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Miraldo, Marisa. "Essays in health care financing." Thesis, University of York, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441019.
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Woode, Maame Esi. "Health care financing and the macroeconomy." Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM1101.
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Cette thèse examine différents aspects du financement de la santé et ses effets sur l'accumulation de variables stratégiques pour le développement. Le deuxième chapitre analyse les effets des risques de maladie sur l'éducation des enfants en utilisant un model théorique et empirique qui lie les risques (pour les parents) de tomber malade et le choix de l'éducation. Nous trouvons que, s'il est impossible pour les parents de demander plus d'argent en cas de maladie, une augmentation de la probabilité de tomber malade implique une réduction de l'éducation des enfants. Le chapitre trois étudie empiriquement l'effet de l'assurance maladie sur l’enfant en employons la méthode de scores de propension pour analyser l'effet moyen du traitement (chef de ménage ayant une assurance santé ou non) sur les traités. Nous trouvons que l'assurance maladie favorise l'éducation des enfants. Le chapitre quatre étudie, en utilisant le modèle de générations imbriquées, les effets du financement de la santé sur la croissance économique. Le gouvernement a deux possibilité: soit de co-financer la santé, soit la financer tout seul en utilisant une taxe sur la production. Nous trouvons que, s'il y a hétérogénéité des préférences des agents, le financement public domine le co-financement public-privé. Le dernier chapitre étudie les effets d’épidémies sur la pauvreté, dans un modèle de générations imbriquées continu. Nous trouvons que l'investissement dans les variables qui réduisent la transmission de la maladie est nécessaire pour pousser d'un état stationnaire avec faible consommation/niveau d'actifs vers un état stationnaire avec un mixe consommation-niveau d'actifs plus élevéThis thesis explores different aspects of the financing of health care and how it affects various facets of the economy. Chapter two we studies the relationships between health risks and education using both a theoretical and an empirical model. We find that considering a child's income as an insurance asset can reverse the usual negative relationship between disease prevalence and educational investment. Chapter three empirically looks at the impact of health insurance on the child using the propensity score matching technique. We find that while the health insurance status of the household has a positive effect on the enrolment of children, its effect on child work is negative. In chapter four we analyse the impact of health care financing on economic growth, focusing on the issue of joint public-private financing of health care using an overlapping-generations model with endogenous growth based on health human capital accumulation, where families pay for childhood preventive care and the government can either fully finance or co-finance adulthood curative care. From a growth maximising perspective, if agents are assumed have heterogeneous preferences, full public financing can become the best option. Finally in chapter five we study how health shocks in the form of epidemics affects the economy in a continuous OLG model by focusing on how the economy could be pushed to a higher consumption-assets combination. We find that it is necessary for the government to invest more in the reduction of transmission rates if its goal is to eradicate the disease from the economy, achieving a higher consumption-assets mix
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Wu, Yaping. "Essays on health care financing and health services." Thesis, Toulouse 1, 2014. http://www.theses.fr/2014TOU10007.
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Le monde dépense une part significative et en augmentation constante de ses ressources sur les soins de santé. Les débats sur les modèles de financement des soins de santé et sur les méthodes de paiement des praticiens se déroulent dans le monde. Néanmoins, il n’existe toujours pas de consensus sur le choix idéal des mécanismes de financement. Cette thèse vise à contribuer aux débats sur le financement des soins de santé et sur la politique des services de santé. Le chapitre premier examine la règle de compensation non-linéaire optimale des praticiens, le principe selon le paiement à la performance, le paiement à l’acte et la capitation en présence à la fois l’antisélection et l’aléa moral au niveau de l’offre. Nous avons trouvé que lorsque l’aléa moral est le seul problème, le paiement à l’acte ne peut que conduire à la substitution de la quantité de traitement par rapport à l’effort du praticien, ce qui est inefficace. En conséquence, le paiement à l’acte ne devrait être utilisé dans ce cas. Toutefois, lorsque l’aléa moral se combine au problème de l’antisélection, un screening efficace requiert une utilisation continue du système de paiement à l’acte pour les praticiens à faible productivité et un moindre recours au système du paiement à la performance. L’élaboration de l’utilisation du paiement améliore le screening. Nous apportons des arguments sur l’analyse critique des points faibles du paiement à l’acte. Et, plus important encore, nous établissons les raisons de l’utilisation continue du paiement à l’acte malgré le fait que de sérieux problèmes concernant ce système aient été largement reconnus. Le chapitre deux analyse le problème du contrat trilatéral entre le payeur, le patient et le praticien, lorsque le praticien et le patient peuvent s’entendre pour exploiter des opportunités avantageuses à l’un et à l’autre. En prenant pour hypothèse qu’un transfert secondaire entre le patient et le praticien est exclu, nous analysons le problème de la mise en place du mécanisme où le praticien et le patient soumettent la réclamation du diagnostic au payeur par un jeu de déclaration. Nous en déduisons aussi le schéma optimal de l’assurance et du paiement pour le patient et le praticien. Le schéma optimal de l’assurance et du paiement qui est collusion-proof (faible) est tel que l’un des deux dise la vérité ; mais l’arbitrage du payeur est différent selon les différentes manières qu’il choisit pour répartir les incitations entre le patient et le praticien. De plus, nous montrons que si le payeur parvient à demander aux deux parties de présenter le diagnostic de manière séquentielle, l’avantage du pouvoir de veto du second agent permet au payeur de réaliser le meilleur résultat. Mon domaine d’étude secondaire traite de l’économie du développement. Le troisième chapitre a pour but d’examiner si la migration des villages vers les villes entraîne une éviction des contrats informels de partage de risque et conduit des ménages à une moindre (auto-)assurance de consommation des villages Thai. Pour ce qui concerne la motivation théorique, notre idée est que la migration peut être utilisée comme un contrat d’investissement réalisé à l’avance entre le ménage et l’enfant. Le ménage investit en payant d’avance en échange de versements futurs dépendants des circonstances, ce qui change le processus de revenus du ménage. Pour l’estimation, nous avons utilisé le tableau de Townsend Thai Annual Surveys (1997-2010). L’hypothèse d’aucun biais de sélection est rejetée au niveau du marché de l’assurance du village, ce qui conforte notre conjecture selon laquelle la migration change le statut de partage des risques des ménages à l’intérieur du village. Lorsque les biais sont corrigés, nos résultats montrent que la migration entraîne une éviction du partage des risques informels dans le village et conduit même à une diminution de l’(auto)assurance de consommation des ménages ThaiThe world spends a significant and increasing share of its resources on health care. The debates on the models of health care financing and the methods of payment for the physician continue all over the world. Nevertheless, there is still no consensus on the ideal choice of financing mechanisms. This thesis aims at contributing to the debates on the health care financing and health service policy. Chapter one examines the optimal non-linear compensation rule of physicians under pay-for-performance, fee-for-service and capitation in the presence of both adverse selection and moral hazard on the supply side. We found that when moral hazard is the only problem, fee-for-service can only lead to the substitution of treatment quantity to physician’s effort, which is inefficient. Consequently, fee-for-service payments should not be used in this case. However, when moral hazard is combined with the adverse selection issue, an efficient screening requires a continued use of fee-for-service for the lower productivity physicians and less pay-for-performance. The design of the use of fee-for-service effectively improves screening. We provide an argument for the criticism on the shortcomings of fee-for-service. More importantly, we also provide a rationale for the continued use of fee-for-service payment even though the serious problems with fee-for-service have been widely acknowledged. Chapter two analyzes the three-party contracting problem among the payer, the patient and the physician when the patient and the physician may collude to exploit mutually beneficial opportunities. Under the hypothesis that side transfer is ruled out, we analyze the mechanism design problem when the physician and the patient submit the claim to the payer through a reporting game. We also derive the optimal insurance payment scheme for the patient and the physician. The insurance payment scheme which is (weak) collusion-proof is such that it is sufficient that one of them tells the truth ; but the payer’s trade-offs are different when he chooses different manners of splitting incentives between the patient and the physician. Moreover, we show that if the payer is able to ask the two parties to report the diagnosis sequentially, the advantage of the veto power of the second agent allows the payer to achieve the first best outcome. My secondary field is Development Economics. The third chapter examines whether migration crowds out informal risk-sharing contracts and leads to less consumption insurance for households in Thai villages. For the theoretical motivation, our idea is that migration may be used as a cash-in-advance contract between the household and the child. The household invests upfront in exchange for future state-contingent remittance which changes the income process of the household. For the estimation, We use the panel from Townsend Thai Annual Surveys (1997-2010). The hypothesis of no selection bias is rejected at within village insurance market level, which supports our conjecture that migration changes the risk-sharing status of households within village. After the bias are corrected, our results show that migration crowds out informal risk-sharing within village and even leads to less consumption insurance for households in Thai villages
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何知行 and Chi-hang Bruce Ho. "Health care financing options for Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31966822.
