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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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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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Goto, Etsu. "Factors affecting regional variations in hospitalization expenditures of elderly residents in Japan." 京都大学 (Kyoto University), 2015. http://hdl.handle.net/2433/195972.
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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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Škrobák, Martin. "Výdaje na zdravotnictví-trendy a současnost." Master's thesis, Vysoká škola ekonomická v Praze, 2015. http://www.nusl.cz/ntk/nusl-264125.
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Diploma thesis "Health care expenditures- future prospects and current situation" is focused on three areas linked to health care expenditures in EU and USA. First area, health expenditures financing, is analyzed in first chapter of the thesis. In the chapter, the development of modern health systems from its beginnings to 2014 is described. Second chapter is based on statistical hypothesis testing- paired two-sample t-tests. Firstly, share of health expenditures on GDP in 2000 and 2014 is tested. Secondly, share of public financing on health expenditures in 2000 and 2014 in tested. Third chapter explores influence of demography factors on health care expenditures and tests structure of health care expenditures in 2004 and 2013.
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Koubová, Lenka. "Zdravotní systém Německa." Master's thesis, Vysoká škola ekonomická v Praze, 2017. http://www.nusl.cz/ntk/nusl-360171.
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The diploma thesis contains a comprehensive view of the health system in the Federal Republic of Germany in 1995-2015. The main aim of this work is to establish recommendations for improvement of the Czech health system based on the evaluation of the findings on the German health system. The partial aims of the diploma thesis are the characteristics of the health system and the analysis of income and expenditure in health care in Germany. The thesis is divided into six chapters. The first chapter is focused on the information obtained from professional literature. In particular, it describes the different concepts related to healthcare and its financing. The second chapter focuses on the economic concept and the issue of the health system. The third part contains a description of the country's health system. Here are also some selected data about Germany, organization or authority at federal, state and local levels. The fourth chapter deals with the insurance market in Germany. The fifth part summarizes the fundamental reforms of the health system of the Federal Republic. The last chapter is an analysis of income and expenditure of the health system. This section analyzes the data available from statistics from the German Statistical Office or from multinational organizations such as WHO, OECD or the World Bank.
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Kuchařová, Jana. "Finanční stimuly ovlivňující spravedlnost, účinnost a zodpovědnost pro pacienta v různých režimech zdravotního pojištění na zdravotním trhu zemí OECD." Master's thesis, Vysoká škola ekonomická v Praze, 2009. http://www.nusl.cz/ntk/nusl-3970.
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This thesis contains a characteristic of ways, rules and resources of health care financing in various health care systems and their influence on impartiality, responsibility and efficiency. You can find an analysis of sources and expenditures on health in individual OECD countries - their structure, quality and development trend in this thesis too. The goal of the thesis is to approach the questions of responsibility of a patient, impartiality of health care system and its efficiency through financial stimuli.
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Scheier, Samuel. "Social Determinants of Health and Economy: the Global Financial Crisis 2007/08 and its impact on well-being of Europeans." Master's thesis, Vysoká škola ekonomická v Praze, 2014. http://www.nusl.cz/ntk/nusl-196994.
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Objective Objective of this study was to investigate the impact of the recent economic crisis of 2007/2008 on the subjective well-being and health status in thirteen European countries. Methods The European Social Survey (ESS) database was searched for individual health and wellbeing indicators and the database of the European Commission Eurostat for economic indicators. Data representing social determinants like education, housing and employment status and others before, during and after the crisis were retrieved. Eurostat data were used to analyse economic indicators and health outcomes on country level. Descriptive statistics were used to describe the changes in the different parameters over time. Regression analysis was performed to demonstrate relations between subjective well-being and different social determinants. Results Between 2006 and 2012 all countries experienced changes in their populations' subjective well-being. From 2006 to 2010 (crisis) the number of people with good or very good subjective well-being increased in France, Ireland, Belgium and Portugal by 0.6%, 1.0%, 1.2% and 6.5%, respectively. In Denmark and Spain this number remained basically stable. In Sweden, the United Kingdom, Finland and Germany the percentage of the population with good or very good subjective well-being decreased by 1.1%, 2.7%, 1.7% and 2.8%, respectively. Regression analysis demonstrated a significant relation between good and very good subjective well-being and level of education, main activity during the last 7 days, satisfaction with life, satisfaction with household income, main source of household income, gender and age. This relation differed for various factors and countries. In none of the countries satisfaction with national health services and satisfaction with current state of economy within the country was found significantly related to subjective well-being. The main amendable determinant correlating with a higher degree of subjective well-being is good education. The correlation between education and subjective well-being got stronger after the crisis than before or during the crisis. Conclusion Economic development does not have a uniform impact on subjective well-being. Education is a major amendable determinant influencing individual well-being. We could not find evidence for any significant impact of the organization of the healthcare services or social system on the subjective well-being.
