To see the other types of publications on this topic, follow the link: Universal Health Coverage(UHO).
Dissertations / Theses on the topic 'Universal Health Coverage(UHO)'
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 'Universal Health Coverage(UHO).'
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
Nkosi, Mbhekeni Sabelo. "National Health Insurance (NHI) – towards Universal Health Coverage (UHC) for all in South Africa: a philosophical analysis." University of the Western Cape, 2020. http://hdl.handle.net/11394/7703.
Full textAbstract:
Philosophiae Doctor - PhD<br>This study is a philosophical analysis of the National Health Insurance (NHI) policy and legislation, including the related NHI Fund, with a view to assessing its prospects in realising Universal Health Coverage (UHC). The NHI system is about ensuring universal access to quality healthcare for all. The rationale is to provide free healthcare for all at the point of care/service. This legislation has the potential to transform, on the one hand, the relationship between the public and private healthcare sectors and, on the other, the nature of public funding for healthcare. Part of the challenge with the NHI system is that it seeks to provide healthcare for all, but by seeking to integrate the private sector it runs the risk of commercializing healthcare. The study is philosophical in that it holds that ideas have consequences (and conversely actions have presuppositions with certain meanings). In part, it aims to show that an implementing mechanism of the NHI system as presently envisaged has socio-political and economic implications with fundamental contradictions within it; for it seeks to incorporate the private healthcare sector in offering free public healthcare services. This introduces a tension for private healthcare services operate with a neoliberal outlook and methodology which is at odds with a public approach that is based on a socialist outlook. The analysis may make explicit conceptual and ideological tensions that will have practical consequences for healthcare. Much of the commentary on the NHI system have focused on the practical consequences for healthcare; my intervention is to explore and critically assess the various philosophical assumptions that lie behind these practical concerns. Some of these practical consequences are related to the possibility that healthcare is likely to become commercialized and the public healthcare sector will remain in a crisis. This study argues for the provision of access to high quality healthcare facilities for all members of the South African population. Healthcare must be provided free at the point of care through UHC legislation or by the setting up of the NHI Fund as financing mechanism. The study provides reason for the decommercialization of healthcare services completely – that is for eliminating private healthcare from contracting with the NHI Fund. Essentially, it argues for the claim that healthcare should not be traded in the market system as a commodity and that the NHI system in its current incarnation seeks to do precisely that. I further argue that in theory and in practice the neoliberal and socialist assumptions underlying the NHI system in its present formulation do not fit together. On the contrary, rather than a two-tiered system incorporating the private and public healthcare sectors, the dissertation argues for a different way of conceptualizing the NHI system that privileges the latter.
2
Roman, Tamlyn. "Universal health coverage: a systems thinking approach." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/11976.
Full textAbstract:
Includes abstract.<br>Includes bibliographical references.<br>This dissertation uses a systems thinking approach to investigate how current health system frameworks conceive of universal coverage schemes and the conditions which led to their implementation and sustainability.
3
Nandi, Sulakshana. "Equity, access and utilisation in the state-funded universal insurance scheme (RSBY/MSBY) in Chhattisgarh State, India: What are the implications for Universal Health Coverage?" University of the Western Cape, 2019. http://hdl.handle.net/11394/7393.
Full textAbstract:
Philosophiae Doctor - PhD<br>Universal Health Coverage (UHC) has provided the impetus for the
introduction of publicly-funded health insurance (PFHI) schemes, involving the private sector,
especially in low-and middle-income countries with mixed health systems. Although equity is
considered as being core to UHC, the implication of UHC interventions for equity in access
(availability, affordability and acceptability) beyond financial protection is inadequately
researched. India introduced a national PFHI scheme (Rashtriya Swasthya Bima Yojana) in 2007 which
has since then been expanded considerably through the Pradhan Mantri Jan Aarogya Yojana (PMJAY)
scheme. However, contestation remains as to whether PFHI schemes are the most appropriate
interventions for UHC in India. Evidence so far provides cause for concern regarding their impact
on financial protection and health equity. With PFHI schemes burgeoning globally, there is an
urgent need for a holistic understanding of the pathways of impact of these schemes, including
their roles in promoting equity of access and achievement of UHC objectives. The state-funded
universal health insurance scheme (RSBY/MSBY) in Chhattisgarh State provided the opportunity to
explore these pathways of impact, especially on vulnerable communities, as the State has a
universal health insurance scheme. This PhD aims to study equity, access and utilisation in the
state-funded universal insurance scheme in Chhattisgarh State of India, in the context of Universal
Health
Coverage. It is presented as a thesis by publications.