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Ho, Chi-hang Bruce. "Health care financing options for Hong Kong." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25139526.
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Chan, David C. (David Cchimin). "Essays on health care delivery and financing." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/81038.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2013.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 167-172).
This thesis contains essays on health care delivery and financing. Chapter 1 studies the effect of organizational structure on physician behavior. I investigate this by studying emergency department (ED) physicians who work in two organizational systems that differ in the extent of physician autonomy to manage work: a "nurse-managed" system in which physicians are assigned patients by a triage nurse "manager," and a "self-managed" system in which physicians decide among themselves which patients to treat. I estimate that the self-managed system increases throughput productivity by 10-13%. Essentially all of this net effect can be accounted for by reducing a moral hazard I call "foot-dragging": Because of asymmetric information between physicians and the triage nurse, physicians delay discharging patients to appear busier and avoid getting new patients. Chapter 2 explores the development of physician practice styles during training. Although a large literature documents variation in medical spending across areas, relatively little is known about the sources of underlying provider-level variation. I study physicians in training ("housestaff") at a single institution and measure the dynamics of their spending practice styles. Practice-style variation at least doubles discontinuously as housestaff change informal roles at the end of the first year of training, from "interns" to "residents," suggesting that physician authority is important for the size of practice-style variation. Although practice styles are in general poorly explained by summary measures of training experiences, rotating to an affiliated community hospital decreases intern spending at the main hospital by more than half, reflecting an important and lasting effect of institutional norms. Chapter 3, joint with Jonathan Gruber, examines insurance enrollee choices in a "defined contribution exchange," in which low-income enrollees are responsible for paying for part of the price of insurance. Estimating the price-sensitivity of low-income enrollees for insurance represents a first step for understanding the implications of such a system that will soon become widespread under health care reform. Using data from Massachusetts Commonwealth Care, we find that low-income enrollees are highly sensitive to plan price differentials when initially choosing plans but then exhibit strong inertia once they are in a plan.
by David C. Chan.
Ph.D.
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Akazili, James. "Equity in Health Care Financing in Ghana." Doctoral thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/9390.
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Includes bibliographical references.Financial risk protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". The study (the first of kind in Ghana) measured the relative progressivity of health care financing mechanisms, the catastrophic and impoverishment effect of direct health care payments, as well as evaluating the factors affecting enrolment in the national health insurance scheme (NHIS), which is the intended means for achieving equitable health financing and universal coverage in Ghana. To achieve the purpose of the study, secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other ministries and departments, and further complemented with primary household data collected in six districts. In addition 44 focus group discussions with different groups of people and communities were conducted. In-depth interviews were also conducted with six managers of District NHI schemes as well as the NHIS headquarters. The study found that generally Ghana's health care financing system is progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes which account for over 50% of health care funding. The national health insurance levy is mildly progressive as indicated by a Kakwani index of 0.045. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are associated with significant catastrophic and impoverishment effects on households. The results also indicate that high premiums, ineffective exemptions, fragmented funding pools and perceived poor quality of care affect the expansion of the NHIS. For Ghana to attain adequate financial protection and ultimately achieve universal coverage, it needs to extend cover to the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the NHI. Furthermore, the funding pool for health care needs to grow and this can be achieved by improving the efficiency of tax collection and increasing the budgetary allocation to the health sector.
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Mak, Yuen-yung, and 麥菀容. "Hong Kong's health financing system." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B50255745.
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Despite attempts to contain health care cost, healthcare expenditure has been surging worldwide. Healthcare financing remains high on the political agenda and nations are struggling hard to balance cost containment with service quality, accessibility, efficiency, etc (Froetschel 2011). Hong Kong, of no exception, faces increasing pressure to raise public expenditure on health and is seeking new ways to finance healthcare. This paper attempts to provide an overview of Hong Kong’s existing health financing system and identify possible reform options.published_or_final_version
Politics and Public Administration
Master
Master of Public Administration
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Chan, Hung-yee. "Health care delivery and financing in Hong Kong." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B23294735.
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Bogg, Lennart. "Health care financing in China : equity in transition /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-270-1/.
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Chan, Hung-yee, and 陳鴻儀. "Health care delivery and financing in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31966445.
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Sun, Xiao Ming. "Health access and health financing in rural China." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263121.
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Mutopo, Yvonne. "Rethinking health care financing models: the case of Zimbabwe's health sector." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27236.
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The purpose of the current study was to assess how RBF performed in terms of efficiency, effectiveness, equity and governance in the Zimbabwean context. It outlines the evolution of health systems thinking and health funding models over time to show the history and changing landscape of health care financing and their actors. General consensus is there is need to focus on results of health care investments against a background of prodigious amounts of foreign aid with marginal or no improvements in heath care delivery for decades of development assistance in developing countries. Health systems in developing countries are beset with burgeoning domestic and foreign debts as well as diminishing fiscal space that has more often put the primary health delivery system in developing nations in "comatose". The research made use of both qualitative and quantitative dimensions. Findings indicate that the pre-RBF era was characterised by poor primary health outcomes, unsound governance and a lack of confidence in the public health delivery system. However, since RBF implementation, access to health care by marginalised groups has increased, with incentives and community participation liberalising health systems to greater efficiency as shown by slight increases in post-natal care visits in rural health care centres. A trade-off between achieving efficiency and equity was found especially when scaling up health programmes under the RBF initiative. Through embracing RBF, the primary health delivery system is poised for future development attributed to community buy-in and people-centric empowerment approaches.
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Ngai, Wing William, and 魏詠. "Review on health care financing options for Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42997653.
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Nyanjom, Eric Othieno. "Equity in health care financing and delivery in Kenya." Thesis, University of Sussex, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424190.
