To see the other types of publications on this topic, follow the link: Medical economics Medical care.
Dissertations / Theses on the topic 'Medical economics Medical care'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Medical economics Medical care.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Foran, Jameson D. "Medicaid Expansion Implications on Health Insurance Coverage and Medical Out-Of-Pocket Payments." Miami University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=miami1524669331674427.
Full text
2
Kowalski, Amanda. "Essays on medical care using Semiparametric and structural econometrics." Thesis, Massachusetts Institute of Technology, 2008. http://hdl.handle.net/1721.1/43729.
Full textAbstract:
Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2008.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Includes bibliographical references.
This dissertation consists of an empirical chapter, an econometrics chapter, and a theoretical chapter, all of which advance the study of the price elasticity of expenditure on medical care. In Chapter 1, I estimate the price elasticity of expenditure on medical care across the quantiles of the expenditure distribution. My identification strategy relies on family cost sharing provisions that generate differences in marginal prices between individuals who have injured family members and individuals who do not. I use a new censored quantile instrumental variables (CQIV) estimator, which allows me to examine variations in price responsiveness across the skewed distribution of medical expenditure. The CQIV estimator does not require any parametric assumptions to account for individuals who consume zero medical care. Using CQIV, as well as traditional estimators, I find elasticities that are an order of magnitude larger than those in the literature. My CQIV estimates suggest strong price responsiveness among people who spend the most. I find that the price elasticity of expenditure is approximately -2.3, which is stable across the .65 to .95 quantiles of the expenditure distribution. In Chapter 2, Chernozhukov and Kowalski (2008), we develop a censored quantile instrumental variables (CQIV) estimator. The CQIV estimator handles censoring nonparametrically in the tradition of Powell (1986), and it generalizes standard censored quantile regression (CQR) methods to incorporate endogeneity. Our computational algorithm combines a control function approach with the Chernozhukov and Hong (2002) CQR algorithm. Through Monte-Carlo simulation, we show that CQIV performs well relative to Tobit IV in terms of median bias and interquartile range.
(cont.) In Chapter 3, I develop a structural model to estimate the price elasticity of expenditure on medical care. The model relies on deductibles, coinsurance rates, and stoplosses that generate nonlinearities in consumer budget sets. The model generalizes existing nonlinear budget set models by allowing for more than one nonconvex kink. Furthermore, it incorporates censoring as a corner solution. Unlike reduced form models, the model utilizes identification from utility theory, it allows for preference heterogeneity, and it allows for the direct calculation of welfare effects.
by Amanda Ellen Kowalski.
Ph.D.
3
Huesch, Marco D. "Three essays in healthcare economics." Diss., Restricted to subscribing institutions, 2008. http://proquest.umi.com/pqdweb?did=1619406861&sid=2&Fmt=2&clientId=1564&RQT=309&VName=PQD.
Full text
4
Ho, Chi-wan Nelson. "Factors affecting one's health care choice /." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B20897583.
Full text
5
Koc, Cagatay. "Moral hazard and adverse selection in the economics of health care : three essays /." Digital version accessible at:, 2000. http://wwwlib.umi.com/cr/utexas/main.
Full text
6
Staines, Amber Irene. "The Effect of Medical Care on Infant Mortality in the United States in the Early 20th Century." Miami University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=miami1438190193.
Full text
7
Quayyum, Zahidul. "Developing a needs-based resource allocation model for health care expenditure in Bangladesh." Thesis, University of Aberdeen, 2012. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=194789.
Full textAbstract:
The allocations of health care resources in Bangladesh are not based on the needs of the population. Equality in health care expenditure can be achieved by the use of needs-based resource allocation formulae. Applying such methods in Bangladesh can provide an essential guideline to achieve equality in resource allocation. This thesis examines the prospect of developing a needs-based allocation of health care resources. It attempts to address the counterfactual question of what would have been the allocation to each district had the needs of the population been accounted for. Two alternative approaches are considered. The first uses a simple capitation formula in which weights for the adjustment of the current allocation are generated directly based on the relative values of proxies for needs. The second approach predicts adjustment weights from the estimation of a standard econometric model of needs, controlling for a range of determinants including individual, household and district characteristics. Important predictors of current allocation were found to be the number of hospital beds and health workers rather than need factors. Important predictors of needs include demographic and socio-economic characteristics. The findings suggest that a needs-based allocation can be developed for Bangladesh. This research provides an alternative approach to generating weights showing systematic relationships between the need adjustment factors. The robustness of the methods used will be sensitive to the quality of the data and the assumptions of the models. As these approaches are based on sound economic analysis and are open to independent assessment, they will help to inform policy debate and can reduce the influence of politically motivated allocations. A gradual process of implementation and regular review of the methods used would be a way forward. Future areas of research may include: re-analysing data at smaller area level and use of different components of allocations.
8
Stern, Ariel Dora. "Essays in the Economics of Health Care and the Regulation of Medical Technology." Thesis, Harvard University, 2014. http://dissertations.umi.com/gsas.harvard:11678.
Full textAbstract:
The first chapter of this dissertation explores how the regulatory approval process affects innovation incentives in medical technologies. While prior studies of medical innovation under regulation have found an early mover regulatory advantage for drugs, I find the opposite to be true for medical devices. Using detailed data on over three decades of high-risk medical device approval times in the United States, I show pioneer entrants spend approximately 34 percent (7.2 months) longer in the approval process than the first follow-on innovator. Back-of-the-envelope calculations suggest that the opportunity cost of capital of a delay of this length is upwards of 7 percent of the total cost of bringing a new device to market. I consider how different types of regulatory uncertainty affect approval times and find that a product's technological novelty is largely unrelated to time spent under review. In contrast, uncertainty about application content and format appears to play a large role: when objective guidelines for evaluation are published, approval times quicken for subsequent entrants. Finally, I consider how the regulatory process affects firms’ market entry strategies and find that financially constrained firms are less likely to enter new device markets as pioneers.
9
Balzer-Carr, Alexander. "United States healthcare the need for a more comprehensive approach /." Diss., Connect to the thesis, 2008. http://hdl.handle.net/10066/1442.
Full text
10
Ssemanda, Henry F. Z. "Establishing a reformed national health care system for the U.S.A. based on the critical appraisal approach that considers the needs of the consumer first /." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1991. http://www.kutztown.edu/library/services/remote_access.asp.
Full text
11
Farnworth, Michael G. "Three essays in health economics /." Thesis, *McMaster only, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape3/PQDD_0033/NQ66265.pdf.
Full text
12
Li, Chenghui. "Reexamination of the disparity in utilization of medical care services between the insured and uninsured." [Bloomington, Ind.] : Indiana University, 2005. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:3167798.
Full textAbstract:
Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2005.Source: Dissertation Abstracts International, Volume: 66-04, Section: A, page: 1435. Adviser: Pravin K. Trivedi. "Title from dissertation home page (viewed Nov. 9, 2006)."
13
Basu, Rashmita. "Healthy lifestyle, disease prevention and health care utilization." Pullman, Wash. : Washington State University, 2009. http://www.dissertations.wsu.edu/Dissertations/Fall2009/r_basu_112309.pdf.
Full text
14
Lari, Nasim. "The Impact of Diabetes Patientsâ Trust in Their Physicians on Medical Care & Health-Producing Activities." NCSU, 2009. http://www.lib.ncsu.edu/theses/available/etd-06222009-174614/.