4
Koon, A. D. "Framing Universal Health Coverage in Kenya : an interpretive analysis of health financing politics." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2017. http://researchonline.lshtm.ac.uk/4398421/.
Full textAbstract:
Universal Health Coverage (UHC), comprehensive access to affordable and quality health services, is a key component of the newly adopted 2015 Sustainable Development Goals (SDGs). Prior to formally adopting the goals at the United Nations in September 2015, several countries began incorporating elements of UHC into the domestic policy arena. Little research has been conducted on the process through which UHC financing policies have been contested in the political realm. In 2013, President Uhuru Kenyatta of Kenya announced initiatives aimed at moving the country towards UHC, which have proven controversial. This study drew on recent theoretical innovations in the field of critical policy studies to examine the ways in which actors understood and engaged with three highly contested health financing polices introduced as part of the movement towards UHC in Kenya: user fee removal, raising contributions to the mandatory health insurer, and the failed 2004 Bill on Social Health Insurance. In addition to document review, this study involved interpretive analysis of transcripts from 50 semi-structured interviews with leading actors involved in the health financing policy process in Kenya. The frame-critical analysis focused on how actors 1) make sense of the policy environment and create meaning through circulating finance ideas; 2) name various elements of the policy design through a process of selecting and categorizing; 3) tell stories and create narratives in ways that illustrate salient features of the process and generate shared understandings. Furthermore, this analysis also focused on what is subject to framing in this dynamic process, including 1) the substantive issues of the policies in question; 2) actor identities and relationships; and 3) the policy process itself. This study found that user fee removal was framed by finance experts as an achievable shortterm target for the Jubilee Coalition’s party manifesto. The rate increase for the mandatory insurer, the National Hospital Insurance Fund (NHIF), was consistently obscured by framing the debate around the shortcomings of NHIF and its damaged legacy. Lastly, the failed 2004 Bill on National Social Health Insurance has since fragmented into several incremental policy proposals that remain the subject of divisive framing contests. This study provides timely insight into the political dynamics surrounding the UHC movement, the policy process for health financing in Kenya, as well as theoretical and methodological considerations for frame-critical policy analysis and the field of critical policy studies more widely.
5
Makhloufi, Khaled. "Towards universal health coverage in Tunisia : theoretical analysis and empirical tests." Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0025/document.
