available

Thesis (MPhil)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: This evaluation serves the purpose of illuminating concepts and ideas behind the moral impact of business values in healthcare and to establish a framework for the analysis of moral dilemmas found in the sphere ofbio-medical ethics. The historic developments of business in healthcare are examined, looking at how and why business became an integral part of the health care system. The concept of "managed healthcare" is introduced and used as the context in which the different institutional role-players are brought together. Managed healthcare is defined by a discussion of the different organisational structures through which it manifests itself. The policies, procedures and regulations that managed healthcare organisations implement and control to fulfil their general function are also examined. Some normative aspects pertaining to the concept of managed health care are explored, including the institutional values of business and that of medicine. A brief discussion of the economic system in which the business agents or role players function are included in the evaluation of the institutional values of business. Further arguments are made to show how the healthcare system with all its role players displays the characteristics of a complex system. Discussions on the fundamental values of medicine concentrate on the basic ideas behind virtues and principles of medical ethics. It is argued that the development of these virtues and principles are important foundations on which the medical profession stands. The moral impact of combining these institutional values within the context of managed healthcare relationships is examined and some important moral dilemmas or conflicts are identified. It is further argued that the fundamental relationships between all the role players in the health care system have changed as all the agents function within a complex system, giving rise to new organisational structures and relationships, with new conceptual roles, ideals, values and practices. / AFRIKAANSE OPSOMMING: Hierdie evaluasie het dit ten doelom sekere konsepte en idees agter die morele impak van besigheidswaardes in gesondheidsorg te illumineer en om 'n raamwerk daar te stel vir die verdere analise van morele dilemmas in die sfeer van bio-mediese etiek. Die historiese ontwikkeling van besigheid in gesondheidsorg word verken deur die redes aan te voer waarom besigheid deel van die gesondheidsorgsisteem geword het. Die konsep "bestuurde gesondheidsorg" word gebruik as die konteks waarin die verskillende institusionele rolspelers bymekaar gebring word. Bestuurde gesondheidsorg word gedefinieer deur die verskillende organisatoriese strukture waardeur dit manifesteer. Die prosedures, regulasies en bereid wat bestuurde gesondheidsorgorganisasies implementeer om hul funksies te vervul word ook verken. Normatiewe aspekte van bestuurde gesondheidsorg word verken, waarby ingesluit word die institusionele waardes van besigheid sowel as dié van medisyne. 'n Kort beskrywing van die ekonomiese sisteem waarin die besigheidsagente, of rolspelers funksioneer word ingesluit by die evaluasie van die institusionele waardes van besigheid. Verdere argumente word gevoer om te wys daarop hoe die gesondheidsorgsisteem met al sy rolspelers die karakter toon van 'n komplekse sisteem. Die basiese idees agter deugsaamheid en morele beginsels van bio-mediese etiek word bespreek om die fundamentele waardes van medisyne te beskryf. Daar word geargumenteer dat die ontwikkeling van hierdie waardes 'n belangrike fondament is waarop die mediese professie staan. Die morele impak van die kombinasie tussen die institusionele waardes van besigheid en medisyne binne die konteks van bestuurde gesondheidsorg word geevalueer en belanrike morele dilemmas en konflikte word geidentifiseer. Verder word geargumenteer dat die fundamenrele verhouding tussen al die rol spelers in die gesondheidsisteem verander het danksy die funksionering van die agente binne hierdie komplekse sisteem. Dit lei op sy beurt na veranderinge in organisatoriese strukture en verhoudinge met nuwe konsepsuele rolle, idiale, waardes en praktyke.