Full textAbstract:
This research evaluates how a diabeticâs trust in his physician, as measured through the area of communication between the patient and physician, and his travel costs influence his decision to obtain medical care and spend time on health-producing activities such as diet and exercise. By identifying the factors that prevent the patient from properly managing his diabetes, certain policy measures can be implemented (e.g. providing transportation, funds for transportation, translators, etc.) to encourage proper disease management. Further, with an increase in group practices, it would be interesting to evaluate how the effectiveness of these programs is influenced by better patient-provider relationships.
15
Timmins, Lori L. "Three essays in health economics : determinants of individual health, medical care use, and treatment." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/51975.
Full textAbstract:
This dissertation studies and identifies determinants of individual health. The first chapter analyzes how the supply of medical care affects patient treatment and health outcomes, focusing on how hospitals respond to the loss of a profitable service line. This chapter provides strong evidence that hospital spillovers across service lines are empirically important and that hospitals differentiate treatment by patient payer type. Hospitals practice both revenue augmenting and cost-cutting behavior in other lines of care, targeting specific procedures and payers according to their profitability. Specifically, they increase the number of surgical procedures and perform more marginal surgeries. The effects are concentrated in medical specialties where there are more discretionary surgeries and higher profit margins. Furthermore, hospitals cut back on unprofitable treatment by reducing non-elective admissions and uninsured elective care. Hospitals also increase the intensity of treatment among private payers. The second chapter of this dissertation investigates the demand side of health care, analyzing the role that health insurance plays on primary medical care usage by young American adults. I find office-based physician visits and prescription drugs are not affected by insurance, but dental visits are. There is a small increase in out-of-pocket expenditures caused by insurance loss, concentrated heavily at the top of the distribution. No change in health status or ability to afford care is found. The findings shed light on the expected welfare benefits of recent US health care policies targeting young adults. The final chapter of this dissertation analyzes the extent to which the early childhood environment shapes child health and development outcomes and, specifically, whether universal childcare levels the playing field across children. I analyze the introduction of a universal childcare program in Quebec in 1997, testing its impact on the distribution of child health and development outcomes. I find that there is little heterogeneity in the response to the policy across the distributions of child motor skills and cognitive outcomes. I do, however, find evidence that it led to a reduction in child body weight at the upper end of the distribution.Arts, Faculty of
Vancouver School of Economics
Graduate
16
Lavelle, Tara. "Examining Health and Economic Outcomes Associated with Pediatric Medical Conditions in the United States." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10450.
Full textAbstract:
The objective of this dissertation is to estimate the health and economic outcomes associated with two prominent child health conditions: autism spectrum disorder and influenza illness. Chapter 1 derives utility values associated with the health of children with autism spectrum disorder (ASD) and their parents. Our findings suggest that ASD has a large impact on the health-related quality of life of children and their caregivers, and that this impact is influenced by both the child’s specific diagnosis and the severity of their core social communication and repetitive behavior symptoms. Chapter 2 estimates the annual incremental costs associated with caring for a child with ASD from the societal perspective. Our findings suggest that there is a large economic burden both in terms of formal costs (healthcare, school and other direct costs of care) as well as the informal time costs of caregiving. Specifically, the societal costs of caring for this population amounted to $9.1 billion in 2011 alone, highlighting the tremendous financial challenges our society faces in meeting the needs of children with ASD. Chapter 3 uses a decision analytic model to evaluate 1-year clinical and economic outcomes associated with oseltamivir treatment for seasonal influenza in children, and considers the impact of oseltamivir resistance on these findings. Our results indicate that for unvaccinated children who present to their physician’s office with influenza-like symptoms, empiric antiviral treatment with oseltamivir appears to be a cost-effective treatment option. This is particularly true for ill children aged 1 to 12 years, but results are dependent on the prevalence of circulating seasonal influenza viruses that are resistant to oseltamivir.
17
Yamada, M. "The effects of cost-saving efforts in the U.S. healthcare market." View abstract/electronic edition; access limited to Brown University users, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3318376.
Full text
18
Shahinpoor, Nasrin. "DETERMINANTS OF THE DEMAND FOR SECONDARY PREVENTIVE MEDICAL CARE: THE CASE OF BREAST CANCER." University of Cincinnati / OhioLINK, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=ucin976115782.
Full text
19
Dutto, Shannon Marina. "The economic determinants of the rising costs of health care in the United States." Thesis, Georgia Institute of Technology, 1996. http://hdl.handle.net/1853/30544.
Full text
20
Botha, Pieter. "The profile and cost of end-of-life care in South Africa - the medical schemes' experience." Master's thesis, University of Cape Town, 2020. http://hdl.handle.net/11427/32460.
Full textAbstract:
South African medical schemes spend billions of Rands each year on medical care costs for their beneficiaries near their end of life. Hospi-centric benefit design, fee-for-service reimbursement arrangements and fragmented, silo-based delivery of care result in high, often unnecessary spending near the end of life. Factors including an ageing population, increasing incidence rates of cancer and other non-communicable diseases, and high levels of multi-morbidity among beneficiaries near their end of life further drive end-of-life care costs. Low levels of hospice or palliative care utilisation, a high proportion of deaths in-hospital and chemotherapy use in the last weeks of life point to potentially poor-quality care near the end of life. The usual care pathway for serious illness near the end of life acts like a funnel into private hospitals. This often entails resource intensive care that includes aggressive care interventions right up until death. The result is potentially sub-optimal care and poor healthcare outcomes for many scheme beneficiaries and their surviving relatives. Understanding the complex nature of the end of life, the different care pathways, the available insurance benefits, the interactions between key stakeholders and the multitude of factors that drive end-of-life care costs are vital to setting end-of-life care reform in motion. In order to increase value at the end of life, i.e. to increase quality and/or to reduce costs, benefit design reform, alternative reimbursement strategies, effective communication and multi-stakeholder buy-in is key.
21
Petrou, Stavros. "Examining QALY's : analysing the use of quality adjusted life years in the allocation of health care resources." Thesis, University of St Andrews, 1992. http://hdl.handle.net/10023/13344.
Full textAbstract:
This thesis examines the use quality adjusted life years (QALY'S) in the allocation of health care resources. It is divided into three broad sections. The first section discusses how health status measurement techniques can be used to derive the utility values incorporated into QALY'S. The second section uses one health status measurement instrument, the Rosser-Kind Classification of Illness States, to estimate the QALY'S gained by patients who have undergone hip and knee joint replacement surgery. It is shown that the Rosser-Kind Classification of Illness States is as effective in measuring the health-related quality of life of these patients as more detailed questionnaires. In addition, it is found that further research is required before any generalisations concerning the acceptability of retrospective data can be made. A third important result is that there are significant improvements in health- related quality of life following both types of surgery, with the highest Rosser- Kind rating scores achieved after the first year following knee replacement surgery and after the second year following hip replacement surgery. The third section of the thesis performs an extensive sensitivity analysis on the widely-quoted cost utility estimates for seven medical procedures, calculated by Gudex (1986). The estimates are shown to be sensitive to Gudex's conversion of health outcome data into the Rosser-Kind Classification, her assumptions concerning the survival period / life expectancy following each of the medical procedures and the selected discount rate. A more in depth analysis is then performed on the cost utility estimate for one of the seven procedures, ceftazidime treatment of cystic fibrosis. It is demonstrated that the health outcome and cost assumptions underlying the cost utility estimate for this procedure are not supported by the medical literature. Finally, the thesis raises a number of issues for discussion.
