Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
Ministry of Health, Welfare and Sport, The Hague, The Netherlands.
BMC Health Serv Res. 2020 Nov 10;20(1):1024. doi: 10.1186/s12913-020-05870-7.
In the Netherlands, the for-profit sector has gained a substantial share of nursing home care within just a few years. The ethical question that arises from the growth of for-profit care is whether the market logic can be reconciled with the provision of healthcare. This question relates to the debate on the Moral Limits of Markets (MLM) and commodification of care.
The contribution of this study is twofold. Firstly, we construct a theoretical framework from existing literature; this theoretical framework differentiates four logics: the market, bureaucracy, professionalism, and care. Secondly, we follow an empirical ethics approach; we used three for-profit nursing homes as case studies and conducted qualitative interviews with various stakeholders.
Four main insights emerge from our empirical study. Firstly, there are many aspects of the care relationship (e.g. care environment, personal relationships, management) and every aspect of the relationship should be considered because the four logics are reconciled differently for each aspect. The environment and conditions of for-profit nursing homes are especially commodified. Secondly, for-profit nursing homes pursue a different professional logic from the traditional, non-profit sector - one which is inspired by the logic of care and which contrasts with bureaucratic logic. However, insofar as professionals in for-profit homes are primarily responsive to residents' wishes, the market logic also prevails. Thirdly, a multilevel approach is necessary to study the MLM in the care sector since the degree of commodification differs by level. Lastly, it is difficult for the market to engineer social cohesion among the residents of nursing homes.
The for-profit nursing home sector does embrace the logic of the market but reconciles it with other logics (i.e. logic of care and logic of professionalism). Importantly, for-profit nursing homes have created an environment in which care professionals can provide person-oriented care, thereby reconciling the logic of the market with the logic of care.
在荷兰，营利性部门在短短几年内获得了相当大的份额的养老院护理。营利性护理的增长所引发的伦理问题是，市场逻辑是否可以与医疗保健服务相协调。这个问题涉及到市场伦理限制（MLM）和护理商品化的辩论。
本研究的贡献有两点。首先，我们从现有文献中构建了一个理论框架；这个理论框架区分了四种逻辑：市场、官僚主义、专业主义和关怀。其次，我们遵循实证伦理方法；我们使用了三家营利性养老院作为案例研究，并对各种利益相关者进行了定性访谈。
我们的实证研究得出了四个主要结论。首先，关怀关系有很多方面（如关怀环境、人际关系、管理），每一个方面都应该被考虑，因为这四种逻辑在每一个方面的协调方式都不同。营利性养老院的环境和条件尤其被商品化。其次，营利性养老院追求一种不同于传统非营利部门的专业逻辑——一种受关怀逻辑启发并与官僚主义逻辑形成对比的逻辑。然而，由于营利性养老院的专业人员主要响应居民的愿望，市场逻辑也占主导地位。第三，需要采用多层次的方法来研究护理行业的 MLM，因为商品化的程度因层次而异。最后，市场很难在养老院居民中营造社会凝聚力。
营利性养老院部门确实接受市场逻辑，但将其与其他逻辑（即关怀逻辑和专业主义逻辑）相协调。重要的是，营利性养老院创造了一个环境，使护理专业人员能够提供以患者为中心的护理，从而将市场逻辑与关怀逻辑相协调。