Full textAbstract:
La présente thèse explore, à travers quatre papiers, la possibilité d’étendre le régime d’assurance maladie sociale (SHI) vers la couverture santé universelle (CSU) et ce en présence d’obstacles structurels économiques.Les effets moyens de deux traitements, les deux assurances MHI et MAS, sur l’utilisation des soins de santé (consultations externes et hospitalisations) sont estimés. L’actuel régime d’assurance sociale en Tunisie (SHI), malgré l’amélioration de l’utilisation des soins de santé procurée aux groupes couverts, reste incapable d’atteindre une couverture effective de tous les membres de la population vis-à-vis des services de soins dont ils ont besoin. L’atteinte de cet objectif requière une stratégie qui cible les ‘‘arbres’’ et non la ‘‘forêt’’.Le chapitre deux contourne les principaux obstacles à l’extension de la couverture par l’assurance maladie et propose une approche originale permettant de cibler les travailleurs informels et les individus en chômage. Une étude transversale d’évaluation contingente (CV) a été menée en Tunisie se proposant d’estimer les volontés d’adhésion et les consentements à payer (WTP) pour deux régimes obligatoires présentés hypothétiquement à l’adhésion. Les résultats confirment l’hypothèse selon laquelle la proposition d’une affiliation volontaire à un régime d’assurance obligatoire serait acceptée par la majorité des non couverts et que les WTP révélés pour cette affiliation seraient substantiels. Enfin, dans le chapitre trois, on insiste sur l'’importance de prendre en compte les attitudes protestataires en évaluant la progression vers la CSU<br>This thesis explores, in a four paper format, the possibility of extending social health insurance (SHI) schemes towards Universal Health Coverage (UHC) in presence of structural economic obstacles.The average treatment effects of two insurance schemes, MHI and MAS, on the utilization of outpatient and inpatient healthcare are estimated. The current Tunisian SHI schemes, despite improving utilization of healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for needed services. Attaining the latter goal requires a strategy that targets the “trees” not the “forest”.Chapter two gets around major challenges to extending health insurance coverage and proposes an original approach by targeting informal workers and unemployed. A cross-sectional Contingent valuation (CV) study was carried out in Tunisia dealing with willingness-to-join and pay for two mandatory health and pension insurance schemes.Results support the hypotheses that the proposition of a voluntary affiliation to mandatory insurance schemes can be accepted by the majority of non-covered and that the WTP stated are substantial.Finally in chapter three we focus on methodological aspects that influence the value of the WTP. Our empirical results show that the voluntary affiliation to the formal health insurance scheme could be a step towards achieving UHC in Tunisia. Overall, we highlight the importance of taking into account protest positions for the evaluation of progress towards UHC
6
Diallo, Elhadj Mamadou Saliou. "Three essays on progress towards universal health coverage in developing countries." Electronic Thesis or Diss., Université Clermont Auvergne (2021-...), 2021. http://www.theses.fr/2021UCFAD034.
Full textAbstract:
De nombreux efforts, et d’immenses progrès ont été réalisés ces dernières années par les pays à revenu faible et intermédiaire vers la couverture universelle de santé. Celle-ci est atteinte lorsque tous les individus ont accès à des soins de santé de qualité lorsqu’ils en expriment le besoin, et sans encourir de difficultés financières. Cette thèse s’efforce de mesurer les progrès réalisés par les pays à revenu faible et intermédiaire en matière de couverture universelle de santé, d’en déduire les déterminants et de mettre en évidence les effets que peuvent avoir la couverture universelle de santé sur l’état de santé. La thèse s’organise autour de trois chapitres. Le premier chapitre montre l’effet des paiements directs sur la pauvreté. L’analyse vise à décrire la nécessité de progresser vers la couverture universelle de santé en mettant en exergue l’effet des paiements directs sur la pauvreté. Le deuxième chapitre vise à exposer les facteurs qui expliquent les progrès réalisés par certains pays en matière de couverture universelle de santé, en analysant l’effet spécifique des recettes du gouvernement. En outre, à la différence d’autres études, ce chapitre déduit le niveau minimal de recettes du gouvernement en pourcentage du PIB que les pays à revenu faible et intermédiaire devraient mobiliser pour progresser significativement vers la couverture universelle de santé. Enfin, le chapitre trois étudie l’effet du progrès vers la couverture universelle de santé sur l’état de santé<br>Many efforts and tremendous progress has been made in recent years by low- and middle-income countries towards universal health coverage. It is achieved when all individuals have access to quality health care when they need it, without incurring financial hardship. This thesis aims to measure the progress made by low- and middle-income countries in universal health coverage, deduce their determinants, and highlight the effects of universal health coverage on health outcomes. The thesis is organized around three chapters. The first chapter shows the effect of out-of-pocket expenditures on poverty. The analysis aims to show the necessity to move towards universal health coverage by highlighting the effect of out-of-pocket expenditures on poverty. The second chapter aims to show the factors that explain the progress made by some countries in universal health coverage and analyzing the specific effect of government revenue. In addition, this chapter, unlike other studies, deduces the minimum level of government revenue as a share of GDP that low and middle-income countries should mobilize to make significant progress towards universal health coverage. Finally, chapter three examines the effect of progress towards universal health coverage on health status
7
Barroy, Hélène. "Toward Universal Health Coverage : Assessing Health Financing Reforms in Low and Middle Income Countries." Thesis, Clermont-Ferrand 1, 2014. http://www.theses.fr/2014CLF10459.