22
Nordyke, Robert. "Privatization of health care provision in a transition economy : lessons from the Republic of Macedonia /." Santa Monica, CA : RAND, 2000. http://www.rand.org/pubs/rgs%5Fdissertations/RGSD155/.
Full text
23
AYIVOR, EDWARD CARLOS KOFI. "AN ECONOMETRIC STUDY OF THE DECISION TO SEEK MEDICAL CARE IN WEST AFRICA: A CASE STUDY OF THE GHANA DANFA HEALTH PROJECT USING DISCRETE CHOICE MODELS (DEMAND, LOGIT)." Diss., The University of Arizona, 1985. http://hdl.handle.net/10150/187923.
Full textAbstract:
A theoretical and an empirical investigation using Logit Analysis, Discriminant Analysis, (Hierarchical) Log-Linear models with factor interactions and Goodman's measures of optimal prediction and uncertainty within the framework of consumer choice theory to explain the usage of health-care facilities and the behavior of individual consumers and different population segments seeking medical care within the Danfa Community in Ghana, West Africa. Based upon the household objective of utility maximization and the set of constraints--income, wealth, time, information and health, the demand for medical care is estimated as a function of individual and system characteristics, i.e. those characteristics describing in broad terms the factors of the household's needs, perception, willingness to secure care, and ability to secure care (e.g. age, sex, education, ethnicity, type of disease, literacy, health condition, occupation and costs of medication, travel and consultation. The sources of treatment or the providers of medical care were classified into five categories: self, family, drug seller, herbalist, and clinic. Our empirical results indicate that an individual's decision to seek or purchase medical care is more likely to be based on individual characteristics such as the number of unhealthy days rather than on system characteristics such as prices or costs of medication, travel, etc. This study has also revealed that some segments of the Danfa population in Ghana are more likely to exhibit an increasing preference or avoidance for certain health care facilities than others or use health-care facilities in different ways by either purchasing more or less medical care than other consumer groups. In assessing the effects of changes in the levels of particular factors on health-care decisions, our empirical results indicate that there is a reduction in total medical outlays for some consumers if there is a rise in the number of unhealthy days or an increase in the cost indices of medication, travel, and consultation. Policy measures for improvement in the future, including the reduction of the number of unhealthy days and household medical care expenditures through preventive health care education, community-based health insurance schemes for various occupational groups, and improvement of access capabilities or income earning capabilities through the encouragement of proper organization of economic activities within the rural community have been recommended in this study.
24
Yamada, Go. "Input-output analysis on the economic impact of medical care in Japan." 京都大学 (Kyoto University), 2016. http://hdl.handle.net/2433/215218.
Full text
25
Valentine, Nicole Britt. "An evaluation of expenditure in the private health care sector and its reporting in the national accounts of South Africa." Master's thesis, University of Cape Town, 1997. http://hdl.handle.net/11427/17539.
Full textAbstract:
Bibliography: pages 94-102.There is currently much work underway internationally to improve the accuracy and to refine the detail of accounting for health care expenditures. This research was initiated by the increasing activity in the field of national health accounting, as well as by previous research indicating that the Reserve Bank might be underestimating private health care expenditure in the national accounts. The Reserve Bank estimate of health care expenditure is important as it is the only complete and regularly produced estimate of private sector health care expenditure for South Africa. It was posited that an independent estimation of private health care expenditure would show that its magnitude is underestimated in the expenditure estimates published by the Reserve Bank for the national accounts. This thesis was upheld by the results of the research. The thesis estimate of private health care expenditure was R15 billion, 39% higher than the Reserve Bank estimate available at the time. It was also 21% higher than the final Reserve Bank estimate published in December 1995. The methodology used to derive the thesis estimate involved a survey of national income accounting concepts and guidelines embodied in the internationally used publication, the 1993 System of National Accounts. Primary data was collected from a wide range of institutions in the South African health sector. Secondary data sources were also consulted in several instances. In particular, the Registrar of Medical Schemes was consulted for medical scheme expenditure estimates as they constitute the largest portion of private sector health care expenditure in South Africa. The thesis estimate was then calculated for a single year according to the 1993 System of National Accounts guidelines. The year chosen was the government financial year from April 1992 to March 1993. The year was chosen to coincide with the year chosen for a national health expenditure review. In the presentation of the results, the estimate was broken down in separate "sources" and "uses" matrices, which are being used internationally to present national health accounting information. From the comparison of the Reserve Bank and thesis expenditure estimates, one of the most important recommendations that emerged was that the Reserve Bank should consult a wider range of expenditure data sources, more timeously and regularly. In particular, it was suggested that the Reserve Bank should negotiate earlier access to the data held by the Registrar of Medical Schemes, as well as cross-check household survey data with independent estimates of out-of-pocket and statutory scheme health care expenditure. In addition to providing a new benchmark estimate for private sector health care expenditure in the government financial year 1992/93, the breakdown of the estimate into matrices provides a framework that could be used as the basis for the development of more detailed satellite national health accounts, in accordance with 1993 SNA standards.
26
Witter, Sophie. "Making delivery care free : evidence from Ghana and Senegal on implementation, costs and effectiveness of national delivery exemption policies." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=25753.
Full text
27
Ho, Chi-wan Nelson, and 何志雲. "Factors affecting one's health care choice." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31220873.
Full text
28
Drymoussis, Michael. "Globalisation and commercialisation of healthcare services : with reference to the United States and United Kingdom." Thesis, University of Sussex, 2014. http://sro.sussex.ac.uk/id/eprint/61483/.
Full textAbstract:
The thesis seeks to interrogate historically the relationship between multinational healthcare service companies and states in the pursuit of market-oriented reforms for healthcare. It constitutes a critical reading of the idea of globalisation as a concept with substantive explanatory value to analyse the causal role of multinational service firms in a commercial transformation in national healthcare service sectors. It analyses the development and expansion of commercial (for-profit) healthcare service provision and financing in the healthcare systems of OECD countries. The hospital and health insurance sectors in the US and UK are analysed as case studies towards developing this critical reading from a more specific national setting. The thesis contributes to developing a framework for analysing the emergence of an international market for trade in healthcare services, which is a recently emerging area of research in the social sciences. As such, it uses an interdisciplinary approach, utilising insights from health policy and international political economy. The research entails a longitudinal study of secondary and primary sources of qualitative data broadly covering the period 1975-2005. I have also made extensive use of quantitative data to illustrate key economic trends that are relevant to the changes in the particular healthcare services sectors analysed. The research finds a substantive shift in the mixed economy of healthcare in which commercial healthcare service provision and financing are increasing. However, while the internationalisation of healthcare service firms is a key element in helping to drive some of this change, the changes are ultimately highly dependent on state-level decision making and regulation. In this context, the thesis argues that globalisation presents an inadequate and potentially misleading conceptual framework for analysing these changes without a historical grounding in the particular developments of national and international markets for healthcare services.
29
Alshammasi, Abdrabalamir Abbas Abdullah. "The influence of economic, political and socio-cultural factors on the development of health services in Saudi Arabia." Thesis, University of Hull, 1986. http://hydra.hull.ac.uk/resources/hull:5105.
