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Medicine and Social Justice: Essays on the Distribution of Health Care

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Rosamond Rhodes


(Editor),

Margaret P. Battin


(Editor),

Anita Silvers


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Because medicine can preserve and restore health and function, it has been widely acknowledged as a basic good that a just society should provide its members. Yet there is wide disagreement over the scope of what is to be provided, to whom, how, when and why. In this uniquely comprehensive book some of the best-known philosophers, doctors, lawyers, political scientists, and economists writing on the subject discuss the concerns and deepen our understanding of the theoretical and practical issues that run through the contemporary debate. The first section lays a broad theoretical basis for understanding the concept of justice, particularly as it relates to the distribution of health care. The second section critically examines how medical care is distributed in different countries around the world and the particular advantages and injustices associated with those systems. The third section draws attention to the special needs of different social groups and the specific issues of justice that are raised by the impact of various policies on health care distribution. The concluding section delves intothe dilemmas that confront those designing health care systems–the politics, the priorities, and the place of desires as opposed to needs in a socially just scheme.



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Product details

  • Hardcover: 488 pages
  • Publisher: Oxford University Press; 1 edition (August 15, 2002)
  • Language: English
  • ISBN-10: 019514354X
  • ISBN-13: 978-0195143546

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    Global Health Equity

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    Travelling Well : Essays in Medical Tourism

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    • Travelling well : essays in medical tourism

    Labonté, R., Runnels, V., Packer, C. and Deonandan, R. (eds.) (2013).  Travelling well: Essays in medical tourism . Transdisciplinary Studies in Population Health Series, Vol. 4 Issue 1. Ottawa: Institute of Population Health, University of Ottawa.

    The opening years of the 21st century have been characterized by a variety of  technological, social, political and economic factors that have seen the disintegration of the  meaning and importance of international borders. From the power of the Internet to link  disparate populations, to the consolidation of blocs of politically intertwined nations such as the  European Union (EU), and the rise of affordable international travel, forces have been  combining to bring about a globalized world economy that was only theorized  in decades past. An obvious facet of this new globalization is the permeability of borders to the movement of consumers seeking a variety of medical services, and providers willing to accommodate, if not  also profit, from this demand. Medical tourism refers to situations wherein an individual makes a decision to physically travel to a location in another country for the purpose of obtaining medical treatment for which he or she has paid (out-of-pocket or through individual insurance plans).

    This book draws from the collective efforts and thoughts of a collaboration of researchers interested in the phenomenon of medical tourism. The services sought span a surprisingly diverse array of medical products, interventions and technologies and the motivations of travellers seeking these services are equally as diverse. The book reflects the diverse aspects of medical tourism and reflects on future directions for this globalized industry.

    The book’s contents are as follows:

    ·    Chapter 1: Introduction

    Sets the stage for the book with modern medical tourism viewed as a commercial enterprise and a manifestation of the processes of globalization.  Our use of the term ‘medical tourism’ refers to situations wherein an individual makes a decision to physically travel to a location in another country for the purpose of obtaining medical treatment for which he or she has paid (out-of-pocket or through individual insurance plans).

    ·    Chapter 2: Overview: Medical Tourism Today – What, Who, Why and Where?

    This chapter reviews and updates the current evidence of medical tourism, with a focus on the cross-border pursuit of more conventional or customary forms of healthcare (dental, surgical, and diagnostic).

    ·  Chapter 3: South-South and North-South Medical Tourism: The Case of South Africa

    Provides an overview of the volume and various types of medical tourism to South Africa, while also highlighting the differences between North-South and South-South medical travel to South Africa. The article also examines the emergence of inter-governmental agreements on medical treatment between South Africa and other African countries, and discusses the implications of the South African case study on our understanding of medical tourism.

    ·    Chapter 4: Medical Value Travel in India: Prospects and Challenges 

    Analyzes the medical tourism industry in India. The article discusses the facilitators and constraints to India’s medical tourism industry, presents the benefits and concerns, and outlines positive steps for India domestically, as well as internationally, in order to facilitate its medical tourism exports.

    ·    Chapter 5: Exploring Medical Tourism in Latin America – Two Case Examples 

    Provides an overview of two country case examples (Mexico and Cuba), which represent two fundamentally different models of medical tourism. The article discusses the medical services offered and the effects the industry has on the overall healthcare system of each respective country.

