Ethical Issues of Globalization in Health Care Administration - Research Paper Example

Ethical Issues of Globalization in Health Care Administration The study examines the ethical issues of globalization in health care administration. Globalization facilitates interaction of people across nations. It enables patients move to other countries to seek for medical services while physicians especially in developing countries migrate to developed country to offer their services. The advent of communication technology and the increasing use of the internet many health care providers are offering medical services to the internet users. The study examines the effects of such interactions to establish the ethical effects it has on administrators of healthcare services. The results of the study established that there is an issues of inequality, inaccessibility and affordability of medical services. The managers may discriminate their diverse employees and there is lack of efficiency and potential breach of patient’s data. Study recommends healthcare administrators to integrate ethical principles to ensure equality, accessibility and affordability of members of the society. Introduction The advent computers and telecommunication have revolutionized the provision of health care service across the global. With the use of the internet, there has been increased communication across the globe regarding health care issues. This has increased health awareness that has led to an improvement in medical treatment, wellness and disease prevention (Hodges, Kimball, & Turner, 2012). Globalization of healthcare has increased the exchange or medical information, movement of patients and physicians across nations that have improved the delivery of health services (Hodges et al., 2012). However, there are various challenges associated with healthcare globalization. The main objective of this study is to evaluate ethical issues of globalization on health care administration. The specific objectives will be to examine ethical dilemmas of medical tourism, medical migration, telemedicine and clinical trials on globalize health care administration. Various research has either focused on ethical issues associated with health care or how globalization has impacted health care delivery (Chadwick, Have & Meslin, 2011). However, there has been little focus on ethics and globalization of health care administration that is the primary goal of this study. This study is essential for learners, policy makers and health care providers of globalized health care services to ensure it achieves the objectives of affordability, quality and accessibility fairly and without compromising privacy and status of other stakeholders. Literature Review According to Cohen (2013), globalization of health care has taken various forms and dimensions such as telemedicine, medical tourism, medical migration, Pharmaceutical trials and in form of medical assistance provided by various countries to victims of a disaster or catastrophe. Globalization of healthcare several advantages to the such as increasing “accessibility and affordability of health care, promoting good relationship across countries, prompting innovation of medical services, creation of jobs for medical service providers, easing of staff shortages in developed countries and creation of wealth for developing countries because of direct remittances from health care practitioners working abroad” (Cohen, 2013, 16). However, the practice has posed various challenges especially to the developed countries because they lose competent medical staff, the issue of accessibility of health care services by all persons, adverse effects of clinical trials carried out in developing countries, the concerns about affordability, accessibility and the quality of services (Chadwick, Have & Meslin, 2011). The health care administration has a moral obligation to ensure the services have more benefits to the society and mitigate adverse effects of globalized health care to the society. Telemedicine involves the provision of health care services online by use of the internet (Harris, 2011). Telemedicine has reshaped the system of delivering health care services. Depending on the capital requirement for delivery, telemedicine can be categorized as cybersurgery (e.g. remote robotic surgery), office-based telemedicine such as telecardiology and telepsychiatry, and teleradiology, teleretinology and telepathology (Harris, 2011). The cost of purchasing and installing these services differ significantly while the cost technicians and other hidden cost affect the delivery of telemedicine (Harris, 2011). For example, “the instruments for robotic surgery used in cybersurgery cost over $1 million in U.S., while teleradiology are relatively inexpensive since they cost about $150,000” (Cohen, 2013, 47). Most countries cannot afford the cost of telemedicine hence they have to outsource from other countries. India has been the main beneficiary of outsourcing of the equipment. Furthermore, they have experienced workforce who may continue to provide telemedicine to most of the developing countries (Cohen, 2013). This raises the ethical issue of affordability and quality of health care services provided online. Additionally, there is medical tourism that involves clients traveling from their home countries to foreign nations to get health care at affordable cost, access medical services unavailable in their country of origin or get insurance coverage. Cohen (2013) argues that in 2007 an estimated 750,000 U.S. patients traveled to different parts of the world to look for health care services. There was a prediction that the number would rise to one million by the year 2010. Studies also indicated that in California the annual migration of patients to Mexico for medical care, prescription drugs or dental care were about 952,000 patients (Cohen, 2013). In 2004, Indian and Malaysian hospitals treated 150,000 and 130,000 foreigners respectively. The trend indicates these figures have been growing over years with Malaysian