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Yu, Chai Ping. "Equity in health care financing : the case of Malaysia." Thesis, University of Nottingham, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.479345.
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Ngai, Wing William. "Review on health care financing options for Hong Kong." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42997653.
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Patcharanarumol, Walaiporn. "Health care financing for the poor in Lao PDR." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2008. http://researchonline.lshtm.ac.uk/4646530/.
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As in many other developing countries, an official policy of user fees was adopted for the Lao health system in the 1990s. In principle, the poor were to be exempted from paying user fees at public health providers. This study aimed to contribute to policy on financial protection of the poor by (1) improving understanding of health care utilization and strategies adopted by households to deal with costs of Illness; (2) examining attitudes of policy makers and actual practice of public health care providers on fee exemptions of the poor; and (3) proposing better ways of protecting the poor. Both quantitative and qualitative methods were employed. Data were collected from 172 households of 4 villages in Savannakhet Province; 26 public providers in Savannakhet Province and 3 public providers in Vientiane capital; and 22 policy makers in Vientiane capital, between October 2005 and July 2006. The exemption policy has been ineffectively implemented. In practice, criteria for identifying the poor were not specified and no budget was provided to hospitals to finance exemptions. Providers preserved exemptions for 'the destitute'. The payment of user fees could be delayed without interest when 'the poor' had insufficient cash. Villagers strongly believed in the principle of paying user fees to providers either at the point of service or through delayed payment, even though they lived In difficult conditions and their average consumption was below $US1.00 a day. Importantly, they did not perceive exemption from fees to be possible for 'the poor'. The majority of households did not access health care services when III for reasons such as financial and geographical barriers; some of them suffered adverse health consequences as a result such as death or disability. The better the socio-economic group, the better was access to health care services. Among a total of 172 sampled households, twelve households were faced with catastrophic health expenditure, most from the middle and poorest socio-economic group. The villagers managed health crises themselves mainly through drawing on social networks within the community in order to sell assets, borrow, and get other forms of support from neighbours. Although the study of households was small in scale, it was likely to echo households' difficulties elsewhere as the studied villages were similar to other rural areas without roads of Lao PDR. This study suggests that there is an urgent need for the government to improve two main areas: accessibility to adequate health care for everyone, everywhere; and reform of the nationwide policy on health financial risk protection for the poor and the less-poor in order to reduce catastrophic health expenditure.
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Mulenga, Arnold. "Income redistributive effect of health care financing in Zambia." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/13786.
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Equity in health care financing and progress towards universal health coverage (UHC) have increasingly received recognition and growing attention for their potential to improve health outcomes globally. However, most low income countries and in particular those in sub-Saharan Africa which have borne the greater share of global disease burden have had relatively lesser success in their endeavours to improve their health care financing systems. It is only a few that have made considerable progress towards universal health coverage. Zambia, a developing country struggling with income inequalities and poor progress to achieving universal health coverage, is no exception. The current discussion on countries moving toward universal health coverage, however, requires an understanding of the impact of the prevailing health care financing mechanisms on income distribution. Investigation of an overall income redistributive effect of health care financing thus requires assessing health care financing in relation to the principles of contributing to financing health care according to ability to pay. Zambia is currently considering major health systems reforms toward a universal health system. Health care financing system in Zambia is however faced with numerous challenges that must be addressed prior to meeting this goal. To promote the goal of achieving universal health coverage, there is a need to measure the extent of the redistributive effect of the current health care financing mechanisms. This allows identifying which health care financing mechanisms provide financial protection and promote universal health coverage in the country. With this growing focus on the goal of universal health coverage (UHC), health care financing mechanisms should not only relate to who pays and who receives the benefit, but also to their effects on income distribution. This is because financing of health care may have redistributive effects and equity consequences. This income redistribution may be intended or unintended. Even in the latter case, policy makers may be interested in the degree to which it occurs. This is because it has consequences for the distribution of goods and services other than health care and, ultimately, for welfare. This study investigates the extent to which the current health care financing in Zambia redistributes income, particularly whether or not it reduces income inequality. The study seeks to evaluate an overall pattern of income redistributive effect of the current health care financing mechanisms. It specifically assesses the income redistributive effect of two broad health care financing mechanisms; general tax and out of pocket (OOP) payments. Using a standard procedure for analyzing income redistribution of health care financing in Zambia, the study decomposes the income redistributive effect of each of the two broad health care financing mechanisms into the vertical, horizontal and reranking components.
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Mtei, Gemini Joseph. "Health care financing progressivity and household risk protection in the context of health system financing reforms in Tanzania." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.590553.
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Lima, Elvira. "The financing health care : an analysis of the impact of the Portuguese hospital financing systems." Thesis, University of Nottingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.267133.
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Jasaitytė, Neringa. "Financing of Health Care System in Lithuania and its Efficiency." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2010. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2010~D_20100623_094255-19127.
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This Thesis focuses on the health care system in Lithuania and discusses the manifestations and reasons of its inefficiency. The major problems in this sector are inappropriate allocation of funds and inefficient use of resources possessed, which lead to quite low performance of the overall system. The aim of the Thesis is to find relations linking selected factors such as expenditure on pharmaceuticals or number of hospital beds to the health care spending, and to see, which resources are used in the most inefficient way.
The empirical research is divided into costs dissection, done by applying fixed effects panel regression, and system efficiency examination, conducted using data envelopment analysis technique. The findings revealed that declining numbers of hospital beds and inpatient consultations do not lower health care spending and might even result in its increase. Meanwhile, data envelopment analysis confirmed that a large proportion of inefficiency in the health care sector can be addressed to overstaffing. It also showed that problems are much higher in Central and Eastern Europe countries, where the resources should be reduced by on average 30% compared to required reductions of 10% in Western Europe. On the other hand, the overall system efficiency analysis revealed that high spending does not necessarily lead to good performance of the system in terms of health status or country’s health care system’s rating.
One of the conclusions drawn from the conducted... [to full text]Šiame darbe yra aptariama Lietuvos sveikatos apsaugos sistema ir jos neefektyvumo apraiškos bei priežastys. Pagrindinės problemos, susijusios su analizuojama sritimi, yra netinkamas lėšų paskirstymas ir neefektyvus turimų išteklių panaudojimas, nulemiantys sistemos žemesnę kokybę. Atliekamo tyrimo tikslas – nustatyti ryšius, siejančius išlaidas sveikatos apsaugai ir įvairius sistemos elementus, kaip kad išlaidos vaistams ar ligoninių lovų skaičius, bei suprasti, kurie iš turimų išteklių panaudojami neefektyviausiu būdu. Empirinis tyrimas yra padalintas į išlaidų nagrinėjimą naudojant fiksuotų efektų panelinę regresiją bei sistemos efektyvumo tyrimą, vykdomą pasitelkiant duomenų apgaubimo analizės techniką. Gauti rezultatai atskleidė, jog mažėjantys ligoninių lovų ar ligonių apsilankymų stacionare skaičiai neskatina išlaidų sveikatos apsaugai smukimo, o netgi gali lemti jų išaugimą. Tuo tarpu duomenų apgaubimo analizė patvirtino tai, jog ypač didelę reikšmę sistemos neefektyvumui turi per didelis sveikatos apsaugos darbuotojų skaičius. Taip pat pastebėta, jog ši problema ypač didelė rytų Europos šalyse, kur ištekliai turėtų būti sumažinti vidutiniškai 30%, lyginant su 10% sumažinimu siūlomu vakarų šalims. Kita vertus, analizuojant bendrą sistemos efektyvumą nustatyta, kad didelės išlaidos sveikatai nebūtinai reiškia gerą gyventojų sveiktos būklę ar aukštus šalies rezultatus sveikatos apsaugos sistemų reitinguose. Viena iš šio darbo išvadų yra ta, jog prieš imantis kokių nors... [toliau žr. visą tekstą]
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Balabanova, Dina Chadarova. "Financing the health care system in Bulgaria : options and strategies." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/682297/.