    ·    Chapter 6: Exceptional Aspects of the Experiences of Canadian Medical Tourists from Patient Narratives 

    This chapter presents five vignettes that bring forth uncommon or exceptional aspects of particular Canadian medical tourists’ experiences in order to raise questions and offer caveats to the many generalizations and conspicuous absences that are found in current popular and academic discussions of how a medical tour unfolds.

    ·    Chapter 7: Out of Canada – A Personal Experience of Bariatric Surgery 

    A personal story of a patient battling to sustain weight loss, and her experience at a US facility conducting bariatric surgery.

    ·  Chapter 8: Travelling for Healthcare from Canada – An Overview of Out-of-Country Care Funded by Provincial/Territorial Health Insurance Plans

    This chapter examines Out of Country Care (OOCC) funded by Canadian provincial/territorial health insurance plans. It specifically looks at some challenges to the current system and suggests some potential research questions and general implications of cross-border and OOCC for a country with a publicly-funded healthcare system.

    ·  Chapter 9: An Introduction to the Ethical Dimensions of Reproductive Medical Tourism

    Analyzes the ethical implications of reproductive medical tourism, including travel for IVF, ICSI, sex-selection, PGD and maternal surrogacy.

    ·    Chapter 10: The Impact of Trade Treaties on Health Tourism

    This chapter examines the extent to which trade agreements can impact health tourism.

    ·   Chapter 11: Let’s Make a Deal – The Commerce of Medical Tourism.   This chapter summarizes the author’s first-hand experiences and the issues presented of a commercial international medical tourism conference

    ·  Chapter 12: Conclusion – Medical Tourism Today and Tomorrow.  Closes the book with a brief summary and some reflections on future directions.

     


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    Sample Medical School Essays


    This section contains two sample medical school essays

    1. Medical School Sample Essay One
    2. Medical School Sample Essay Two

    Medical School Essay One

    Prompt: What makes you an excellent candidate
    for medical school? Why do you want to become a physician?

    When I was twelve years old, a drunk driver hit the car my mother was driving while I was in the backseat. I have
    very few memories of the accident, but I do faintly recall a serious but calming face as I was gently lifted out of
    the car. The paramedic held my hand as we traveled to the hospital. I was in the hospital for several weeks and that
    same paramedic came to visit me almost every day. During my stay, I also got to know the various doctors and nurses
    in the hospital on a personal level. I remember feeling anxiety about my condition, but not sadness or even fear. It
    seemed to me that those around me, particularly my family, were more fearful of what might happen to me than I was.
    I don’t believe it was innocence or ignorance, but rather a trust in the abilities of my doctors. It was as if my
    doctors and I had a silent bond. Now that I’m older I fear death and sickness in a more intense way than I remember
    experiencing it as a child. My experience as a child sparked a keen interest in how we approach pediatric care,
    especially as it relates to our psychological and emotional support of children facing serious medical conditions.
    It was here that I experienced first-hand the power and compassion of medicine, not only in healing but also in
    bringing unlikely individuals together, such as adults and children, in uncommon yet profound ways. And it was here
    that I began to take seriously the possibility of becoming a pediatric surgeon.

    My interest was sparked even more when, as an undergraduate, I was asked to assist in a study one of my professors
    was conducting on how children experience and process fear and the prospect of death. This professor was not in the
    medical field; rather, her background is in cultural anthropology. I was very honored to be part of this project at
    such an early stage of my career. During the study, we discovered that children face death in extremely different
    ways than adults do. We found that children facing fatal illnesses are very aware of their condition, even when it
    hasn’t been fully explained to them, and on the whole were willing to fight their illnesses, but were also more
    accepting of their potential fate than many adults facing similar diagnoses. We concluded our study by asking
    whether and to what extent this discovery should impact the type of care given to children in contrast to adults. I
    am eager to continue this sort of research as I pursue my medical career. The intersection of medicine, psychology,
    and socialization or culture (in this case, the social variables differentiating adults from children) is quite
    fascinating and is a field that is in need of better research.

