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Taking Care of The Other or Looking After Yourself . The Conflict of Accountabilities in European Health Care Reforms

There has been a considerable amount of research into the health care reforms across Europe and the impact that these reforms have had on the organisation and economic efficiency of health care. However, while there have been studies of specific medical ethical issues, as yet there seems to be little analysis of how the reforms are effecting the fundamental ethical relationships involved in the provision of health care in more general terms (Taylor & Boor 1994; Ezzamel & Willmott 1991). This paper draws on two case studies: one in Sweden and one in Scotland, in order to investigate health care reforms from an ethical perspective. The paper describes how the problem of providing health care has been addressed in both countries and whether and how recent health care reforms are affecting the ethical relationships involved in providing health care. We draw on the case studies to develop a relational model for analysing ethical/ accountability relationships and we use this model to identify and analyse the main ethical relationships involved in the provision of health care in the two countries we studied. The paper identifies three main relationships. Firstly, the general relationship between individual members of society: my relationship to any other member of the society I live within in regard to the provision of health care. Secondly, the relationship between the doctor and the patient. And finally the relationship between the state as a provider of resources and the medical profession as a user of those resources. The paper draws on the work of Micheal Foucault, Zygmunt Bauman and Emmanuel Levinas in order to explore each of these ethical relationships.