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Risking the Sustainability of the Public Health System: Ethical Conundrums and Ideologically Embedded Reform

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Abstract

The purpose of this paper is to examine the outcomes arising from ideologically driven health reforms, which confronted an enduring socialized model of public health care in New Zealand. The primary focus is on the narratives arising from the unprecedented strike action of junior doctors, symbolic of industrial unrest in the public health sector. Analysis revealed the way in which moral obligations ingrained in the professional identities of junior doctors can be both enacted and persistently challenged by ongoing and extensive ideologically embedded reform. A socialized public healthcare system privileges cooperation and relies on a public service ethos, espousing commitment and goodwill of health professionals. The inverse tenets of a pursuit of efficiency through New Public Management validate an ideology of market principles which legitimate competitive and self-interested behavior. The value-based disconnect that occurred not only affected the goodwill and trust of junior doctors, but also destabilized their commitment to their work in a way that threatened the ongoing sustainability of the public health service. This paper suggests four areas in which research might help solve the ethical conundrums currently undermining a public health service. The suggested direction moves the emphasis on systems and activities toward the cognitive and emotional needs of healthcare professionals.

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  1. School of Communication, Journalism & Marketing, Massey University, Private Bag 102 904, North Shore Mail Centre, Auckland, 0745, New Zealand

    Margaret Brunton

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Brunton, M. Risking the Sustainability of the Public Health System: Ethical Conundrums and Ideologically Embedded Reform. J Bus Ethics 142, 719–734 (2017). https://doi.org/10.1007/s10551-016-3041-x

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