    Although much headway has been made in this area in the past twenty or so years, I feel there is a still a tendency
    in medicine to treat diseases the same way no matter who the patient is. We are slowly learning that procedures and
    drugs are not always universally effective. Not only must we alter our care of patients depending upon these
    cultural and social factors, we may also need to alter our entire emotional and psychological approach to them as
    well.

    It is for this reason that I’m applying to the Johns Hopkins School of Medicine, as it has one of the top programs
    for pediatric surgery in the country, as well as several renowned researchers delving into the social, generational,
    and cultural questions in which I’m interested. My approach to medicine will be multidisciplinary, which is
    evidenced by the fact that I’m already double-majoring in early childhood psychology and pre-med, with a minor in
    cultural anthropology. This is the type of extraordinary care that I received as a child—care that seemed to
    approach my injuries with a much larger and deeper picture than that which pure medicine cannot offer—and it is this
    sort of care I want to provide my future patients. I turned what might have been a debilitating event in my life—a
    devastating car accident—into the inspiration that has shaped my life since. I am driven and passionate. And while I
    know that the pediatric surgery program at Johns Hopkins will likely be the second biggest challenge I will face in
    my life, I know that I am up for it. I am ready to be challenged and prove to myself what I’ve been telling myself
    since that fateful car accident: I will be a doctor.

    Tips for a Successful Medical School Essay

    • If you’re applying through AMCAS, remember to keep your essay more general rather than tailored to a
      specific medical school, because your essay will be seen by multiple schools.
    • AMCAS essays are limited to 5300 characters—not words! This includes spaces.
    • Make sure the information you include in your essay doesn’t conflict with the information in your other
      application materials.
    • In general, provide additional information that isn’t found in your other application materials. Look at
      the essay as an opportunity to tell your story rather than a burden.
    • Keep the interview in mind as you write. You will most likely be asked questions regarding your essay
      during the interview, so think about the experiences you want to talk about.
    • When you are copying and pasting from a word processor to the AMCAS application online, formatting and
      font will be lost. Don’t waste your time making it look nice. Be sure to look through the essay once
      you’ve copied it into AMCAS and edit appropriately for any odd characters that result from pasting.
    • Avoid overly controversial topics. While it is fine to take a position and back up your position with
      evidence, you don’t want to sound narrow-minded.
    • Revise, revise, revise. Have multiple readers look at your essay and make suggestions. Go over your
      essay yourself many times and rewrite it several times until you feel that it communicates your message
      effectively and creatively.
    • Make the opening sentence memorable. Admissions officers will read dozens of personal statements in a
      day. You must say something at the very beginning to catch their attention, encourage them to read the
      essay in detail, and make yourself stand out from the crowd.
    • Character traits to portray in your essay include: maturity, intellect, critical thinking skills,
      leadership, tolerance, perseverance, and sincerity.

    Medical School Essay Two

    Prompt: Where do you hope to be in ten years’
    time?

    If you had told me ten years ago that I would be writing this essay and planning for yet another ten years into the
    future, part of me would have been surprised. I am a planner and a maker of to-do lists, and it has always been my
    plan to follow in the steps of my father and become a physician. This plan was derailed when I was called to active
    duty to serve in Iraq as part of the War on Terror.

    I joined the National Guard before graduating high school and continued my service when I began college. My goal was
    to receive training that would be valuable for my future medical career, as I was working in the field of emergency
    health care. It was also a way to help me pay for college. When I was called to active duty in Iraq for my first
    deployment, I was forced to withdraw from school, and my deployment was subsequently extended. I spent a total of 24
    months deployed overseas, where I provided in-the-field medical support to our combat troops. While the experience
    was invaluable not only in terms of my future medical career but also in terms of developing leadership and creative
    thinking skills, it put my undergraduate studies on hold for over two years. Consequently, my carefully-planned
    journey towards medical school and a medical career was thrown off course. Thus, while ten-year plans are valuable,
    I have learned from experience how easily such plans can dissolve in situations that are beyond one’s control, as
    well as the value of perseverance and flexibility.