Full textAbstract:
In this thesis I examine the influence of economic, political and socio-cultural factors on the development of health services in Saudi Arabia. There are four main parts and a conclusion. In Part One I review the situation in developing countries. Many commentators have argued that economic factors, and to some extent political factors, are the main determinant of health services development in developing countries. Socio-cultural factors are generally neglected in these analysis. In this thesis I redress the balance by examining the relationship between economic, political and socio-cultural factors in the development of the Saudi health care system.In Part Two I analyse the Saudi resource situation. Although the health service is not considered a priority in the overall Saudi development strategy, the government provides generous financial resources for its development. However, non-financial resources remain a problem. Relatively abundant financial resources can provide a short-term solution to some of the resource shortages, such as the lack of skilled manpower, but the use of expatriate health personnel may have unanticipated negative consequences.In Part Three I examine the resource allocation process. The Saudi political system contains a mixture of modern and traditional elements, and the decision making process is affected by traditional social relationships. The King and public bureaucrats play a key role in the allocation process, but local leaders and Governors have wide scope to influence their decisions. While health provision is not a political issue in the country, it contributes to the social cohesion between the government and the general public.In Part Four I examine the influence of socio-cultural factors on the development of the Saudi health service. In the Saudi society socio-cultural factors affect the behaviour of individuals in their interaction with the health system. For example, the annual pilgrimage to Mecca by millions of moslems from all over the world presents a formidable challenge to health authorities. Health authorities accept the importance of socio-cultural factors, and respond by compromising policies. In the conclusion I consider the policy and theoretical implications of the study. In particular I examine the need for the formal recongnition and incorporation of socio-cultural factors into health policy decision making. This would lead to the generation of alternative policy options which complement other options based on economic and political considerations. The socio-cultural oriented approach can contribute significantly to the improvement of the long term prospect for health services in Saudi Arabia, and developing countries generally.
30
Esser, Jan Hendrik. "Who cares? : moral reflections on business in healthcare." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52612.
Full textAbstract:
Thesis (MPhil)--University of Stellenbosch, 2001.ENGLISH ABSTRACT: This evaluation serves the purpose of illuminating concepts and ideas behind the moral impact of business values in healthcare and to establish a framework for the analysis of moral dilemmas found in the sphere ofbio-medical ethics. The historic developments of business in healthcare are examined, looking at how and why business became an integral part of the health care system. The concept of "managed healthcare" is introduced and used as the context in which the different institutional role-players are brought together. Managed healthcare is defined by a discussion of the different organisational structures through which it manifests itself. The policies, procedures and regulations that managed healthcare organisations implement and control to fulfil their general function are also examined. Some normative aspects pertaining to the concept of managed health care are explored, including the institutional values of business and that of medicine. A brief discussion of the economic system in which the business agents or role players function are included in the evaluation of the institutional values of business. Further arguments are made to show how the healthcare system with all its role players displays the characteristics of a complex system. Discussions on the fundamental values of medicine concentrate on the basic ideas behind virtues and principles of medical ethics. It is argued that the development of these virtues and principles are important foundations on which the medical profession stands. The moral impact of combining these institutional values within the context of managed healthcare relationships is examined and some important moral dilemmas or conflicts are identified. It is further argued that the fundamental relationships between all the role players in the health care system have changed as all the agents function within a complex system, giving rise to new organisational structures and relationships, with new conceptual roles, ideals, values and practices.
AFRIKAANSE OPSOMMING: Hierdie evaluasie het dit ten doelom sekere konsepte en idees agter die morele impak van besigheidswaardes in gesondheidsorg te illumineer en om 'n raamwerk daar te stel vir die verdere analise van morele dilemmas in die sfeer van bio-mediese etiek. Die historiese ontwikkeling van besigheid in gesondheidsorg word verken deur die redes aan te voer waarom besigheid deel van die gesondheidsorgsisteem geword het. Die konsep "bestuurde gesondheidsorg" word gebruik as die konteks waarin die verskillende institusionele rolspelers bymekaar gebring word. Bestuurde gesondheidsorg word gedefinieer deur die verskillende organisatoriese strukture waardeur dit manifesteer. Die prosedures, regulasies en bereid wat bestuurde gesondheidsorgorganisasies implementeer om hul funksies te vervul word ook verken. Normatiewe aspekte van bestuurde gesondheidsorg word verken, waarby ingesluit word die institusionele waardes van besigheid sowel as dié van medisyne. 'n Kort beskrywing van die ekonomiese sisteem waarin die besigheidsagente, of rolspelers funksioneer word ingesluit by die evaluasie van die institusionele waardes van besigheid. Verdere argumente word gevoer om te wys daarop hoe die gesondheidsorgsisteem met al sy rolspelers die karakter toon van 'n komplekse sisteem. Die basiese idees agter deugsaamheid en morele beginsels van bio-mediese etiek word bespreek om die fundamentele waardes van medisyne te beskryf. Daar word geargumenteer dat die ontwikkeling van hierdie waardes 'n belangrike fondament is waarop die mediese professie staan. Die morele impak van die kombinasie tussen die institusionele waardes van besigheid en medisyne binne die konteks van bestuurde gesondheidsorg word geevalueer en belanrike morele dilemmas en konflikte word geidentifiseer. Verder word geargumenteer dat die fundamenrele verhouding tussen al die rol spelers in die gesondheidsisteem verander het danksy die funksionering van die agente binne hierdie komplekse sisteem. Dit lei op sy beurt na veranderinge in organisatoriese strukture en verhoudinge met nuwe konsepsuele rolle, idiale, waardes en praktyke.
31
Sidler, Daniel. "Medical futility as an action guide in neonatal end-of-life decisions." Thesis, Stellenbosch : Stellenbosch University, 2004. http://hdl.handle.net/10019.1/50017.
