Are DRGs just? This is the primary question which this essay will answer. But there is a prior methodological question that also needs to be addressed: How do we go about rationally (non-arbitrarily) assessing whether DRGs are just or not? I would suggest that grand, ideal theories of justice (Rawls, Nozick) have only very limited utility for answering this question. What we really need is a theory of “interstitial justice,” that is, an approach to making justice judgments that is suitable (...) to assessing the social practices and institutions that comprise the interstices of our social life as opposed to its basic structure. Rawls's appeal to “our considered moral judgments” provides us with a useful starting point for this task, which we shall discuss in the first part of this essay. In the second part, we shall actually assess DRGs from the perspective of interstitial justice. What we shall show is that DRGs violate a large number of our considered judgments regarding a just approach to financing health care for the elderly in a cost-effective manner. This is true to such an extent that efforts to reform DRGs and make them fairer, such as the recent effort by Robert Veatch, should be abandoned. In the concluding section of the essay we discuss one especially pernicious feature of DRGs, namely, that they represent an invisible approach to rationing access to health care. In the minds of many this is one of the virtues of DRGs. That claim needs critical examination. (shrink)

To allocate resources ethically under DRGs, we need an expanded medical ethics. Appealing to traditional patient-centred principles such as beneficence and autonomy will not be sufficient. We also need to take into account the social principles of full beneficence and justice. If marginal benefits must be eliminated, clinicians should not participate in deciding who should get less care but should remain committed to their patients' interests.

Ostensibly, the DRG prospective payment system represents a modern effort to legislate an enforceable system of just prices. As a practical matter, however, justice is conflated with mere familiarity, and the real goal of DRGs has always been cost containment. Abstract and concrete discussions of the computation of DRG payment schedules illustrate their actual operation. Keywords: DRG, cost containment, just price, Medicare CiteULike Connotea Del.icio.us What's this?

DRGs may contain costs, but they threaten to restrict access to health care, to compromise its quality, and to impede the development of new medical technologies. Immediate corrections are necessary to ensure that hospitals continue to serve the poorest and sickest.

Commentary by Swami Tejomayananda. In this short and beautiful composition, Adi Sankara, the Master, has condensed the essence of Vedanta in just 31 verses, which are very useful to all serious seekers.

This series of articles by Charles Dougherty, Robert Berenson, and Kathleen Powderly and Elaine Smith, as well as “Cost Containment: Challenging Fidelity and Justice” by E. Haavi Morreim (Hastings Center Report, December 1988), result from a Hastings Center project, “Ethics and Prospective Payment Systems: DRGs.” The two-year project was jointly funded by The General Electric Foundation and the American Medical Association Education and Research Foundation.The project tried to gauge the systematic effects of the introduction of cost containment strategies, prospective payment (...) by Diagnostic Related Groups in particular, on the provision of health care and the ethical practice of medicine. Cost containment strategies, no matter how necessary in curbing spiraling medical costs, leave no sector or participants in the health care system untouched—hospitals and other health care institutions; doctors, nurses, social workers and other health care professionals; patients, their families, and the thirty-six to forty million medically indigent. The articles discuss the several and interrelated ethical issues raised by the DRG prospective payment system (Dougherty); its particular affect on the doctor-patient relationship and how it is transforming the ethical practice of medicine (Berenson and Morreim); and its specific impact on the professions and professional ethics of nursing and social work (Powderly and Smith). The overall message of the articles is that the health professions, their provision of care, and the ethics of their practices—as driven by economic considerations and realities—are in the midst of a more or less radical sea change. (shrink)

The goal of this article is to present the possibility of using Diagnosis- Related Groups (DRG) in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training users (...) in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries. (shrink)

As they struggle to maintain high‐quality health care in the face of new economic limitations, physicians should not endanger their relationships with patients. But they should collectively revise the informal protocols that guide clinical decision making.