    Eventually, I returned to school. Despite my best efforts to graduate within two years, it took me another three
    years, as I suffered greatly from post-traumatic stress disorder following my time in Iraq. I considered abandoning
    my dream of becoming a physician altogether, since I was several years behind my peers with whom I had taken biology
    and chemistry classes before my deployment. Thanks to the unceasing encouragement of my academic advisor, who even
    stayed in contact with me when I was overseas, I gathered my strength and courage and began studying for the MCAT.
    To my surprise, my score was beyond satisfactory and while I am several years behind my original ten-year plan, I am
    now applying to Brown University’s School of Medicine.

    I can describe my new ten-year plan, but I will do so with both optimism and also caution, knowing that I will
    inevitably face unforeseen complications and will need to adapt appropriately. One of the many insights I gained as
    a member of the National Guard and by serving in war-time was the incredible creativity medical specialists in the
    Armed Forces employ to deliver health care services to our wounded soldiers on the ground. I was part of a team that
    was saving lives under incredibly difficult circumstances—sometimes while under heavy fire and with only the most
    basic of resources. I am now interested in how I can use these skills to deliver health care in similar
    circumstances where basic medical infrastructure is lacking. While there is seemingly little in common between the
    deserts of Fallujah and rural Wyoming, where I’m currently working as a volunteer first responder in a small town
    located more than 60 miles from the nearest hospital, I see a lot of potential uses for the skills that I gained as
    a National Guardsman. As I learned from my father, who worked with Doctors Without Borders for a number of years,
    there is quite a bit in common between my field of knowledge from the military and working in post-conflict zones. I
    feel I have a unique experience from which to draw as I embark on my medical school journey, experiences that can be
    applied both here and abroad.

    In ten years’ time, I hope to be trained in the field of emergency medicine, which, surprisingly, is a
    specialization that is actually lacking here in the United States as compared to similarly developed countries. I
    hope to conduct research in the field of health care infrastructure and work with government agencies and
    legislators to find creative solutions to improving access to emergency facilities in currently underserved areas of
    the United States, with an aim towards providing comprehensive policy reports and recommendations on how the US can
    once again be the world leader in health outcomes. While the problems inherent in our health care system are not
    one-dimensional and require a dynamic approach, one of the solutions as I see it is to think less in terms of
    state-of-the-art facilities and more in terms of access to primary care. Much of the care that I provide as a first
    responder and volunteer is extremely effective and also relatively cheap. More money is always helpful when facing a
    complex social and political problem, but we must think of solutions above and beyond more money and more taxes. In
    ten years I want to be a key player in the health care debate in this country and offering innovative solutions to
    delivering high quality and cost-effective health care to all our nation’s citizens, especially to those in rural
    and otherwise underserved areas.

    Of course, my policy interests do not replace my passion for helping others and delivering emergency medicine. As a
    doctor, I hope to continue serving in areas of the country that, for one reason or another, are lagging behind in
    basic health care infrastructure. Eventually, I would also like to take my knowledge and talents abroad and serve in
    the Peace Corps or Doctors Without Borders.

    In short, I see the role of physicians in society as multifunctional: they are not only doctors who heal, they are
    also leaders, innovators, social scientists, and patriots. Although my path to medical school has not always been
    the most direct, my varied and circuitous journey has given me a set of skills and experiences that many otherwise
    qualified applicants lack. I have no doubt that the next ten years will be similarly unpredictable, but I can assure
    you that no matter what obstacles I face, my goal will remain the same. I sincerely hope to begin the next phase of
    my journey at Brown University. Thank you for your kind attention.

    Additional Tips for a Successful Medical School Essay

    • Regardless of the prompt, you should always address the question of why you want to go to medical school
      in your essay.
    • Try to always give concrete examples rather than make general statements. If you say that you have
      perseverance, describe an event in your life that demonstrates perseverance.
    • There should be an overall message or theme in your essay. In the example above, the theme is overcoming
      unexpected obstacles.
    • Make sure you check and recheck for spelling and grammar!
    • Unless you’re very sure you can pull it off, it is usually not a good idea to use humor or to employ the
      skills you learned in creative writing class in your personal statement. While you want to paint a
      picture, you don’t want to be too poetic or literary.
    • Turn potential weaknesses into positives. As in the example above, address any potential weaknesses in
      your application and make them strengths, if possible. If you have low MCAT scores or something else
      that can’t be easily explained or turned into a positive, simply don’t mention it.

    To learn more about what to expect from the study of medicine, check out our
    Study Medicine in the US section.

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