Full textAbstract:
La Couverture Santé Universelle (CSU) vise permettre à chaque individu d’utiliser les services de santé dont il a besoin sans risque de ruine financière ou d’appauvrissement. Bien que le concept de CSU offre un cadre directeur important pour une nation, tous les pays, quel que soit leur niveau de revenu, sont aux prises avec la réalisation ou le maintien de la couverture universelle. Dans ce contexte, générer des preuves sur les expériences des pays et partager les leçons sur les principales contraintes et les choix stratégiques utilisés pour surmonter les barrières techniques serait susceptible de permettre aux pays à revenus faibles ou intermédiaires d’aller de l'avant et de progresser plus rapidement vers la CSU. La thèse propose une analyse comparative de plusieurs instruments politiques, utilisés par cinq cas pays (Niger, Vietnam, Bangladesh, Gabon, France), pour étendre la couverture sanitaire et la protection financière. L’analyse montre que les interventions simples, comme la suppression des frais des utilisateurs (Niger) ou de l'assurance santé à base communautaire (Bangladesh), peuvent accroître l'utilisation des services pour les groupes les plus défavorisés, mais font face à de fortes limitations dans l’atteinte de plus grandes ambitions. Des réformes plus articulées ont démontré des gains importants dans le développement de la couverture santé, mais font également face à des défis pour trouver l'espace budgétaire suffisant (Gabon) et améliorer l’efficience et l'équité du système (Vietnam). Enfin, la thèse analyse les effets de différentes réformes utilisées pour maintenir les gains de la CSU dans des systèmes de santé mûrs, tel que la France. Dans l'ensemble, la thèse a démontré que le menu des réformes vers la couverture universelle est vaste, complexe et perpétuel mais que certains chemins peuvent conduire au succès<br>Universal Health Coverage (UHC) is to ensure that everyone can use the health services they need without risk of financial ruin or impoverishment. While the UHC concept offers a powerful framework for a nation, all countries, irrespective of their income level, are struggling with achieving or sustaining universal coverage. In this context, generating evidence about countries’ experiences and sharing lessons on key constraints and strategic choices used to overcome technical barriers would likely enable low-and-middle countries to move forward and make faster progress toward UHC. The thesis provides a comparative analysis of policy instruments used by five selected country cases (Niger, Vietnam,Bangladesh, Gabon and France), to expand health coverage and financial coverage. Analysis shows that single interventions, like user fee removal (Niger) or community-based insurance (Bangladesh), can increase service utilization for the most disadvantaged groups but face strong limitations toward greater ambitions. More articulated reforms have demonstrated significant gains in expanding health coverage but also face challenges in finding the adequate fiscal space (Gabon) and in strengthening system’s efficiency and equity (Vietnam). Finally, the thesis analyzed the effects of different reforms used to sustain gains of UHC in mature health systems, like France. Overall, the thesis demonstrated that the reform agenda for universal coverage is large, complex and perpetual but that certain pathways can ensure success
8
Chamchan, Chalermpol. "Thailand's universal coverage implementation : performances and impacts on public health service system." 京都大学 (Kyoto University), 2007. http://hdl.handle.net/2433/137062.