Full textAbstract:
Thesis (MPhil)--University of Stellenbosch, 2004.ENGLISH ABSTRACT: This thesis discusses the value of medical futility as an action guide for neonatal endof- life decisions. The concept is contextualized within the narrative of medical progress, the uncertainty of medical prognostication and the difficulty of just resource allocation, within the unique African situation where children are worse off today than they were at the beginning of the last century. parties actively engage in an interactive deliberation for a plan of action. Both parties ought to accept moral responsibility. Such a model of deliberation has the added advantage of transcending the limitations of the participants to arrive at a higher-level solution, which is considered more than just a consensus. It has been argued that medical progress has obscured the basic need for human compassion for the dying and for their loved ones. The literature furthermore reports that the quality of end-of-life care is unsatisfactory for both patients and their families. It is within this context that the concept of medical futility is positioned as a useful action guide. As we do not have the luxury of withdrawing from the responsibility to engage in the deliberation of end-of-life decisions, such responsibility demands an increasing awareness of ethical dilemmas and a model of medical training where communication, conflict-resolution, inclusive history taking, with assessment of patient values and preferences, is focussed on. The capacity for empathetic care has to be emphasized as an integral part of such approach. Finally, in this thesis, the concept of medical futility is tested and applied to clinical case scenarios. It is argued that the traditional medical paradigm, with its justification of an 'all out war' against disease and death, in order to achieve utopia for all, is outdated. Death in the neonatal intensive care unit is increasingly attributed to end-of-life decisions. Futile treatment could be considered a waste of scarce resources, contradicting the principle of nonmaleficence and justice, particularly in an African context. The ongoing confidence in, and uncritical submission to the technological progress in medicine is understood as a defence and coping mechanism against the backdrop of the experience of life's fragility, suffering and the inevitability of death. Such uncritical acceptance of the technological imperative could lead to a harmful fallacy that cure is effected by prolonging life at all cost. What actually occurs, instead, is the prolongation of the dying process, increasing suffering for all parties involved. The historical development of the concept of medical futility is discussed, highlighting its applicability to the paradigmatic scenario of cardio-pulmonary resuscitation. Particular attention is given to ways in which the concept could endanger patient-autonomy by allowing physicians to make unilateral, paternalistic decisions. It is argued that the informative model of the patient-physician relationship, where the physician's role is to disclose information in order for the patient to indicate her preferences, ought to be replaced by a more adequate deliberative model, where both
AFRIKAANSE OPSOMMING: Hierdie tesis bespreek die waarde van mediese futiliteit as 'n maatstaf vir aksie in gevalle van neonatale 'einde-van-lewe' besluite. Die konsep word gekontekstualiseer binne die wêreldbeskouing van mediese vooruitgang, die onsekerheid van mediese prognostikering en die probleme wat geassosieer IS met regverdige hulpbrontoekenning; spesifiek binne die unieke Afrika-situasie. Dit word aangevoer dat die tradisionele mediese paradigma, met regverdiging vir voorkoming van siekte en dood ten alle koste, verouderd is. Sterftes in neonatale intensiewe sorgeenhede word toenemend toegeskryf aan 'einde-van-lewe' besluite Futiele behandeling sou dus beskou kon word as 'n vermorsing van skaars hulpbronne, wat teenstrydig sou wees met die beginsels nie-skadelikheid ('nonmaleficence') en regverdigheid. Die volgehoue vertroue in en onkritiese aanvaarding van aansprake op tegnologiese vooruitgang lil geneeskunde, kan beskou word as verdediging- en hanteringsmeganisme in die belewenis van lewenskwesbaarheid, lyding en die onafwendbaarheid van die dood. Sodanige onkritiese aanvaarding van die tegnologiese imperatief kan tot 'n onverantwoordbare denkfout, naamlik dat genesing plaasvind deur verlenging van lewe ten alle koste, lei. Wat hierteenoor eerder mag plaasvind, is 'n verlenging die sterwensproses en, gepaard daarmee, toenemende lyding van all betrokke partye. Die historiese ontwikkeling van die konsep van mediese futiliteit word bespreek met klem op die toepaslikheid daarvan op die paradigmatiese situasie van kardiopulmonêre resussitasie. Spesifieke aandag word gegee aan maniere waarop die konsep pasiënte se outonomie in gevaar stel, deur die betrokke medici die reg te gee tot eensydige, paternalistiese besluitneming. Die argument is dan dat die informatiewe model, waar die verhouding tussen die dokter en pasiënt gebasseer is op die beginsel dat die dokter inligting moet verskaf aan die pasiënt sodat die pasiënt 'n ingeligte besluit kan neem, vervang moet word met 'n meer toepaslike beraadslagende model, waar sowel die dokter as die pasiënt aktief deelneem aan interaktiewe beraadslaging oor 'n aksieplan. Albei partye word dan moreel verantwoordbaar. So 'n model van beraadslaging het die bykomende voordeel dat dit die beperkings van die deelnemers kan transendeer. Sodoende word 'n hoër-vlak oplossing - iets meer as 'n blote consensus - te weeg gebring. Die argument word ontwikkel dat mediese vooruitgang meelewing met die sterwendes en hul geliefdes mag verberg. Verder dui die literatuur daarop dat die kwaliteit van einde-van-lewe-sorg vir sowel die pasiënte as hul familie onaanvaarbaar is. Dit is binne hierdie konteks dat die konsep van mediese futiliteit kan dien as 'n maatstaf vir aksie. Medici kan nie verantwoordelikheid vir deelname aan beraadslaging rondom eindevan- lewe beluitneming vermy nie, en as sodanig vereis die situasie toenemende bewustheid van sowel die etiese dilemmas as 'n mediese opleidingsmodel waann kommunikasie, konflikhantering, omvattende geskiedenis-neming, met insluiting van die pasient se waardes en voorkeure, beklemtoon word. Die kapasiteit vir empatiese sorg moet weer eens beklemtoon word as 'n integrale deel van hierdie benadering. Ten slotte, hierdie tesis poog om die konsep van mediese futiliteit te toets en toe te pas op kliniese situasies.
32
Behkami, Nima A. "Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home." PDXScholar, 2012. https://pdxscholar.library.pdx.edu/open_access_etds/237.
Full textAbstract:
It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to provide information about their payer mix, implementation barriers, registry implementation, registry use, and clinic satisfaction. The survey instrument was validated by an expert panel which included practitioners and researchers. Statistical methods including Structural Equation Modeling were used for analysis and to test the research hypotheses. The majority of medical home practices that responded used some type of computerized registry, either with basic patient information or integrated with detailed clinical information. And on average, they somewhat used registries for population management, individual health management, proactive care and planned care visits. All practices encountered some combination of barriers when implementing a medical home program. Most practices reported clinic satisfaction at least improved after becoming a medical home. The results of the analysis show that indeed payer mix, in particular Medicare and private insurance, has a significant relationship with level of registry implementation. There were no significant relationships between barriers and registry implementation or use. More sophisticated registry implementation led to greater registry use. And registry use is associated with increased clinic satisfaction. This research fills an important gap in understanding Health IT use, registries in particular, among Patient-Centered Medical Homes. The findings suggest that: 1) Implementation barriers may not be influencing use of computerized registries in medical home practices; 2) Using more sophisticated computerized registries facilitates registry use, which can help improve clinic satisfaction; 3) Payer mix may influence use of more sophisticated Health IT in medical home practices.
33
Kennedy, Christine A. "Development of an evaluation protocol for an alternative funding plan for academic pediatricians." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ34192.pdf.
Full text
34
Walker, Lauryn. "Patient-Centered Medical Homes and Hospital Value-Based Purchasing: Investigating Provider Responses to Incentives." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/5796.
Full textAbstract:
Provider incentives are a commonly used policy tool to mold provider behaviors.1 However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.
Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic surveys to member experience with care in order to evaluate characteristics key to patient-centered medical homes. I find that patient-perceived patient-centeredness of a practice is not related to the number of PCMH attributes a practice reports. However, some characteristics do play specific and significant roles in patient perception and outcomes. For instance, case management is not only associated with increased patient perception of after-hours access to care, but overall costs were reduced. Interestingly, having after hours clinic hours was more common with practices highly consistent with PCMH criteria, but these hours did not result in decreased emergency department use or cost of care.
Chapter 2: The second provider incentive studied is the Medicare Hospital Value-Based Purchasing Program (HVBP). This program assigns payment adjustments based on performance on a series of rotating quality metrics. To date, changes in patient outcomes cannot be attributed to the program; however, it should not be concluded that hospitals are not responding at all. I identify changes in staffing by provider type as an early indicator of hospital response to payment incentives. Data come from the Virginia Health Information (VHI) Hospital Cost Report, 2010-2017. Using a generalized linear model, I find that when receiving a penalty, hospitals reduce staffing among the most and least expensive personnel (physicians and nursing aides). Hospitals increase nursing and administrative staff following a bonus. These findings are consistent with hospitals responding to incentives both by aiming to improve efficient use of resources and maintain or improve quality of care.