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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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Ilgin, Yasemin. "Health care expenditures, innovation, and demographic change." Frankfurt, M. Berlin Bern Bruxelles New York, NY Oxford Wien Lang, 2007. http://d-nb.info/989527727/04.
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Karaca, Zeynal. "Essays on pharmaceuticals and health care expenditures." Thesis, [College Station, Tex. : Texas A&M University, 2007. http://hdl.handle.net/1969.1/ETD-TAMU-1915.
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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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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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Ray, Debabrata. "Disparities in Health Care Resource Utilization and Expenditures in Prostate Cancer Patients in the United States." University of Toledo Health Science Campus / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=mco1321955553.
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Lin, Pei-Jung Biddle Andrea K. "Predictive modeling of health care expenditures for Medicare beneficiaries with Alzheimer's disease." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,1529.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.Title from electronic title page (viewed Sep. 16, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Policy and Administration, School of Public Health." Discipline: Health Policy and Administration; Department/School: Public Health.
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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.
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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.
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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.
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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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Seshamani, Meena. "The impact of aging on health care expenditures : impending crisis, or misguided concern." Thesis, University of Oxford, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269483.
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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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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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Castora-Binkley, Melissa. "The Impact of the Veterans Health Administration's Home Based Primary Care on Health Services Use, Expenditures, and Mortality." Scholar Commons, 2015. https://scholarcommons.usf.edu/etd/5457.
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Background: Among patients with multiple chronic conditions, care coordination and integration remains one of the major challenges facing the U.S. health care system. A home-based, patient-centered primary care program has been offered through the Veterans Health Administration (VHA) since the 1970s for frail veterans who have difficulty accessing VHA clinics. The VHA Home Based Primary Care (VHA HBPC) aims to integrate primary care, rehabilitation, disease management, palliative care, and coordination of care for frail individuals with complex, chronic diseases within their homes. Early research suggested that VHA HBPC was associated with positive outcomes (e.g., reduced resource use and patient satisfaction). However, evidence regarding the effect of the VHA HBPC program on health services use (especially hospital and nursing home use), expenditures, and other patient outcomes remains limited. The present study is designed to fill this gap as the rise in the number of veterans with complex health care needs will likely increase in the coming decades.
Objectives: The current study aimed to examine the impact of VHA HBPC on health services use, expenditures, and mortality among a cohort of new VHA HBPC enrollees identified in the national VHA data system. The specific aims of this study were: 1) to examine the effect of VHA HBPC on major health service use (hospital, nursing home, and outpatient care) paid for by the Veterans Administration; 2) to examine the effect of VHA HBPC on total health services expenditures; and 3) to examine whether VHA HBPC enrollees experienced similar mortality and survival as compared to a matched concurrent cohort.
Methods: This study used a retrospective cohort design. A new VHA HBPC enrollee cohort (the treatment group) and a propensity matched comparison cohort (the comparison group) were identified from VHA claims in fiscal years (FY) 2009 and 2010 and were followed through FY 2012. Data on health service use, expenditures, and mortality/survival data were obtained via the VHA administrative datasets (i.e., Decision Support System, Purchased Care, and Vital Status Files). Propensity scores of being enrolled in the VHA HBPC were generated by a logistic regression model controlling for potential confounders. After 41,244 matched pairs were determined adequate through several diagnostic methods, means tests, relative risk analyses, and generalized linear models were used to estimate the effect of VHA HBPC on outcomes. Additionally, a Cox proportional hazards regression model was used to estimate the effect of VHA HBPC on survival. Subgroup analyses were conducted stratifying by age (85 and older), comorbidities (2 or more), and the receipt of palliative care. Based on the results of the original analyses, a series of sensitivity analyses were conducted that modified the described sample selection criteria and matching algorithm.
