How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach
Abstract Background 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...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-020-05870-7 |
| _version_ | 1831805481347186688 |
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| author | Florien M. Kruse Wieke M. R. Ligtenberg Anke J. M. Oerlemans Stef Groenewoud Patrick P. T. Jeurissen |
| author_facet | Florien M. Kruse Wieke M. R. Ligtenberg Anke J. M. Oerlemans Stef Groenewoud Patrick P. T. Jeurissen |
| author_sort | Florien M. Kruse |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-12-22T19:24:20Z |
| format | Article |
| id | doaj.art-795946c8531e42568473ab4d7be035c7 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-22T19:24:20Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-795946c8531e42568473ab4d7be035c72022-12-21T18:15:17ZengBMCBMC Health Services Research1472-69632020-11-0120111610.1186/s12913-020-05870-7How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approachFlorien M. Kruse0Wieke M. R. Ligtenberg1Anke J. M. Oerlemans2Stef Groenewoud3Patrick P. T. Jeurissen4Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcareAbstract Background 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. Methods 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. Results 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. Conclusions 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.http://link.springer.com/article/10.1186/s12913-020-05870-7Moral limits of marketsLong-term careCommodificationEmpirical ethics |
| spellingShingle | Florien M. Kruse Wieke M. R. Ligtenberg Anke J. M. Oerlemans Stef Groenewoud Patrick P. T. Jeurissen How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach BMC Health Services Research Moral limits of markets Long-term care Commodification Empirical ethics |
| title | How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach |
| title_full | How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach |
| title_fullStr | How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach |
| title_full_unstemmed | How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach |
| title_short | How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach |
| title_sort | how the logics of the market bureaucracy professionalism and care are reconciled in practice an empirical ethics approach |
| topic | Moral limits of markets Long-term care Commodification Empirical ethics |
| url | http://link.springer.com/article/10.1186/s12913-020-05870-7 |
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