Chapter 3: Finally, I assess potential unintended consequences of the HVBP program, specifically the provision of charity care. Using the VHI cost reports for year 2013 to 2017 with a regression discontinuity model, I find that hospitals receiving a bonus decrease their charity care among the lowest income patients (under 100% federal poverty level (FPL)). Hospitals receiving a penalty tend to reduce charity care among higher income patients (100%-200% FPL). These findings are consistent with two separate responses to the incentives. Hospitals receiving bonuses appear to be cream-skimming healthier, wealthier individuals while hospitals receiving penalties appear to be shifting the focus of their charity care to the most needy, likely in an effort to reduce cost of care levels overall while maintaining their community benefit programs, potentially as a result of goal gradient cognitive bias.
35
Choi, Chung Ho. "Patient journey shortening using a multi-agent approach." HKBU Institutional Repository, 2010. http://repository.hkbu.edu.hk/etd_ra/1228.
Full text
36
Mahlati, Malixole Percival. "The medical profession in a transforming South Africa society : ideals, values and role." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51996.
Full textAbstract:
Thesis (MPhil)--Stellenbosch University, 2000.Some digitised pages may appear illegible due to the condition of the original hard copy.
ENGLISH ABSTRACT: Medicine in our country is under severe stress, brought about by internal and external forces that need a response from the medical profession. The profession's attempts and response will fall short unless the profession itself is aligned with the new social ethos and the responses are based on the profession's inherent values. Problem Statement: Medical doctors have always been highly valued in society because of the duty they have when illness and disease set in. As individuals, doctors have fulfilled other important roles in the communities where they work. These include giving advice to young people on career choices, counseling on various matters and provision of material help where there is need. This profession has for a long time been shrouded in mystery, being a trade learnt by a few. All these factors contributed to their social standing increasing phenomenally. There is a view that this has also led to public perceptions that doctors are the rich untouchable elite who have no interest or are unconcerned about problems faced by society. The medical profession faces a challenge that is more significant because of the value placed on it by society. The numerous submissions by the victims of human rights abuses to the Truth and Reconciliation Commission have cast a shadow of doubt on the medical profession for its complicity in these acts. The present government has declared transformation of health care as one of its top priorities. The response of the medical profession to this initiative has so far not led to any significant changes of public perception that the profession is unwilling to participate in the transformation of our society. The challenge and subject of discussion in this thesis therefore is: "What is the ideal role of the medical profession in a transforming South African society?" The medical profession, being the nerve centre of health care, has a big responsibility in social transformation. Doctors stand accused as a collective for failing to protect the human rights of patients and not living up to the standards of ethics required of them when patients' rights were violated. The Truth and Reconciliation Commission record of the hearings into the role of the professional organisations in health is used in this thesis to illustrate how serious society views the medical profession's role in the human rights abuses of the past. Based on the T. R. C's report and the assumption that society traditionally places high value on the medical profession, I conducted a survey among South African doctors to test their attitudes towards a range of policy and transformational issues. The unit of analysis was the medical doctors who are in active practice in South Africa in whatever mode of practice. The survey sought to explore the awareness of the respondents about a range of transformation policy changes and invite their comments on the role that they envisage for the medical profession in the process of transformation of society. There is unfortunately scarcity or a lack of applicable South African literature on this topic thus limiting local material for referencing. The search of international literature only yielded the subject of the study of professional values and not necessarily the role of a medical profession in a transforming society. The medical profession has to re-visit its foundations, analyse its history and map out its future in the context of the South African realities. It must find a way of aligning itself with the new ethos and diverse cultures South Africa possesses. Medicine has its own traditional goals and values derived and adapted from society's diverse cultural value systems. With its national and international networks, the inherent knowledge and skills that it possesses, guided by an ethical code, the Hippocratic Oath that serves as a public promise, it influences policy on the country's health care system - a mechanism that government uses to provide a basic human need. The medical profession therefore has to be responsive to the needs of society as much as society needs to support the profession. This thesis explores the role that the profession should play in a transforming South African society. The argument is that this can only be done through the profession examining its values and aligning itself with broader societal value systems, the moral and social norms. It is further argued that visible realistic commitment by the profession to public health will lead to an improvement in its public image. It is the actions or non-actions of the majority that the public notices. The majority of respondents to the survey have indicated that they approve of the transformation policies in health but that they may differ in the way they were introduced.
AFRIKAANSE OPSOMMING: Die geneeskunde in ons land is onder geweldige druk as gevolg van interne en eksterne faktore en dit is nodig dat die mediese beroep reageer. Dit sal die beroep egter nie help om te reageer indien sy lede hulle nie met die nuwe maatskaplike etos vereenselwig nie en die reaksie op die inherente waardes van die mediese beroep geskoei word nie. Probleemstelling Mediese dokters is nog altyd baie hoog geag deur die gemeenskap as gevolg van die verpligting wat hulle het om na mense om te sien wanneer hulle siek word. In hulle individuele hoedanigheid het dokters ook ander belangrike bydraes tot hulle gemeenskappe gelewer. Dit sluit in: advies aan jong mense oor loopbaankeuses, berading en die verskaffing van finansiele hulp waar nodig. Die beroep as sulks was egter vir baie lank ietwat van 'n misterie omdat dit 'n vakrigting is waarin baie min mense hulle kon bekwaam. Al hierdie faktore het die maatskaplike aansien/waarde van dokters geweldig verhoog. Daar is ook diegene wat van mening is dat hierdie faktore aanleiding gegee het tot die openbare mening dat dokters 'n ryk en onaantasbare elite is en glad nie in die probleme van die gemeenskap belangstel nie. Die etlike voorleggings deur die slagoffers van menseregtevergrype aan die Waarheids- en Versoeningskommissie het ook vrae rondom die beroep se betrokkenheid by sodanige gevalle laat ontstaan. Die huidige regering het die transformasie van gesondheidsorg as een van sy grootste prioriteite verklaar. Die reaksie van die beroep hierop het tot dusver nie tot enige noemenswaardige veranderinge in die openbare mening dat dokters nie bereid is om aan die transformasie van ons gemeenskap deel te neem gelei nie. Wat is die ideale rol van die mediese beroep in die transformasie van die Suid- Afrikaanse gemeenskap? As die senusentrum van gesondheidsorg het die mediese beroep 'n groot verantwoordelikheid in maatskaplike transformasie. Dokters word kollektief beskuldig dat hulle nagelaat het om die menseregte van pasiente te beskerm en nie voldoen het aan die nodige etiese standaarde wat van hulle verwag word in die tyd toe pasienteregte geskend is nie. Die rekord van die verhore van die Waarheids- en Versoeningskommissie oor die rol van professionele gesondheidsorganisasies is vir die doeleindes van hierdie tesis gebruik om te illustreer hoe ernstig die gemeenskap voeloor die mediese beroep se rol in die menseregte vergrype van die verlede. Gegrond op die WVK-verslag en die aanname dat die gemeenskap die mediese beroep hoog ag, het ek 'n meningsopname onder 300 Suid-Afrikaanse dokters gedoen om hulle houding jeens 'n aantal beleids- en transformasiekwessies te toets. Die eenheid van analise was mediese dokters wat in die aktiewe praktyk staan, ongeag hulle praktykgebied. Die opname het gepoog om te bepaal wat die vlak van bewustheid by die respondente oor 'n aantal beleidsveranderinge gerig op transformasie is, en hulle uit te nooi om kommentaar te lewer op die rol wat hulle meen die mediese beroep behoort in die proses te speel. Ongelukkig is daar nie toepaslike Suid-Afrikaanse literatuur oor die onderwerp beskikbaar me. 'n Internasionale literatuursoektog het net studies rondom waardes opgelewer, en nie oor die rol van 'n mediese beroep in die transformasie van 'n gemeenskap nie. Die mediese beroep moet die grondslag van sy wese in oenskou neem, die geskiedenis analiseer en sy toekoms in die konteks van die Suid-Afrikaanse realiteite uitstippel. Die beroep moet 'n manier vind om homself met die nuwe etos en uiteenlopende kulture van Suid-Afrika te vereenselwig. Die geneeskunde het sy eie tradisionele doelwitte en waardes gekry en aangepas vanuit die uiteenlopende kulturele waardestelsels van die gemeenskap. Deur middel van sy nasionale en internasionale netwerke, inherente kennis en vaardighede, die leiding van 'n etiese kode, die Eed van Hippokrates wat as 'n belofte aan die publiek dien, beinvloed die mediese beroep die land se gesondheidsorgstelsel - 'n meganisme van die regering om in 'n basiese menslike behoefte te voorsien. Die mediese beroep moet daarom ingestel wees op die behoeftes van die gemeenskap in dieselfde mate as wat die gemeenskap die beroep behoort te ondersteun. Hierdie tesis ondersoek die rol wat die mediese beroep behoort te vervul in 'n Suid-Afrikaanse gemeenskap waar transformasie besig is om plaas te vind. Daar word geargumenteer dat dit net gedoen kan word indien die beroep sy waardes ondersoek en hom met die breer maatskaplike waardestelsels vereenselwig. Daar word verder geargumenteer dat 'n sigbare realistiese verbintenis van die mediese beroep tot openbare gesondheid tot die verbetering van sy openbare beeld sal lei. Dit is die optrede of nie-optrede van die meerderheid wat die publiek raaksien. Die meerderheid respondente in die meningsopname het aangedui dat hulle die transformasiebeleid vir gesondheid ondersteun, maar dat hulle verskil van die wyse waarop dit in werking gestel is.