Full textAbstract:
Kyoto University (京都大学)<br>0048<br>新制・課程博士<br>博士(地域研究)<br>甲第13194号<br>地博第44号<br>新制||地||14(附属図書館)<br>UT51-2007-H467<br>京都大学大学院アジア・アフリカ地域研究研究科東南アジア地域研究専攻<br>(主査)教授 水野 廣祐, 教授 松林 公蔵, 教授 玉田 芳史<br>学位規則第4条第1項該当
9
Tapsoba, Palingwindé Yann. "Sustainable health financing for progress towards universal health coverage in low- and middle-income countries." Thesis, Université Clermont Auvergne (2017-2020), 2017. http://www.theses.fr/2017CLFAD022/document.
Full textAbstract:
Cette thèse s’intéresse aux questions de soutenabilité dans le financement de la santé au sein des pays à revenus faible et intermédiaire. Elle est articulée autour de quatre chapitres. Les deux premiers chapitres proposent respectivement d’explorer les déterminants de l’efficience technique des dépenses de santé et de leur niveau par habitant dans les pays à revenus faible et intermédiaire. Le premier chapitre analyse l’effet de l’ouverture commerciale sur l’efficience technique des dépenses de santé. Le second chapitre étudie l’effet de la pollution de l’air sur les dépenses de santé. Dans les deux derniers chapitres, nous nous focalisons sur les pays d’Afrique subsaharienne. Le troisième chapitre étudie le rôle que joue le financement prépayé de la santé pour l’amélioration de la santé dans les ménages tandis que le quatrième chapitre se fixe pour objectif d’analyser les déterminants des dépenses prépayées de santé en se focalisant plus particulièrement sur l’instabilité politique<br>This thesis focuses on the sustainability issues in health financing in low-and middle –income countries. It is articulated around four chapters. The two first chapters propose to respectively explore the determinants of technical efficiency of health expenditures and their level per capita in low-and middle –income countries. The first chapter analyzes trade openness effect on the technical efficiency of health expenditures. The second chapter investigates air pollution effect on health expenditures. In the two last chapters, we focus on Sub-Saharan African countries. The third chapter studies the role that plays prepayment health financing for health improvement in households whereas the fourth one sets the goal to analyze the determinants of prepayment health expenditures, by particularly focusing on political instability
10
Wungchun, Kittipadakul Nonglak Pancharuniti. "Client satisfaction towards oral health services under universal health coverage project in Singburi province, Thailand /." Abstract, 2004. http://mulinet3.li.mahidol.ac.th/thesis/2547/cd363/4637905.pdf.
Full text
11
Pitayarangsarit, Siriwan. "The introduction of the universal coverage of health care in Thailand : policy responses." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2005. http://researchonline.lshtm.ac.uk/682331/.
Full textAbstract:
In 2001, Thailand introduced the Universal Coverage of Health Care Policy (UC) very rapidly after the new government came to power. The policy aims to entitle all citizens to health care and includes health system reforms to achieve equity, efficiency, and accountability. The overall question this thesis asks is how did this policy come about, and how likely is it that the policy will achieve its goals? Literature suggests that understanding the policy process is as important as assessing the content of particular policies when judging policy outcomes. By using an analytical framework to explore four elements: context, actors, process, and content, this thesis aims to generate general understanding of the UC policy process, and to use this analysis to assess implementation. It starts by addressing how and why universal coverage, which had long been discussed in Thailand, got on to the policy agenda in 2001, and then explores how the policy was formulated nationally. It goes on to look at implementation in one province, examining the inter-relationships between provincial, district and community facilities. Data were gathered from key informant interviews, document and media analysis, and group discussion with villagers. The analysis suggests that Thailand's democratization, created new actors in health policymaking processes which had long been under control of bureaucrats and professionals. The 1997 Constitution encouraged a more pluralistic political system. Universal access to health was advocated by a group of non-government organizations who pushed to get UC through legislation and announced their campaign a few months before the 2001 election. NGO interest was paralleled by a political party campaign, announced in 2000 by the Thai-Rak Thai Party, and implemented as UC when the Party came to power. UC was picked up because it was seen as legitimate, feasible under the existing infrastructure and government budget, and also congruent with the reform intention of the political party. Once it became the government in 2001, an important factor in early policy formulation was the extent to which national research provided evidence to support the policy. The research community was tightly-knit and concentrated in medical-related professions. One member of this policy community played an important role as a policy entrepreneur. This policy community continued to support evidence for debates in policy-making during both policy formulation and implementation. The implementation process was a top-down process; however, there were some spaces for street level bureaucrats to adapt decisions to fit their context. Implementation started through the extension of insurance coverage in four phases under the execution of the Ministry of Public Health. Private providers were only minimally involved in these formulation and implementation phases. The UC policy in 2001-2 was characterised by clear policy goals, limited participation, strong institutional capacity, and very rapid implementation - all factors which anticipated success of the policy. However, the complex technical features of the policy and the big change in system reform were a brake on success. One of the implementation problems was the mobilization of human resources, especially where bureaucrats were resistant to change. It seems that the implementation of the UC policy in Thailand reflected both managerial as well as political problems. Given the findings of this study, policy monitoring should pay attention to political as well as technical assessment.