case recording a figure of 587,403 in the year 2011 (Cohen, 2013). The studies have further indicated that medical tourism is likely to continue growing as some insurers in developed countries such as U.S. and European Union establishes plans to promote medical tourism. An example is the European Union directives requiring the government to refund for the services provided in other Member States (Cohen, 2013). Such a high rate of medical migration raises the ethical issue regarding the quality of services the patients get in foreign countries. The clients get exposed to illegal medical services such as assisted suicide, procurement of abortions, services on reproductive technology, etc. (Cohen, 2013). Some clients are using that opportunity to traverse the issue of morality. Also, globalization has occurred through medical migration whereby health care providers, especially in developing countries, relocate to foreign countries to offer their services because of better remunerations, favorable work environment and improved facilities (Chadwick et al., 2011). An example of the United States that for a long time has relied on doctors trained in other countries. As of 2005, about 20% of the doctors operating in U.S. were foreign trained. The majority of these doctors are from the developing countries (Bennett & Tomossy, 2006). While developed countries continue to enjoy high-quality health services, developing countries are adversely affected because they incur a huge cost to train those doctors yet they continue experiencing a shortage of medical experts (Bennett & Tomossy, 2006). This raises a serious ethical issue as developing countries continue to incur the huge cost of training doctors while they continue experiencing a shortage of physicians at the expense of developed countries. Additionally, globalization may also involve clinical trials where medical researchers are carried out in some part of developing countries while the outcome of the research is taken back to the developed countries to benefit their citizens (Singer, 2004). For example, in 2004 pharmaceutical companies in U.S. spent about 21% of their research activities in outside the U.S. (Harris, 2011) They conducted most of their clinical trials in developing countries while the studies projected a rapid increase in such trials outside U.S. in the future. The irony of the issue is that most of the developing countries continue to suffer from preventable diseases such as syphilis, measles, diarrhea, etc. (Harris, 2011). On the contrary, developing countries continues to suffer from illnesses such as malaria yet pharmaceutical from developed countries have not taken much interest in research on those diseases that are not prevalent in developed countries (Lee, 2004). Therefore, whereas most of the clinical trials occur in developing countries, developed countries are the main beneficiaries of clinical results while developing countries continue to languish in preventable illnesses and poverty. Analysis The ethical challenges facing health care regarding telemedicine is the issue of quality of services they offer to their clients (John, 2010). Administrators should take full responsibility for their practices and ensure the quality of services is not compromised. However, the issue of accessibility becomes a serious problem because some clients lack accessibility to the services due to lack of internet connectivity, language barrier, etc. (John, 2010). Additionally, the question arises regarding the effectiveness of client-patient relationship (John, 2010). The procedure of addressing issues between the clients and the medical professionals is of great concern when providing telemedicine services. The administrators have a duty to improve the accessibility of health care services to all interested persons including persons with disability (John, 2010). The health care administration has a moral obligation to improve accessibility, affordability and quality of the health care services to their clients irrespective of their geographical location or socio-economic background. The use of telemedicine can potentially compromise the privacy of client’s information. This is because the clients’ data may be shared without the customer’s consent (Mercuri, 2010). Whether accidentally or intentionally thousands of client’s health data are exposed to other internet users and consequently most clients have no confidence in sharing sensitive information with service providers (Mercuri, 2010). Therefore, this may compromise the quality of health care to the patients. The health care administration has a moral obligation to safeguard the privacy of client’s data to promote confidence and trust of the clients (Mercuri, 2010). However, there is great challenge of ensuring that the information comes from the right person and is used by the intended person. Without physical contact between the clients and the health service providers, the breach of privacy may be inevitable because a relative or another person can posit as the client or behalf of the customer (Mercuri, 2010). Therefore, it is difficult for the health care administration to ensure they are dealing with the right persons and safeguard the clients’ privacy against breach. While medical tourism has been of significant benefit to the patients from various countries who visits other countries to get the services the practice poses a serious ethical issue to administration (Chadwick et al., 2011). The service providers should explore the opportunities to expand services for ease of accessibility of health care by local patients. With increasing number of foreign patients, the cost of health services may continue rising and increase congestion to the detriment of the local clients (Chadwick et al., 2011). The ethical issue facing administrators of medical services is to ensure better quality of services for the local citizens especially the poor people while they continue to provide services to the tourist patients. The health care administrators face ethical challenges