Die Einführung der kostenkalkulierten und landesweit einheitlich bepreisten DRGs hat die Möglichkeiten gewinnorientierter Krankenhausträger, ehemals kommunale, defizitäre Krankenhäuser in die Gewinnzone zu führen, erschwert. Diese reagieren darauf mit dem Einsatz bisher nicht gekannter Werkzeuge wie beispielsweise der Steuerung von Patientenströmen, Anreizsystemen, Gründung von Privatkliniken sowie erlösorientierten Therapien und Abrechnungen. Mittlerweile bedienen sich auch andere Trägergruppen dieser Instrumente, so dass sich die Frage stellt, ob angesichts der Wettbewerbssituation nicht gewinnorientierte Träger eines besonderen wirtschaftlichen Schutzes bedürfen, damit die bisher im Krankenhaus gültigen (...) ethischen Prinzipien auch weiterhin Anwendung finden können. (shrink)

Una poderosa intuición atravesaba el discurso con el que Jawaharlal Nehru, en la medianoche del 15 de agosto de 1947, se dirigía a la asamblea y, a través de la radio, a millones de indios esperanzados y jubilosos: “Hace muchos años fijamos una cita con el destino; ahora llega el momento de cumplir nuestra promesa. Cuando suene la hora de la medianoche, mientras el mundo duerme, la India despertará a la vida y a la libertad”. La estabilidad del futuro (...) de la India y su democracia solo se alcanzarían rescatando de su olvidada historia y su denostada tradición las raíces democráticas silenciadas durante tanto tiempo por la devastación intelectual producida por el colonialismo y su infame ejercicio, que encerró al país en un anquilosado arquetipo atemporal, en el que la religiosidad, la mística y la espiritualidad se establecieron como señas de identidad y orgullo de un pueblo que acabaría por identificar lo genuinamente indio con aquello que se desmarcaba de lo “presumiblemente” occidental, hasta acabar convirtiéndolo en un elemento de lucha y afirmación contra la metrópoli, desterrando de la dignidad india su pasado más racional y argumentativo. (shrink)

The federal government's introduction in 1983 of DRG‐based reimbursement for Medicare patients shook the entire health care industry into the vigorous and dramatic cost containment efforts which today are reshaping health care in America.

Bourdieu’s concept of habitus claims to solve the problem of the individual/society duality. However, the concept of habitus appears to be inadequate to explain the idiosyncratic features of individual field actors’ practices. In this article, I argue that to explain the particularity of individual habitus, we must appreciate the operationalization of relational logic in field theory. I further argue that individuals learn to prediscursively identify certain types of practices as meaningful for a given field position because of their embodied experiences (...) of movements within the historically specific relational structure of the field. Thus, the same individual can exhibit multiple and even contradictory practices depending on the person’s relational position in the field. I illustrate this insight by discussing the political habitus of the first prime minister of India, Jawaharlal Nehru. (shrink)

This essay uses the seminal figure of Jawaharlal Nehru to interrogate the nature and representation of science in modern India. The problem posed by Nehruvian science—the conflict between science as both universal phenomenon and local effect—lies at the heart of current debates about what science means for the non-West. The problematic of Nehruvian science can be accessed through Nehru's own speeches and writings, but also through the wider project of science with which he identified—critiquing colonialism, forging India's place in (...) the modern world, marrying intellectual endeavor with practical nation building. The essay makes a case for looking at Nehruvian science as a way of structuring the problem of postcolonial science, particularly in relation to understanding the authority of science and its evaluation in terms of its capacity to deliver socioeconomic change. (shrink)

The lack of academic religious studies in India has several causes: the choice of the secular University of London as model for the first universities in India in 1857, the secular constitution, the secularist approach of the first prime minister of India, Jawaharlal Nehru, and the explosive relation between major faith traditions. However, with the waning of the Indian secularist framework and the continued power and influence of Hindutva ideology, there is a need to discuss different models for religious (...) studies in India. In this article, the point of departure is Banaras Hindu University, one of the few universities in India that has religious studies, but also a faculty of Hindu theology. The focus is on the history of BHU and the recommendations of several educational commission from the 1930s to the 60s, with a note on recent attempts at BHU of renewing value education. The aim is to highlight one alternative for developing religious studies in India, whose primary goal is the formation of good citizens enabled by a set of universal human values instantiated in local traditions. (shrink)