12
López, Alejandra. "The impact of universal health coverage and national health expenditure on the main health determinants on central America countries and the Caribbean." University of Western Cape, 2020. http://hdl.handle.net/11394/7891.
Full textAbstract:
>Magister Scientiae - MSc<br>Health is considered as a sensitive marker of the sustainable development of a population. In Central America and Caribbean (CAC) region, the majority of countries are considered middle-income economies with significant inequalities mainly between the different types of health coverage and health expenditure.The main objective of the dissertation is to identify a possible relationship between universal health coverage and health investment in the main health and some sociodemographic determinants defined by the WHO/PAHO from 2009 to 2018. Additional characterizations of current types of health coverage, investment in health and the main health and socio-demographic indicators of the region were made.
13
Faruqui, Neha. "Accessing childhood cancer care in the era of Universal Health Coverage: Insights from India." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21884.
Full textAbstract:
Childhood cancers are a rare group of diseases for which despite relatively high cure rates for some cancers when detected early, survival rates remain low in many low and middle-income countries (LMICs) compared to high income countries. This is in part due to multiple socioeconomic and health system related factors impeding access to timely diagnosis and treatment. An essential component of Universal Health Coverage (UHC) is improving ‘access to health services’ and ensuring all people have equitable access - including children with cancer, particularly since health systems strengthening for childhood cancers is likely to improve the health system for other disease conditions as well. For UHC to include a disease like childhood cancer, an understanding of the barriers to accessing childhood cancer care at the individual and health system levels is necessary. India manages childhood cancers through a fragmented health system while simultaneously embarking upon a commitment towards achieving UHC. While research has been undertaken on childhood cancer care in India, there are still gaps in research regarding specific health system and individual barriers to cancer diagnosis and treatment for children. Therefore, the overarching aims of this thesis were to identify and understand barriers in accessing childhood cancer care and to explore how these findings might assist in the quest to achieve UHC. This thesis did not aim to prescribe any single approach or package for the inclusion of childhood cancers in UHC, nor does it evaluate policy-making strategies or financial measures to support this. Rather, this thesis aims to present evidence of access to care issues which should be considered when developing actionable UHC policy agendas for addressing childhood cancer care in India. The thesis addresses its aims through a series of interrelated qualitative and quantitative methodological studies which highlight delays to diagnosis and treatment as well as health system and individual related barriers affecting access to care. It concludes with examining the current strategies for childhood cancer care in India and recommendations for future advancements.
14
Mee-Udon, Farung. "The contribution of universal health insurance coverage scheme to villagers' wellbeing in northeast Thaila." Thesis, University of Bath, 2009. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.512326.
Full text
15
Preker, Alexander Shalom. "Public financing of health care in eight Western countries : the introduction of universal coverage." Thesis, London School of Economics and Political Science (University of London), 1991. http://etheses.lse.ac.uk/1167/.