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The transition to democracy in 1989 forced the Bulgarian health system to change. Falling government revenues and popular demand for a more transparent regime brought pressure for a new system of financing. The process of reform was slow and inconsistent. In part this reflected a lack of political will but there was also an absence of relevant information on the consequences of different options. This thesis seeks to fill this gap by means of an integrated series of studies to analyse the previous system and evaluate the options for change. The research uses literature review, documentary analysis, quantitative research (a population based survey) and qualitative research (interviews and focus groups). The research documents the scale of inequalities in health and health seeking behaviour. Self reported health varies considerably. Utilisation is more evenly distributed, although the poor access less care after allowance for their poorer health. They are also more likely to be cared for in lower tiers in the system. Informal transactions play an important role in the Bulgarian health care system. This has two components. One is a traditional 'culture of gifts which typically imposes no more than minor inconvenience and is not a prerequisite to receive care. A second has appeared more recently. It compensates for genuine shortages and reductions in salaries and does have an impact on access. The existing financing system is regressive and hospital stays can incur considerable expenditure. This is generally found from current income and there was little evidence of ill health leading to impoverishment. This was, however, largely because of the persistence of strong informal support mechanisms. The introduction of social insurance is seen as a solution to the problems of the existing system and receives widespread support, but it is poorly understood. The misconceptions threaten its sustainability. This thesis demonstrates how different methods can be integrated to evaluate a health care financing system and provides important new insights into payment for health care in countries in transition.
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Fan, Yun-sun Susan, and 范瑩孫. "Medical insurance: the solution to health care financing in Hong Kong?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1992. http://hub.hku.hk/bib/B31964047.
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Fan, Yun-sun Susan. "Medical insurance : the solution to health care financing in Hong Kong? /." [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13236404.
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Mbatsha, Sandi Andrew. "Decentralised resource allocation and its impact on equitable health care financing." Master's thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/11186.
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Includes abstract.Includes bibliographical references (leaves 81-87).
The main objectives of this thesis are to: (i) Map the financing of non-hospital primary health care within local government areas in South Africa; analyse the equity of financing health care in relation to need (iii) and document the process followed at provincial and local government level in decision making around budgeting for non-hospital Public Health Care services.
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Juin, Sandrine. "Care for dependent elderly people : dealing with health and financing issues." Thesis, Paris Est, 2016. http://www.theses.fr/2016PESC0052/document.
Full textAbstract:
Dans un contexte de vieillissement rapide de la population, cette thèse explore les liens existants entre santé et modes de prise en charge des personnes âgées dépendantes et s'intéresse à la question du financement de la dépendance.La satisfaction des besoins d'aide des personnes âgées dépendantes constitue un objectif central de politiques publiques. Le Chapitre 1 estime l'effet de l'aide informelle (i.e. familiale) et de l'aide formelle (i.e. professionnelle) à domicile sur la santé mentale des personnes âgées dépendantes en France. Les résultats montrent que l'aide informelle réduit le risque de dépression et que l'aide formelle peut améliorer la santé mentale générale.De récentes études reconnaissent qu'aider un proche dépendant a des effets négatifs sur la santé des aidants et soulignent l'importance de les soutenir. Le Chapitre 2 s'intéresse à l'effet du soutien social sur la santé des aidants informels. Il montre que l'aide formelle et le soutien informel réduisent les problèmes de santé mentale associés à l'activité d'aide.Enfin, étant donné la pression financière et fiscale qui pèse sur les systèmes publics, le Chapitre 3 étudie dans quelle mesure les Européens seraient capables de financer leurs périodes de dépendance sur la base de leurs revenus et de leur patrimoine financier et immobilier. Il s'intéresse également au rôle du prêt viager hypothécaire. Les simulations soulignent que seule une faible proportion des individus serait capable de financer l'ensemble de ses dépenses de dépendance. Par ailleurs, le patrimoine immobilier pourrait jouer un rôle important dans le financement de la dépendanceIn the context of a rapidly aging population, this doctoral dissertation explores the relationship between health and long-term care arrangements and addresses the issue of the financing of long-term care.Meeting the needs of dependent elderly is an important objective of public policy. Chapter 1 estimates the effects of both informal (i.e. family) care and formal (i.e. professional) home care on the mental health of French dependent elderly. The results highlight that informal care decreases the risk of depression and that formal care can improve general mental health.Recent studies acknowledge that providing informal care has adverse health effects and emphasize the importance of supporting caregivers. Chapter 2 examines the effect of social support on caregivers' health. It shows that formal care and informal support limit the negative consequences of caregiving on mental health.Finally, given the increasing financial and fiscal pressure on public systems, Chapter 3 investigates to what extent Europeans elderly are able to pay for their periods of long-term care needs on the basis of their income, financial assets and home equity. It also studies the role of reverse mortgages. The simulations stress that only a small proportion of individuals would be able to finance totally their long-term care expenses and that housing assets may play an important role in long-term care financing
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Vambe, Adelaide K. "An examination of health care financing models : lessons for South Africa." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1020036.
Full textAbstract:
South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.
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Vambe, Adelaide Kudakwashe. "An examination of health care financing models : lessons for South Africa." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1021110.
Full textAbstract:
South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.
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Chireshe, Jaison. "Financial development, health care system financing and health outcomes: Evidence from sub-Saharan Africa." University of the Western Cape, 2018. http://hdl.handle.net/11394/6691.
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Philosophiae Doctor - PhDThis thesis purposes to examine the impact of financial development on health outcomes, health care expenditure and financial protection in health in 46 selected sub-Saharan African (SSA) countries from 1995 to 2014. It also estimates the impact of health care expenditure on health outcomes. The thesis is premised on the hypothesis that health care expenditure is a critical transmission mechanism through which financial development leads to better health outcomes. The health care expenditure channel is conspicuously absent in the literature on financial development and health outcomes; hence the need for this study to fill the gap in the literature. The thesis explores the effects of both depth and access dimensions of financial development on health outcomes, expenditure and financial protection. Throughout the study, financial access is measured by the number of automated teller machines (ATMs) and commercial bank branches per 100 000 people, while financial depth is measured by the proportion of broad money and bank credit to the private sector, to Gross Domestic Product (GDP). The study uses fixed and random effects and the Two-Stage Least Squares estimation approaches. The Generalised Method of Moments (GMM) is also used to estimate the impact of health care expenditure and health outcomes given the absence of valid instrumental variables. The results of the regression analyses show that financial development leads to increased health care expenditure and health outcomes. The analysis also shows that health care expenditure leads to better health outcomes. Additionally, the study indicates that financial development leads to financial protection in health care by reducing out-of-pocket health care expenditure. Well-developed financial systems provide financial protection from the risk of catastrophic health care expenditure and impoverishment resulting from illness. The study shows that health care systems financed through prepaid mechanisms reduce neonatal, infant and under-five mortality rates and increase life expectancy, while those relying on out-of-pocket expenditure have adverse effects on health outcomes.