Results: Analyses of the original cohort revealed that VHA HBPC patients had significantly higher risks of being admitted into a hospital (RR 1.53, 95% CI 1.51-1.56) or nursing home (RR 1.65, CI 1.50 - 1.81). The average total expenditures during the study period were significantly higher for the VHA HBPC group as compared to the control group ($85,808 vs. $44,833, respectively; p < .001). In terms of mortality and survival, VHA HBPC enrollees had higher mortality (RR 1.45, CI 1.43 - 1.47), and shorter survival (HR 1.89, CI 1.86 - 1.93) as compared to those in the comparison group. Subgroup analyses found that these relationships generally remained when stratified by age 85 or older or having two or more comorbidities. However, for those who received palliative care, VHA HBPC participants had significantly lower risk of VHA hospitalization overall (RR 0.84, CI 0.81 - 0.87) and immediately prior to death. Finally, exploratory post-hoc analysis suggested that VHA HBPC recipients were at higher risk of VHA hospitalization at 30 (RR 1.11, CI 1.06 - 1.16), 60 (RR 1.16, CI 1.11 - 1.20), and 90 days (RR 1.16, 1.12 - 1.21) prior to death relative to the comparison group. After selecting only those that had a baseline hospitalization and refining the matching algorithm to account for time to death and additional comorbidities, VHA HBPC participants who had been enrolled in the program for at least six months had lower risks for hospital (RR 0.89, CI 0.88 - 0.90) and nursing home admissions (RR 0.74, CI 0.67 - 0.81). However, total expenditures remained significantly higher among those in VHA HBPC relative to the comparison group ($89,761 vs. $85,371, respectively; p < .001).
Discussion: This study found that without accounting for important covariates such as initial hospitalization, time to death, and a range of comorbidities, VHA HBPC was associated with higher health service use, higher expenditures, higher mortality, and shorter survival as compared to a similar group of patients not receiving VHA HBPC. After accounting for these factors, VHA HBPC was associated with a lower risk of nursing home use, and after six months, VHA HBPC was associated with lower risk of both nursing home and hospital use. These findings suggest that while VHA HBPC may improve quality of life and patient satisfaction through patient-centered integrated primary care, it may not generate cost savings for the healthcare system. Future research is needed to understand variation in program implementation and how this affects the impact of VHA HBPC on service use and cost.
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Burk, David Morris. "Estimating the Effect of Disability on Medicare Expenditures." BYU ScholarsArchive, 2009. https://scholarsarchive.byu.edu/etd/2127.
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We consider the effect of disability status on Medicare expenditures. Disabled elderly historically have accounted for a significant portion of Medicare expenditures. Recent demographic trends exhibit a decline in the size of this population, causing some observers to predict declines in Medicare expenditures. There are, however, reasons to be suspicious of this rosy forecast. To better understand the effect of disability on Medicare expenditures, we develop and estimate a model using the generalized method of moments technique. We find that newly disabled elderly generally spend more than those who have been disabled for longer periods of time. Also, we find that increases in expenditures have risen much more quickly for those disabled Medicare beneficiaries who were at the higher ends of the expenditure distribution before the increases.
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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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Borges, Ana Rita Galrinho. "Catastrophic health care expenditures in Portugal between 2000-2010: Assessing impoverishment, determinants and policy implications." Master's thesis, NSBE - UNL, 2013. http://hdl.handle.net/10362/11592.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and EconomicsObjectives: This work assesses the extent and evolution of catastrophic health care expenditures (CHE) in Portugal in the years of 2000, 2005 and 2010, to reveal household factors predicting this outcome, and simulates changes in 2010 CHE levels’ following recent reforms in user charges and prices of pharmaceutical products. Methods: The main contribution of this paper is the calculus and analysis of statistical measures to capture CHE incidence, intensity, income distribution and impoverishment effects on households using INE Household Budget Surveys. A logistic model to determine statistical significance and economic effects of 38 variables on the incidence of CHE is also estimated. Finally, a scenario analysis is presented to analyse reforms concerning user charges and prices of pharmaceuticals. Results: Incidence and intensity of CHE decreased between 2000 and 2010, from 5,005% to 2,439% and 4,693% to 0,334%, respectively. During the period, CHE were concentrated amongst the poorer income quintiles. Statistical significance in CHE prediction for all analysed years was observed for households’ income, smoking and drinking habits, area of the house and secondary education of the household head. Scenario analysis shows that the new levels of user charges in 2012, even if mitigated by the new and enlarged economic exemptions, would increase CHE incidence of 2010 to 3,529%. On the other hand, the reduction in the price of ambulatory pharmaceuticals in 2011 and 2012 is effective in reducing CHE incidence, for price demand elasticities equal or smaller (in absolute value) than 0,4. When the two effects are combined, CHE incidence increases, meaning that reductions in the price of pharmaceuticals are not sufficient to countervail the changes in user charges, even with enlarged economic exemptions.
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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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Irigoyen, Josefina. "Mental Health Care in McAllen Texas: Utilization, Expenditure, and Continuum of Care." Antioch University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1398421681.
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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.
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