37
Spitznogle, Robin C. "An analysis of science- and technology-related health assistance provided to lesser developed nations from 1985 to 1995." Morgantown, W. Va. : [West Virginia University Libraries], 1999. http://etd.wvu.edu/templates/showETD.cfm?recnum=891.
Full textAbstract:
Thesis (M.A.)--West Virginia University, 1999.Title from document title page. Document formatted into pages; contains ix, 133 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 88-94).
38
Adams, Ubanesia Lolita. "Reinterpreting the implementation gap : a case based analysis of District Health System implementation in the Western Cape Province in South Africa." Thesis, University of Sussex, 2011. http://sro.sussex.ac.uk/id/eprint/6921/.
Full textAbstract:
This dissertation examined an implementation gap through a case study on implementing a District Health System (DHS) in the Western Cape Province of South Africa between October 2001 and April 2006. The research project explored why this implementation gap existed and what could be learnt about public policy implementation from studying this implementation gap. The main data collection methods included interviews, public and other documents and observations on the public health system in the Western Cape Province. I argue that implementation gaps could be interpreted as a signal of policy change instead of implementation failure. The key finding is that the Provincial Government of the Western Cape shifted its intentions regarding DHS implementation. The initial intention was to decentralise primary health care services to a metropolitan municipality. The decision, which was actively implemented, however centralised these services within the provincial government and started the process of the provincialisation of personal primary health care services in the Western Cape Province. This dissertation contributes to public policy implementation and public policy process literatures. It demonstrates why policy change is an alternative interpretation of implementation gaps to implementation failure and how policy change occurs during implementation. Policy change and public policy implementation are commonly two separate research themes within Public Policy Studies. The persuasion framework developed through this research project is an analytical tool that may be applied in research on implementation processes to examine whether an implementation gap is signalling policy change. The central theoretical elements in this framework that link policy change and implementation processes are the interactive effects of ideas and interests and the role of argument as a persuading factor that leads to policy change. The dissertation emphasises the role of language in public policy processes and argument and persuasion were deemed important elements in public policy processes.
39
Obermann, Konrad. "Public participation in the rationing of health care /." Diss., Aachen : Shaker, 2000. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=009236382&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
Full text
40
Hafez, Reem. "The impact of health insurance on financial risk protection in Ningxia, China." Thesis, University of Oxford, 2014. https://ora.ox.ac.uk/objects/uuid:e5f5892c-da06-408b-b4ac-cfce3c17e483.
Full textAbstract:
In 2009 China launched an ambitious health care reform to ensure equal and affordable access to basic health care for all by 2020. The reform was not only a response to changing patterns of disease, rising health expenditures, and widening regional inequalities, but part of a wider strategy to improve the social security system covering residents in order to increase domestic consumption. Its success will be defined by the efficient use of funds in financing and delivering health care. Against this backdrop, this dissertation evaluates the importance of health insurance characteristics on measures of financial risk protection, household saving and consumption, and preference for health care providers. It uses an experimental design to study the effect of more generous outpatient coverage and a tiered reimbursement structure that sets rates higher at primary care facilities than tertiary hospitals. While middle income households benefitted most in terms of financial risk protection, poorer and sicker households increased utilization at primary care facilities and food consumption â two pathways by which health insurance can improve health outcomes. This suggests that as outpatient coverage improves those most vulnerable will increase their access to health care, where there was previous underutilization, but not necessarily see an improvement in financial risk protection. The increased cover would also offer greater protection for those already using healthcare, but on its own not necessarily change their utilization patterns or reduce household savings. Looking at the quality-price trade-off in choice of provider reveals that, while at lower levels of household consumption demand for outpatient care is elastic with respect to price, as living standards rise past subsistence, individuals begin to value other provider characteristics. Together, these findings highlight the importance of benefit design and quality improvements at lower levels of care to shift patterns of utilization and ensure health services are accessed cost-effectively.
41
Viney, Rosalie. "Health outcomes and utility : experimental evidence on quality adjusted life years." Thesis, The University of Sydney, 2004. https://hdl.handle.net/2123/27958.
Full textAbstract:
Health resource allocation decisions increasingly use measures such as Quality
Adjusted Life Years (QALYs) to value health care interventions. QALYs have
been shown to be consistent with underlying welfare economic theory only if
certain restrictions are placed on individual utility fimctions.
42
Kobelt, Gisela. "Health economic assessment of medical technology in chronic progressive diseases : multiple sclerosis and rheumatoid arthritis /." Stockholm, 2003.
Find full text
43
Mills, Elizabeth Anne. "Embodied precarity : the biopolitics of AIDS biomedicine in South Africa." Thesis, University of Sussex, 2014. http://sro.sussex.ac.uk/id/eprint/48911/.