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Govender, Moganambal. "The financing of health care and health sciences education and training in South Africa." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/9549.
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Includes bibliography.The aim of this study was to critically analyse the funding and expenditure patterns of institutions training health personnel. This included an investigation of the distribution of income from the various sources by geographic areas (i.e. by province), between historically white and black training institutions and between those institutions that are attached to academic hospital complexes and those which are not. The study also attempted, where possible, to determine the unit costs of training different cadres if health personnel. The methodology included a review of the literature on health personnel education and training, a questionnaire survey of nursing colleges and PDoHs in South Africa, and analysis of the Department of Education's South African Post-secondary Education (SAPSE) data base, which records and monitors the funding, staffing and student data of universities and technikons in South Africa.
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Mwase, Takondwa Lucious. "Health care financing and expenditure in Malawi : do efficiency and equity matter?" Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/9677.
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Bibliography: leaves 113-118.The Malawian sector spent about 3.3% of its GNP on health services in 1995/96. The public sector alone spent about 6.2% of its total revenue on health services and this is much high than most other Sub- Saharan African countries (e.g. Zambia, Kenya, Uganda). Despite such high levels of public expenditure, Malawi’s social and health indicators are among the worst in the world. The majority of the Malawian population suffer from a large amount of preventable illness and premature death which could be treated/prevented by simple inexpensive medical interventions. This scenario raises questions with regard to the government stated priority to primary health care and preventive health services. This investigation therefore was undertaken in order to quantify the total health care expenditure in Malawi and its distribution and then evaluate its equity and efficiency implications for the delivery of health services. The analyses focused on the public health sector due to the fact that the public health sector is the largest provider of health services in Malawi and its services are fiee of charge. It was therefore felt that a detailed analysis and evaluation of this sector could go a long way in improving the health status of the majority of Malawians within the resource envelope.
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Mwenge, Felix. "Progressivity and determinants of out-of-pocket health care financing in Zambia." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12369.
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Includes bibliographical references.The need for health care financing mechanisms that are progressive in Zambia cannot be over-emphasized. It is necessary that health care financing mechanisms are in such a way that they are related to ability to pay. This is an equity objective. This is the main motivation for this study. It is envisaged that this study will provide empirical evidence on the progressivity and determinants of OOP payments. This information is important for policy making regarding health care financing.
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Al-Haque, Shahed. "Responding to traveling patients' seasonal demands for health care services in the Veterans Health Administration." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/81112.
Full textAbstract:
Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, 2013.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 60-62).
The Veterans Health Administration (VHA) provides care to over eight million Veterans and operates over 1,700 sites of care distributed across twenty-one regional networks in the United States. Health care providers within VHA report large seasonal variation in the demand for services, especially in healthcare systems located in the southern U.S. that experience a large influx of "snowbirds" during the winter. Since the majority of resource allocation activities are carried out through a single annual budgeting process at the start of the fiscal year, the seasonal load imposed by "traveling Veterans," defined as Veterans that seek care at VHA sites outside of their home network, make providing high quality services more difficult. This work constitutes the first major effort within VHA to understand the impact of traveling Veterans. We found a significant traveling Veteran population (6.6% of the total number of appointments), distributed disproportionately across the VHA networks. Strong seasonal fluctuations in demand were also discovered, particularly for the VA Bay Pines Healthcare System, in Bay Pines, Florida. Our analysis further indicated that traveling Veterans imposed a large seasonal load (up to 46%) on the Module A clinic at Bay Pines. We developed seasonal autoregressive integrated moving average (SARIMA) models to help the clinic better forecast demand for its services by traveling Veterans. Our models were able to project demand, in terms of encounters and unique patients, with significantly less error than the traditional historical average methods. The SARIMA model for uniques was then used in a Monte Carlo simulation to understand how clinic resources are utilized over time. The simulation revealed that physicians at Module A are over-utilized, ranging from a minimum of 92.6% (June 2013) to maximum 207.4% (January 2013). These results evince the need to reevaluate how the clinic is currently staffed. More broadly, this research presents an example of how simple operations management methods can be deployed to aid operational decision-making at other clinics, facilities, and medical centers both within and outside VHA.
by Shahed Al-Haque.
S.M.in Technology and Policy
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Hernandez, Cynthia Lynn. "Adapting the Lean Enterprise Self Assessment Tool for health care." Thesis, Massachusetts Institute of Technology, 2010. http://hdl.handle.net/1721.1/62768.
Full textAbstract:
Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2010.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 61-63).
The Lean Enterprise Self Assessment Tool (LESAT) is a product of the Lean Advancement Initiative (LAI) and the Massachusetts Institute of Technology. This tool has been applied by many organizations to gage their progress toward lean enterprise management, however applying this tool in health care organizations has been inhibited by language and underlying assumptions from product manufacturing. An adaptation of the LESAT specifically for health care is proposed. Review of the literature and special reports on health care are used in determining the recommended changes. "Product life cycle" is reinterpreted as a health care service cycle and context specific enterprise level processes and practices are presented. Comparison to other industry measures shows the content the LESAT for health care to cover all key issues and practices for high quality health care delivery.
by Cynthia Lynn Hernandez.
S.M.in Engineering and Management
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Alspaugh, Jonathan D. (Jonathan Douglas). "The effects of licensing and equity financing cycles on pharmaceutical development." Thesis, Massachusetts Institute of Technology, 2011. http://hdl.handle.net/1721.1/68461.
Full textAbstract:
Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2011.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 30).
The purpose of this paper is to examine the interactions between licensing status, equity issuance cycles, and drug development success at the small pharmaceutical companies that originate these development projects. Specifically, this paper is aimed at identifying how financing alternatives available to small pharmaceutical companies influence development success and firm behavior. The hypotheses developed and tested in this paper are as follows: H 1: Pharmaceutical development projects that are licensed are more likely to advance to the next stage in the clinical development process. H2: A licensed pharmaceutical development projects' likelihood of advancing to the next stage of the clinical development process will depend on the amount of equity issuance during the period in which the project was licensed. H3: Pharmaceutical development projects that are licensed during periods of low equity issuance are more likely to advance to the next stage in the clinical development process than projects that were not licensed or were licensed but not in a low equity issuance period. H4: Pharmaceutical development projects that originate at firms that have multiple projects in development at the beginning of a particular clinical trial stage are less likely to advance from phase I to phase II, but more likely to advance in later stages. H5: Pharmaceutical development projects that originate at firms that have previously launched a project in the market are more likely to be launched in the market. The results of a logistic regression analysis suggest that drugs licensed in periods of lowest equity issuance exhibit a higher rate of advancement from phase II to phase III. The relationship between advancement and amount of equity issuance at the time of licensing suggests that the lower the equity issuance in the licensing period the more likely the drug will advance. These results point to the possible existence of a "lemons" phenomenon in the market for pharmaceutical development projects. However, a different interpretation of the results suggests that large pharmaceutical company licensees are superior evaluators of quality and are perhaps more selective and opportunistically license higher quality drugs when equity issuance is low and licensors have no other financing options. Both interpretations point to the issue of information asymmetry as a central theme to this work.
by Jonathan D. Alspaugh.