This article probes the link between anti-colonial nationalist thought and a theory of jihad in early twentieth-century India. An emotive affinity to the ummah was never a barrier to Muslims identifying with patriotic sentiments in their own homelands. It was in the context of the aggressive expansion of European power and the ensuing erosion of Muslim sovereignty that the classical doctrine of jihad was refashioned to legitimize modern anti-colonial struggles. The focus of this essay is on the thought and politics (...) of Maulana Abul Kalam Azad. A major theoretician of Islamic law and ethics, Azad was the most prominent Muslim leader of the Indian National Congress in pre-independence India. He is best remembered in retrospectively constructed statist narratives as a , who served as education minister in Jawaharlal Nehru's post-independence cabinet. Yet during the decade of the First World War he was perhaps the most celebrated theorist of a trans-national jihad. (shrink)

Health Care Centres are institutions which, because of their specificity and character, are particularly exposed to various kinds of risk. One of the most important and most frequently used methods of risk management is the black spots method. The research material collected for the study comes from one of the hospitals in Wrocław. All hospital stays of the C22 (Face and Jaw Surgery Ward) and H05 (Injury and Orthopaedics Surgery Ward) settlement groups (DRG) were analysed - a total of 178 (...) hospitalisations. The black spots method was used in the study, which consisted of risk identification, the ordering of threats and proposals for remedial actions. Using the black spots method, it was possible to identify adverse events that occurred during the hospitalisation of patients with H05 and C22 DRGs in the Injury and Orthopaedics Surgery Ward and Facial and Jaw Surgery Ward. In both cases, the treatment costs for patients with complications were higher than for the stays without complications. (shrink)

This article examines the visual archive of the 1955 Asian-African Conference held in Bandung, Indonesia. Better known as the Bandung Conference or simply Bandung, this diplomatic meeting hosted 29 delegations from countries in Africa and Asia to address questions of sovereignty and development facing the emergent postcolonial world. A number of well-known leaders attended, including Jawaharlal Nehru of India, Zhou Enlai of China, Gamal Abdel Nasser of Egypt, and Sukarno of the host country, Indonesia. Given its importance, the meeting (...) was documented extensively by photojournalists. The argument of this article is that the visual archive that resulted has contributed to the enduring symbolism and mythology of Bandung as a moment of Third World solidarity. More specifically, the street photography style of many images - with leaders walking down the streets of Bandung surrounded by adoring crowds - depicted an informality and intimacy that conveyed an accessible, anti-hierarchical view of the leaders who were present. These qualities of conviviality and optimism can also be seen in images of conference dinners, airport arrivals, delegate speeches, and working groups. Drawing upon the critical work of scholars of southern Africa and Southeast Asia, this article summarily positions the concept of the 'decolonising camera' to describe both the act of documenting political decolonisation as well as the ways in which visual archives produced during decolonisation can contribute to new iconographies of the political, which are both factual and mythic at once. (shrink)

Contributed articles presented at the Seminar, Nietzsche: Philologist, Philosopher, and Cultural Critics held at Jawaharlal Nehru University, New Delhi in Nov. 2004.

The book is based on the proceedings of the conference on 'Philosophy, Language and the Political - Reevaluating Poststructuralism' held at Jawaharlal Nehru University, New Delhi, on the 10th, 11th and 12th December 2014. Several scholars from India and abroad participated in it. The book comprises 17 papers that were presented at the event, besides three additional papers, plus a Preface by Marc Crepon, as well as a description of the conference and a thematic introduction, both by Franson Manjali. (...) -/- The contributiors discuss diverse aspects of the poststructuralist and related philosophical ideas and practices, in the works of Jacques Derrida, Michael Foucault, Gilles Deleuze, Helene Cixous, Jurgen Habermas, Jean-Luc Nancy, Georgio Agambed, Maurice Blanchot, Emmanuel Levinas, Martin Heideggar, Jean-Paul Sartre, Friedrich Nietzche, Baruch Spinoza, and several other philosophers. The questions of language, literature, culture, art, the political, feminism, self and the other death, theology, violence, shame, the animal, psychoanalysis, Marxism, etc, receive scholarly attention of the contributors. (shrink)