Full textAbstract:
This thesis centres on the lives of women who live in Khayelitsha and who receive AIDS biomedicines through South Africa's public health system. It is tiered across five ethnographic chapters to elucidate a single overarching argument: biopolitical precarity is networked into the permeable body. This argument is based on ethnographic research and seeks to challenge the discursive construction of distance that divorces women's lives and bodies from the governance of AIDS biomedicines as life-giving technologies. The multi-sited ethnography underpinning this thesis was configured to follow the networked threads that weave women's embodied precarity into the governance of technologies and the technologies of governance. To this end, fieldwork was conducted in South Africa from October 2010 – July 2011 in order to understand the embodied and political dimensions of access to AIDS biomedicine. Thereafter, fieldwork was conducted in Brazil from August 2011 – September 2011 to explore the networked connections spanning activist organisations, government coalitions and economic blocs to move out from the intimate spaces of women's lives and bodies to locate them in the regional and global spaces of biomedical developments and health policy dynamics. This thesis argues that although it is crucial to anchor technologies in people's lives, it is also analytically and politically necessary to link people's lives - and the technologies that sustain them - back into the global assemblage that is networked around the governance of medicine. Therefore, I locate biomedical technologies in social and political contexts of lives of the people with whom I worked in Khayelitsha, and I argue further that their lives also need to be understood as part of a complex network of actors (spanning international organisations, regional coalitions and national governments) and actants (HIV and ARVs) that assemble in dynamic configurations and that are woven into and through the body.
44
Cavanaugh, Teresa M. "Comprehensive Direct Medical Costs Associated with Six Months of Care Status Post Acute Rejection Events in Renal Transplant Recipients: A Single Center Retrospective Matched Case Control Analysis." University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1243007844.
Full text
45
Rosenfeld, Mark. "Whiplash-associated disorders from a physical therapy and health-economic perspective : a study of an active physical therapy involvement and intervention for the treatment of acute whiplash-associated disorders and an analysis of its costs and consequenses /." Göteborg : Institute of Neuroscience and Physiology, Division of Physical Therapy, Sahlgrenska Academy at Göteborg University, 2006. http://hdl.handle.net/2077/711.
Full text
46
List, Matthew Patrick. "Inflation and the Elderly." Thesis, Boston College, 2005. http://hdl.handle.net/2345/400.
Full textAbstract:
Thesis advisor: Alicia MunnellSince 1975, Social Security retirement benefits have been tied to the Consumer Price Index to adjust for inflation. The CPI measures price changes for a market basket of goods and services designed to replicate the average consumer's expenditures. The elderly, however, consume a market basket different from that of the typical person. In particular, the elderly tend to purchase more medical services than other consumers. Because the price of medical care increases more rapidly than other prices, the inflation rate experienced by the elderly is greater than the inflation rate for the general population, even when controlling for the upward quality bias in the medical care component of pricing data. However, given that this difference in inflation rates is less than the size of the total measurement error in the CPI, recipients of Social Security retirement benefits are actually overcompensated for increases in inflation. Over the course of a beneficiary's retirement, this overcompensation results in a total benefit that is 5.4 – 6.6% greater than what the total benefit would have been under an ideal inflation indexing scheme
Thesis (BA) — Boston College, 2005
Submitted to: Boston College. College of Arts and Sciences
Discipline: Economics Honors Program
47
Austin, Raymond Edwin. "The changing political economy of hospitals: the emergence of the "business model" hospital." Diss., Virginia Polytechnic Institute and State University, 1989. http://hdl.handle.net/10919/54762.
Full textAbstract:
The hospital industry is now in a major transitional phase which is substantially changing its operational values and organizational forms. This transition was triggered primarily by a crisis brought on by rapidly escalating costs. Many forces centering on the cost containment theme are now forging new political and economic operating rules for health care providers. Collectively these forces are bringing about decisive changes in the quality, quantity and structure of health care delivery systems. The result has been the emergence of a new pattern of hospital organization and administration, described here as the business model hospital. This model is driven by incentives and performance criteria wholly different from those of traditional community hospitals. This research describes this new political economy of health care and identifies, via analysis of field interviews, the crucial issues faced by hospital administrators today and specific actions they are taking to adapt to their new environment. The emergence of the business model hospital has many positive attributes but could have adverse consequences for the broader public interest. Emerging public policy issues are discussed and recommendations are made as to how public policy makers may deal with these issues. These recommendations focus on retaining the major benefits of the business hospital model while preserving useful aspects of the community hospital framework.Ph. D.
48
Peters, Candice Marie. "A comparison of the levels of patient staffing ratios and staffing mix to the number of patient falls in an acute care setting." CSUSB ScholarWorks, 1997. https://scholarworks.lib.csusb.edu/etd-project/1314.
Full text
49
Dakin, Helen A. "Economic evaluation of factorial randomised controlled trials." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:77eda1f6-dd8c-439a-8871-75fd57a4c7f5.
Full textAbstract:
Factorial randomised controlled trials (RCTs) evaluate two or more interventions simultaneously, enabling assessment of interactions between treatments. This thesis presents literature reviews, methodological reviews, simulation studies and applied case studies that explore methods for assessing cost-effectiveness based on factorial RCTs. My systematic review suggests that factorial RCTs account for around 3% of trial-based economic evaluations, although there is currently no guidance or methodological work indicating the most appropriate methods. Around 40% of published studies assumed no interaction between treatments and many were poorly-reported. Various mechanisms are likely to produce large interactions within economic endpoints such as costs, quality-adjusted life-years (QALYs) and net benefits. Failing to take account of interactions can introduce bias and prevent efficient allocation of healthcare resources. I developed the opportunity cost of ignoring interactions as a measure of the implications of this bias. However, allowing for small, chance interactions is inefficient, potentially leading to over-investment in research if trial-based evaluations are used to inform decisions about subsequent research. Nonetheless, analyses on simulated trial data suggest that the opportunity cost of adopting a treatment that will not maximise health gains from the healthcare budget is minimised by including all interactions regardless of magnitude or statistical significance. Different approaches for conducting economic evaluations of factorial RCTs (including regression techniques, extrapolation using patient-level simulation, and considering different components of net benefit separately) are evaluated within three applied studies, including both full and partial factorials with 2x2 and 2x2x2 designs. I demonstrate that within both trial-based and model-based economic evaluation, efficient allocation of healthcare resources requires consideration of interactions between treatments, and joint decisions about interacting treatments based on incremental cost-effectiveness evaluated “inside-the-table” on a natural scale. I make recommendations for the design, analysis and reporting of factorial trial-based economic evaluations based on the results of this thesis.
50
Flores, Michael D. S. B. Massachusetts Institute of Technology. "Analysis of the socio-economic factors that contribute to the access of medical care for different ethnic and racial groups." Thesis, Massachusetts Institute of Technology, 2006. http://hdl.handle.net/1721.1/36743.
Full textAbstract:
Thesis (S.B.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2006."June 2006."
Includes bibliographical references (leaves 24-32).
My review of the health services literature over the past decade and a half since the release of the Task Force Report revealed significant differences in access to medical care by race and ethnicity within certain disease categories and types of health services. Most studies have varied in their attempts to control for possible explanatory variables most important, SES (or some surrogate measure of social and economic status), insurance coverage, stage or severity of disease, comorbidities, and type and availability of health care services. In some cases, when important variables are controlled, racial and ethnic disparities in access are reduced and may even disappear under certain circumstances. Nonetheless, the literature shows that racial and ethnic disparities persist in significant measure for several disease categories and service types. Findings are irrefutably consistent for certain areas (invasive cardiac care), requires careful interpretation in some areas (cancer and HIV/AIDS), and are muddled in other areas (mental health). In specific health care settings (diabetes care) and under certain circumstances, no racial and ethnic disparities are observed. Altogether, findings from the published literature raise many questions about equity and fairness in health care delivery.
by Michael D. Flores.
S.B.