S.M.
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Miller, Brian L. K. "Financing the "Valley of Death" : an evaluation of incentive schemes for global health businesses." Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/54591.
Full textAbstract:
Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2009.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 80-84).
Many early-stage biotech companies face a significant funding gap when trying to develop a new drug from preclinical development to a proof of concept clinical trial. This funding gap is sometimes referred to as the "valley of death", a reflection of the vast number of companies that are unable to raise the needed capital to progress into the clinic. The suggestion behind the "valley of death" phrase is that companies that should be able to attract investment do not get funded, because (1) the technical risks inherent in taking a new drug through clinical trials are high, (2) a significant amount of capital is needed to finance clinical development, and (3) the time horizon of investment is on the order of 6-8 years. Ultimately, the valley of death reflects the perceived imbalance of risk and reward for an investment at this stage as well as the resulting difficulty for a biotech company in raising capital during this time. For companies focused on a neglected disease, this risk/reward profile is even more skewed, with significantly greater market risks and fewer exit opportunities for an investor. As a result, the "valley of death" phenomenon for a global health company developing a therapeutic for a neglected disease is even more pronounced As a result, private sector funding for translational research of neglected disease therapeutics has beeri severely lacking. In an effort to spur more private sector investment into the development of neglected disease therapeutics, several market design mechanisms have been developed including Advanced Market Commitments (AMCs) and Priority Review Vouchers (PRVs). These market design mechanisms are new and unproven.
(cont.) To date venture capital has not yet flowed in a meaningful way into startup companies focusing on neglected diseases. This is partially attributable to uncertainties surrounding the credibility and value of the incentives, but it also raises the question of whether these incentives will be sufficient to attract venture investment to a small biotech company focused on neglected diseases. The objective of this thesis is to explore the potential impact of these market design mechanisms on the financial prospects of early stage, pre-revenue biotech companies focused on neglected diseases, including an evaluation of whether the incentives will be sufficient to attract venture investment to the company. To accomplish this, a simulation model was created to compare the relative impacts of these incentive schemes on a small biotech company focused exclusively on a neglected disease therapeutic. The simulation data presented herein reflect the inherent tensions between the social benefit of a neglected disease therapeutic and the need for investors to pursue a financial return commensurate with the risk of the investment. I conclude that, while market design mechanisms like PRVs and AMCs are an intriguing first step, a dual market strategy is likely still necessary for a neglected disease company to attract private investment.
by Brian L. K. Miller.
S.M.
38
Fowler, Katherine Szabo. "Evolutionary struggles of supply chain strategy in home-based health care delivery." Thesis, Massachusetts Institute of Technology, 2008. http://hdl.handle.net/1721.1/45224.
Full textAbstract:
Thesis (M. Eng. in Logistics)--Massachusetts Institute of Technology, Engineering Systems Division, June 2008.Includes bibliographical references (leaves 68-72).
As the healthcare industry in United States continues to be constrained by increasing costs, new delivery channels are coming into practice. One such channel is home healthcare. Home healthcare presents challenges on the basis of acceptability by the medical community, insurers and patients, availability of care in fragmented locations and affordability of the product or service in comparison to other healthcare modes. This study analyzes these challenges in an attempt to suggest strategies to allow home healthcare to grow as an industry and the successful sustainability of that growth. Methods used to analyze home healthcare include the study of two home healthcare firms, one pharmaceutical manufacturer who used home healthcare to augment their product, and in-depth interviews with several stakeholders within the healthcare system.
by Katherine Szabo Fowler.
M.Eng.in Logistics
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Peck, Jordan S. (Jordan Shefer). "Using prediction to facilitate patient flow in a health care delivery chain." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/79504.
Full textAbstract:
Thesis (Ph. D.)--Massachusetts Institute of Technology, Engineering Systems Division, 2013.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 163-178).
A health care delivery chain is a series of treatment steps through which patients flow. The Emergency Department (ED)/Inpatient Unit (IU) chain is an example chain, common to many hospitals. Recent literature has suggested that predictions of IU admission, when patients enter the ED, could be used to initiate IU bed preparations before the patient has completed emergency treatment and improve flow through the chain. This dissertation explores the merit and implications of this suggestion. Using retrospective data collected at the ED of the Veterans Health Administration Boston Health Care System (VHA BHS), three methods are selected for making admission predictions: expert opinion, naive Bayes conditional probability and linear regression with a logit link function (logit-linear regression). The logit-linear regression is found to perform best. Databases of historic data are collected from four hospitals including VHA BHS. Logit-linear regression prediction models generated for each individual hospital perform well based on multiple measures. The prediction model generated for the VHA BHS hospital continues to perform well when predictive data are collected and coded prospectively by nurses. For two weeks, predictions are made on each patient that enters the VHA BHS ED. This data is then summarized and displayed on the VHA BHS internet homepage. No change was observed in key ED flow measures; however, interviews with hospital staff exposed ways in which the prediction information was valuable: planning individual patient admissions, personal scheduling, resource scheduling, resource alignment, and hospital network coordination. A discrete event simulation of the system shows that if IU staff emphasizes discharge before noon, flow measures improve as compared to a baseline scenario where discharge priority begins at 1pm. Sharing ED crowding or prediction information leads to best patient flow performance when using specific schedules dictating IU response to the information. This dissertation targets the practical and theoretical implications of using prediction to improve flow through the ED/IU health care delivery chain. It is suggested that the results will have impact on many other levels of health care delivery that share the delivery chain structure.
by Jordan Shefer Peck.
Ph.D.
40
Fabricant, Stephen Joel. "Community financing in Sierra Leone : affordability and equity of primary health care costs." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1992. http://researchonline.lshtm.ac.uk/682247/.
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Critics of user charges for government primary health care have focussed on the deterrent effect these charges might have on the poor, but there is little convincing empirical evidence that supports or contradicts these claims. The main research aims were to assess the equity effects of user charges for curative PHC services on households in 2 rural districts of Sierra Leone, a country that has suffered severe economic hardship in the last decade. Secondary objectives were to assess the feasibility of using objective means-testing to identify patients for exemption, and to recoimiend a simple methodology for acquiring the same information for local, operational purposes. A survey of 1156 households was carried out in the dry post-harvest season, and covered a range of household economic factors in addition to the actions taken in response to all reported illness episodes. A followup survey was made the following rainy season to assess seasonal effects. Supplementary information was obtained through focus groups and case studies. The data were analyzed within the framework of a conceptual model which assumed that preferences, access, and ability to pay were the main factors (or groups of factors) that determined which of several medical and non-medical treatment options would be used. Multiple regression models were used to assess the effects of each group of factors. The main findings were that, while wealthier households used cheap market drugs and expensive medical treatment options more than the poor, there was little difference in use of medium-priced PHC treatment. Household wealth and income factors correlated weakly with amounts actually paid for treatment. The immediate availability of money in the household appeared to be the economic factor most affecting utilization, with wealthier households nearly as likely = to have the amounts needed for PHC treatment on hand as poorer ones. Distance was a much more important determinant of choice of treatment than was income or assets, as were certain preference factors. However, the poor spent a much higher proportion of household income on treatment than the wealthy, so a way of limiting total expenditures for the poor would be more important than limiting their deterrence. Several readily-ascertained household factors correlated well with household income, but means-testing was concluded to be an inefficient way to accomplish the objective of selectively limiting expenditures unless incorporated into a prepayment scheme.