Full textAbstract:
The public sector of all western developed countries has become increasingly involved in financing health care during the past century. Today, thirteen OECD countries have passed landmark legislative reforms that call for compulsory prepayment and universal entitlement to comprehensive services, while most of the others achieve similar coverage through a mixture of public and private voluntary arrangements. This study carried out a detailed analysis of why, how and to what effect governments became involved in health care financing in eight of these countries. During the early phase of this evolution, reliance on direct out-of-pocket payment and an unregulated market mechanism for the financing, production and delivery of health care led to many unsatisfactory outcomes in the allocation of scarce resources, redistribution of the financial burden of illness and stabilisation of health care activities. This forced the state to intervene through regulations, subsidies and direct provision of services. Expansion in prepayment of health care gradually occurred through private insurance, social insurance and general revenues in response to different socio-economic, political and bureaucratic forces. Although improving health may have been the ultimate goal, offering universal access to affordable health care was the way the countries examined achieved this objective. Universal comprehensive coverage was associated with a decade of stable public expenditure on health care compared with GDP, total government expenditure and government consumption expenditure. There were no disproportionate increases in health care expenditure or displacement of public funds away from social programmes that depended on cash transfer payments. Nor do the countries that offer such social protection have higher public debt or poorer economic performance compared with the rest of the OECD. Measures of health status are unfortunately still not sufficiently developed or standardised to permit a detailed analysis of this aspect of outcome through cross-national comparisons. Furthermore, the countries examined may be more vulnerable to political backlash because of the high visibility of their government involvement in health care financing.
16
Okungu, Vincent Okongo. "Towards universal health coverage: Exploring healthcare-related financial risk protection for the informal sector in Kenya." Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/20255.
Full textAbstract:
There is a global emphasis to move towards universal health coverage (UHC) with the goal of making health services more equitable and accessible for all, without the risk of financial catastrophe when paying for the services. A key element of UHC reforms is to move away from out-of-pocket payments for health services towards a greater emphasis on mandatory prepayment health financing. The main challenge for low- and middle-income countries is how to extend coverage for informal sector populations, which in most cases are disproportionately exposed to catastrophic and impoverishing healthcare costs. This study explored the nature of the informal sector in Kenya, the experience of members of the informal sector with the health system, their views on different prepayment mechanisms for health services and compares the resource requirements for UHC through a system that requires contributions from the informal sector and a system that is non-contributory.
17
Ouedraogo, Lisa-Marie [Verfasser]. "Approaching Universal Health Coverage in Kenya : the Potential of integrating Community Based Health Insurance Schemes / Lisa-Marie Ouedraogo." Greifswald : Universitätsbibliothek Greifswald, 2017. http://d-nb.info/1129900789/34.
Full text
18
Prakongsai, Phusit. "The impact of the universal coverage policy on equity of the Thai health care system." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2008. http://researchonline.lshtm.ac.uk/682380/.