Identification of the molecular mechanisms underlying axonal branching in vivo has begun in several neuronal systems, notably the projections formed by dorsal root ganglion (DRG) neurons or retinal ganglion cells (RGC). cGMP signalling is essential for sensory axon bifurcation at the spinal cord, whereas brain‐derived neurotrophic factor (BDNF) and ephrinA signalling establish position‐dependent branching of RGC axons. In the latter system, the degradation of specific signalling components, via the ubiquitin‐proteasome system, may provide an additional mechanism involved in axon branching of (...) RGC. The process of arborisation is essential for neurons to innervate multiple targets and to build topographic maps. The various forms of branching found in different types of neurons are regulated by distinct signalling pathways activated by multiple extracellular cues in addition to axonal guidance factors. These signalling cascades, together with transcriptional programs, most likely interact and trigger the polymerisation or depolymerisation of the actin and tubulin cytoskeleton to regulate branching. (shrink)

Contemporary Indian Philosophy is related to contemporary Indian thinkers and contains the proceedings of First Session of Society for Positive Philosophy and Interdisciplinary Studies (SPPIS) Haryana. It is neither easy nor impossible to translate into action all noble goals set forth by the eminent thinkers and scholars, but we might try to discuss and propagate their ideas. In this session all papers submitted electronically and selected abstracts have been published on a website especially develop for this session. In this volume (...) we included some papers from this session and also from open sources and contributors include teachers, research scholars and students etc. This volume is divided into two parts. First part contains papers on Swami Vivekananda and second part contains papers of B. G. Tilak, Sri Aurobindo, Mahatma Gandhi, Jawaharlal Nehru, Saheed Bhagat Singh and Dr. B.R. Ambedkar etc. It is the general intention of the Centre to produce informative as well as positive literature to inspire and motivate the students and the general readers. (shrink)

This Special Issue is an outcome of the lectures and discussions on ‘Cross-cutting Themes and Concepts in Human Rights’, offered as a Seminar Course to the students of the MA Programme, School of International Studies, Jawaharlal Nehru University. As part of the Course, a Webinar on ‘Rethinking Rights and Justice for Non-Humans’ was held in 2022, in which the participants advanced some of the most compelling arguments for the meaningful representation of non-human entities in law and governance. In the (...) three sessions of the webinar, the participants explored the terrain of relevant concepts, emerging norms, and moral justifications that underline the case of non-human entities: (i) The Limits of Animal Rights: Exploring the Case for Multispecies Justice, (ii) Humanist Dimensions of Machines, and (iii) Representing Nature: Rights, Crimes, and Diplomacy. Scholarly literature on the subject matter sheds light on the gaps in existing legal frameworks concerning the responsibilities of human beings towards non-human life forms. There is evidence of a growing universal consciousness embedded in the worth and sacredness of non-human life forms. A series of developments in the fields of technology, philosophy, and other disciplines have moved non-human entities to the forefront of legal reforms, domestic and international. (shrink)

This article explores nationalist interpretations of blood donation activity, examining how some Indians read integrative messages into the practical procedures through which blood is donated and distributed. The first post-Independence Prime Minister of India, Jawaharlal Nehru, proclaimed the need for `national integration' as a bulwark against a myriad of linguistic, caste and ethnic agitations that threatened to disrupt the unity of the newly formed nation-state. This article shows that a striking manifestation of the Nehruvian ideology of national integration possesses (...) a compelling presence in the Indian blood donation milieu. Scholars of India have long been preoccupied with documenting attempts by the Hindu right to redefine the nation in exclusively Hindu, anti-Nehruvian terms. Questioning the prevailing assumption that the only thing that counts politically in India today is the debunking or overriding of Nehruvian ideals of the secular inclusive nation, this article rehabilitates Nehruvianism as an important ethnographic subject. In so doing it demonstrates the roles of anonymity, enumeration and an array of technical and imaginative gathering points in the formation of the `difference-traversing gift'. The article also highlights ways in which technology may be employed for the imagining of social diversity. (shrink)

This long-awaited second volume of Russell's best letters reveals the inner workings of a philosophical genius and an impassioned campaigner for peace and social reform. The letters, only three of which have been published before, cover most of Russell's adult life, a period in which he wrote over thirty books, including his famous History of Western Philosophy . Richly illustrated with photographs from Russell's life, the collection includes letters to Ho Chi Minh, Tito, Jawaharlal Nehru and Albert Einstein.