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Valenzuela, Jose. "Medicare advantage's population make-up and its impact on the future of Medicare financing." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1526966.
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The objective of the study was to validate the assumption that respondents who self-identified as white, were more likely to be enrolled in a Medicare Advantage HMO Plan and underutilize health care services when compared to their non-white counterparts.
The results showed that the majority of the respondents in the stratified population of Medicare eligible respondents were categorized as White, 11,271 out of 15,297, and 42% reported being enrolled in a Medicare Advantage HMO Plan. A total of 3,685 of the White respondents on Medicare Advantage HMO Plans indicated they were in "Good" or better health, which was 78% of all White respondents in this population. The mean number of times that White respondents were seen by an MD (Figure 2) fell within the same range of 5-6 times for the majority of the Race/Ethnic groups. The mean number of hospital stays for Whites and the other Race/Ethnic groups ranged from 1.86-1.92 within the same 12 month period, with the exception of Pacific Islanders.
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Ippolito, Andrea K. (Andrea Katherine). "Architecting the future telebehavioral health system of care in the United States Army." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/79523.
Full textAbstract:
Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 151-159).
Charged by the Chairman of the Joints Chief of Staff, the authors were members of a study to develop innovative recommendations for transforming the military enterprise to better manage post-traumatic stress and related conditions in support of service members and their families. The authors first began their study by performing a stakeholder analysis to understand the unmet needs of stakeholders across the enterprise. By assessing stakeholder values across the life cycle, we found that there was a strong need to improve the continuity of care and accessibility of services for service members and their families, in particular for the Reserve Component and National Guard population. Therefore, the authors investigated the role of technology to serve as a force extender to improve access and timeliness of care to psychological health care services. Specifically, they utilized a systems approach to evaluate the current state of telehealth within the Military Health System. By utilizing the enterprise lenses of strategy, policy, organization, services, processes, infrastructure, and knowledge to analyze the current state of telebehavioral health, they proposed a future state architecture for telehealth delivery. They highlight seven enterprise requirements for developing this future state architecture: 1. MEDCOM shall establish a core funding stream as a line item to support TH service line. 2. MEDCOM Telehealth Service line shall develop standard TBH metrics for deployment across the enterprise 3. MEDCOM Telehealth Service line shall identify eligible populations across the enterprise that could benefit from the expanded access that TBH services provide. 4. MEDCOM Telehealth Service line shall develop an enterprise solution that supports seamless flow of operational information and the electronic health record. 5. MEDCOM Telehealth Service line shall revisit specific policies that are presenting barriers to telehealth growth and sustainability. 6. MEDCOM Telehealth Service line shall encourage learning and best practice sharing across the Army TH enterprise. 7. MEDCOM Telehealth Service line shall collaborate with other Army governance organizations to develop a mobile health strategy and pilot projects for the Army enterprise.
by Andrea K. Ippolito.
S.M.
43
Chong, Stéphane. "The future of primary care : an engineering system approach to fix the U.S. health care system." Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/51654.
Full textAbstract:
Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2009.Includes bibliographical references (p. 75-78).
The ailing U.S. health care system faces two tremendous challenges: a rising health care bill and a growing number of uninsured individuals. Several policies have been enacted to tackle these challenges but they are short-term patchwork solutions rather than long-term holistic solutions needed to address structural issues. Despite the market-based aspect of the U.S. healthcare system, self-correction of structural inefficiencies is unlikely to happen. A new care model has to disrupt the current care system. In line with this observation, we propose to analyze the potential of a new primary care delivery as a solution to address the two key challenges threatening to destabilize the U.S. health care. Based on our analysis of the literature, we note that chronic diseases account for a large proportion of the health care bill. Yet, the delivery model to provide chronic care, where primary care plays a central role, is inefficient, fragmented and insufficient. Compounding these ailments, primary care is facing its own crisis resulting from the shortage of generalist doctors and the inflating demand for primary care services. As primary care is critical for the continuity and coordination of medical care, resolving the urgent situation facing this branch of practice should be a top priority to improve quality of care while reducing health care costs. Every stakeholder in the current health care system should collectively contribute to the primary care model redesign endeavor.
(cont.) To this end, we apply an engineering system approach to devise an appropriate course of actions for health care businesses, health care providers and policy-makers in redesigning primary care. We discuss insights gained through a collaborative project with a local hospital to model and simulate a new primary care practice. These insights were geared to guide decision-makers in the design of care processes, resources allocation and appointment rules. In conclusion, we show that primary care has a critical role to play in the much-needed revolution of the U.S. health care system. It will require active collaboration of health care providers, business leaders and policy-makers to enable this disruptive change.
by Stéphane Chong.
S.M.in Technology and Policy
44
Lavoie, JoseÌe Gabrielle. "Patches of equity : policy and financing of indigenous primary health care providers in Canada." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2005. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417833.
Full text
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Preker, Alexander Shalom. "Public financing of health care in eight Western countries : the introduction of universal coverage." Thesis, London School of Economics and Political Science (University of London), 1991. http://etheses.lse.ac.uk/1167/.
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The public sector of all western developed countries has become increasingly involved in financing health care during the past century. Today, thirteen OECD countries have passed landmark legislative reforms that call for compulsory prepayment and universal entitlement to comprehensive services, while most of the others achieve similar coverage through a mixture of public and private voluntary arrangements. This study carried out a detailed analysis of why, how and to what effect governments became involved in health care financing in eight of these countries. During the early phase of this evolution, reliance on direct out-of-pocket payment and an unregulated market mechanism for the financing, production and delivery of health care led to many unsatisfactory outcomes in the allocation of scarce resources, redistribution of the financial burden of illness and stabilisation of health care activities. This forced the state to intervene through regulations, subsidies and direct provision of services. Expansion in prepayment of health care gradually occurred through private insurance, social insurance and general revenues in response to different socio-economic, political and bureaucratic forces. Although improving health may have been the ultimate goal, offering universal access to affordable health care was the way the countries examined achieved this objective. Universal comprehensive coverage was associated with a decade of stable public expenditure on health care compared with GDP, total government expenditure and government consumption expenditure. There were no disproportionate increases in health care expenditure or displacement of public funds away from social programmes that depended on cash transfer payments. Nor do the countries that offer such social protection have higher public debt or poorer economic performance compared with the rest of the OECD. Measures of health status are unfortunately still not sufficiently developed or standardised to permit a detailed analysis of this aspect of outcome through cross-national comparisons. Furthermore, the countries examined may be more vulnerable to political backlash because of the high visibility of their government involvement in health care financing.
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Okorafor, Okore Apia. "Fiscal federalism an equity in the financing of primary health care: The case of South Africa." Doctoral thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/9414.