regarding the hiring of health care professionals from developing countries that have continued to languish in poverty and shortages of medical experts. They should consider whether there is any justification for developed countries to continue poaching such specialists in the countries that are already experiencing an acute shortage of the same professionals. Furthermore, the ethical issue also faces the health care administrators in the developing countries. The concern is the justifiable means they can apply to restrict the movement of health care professionals to the developed countries. Is it ethical for the administration to engage physicians in long-term contracts for services as a deterrent to their movement to seek employment in other countries? Furthermore, as more foreigners join the workforce the health care administrators bear the responsibility for managing the diversity of the workforce (Khawaja, 2007). This is inherent in a globalized economy because diverse employees have different talents, attitudes, perceptions, etc. and would want do things the way they are used to doing in their own background. Although such diversity brings in new talents and innovations, the administrators have a challenge of recognizing and appreciating these differences (Khawaja, 2007). The managers can improve the performance of their organizations by utilizing the different potential of a diverse workforce to influence change in organizational behavior. However, managing of diversity in the workplace has an ethical issue that concerns the way and employers treat the employees (Khawaja, 2007). Can they treat foreign employees equally with their native workers? In case of a conflict between foreign and local workers can the employer solve the issue fairly without discriminating the foreigners? In some cases, the clinical trials lead in adverse consequences for the residents of the country where the test was carried out. The health care administration has a responsibility to protect those citizens against harmful effects (Lee, 2004). However, the challenge is to ensure they take responsibility for their action and mitigate the adverse effects they cause to the affected countries. Other forms of medical globalization may occur during pandemics whereby various countries are involved in sharing of medical data, equipment, vaccine, intellectual property to expedite innovation and accessibility of health services across the globe, etc. (Singer, 2004). Many organizations such as World Health Organizations (WHO) handle coordinating health activities to the Member States. However, the ethical concern is how the health care administrators ensure equality of medical facilities to the Member States (Gremillion & Nash, 2004 Also, to what extent do these Member States have the right to use the some quantities of the vaccines and other facilities produced in their states? Conclusion Globalization of healthcare services has several advantages and challenges which occur in different dimensions. For example, some of the benefits include improved quality of health care delivery, collaborative effect in the war against chronic diseases, the creation of employment opportunities, etc. However, there are myriad challenges such as inequality of care delivery to developing nations and lack of high cost of medical services to the poor people. Health care administration is faced with an ethical issue regarding the management of diverse workforce to achieve success. The document has examined areas of ethical concern to the health care administration such as medical migration, telemedicine, medical tourism and clinical trials. For example; the issue of poaching qualified medical practitioners developing countries that are already experiencing a shortage of health providers presents an issue of moral responsibility of medical administration. Also, those conducting clinical trials in third world countries have no regard for poor people in those developing countries because they results of the trials are meant for helping the rich countries. Recommendations The health care administration should ensure they act for the interest all nations and citizens to ensure quality, affordable and accessibility of health services in a globalized environment. They should ensure the provision of healthcare services in a global perspective does not lead to adverse effect to less fortunate group and every decision should result to benefits than advantages to all persons affected by that decision. Reference List Bennett, B. & Tomossy, G. F. (Eds.). (2006). Globalization and Health: Challenges for health law and bioethics. Springer Science & Business Media. Chadwick, R., Have, H. & Meslin, E. M. (2011). The SAGE Handbook of Health Care Ethics. SAGE Publications. Cohen, G. (2013). The Globalization of Health Care: Legal and Ethical Issues. OUP USA. Gremillion, C. & Nash, M.G. (2004). Globalization Impacts The Healthcare Organization Of The 21st Century. Demanding New Ways to Market Product Lines Successfully. Nurs Adm Q. Vol. 28(2):86-91. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15181673 Harris D. M. (2011). Ethics in Health Services and Policy: A Global Approach. John Wiley & Sons. Hodges, J. R., Kimball, A. M., &Turner, L. (2012). Risks and Challenges in Medical Tourism: Understanding the Global Market for Health Services. ABC-CLIO. John, J. M. (2010). The Ethics of Electronic Health Records. Retrieved from http://www.clinicalcorrelations.org/?p=2211 Khawaja, S. L, (2007). Globalization of healthcare. Front Health Serv Manage. Winter; 24(2):19-30. http://www.ncbi.nlm.nih.gov/pubmed/18220175 Lee, K. (2004). Globalization: what is it and how does it affect health? Medical Journal of Australia; 180 (4): 156-158. Retrieved from. https://www.mja.com.au/journal/2004/180/4/globalisation-what-it-and-how-does-it-affect-health Mercuri, J. J. (2010). The Ethics of Electronic Health Records. Available at http://www.clinicalcorrelations.org/?p=2211 Singer, P. (2004). One World: The Ethics of Globalization. Yale University Press. Read More