This article explores nationalist interpretations of blood donation activity, examining how some Indians read integrative messages into the practical procedures through which blood is donated and distributed. The first post-Independence Prime Minister of India, Jawaharlal Nehru, proclaimed the need for `national integration' as a bulwark against a myriad of linguistic, caste and ethnic agitations that threatened to disrupt the unity of the newly formed nation-state. This article shows that a striking manifestation of the Nehruvian ideology of national integration possesses (...) a compelling presence in the Indian blood donation milieu. Scholars of India have long been preoccupied with documenting attempts by the Hindu right to redefine the nation in exclusively Hindu, anti-Nehruvian terms. Questioning the prevailing assumption that the only thing that counts politically in India today is the debunking or overriding of Nehruvian ideals of the secular inclusive nation, this article rehabilitates Nehruvianism as an important ethnographic subject. In so doing it demonstrates the roles of anonymity, enumeration and an array of technical and imaginative gathering points in the formation of the `difference-traversing gift'. The article also highlights ways in which technology may be employed for the imagining of social diversity. (shrink)

Revolutionary, philosopher, litterateur, and seer, Sri Aurobindo remains one of the brightest minds India has ever had. This book captures the evolution of his thought through excerpts from his political articles and speeches, essays, talks with and letters to disciples, and public messages-presented chronologically. It includes his views on Jawaharlal Nehru and Subhas Chandra Bose; his doubts about Gandhi's method to attain freedom and insistence on Ahimsa; and his very distinctive contribution to the nascent Nationalist Movement. Both prophetic of (...) the challenges to come India's way post-Independence, and persuaded of her potential to overcome them, Sri Aurobindo's vision of a new India melds the spiritual with the political. More than sixty years after his passing, Sri Aurobindo's penetrating insights on issues such as building on India's cultural and spiritual foundations, a national agenda for education, Hindu-Muslim coexistence and the need to distinguish reason from a blind imitation of the West, continue to resonate. (shrink)

This long-awaited second volume of Russell's best letters reveals the inner workings of a philosophical genius and an impassioned campaigner for peace and social reform. The letters, only three of which have been published before, cover most of Russell's adult life, a period in which he wrote over thirty books, including his famous _History of Western Philosophy_. Richly illustrated with photographs from Russell's life, the collection includes letters to Ho Chi Minh, Tito, Jawaharlal Nehru and Albert Einstein.

Seit der Einführung der G‑DRGs als Instrument zur Vergütung von Krankenhausleistungen steht das Gesundheitswesen als System unter Kritik. Denn die Ausrichtung der Krankenhäuser auf wirtschaftlichen Erfolg relativiert den Anspruch aller Bürgerinnen und Bürger auf gute medizinische Versorgung. Der Artikel geht der Frage nach, von welchem Akteur im System welche Aktivität erzwungen, erwartet, oder verlangt werden kann, dem entgegenzuwirken. Die genannten alltagsmoralischen Urteile werden unter Rückgriff auf Kants Moralphilosophie validiert und auf die wichtigsten Akteure angewandt. Ergebnis: Der Kern des Ökonomisierungs‑/Kommerzialisierungs-Problems besteht (...) in der Entwertung der Professionalität der patientennahen Berufe. Die Neujustierung des Systems kann vom Gesetzgeber nur dann verlangt werden, wenn die verfasste Ärzteschaft sich dazu bekennt, mit den ihr zu Gebote stehenden Mitteln gegen professionswidrige Handlungsanreize vorzugehen. (shrink)

Proceeding of the 22nd International Congress of Vedanta, organized at the Special Center for Sanskrit Studies, Jawaharlal Nehru University, New Delhi during December 27-30, 2015.