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Includes bibliographical references.This thesis investigates the implications of fiscal federalism on the equitable distribution of primary health care resources in South Africa. The study evaluates the processes and criteria for intergovernmental and sector budgeting, the influence of key stakeholders, community involvement in PHC budgeting, and policy objectives of the health sector to assess how they impact on the realisation of an equitable distribution of PHC resources. A combination of qualitative and quantitative analyses was employed in the study. Quantitative analysis of health expenditure and health need data was used to assess whether the distribution of PHC resources has become more or less equitable. Health districts were the units of analysis. Deprivation indices were generated using principal components analysis for each district from demographic and socio-economic variables. The deprivation index was used as a proxy for relative need at the level of districts, and was compared with non-hospital PHC per capita expenditure using regression analysis. This analysis was carried out for per capita PHC from 2001 to 2007. Data on the process for intergovernmental fiscal arrangements and budgeting for health was collected through review of government publications and interviews with government officials. These were analysed thematically. Literature on the subject predicts that if lower levels of government have considerable autonomy in determining primary health care allocations, there is a greater scope for inequities in the distribution of primary health care resources. However, the results of the study are contrary to expectations. Although, the introduction of fiscal federalism in South Africa created an additional constraint to achieving a more equitable distribution of PHC resources, recent trends in primary health care allocations are more equitable than in previous years. A growing public sector budget, consistent increases in health sector allocations, and overwhelming political support for equity in South Africa have been the key reasons for the shifts towards a more equitable distribution of primary health care resources. These findings form the main contribution to the literature on the subject.
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Dawson, Walter. "The CLASS act and long-term care policy : the politics of long-term care financing reform in the United States." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:fa5269a1-8ce2-4105-b643-f9c2fffb23d8.
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This thesis seeks to contribute to the knowledge base about social policy in the United States, using long-term care (LTC) financing policy reform as an illustrative example. Specifically, this thesis explores LTC financing reform efforts during three U.S. Presidential administrations: Bill Clinton (1993-2001), George W. Bush (2001-2009), and Barack Obama (2009-2010). Within this historical framework, the LTC provisions of the Health Security Act of 1993, the development of the Community Living Assistant Services and Supports or 'CLASS' Act during the Bush Administration, and the legislative success of the CLASS Act as a part of the Patient Protection and Affordable Care Act of 2010 provide comparable cases to compare the drivers of social policy. Drawing on the explanatory frameworks of the welfare state such as ideology, historical institutionalism, and an actor-centered approach to policy analysis, this thesis argues that successful path-departing legislation is difficult to achieve due, in part, to the presumed high costs of social programs and the complex institutional framework of the American political system. Policy outcomes result from the interaction between the complex processes and dynamics of the political system through which policy change (or the failure to change) actually occurs. The fact that the CLASS Act was politically successful, yet administratively inoperable as designed, reinforces the argument that social policy outcomes in the United States are reflective of a complex, enduring struggle of competing ideologies. This continual struggle, coupled with a heightened concern over cost control and fiscal austerity, helps to ensure that policies which are legislatively successful within the institutional architecture of the American political system are unlikely to produce major expansions of the welfare state. Social change is therefore highly difficult to achieve, even in the face of significant unmet social needs. Comprehensive reform of U.S. LTC financing arrangements will remain an elusive goal for the foreseeable future. Instead, incremental, highly pro-market solutions are likely to be the types of policies promoted in the years of ahead.
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Chen, Yan, and 陈龑. "Health care financing in China : what lessons China can learn from other countries on healthcare reform?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193770.
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Background
China never stops taking effort to reform its health care system. Health care financing, which is one of the essential control knobs to health care system, has significant influences on the sustainability of the health system, the quality of services it delivers, the health status of the population as well as the success of the whole health care reform process.
Objectives
This article aims to summarize the evolution of China’s health care financing system, its current situation and challenges, discuss what lessons China can learn from the successful experiences or unsuccessful pitfalls of others countries on its health care financing reform.
Methods
Articles were searched through PubMed and CNKI. Further relevant articles were identified by searching the citations listed in retrieved articles manually. 96 articles were reviewed. Statistics about China’s health care system were mainly from government white paper, SHA technical paper, Chinese government websites and WHO website. The information about the performance of health care systems in other countries was mainly from OECD database and WHO website.
Results
In China, insufficient government expenditure and high out-of-pocket payments; social health insurance providing limited risk protection, with low-level risk pooling; escalation of costs; inefficient financing resources allocation in providers; disparities among regions and provinces all lead to the inequity and inefficiency of the health care financing system and create heavy financial burden on patients. Based on experiences from other countries, the total health expenditure in China could take an even larger proportion of GDP in the future; it is reasonable to increase general government expenditure to further reduce the household out-of-pocket payment and provide financial protection and ensure equity; expanding services coverage and proportion of the costs covered, gradually merging the risk-pool units and different schemes can make social health insurance a more powerful tool to make sure people’s access to basic health care; a new payment mechanism and stricter supervision on supply side can effectively contain the escalation of the costs; government should inject more funding to front-line institutions and the function of primary care in China can be stimulated by a good primary health care delivery system, in which the role of primary care provider is clearly defined as the gatekeeper of the health care system, with a proper referral mechanism; more responsibility should be taken by central government to allocate financing resources based on the fiscal capability of local governments; Chinese government should foresee the demand of aging population and take actions before it is too late.
Conclusion
It is consensus that China’s health care reform is heading at the right direction. However, there are a lot of problems in China health care financing system remaining to be solved. Health care financing system varies greatly in each country and there is no perfect health care financing system in the world. Thus no single country can be one hundred percent copied by China. But general principles and one or some most successful and advanced portions of other countries’ health care financing systems can still be used as references by China after further assessment. Unsuccessful oversea experiences are also precious lessons for preventing Chinese government from making same mistakes. A good health care financing system should be designed on the basis of a systematic review of all domestic financing policy and previous international experiences.published_or_final_version
Public Health
Master
Master of Public Health
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Paolucci, Francesco. "The design of basic and supplementary health care financing schemes: implications for efficiency and affordability." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10758.
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Asenso-Boadi, Francis Mensah. "Finding sustainable means of financing health care in Ghana : are the people willing to pay?" Thesis, University of Strathclyde, 2004. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=21593.
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This study seeks to improve the knowledge of health care financing issues in Ghana as the country seeks a sustainable means of financing health care. To this end an empirical study of Ghanaians' willingness to pay for health services and for health insurance is undertaken thereby applying the contingent valuation model of estimating willingness to pay in a different context (health care financing and demand) from the usual applications reported in the literature, which value the benefit component of cost-benefit analysis. Firstly, the study examines the three main methods of raising funds to finance health care (namely, government through taxes, user payments at the point of use, and health insurance) and discusses their advantages and disadvantages. Ghana's experiences in health care financing are considered with particular reference to the introduction of user charges by the government in 1992 and the issues raised concerning revenue generation, health service utilisation and equity, especially those affecting people with lower income levels. The empirical study was undertaken in two district capitals and their immediate environs in the Eastern region of Ghana with a sample of 487 heads of household interviewed in their own homes. The study shows that, overall, Ghanaians are willing to pay for their health care whether delivered by government or private hospitals and they are also willing to contribute into a national health insurance scheme. However, one's willingness to pay does not necessarily mean one will be able to pay for one's health care, since this depends on ability to pay. Since Ghana's per capita income is US$390 and the daily minimum wage is less than US$1, many Ghanaians may find it difficult to pay for their health care at the time of use given the uncertain nature of health care needs. Consequently, this study proposes the establishment of a national/social health insurance scheme, which if properly implemented, could be of immense benefit in raising adequate funds to improve upon health care delivery in the country.