Модели поведения врачей в ситуации назначения платных услуг
The Russian healthcare system provides a set of free and paid diagnostic and therapeutic services. Although, when prescribing additional paid services, a specific doctor is provided with the situation of choice. The doctor is faced with a set of ethical and professional motivators, one of which is paid services as a source of additional medical income. What do doctors do in this situation, what strategies do they choose and what motivates their decision? Conducted and analyzed in-depth interviews (18 interviews, Tver, 2018) with doctors of different specialities revealed several patterns of doctor’s behavior when prescribing paid services. The data analyzed in the tactics of grounded theory allowed the author to build several models of doctor’s behavior, where such choices are associated with certain system of professional and personal values. The described models are conventionally named by author: “Making money”, “Polypragmasia”, “Collegiality”, “Man-System”, “One and a half rates”, “Out of the system”, “Avoidance”.The constructed models of behavior of doctors show that the appointment of additional optional procedures is associated not only with the doctor’s desire to earn money, but also can be explained by a more complex combination of reasons, working conditions, formal and informal social norms, as well as the basic values of the doctors themselves.
We focus on one of these aspects of value theory that has remained relatively underexposed, namely the relation between individual social location and human values. Does one’s position in the social structure—indicated by socio-demographic variables such as age, gender, education and income—affect the values that one prioritizes? We pay special attention to the cross-cultural robustness of the relation between social location and values: Can similar patterns be detected in various European countries? Or do cross-national differences in the relation between structure and values depend on elements of the national context?
We depart from Schwartz’ (1992, 1994, 2006) theory of human values, and make use of the value scale included in the European Social Survey (ESS). We believe that this study adds up to existing research in various ways. First, an exceptionally wide range of European countries is taken into account, including various Eastern European countries. Second, we take up the issue of the cross-cultural equivalence of the measurements. Prior to substantive analysis, we test to what extent different cultural interpretations of values affect the validity of cross-national comparisons. Third, to the best of our knowledge, this is the first study that explicitly addresses the question whether national context affects the relation between social location and values.
This study used basic personal values to elucidate the motivational meanings of “left” and “right” political orientations in 20 representative national samples from the European Social Survey (2002–2003). It also compared the importance of personal values and sociodemographic variables as determinants of political orientation. Hypotheses drew on the different histories, prevailing culture, and socioeconomic level of three sets of countries—liberal, traditional, and postcommunist. As hypothesized, universalism and benevolence values explained a left orientation in both liberal and traditional countries and conformity and tradition values explained a right orientation; values had little explanatory power in postcommunist countries. Values predicted political orientation more strongly than sociodemographic variables in liberal countries, more weakly in postcommunist countries, and about equally in traditional countries.
Two studies investigated reciprocal effects of values and voting. Study 1 measured adults’ basic values and core political values both before (n=1379) and following (n=1030) the 2006 Italian national election. Both types of values predicted voting. Voting choice influenced subsequent core political values but not basic values. The political values of free enterprise, civil liberties, equality, law and order, military intervention, and accepting immigrants changed to become more compatible with the ideology of the chosen coalition. Study 2 measured core political values before (n=697) and following (n=506) the 2008 Italian national election. It largely replicated the reciprocal effects of voting and political values of Study 1. In addition, it demonstrated that left-right ideology mediated the reciprocal effects of voting and political values. Moreover, voter certainty moderated these effects. Political values predicted vote choice more weakly among undecided than decided voters, but voting choice led to more value change among undecided voters.