Loss of Moral Values During Business-Like Transformations in Healthcare Services

BACKGROUND: The shortcomings of business-like management systems in health care were exposed during the coronavirus disease 2019 pandemic when the need for flexibility and a rapid response to patients' needs became pressing. Almost all administrative decisions concerning the management of health care services have an ethical dimension. This research aims to investigate current debates on this subject and fill in the knowledge gaps.<br /> METHODS: A systematic review was undertaken to identify neurosurgical ethical concerns related to transformations in the functioning of health care institutions; however, the data analysis is presented in a narrative format.<br /> RESULTS: Two management models were identified and compared: a business/economic management model versus a medical model. Independent of the management model chosen, problems arise when a framework is adopted where measurement and proxy parameters are implemented and economic mechanisms are used for administrative steering. The proxy measures of physician performance proved to be entirely inappropriate during the pandemic. The pandemic suddenly made many management models obsolete as doctors tried to solve immediate problems according to their medical training rather than by following abstract systems for maximizing public health. The measures were largely taken in a bottom-up fashion based on physicians' training and knowledge, not in a top-down manner dictated by management.<br /> CONCLUSIONS: Purely financial cost containment strategies in health care can be ineffective or even harmful. Therefore, nonfinancial control mechanisms must ensure adherence to personal and professional ethics, together with professionalism based on sound medical knowledge.