Full textAbstract:
In 2001, the government of Thailand implemented a universal coverage (UC) policy for access to health care by introducing a tax-funded health insurance scheme, the UC scheme, to approximately 47 million people who were not previous beneficiaries of the Civil Servant Medical Benefit Scheme (CSMBS) or the Social Security Scheme (SSS). The UC policy resulted in a significant change in health care financing arrangements and financial barriers to health services. The purpose of this research was to explore the likely impact of the UC policy in terms of the following factors: changes in health care use, equity in health care finance, and the distribution of public subsidies on health among different socio-economic groups of Thais. In addition, the effectiveness of the UC policy in protecting households against financial hardship as a result of medical care costs was explored at the household level. Benefit incidence analysis (BIA) was employed as a tool to assess equity in health service use and the distribution of public subsidies. Two case studies of renal replacement therapy (RR T) for end-stage renal disease (ESRD) patients and cardiac operations for heart disease patients were employed as tracers to explore the impact of the UC scheme's benefit package for better-off and less well-off households. Different choices of socio-economic group indicators (household income per capita or an asset index) and the use of aggregate and regional unit subsidies to calculate benefit incidence were also applied. Research results indicate that the UC policy did expand health care coverage to include nearly all Thais and increased the pro-poor nature of the Thai health care system, as well as the distribution of public health-related subsidies. Ambulatory service use and hospitalization of poorer quintiles significantly increased after the UC policy was implemented. The poorest quintiles gained the highest amount and proportion of public subsidies both prior to and after implementation of the UC policy. There was no change in conclusions regarding the distribution of public subsidies among different socioeconomic groups when different choices of socio-economic indicators or different levels of government unit subsidies were used. The analysis of financing incidence between 2000 and 2002 also showed less regressive overall health care finance, a greater decrease in household expenditure for health care among poorer quintiles, and a decrease in the catastrophic expenditure incidence in 2002, compared to 2000. The decision to exclude RRT from the UC benefit package resulted in a considerable financial barrier to health services and a substantial economic impact on poorer ESRD patients. Infrequent access to haemodialysis and the inability to obtain essential and expensive medication (erythropoietin) was shown to be a major cause of patients' death. Financial barriers to RR T prevented poorer ESRD patients from benefiting from access to essential health services, and the financial burden of RR T meant all poorer patients were inevitably faced with financial catastrophe as a result. Poorer ESRD patients adopted various financial strategies to cope with high health care expenditures, which impacted not only the ESRD patients themselves, but also other household members and relatives who had to provide supplemental financial support to help cover the costs of RRT. In contrast, neither poorer nor richer heart disease patients under the UC scheme experienced significant payments for the health care costs of open heart surgery due to the effectiveness of the scheme in financial risk protection. During the operation, a few poorer heart disease patients experienced financial burdens for travel costs and food expenditures for their relatives, but they were able to manage this financial burden by using their savings or taking loans, all without a significant financial impact on household living standards. In conclusion, the UC policy does appear to have overall improved equity in health care use and health care finance, and the distribution of public subsidies. Achievements of the UC policy in Thailand were most likely caused by the following three financing strategies: 1) the expansion of public health insurance to nearly universal coverage; 2) the removal of financial barriers to health services; and 3) the promotion of primary care use which is preferentially accessed and utilized by the poor in rural areas.
19
Grieve, Annabel. "Towards universal health coverage: mapping the development of the faith-based non-profit sector in the Ghanaian health system." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27958.
Full textAbstract:
The equitable provision of accessible quality health services and the achievement of universal health coverage (UHC) continue to be prominent on the global health agenda, yet remains an elusive target for many low- and middle-income countries (LMIC). In these contexts, the private not-for-profit (PNFP) sector plays a significant role, and in many African countries, faith-based non-profit (FBNP) providers dominate this sector. Robust public-private partnerships are increasingly being recognised as important to building and maintaining strong, resilient health systems. However, there is a lack of evidence on whether collaborations between FBNPs and the public sector are complementary, have achieved their intended aims, or exactly how these relationships developed over time to shape these health systems. Furthermore, reliable information on both the historical and current spatial distribution of services and how this relates to geographic accessibility and the achievement of UHC is limited. This study explores this in Ghana, a country with a large FBNP sector, mostly networked under the Christian Health Association of Ghana (CHAG) which has an influential and now formalised relationship with the government. The following health systems research study utilises a mixed methods approach, synthesising geospatial mapping with varied documentary resources (secondary and primary, current and archival). The evolution of the FBNP sector and the shifts in service footprint are reflected in the geospatial maps, aligned with key historical events and contextualised by a narrative analysis. The study highlights that many faith-based facilities were initially located in rural and remote areas beyond colonial governance control (or boundaries), and many of these facilities still exist, demonstrating resilience to change over time. However, this service footprint has changed and today, public and private health facilities are located in similar areas throughout the country. This trend is in-line with social and political events, changing population dynamics and an increasing population of urban poor. The analysis assesses how the growth of the public sector, and these shifts in presence and profile for the FBNPs has influenced their perceived and measured contribution to UHC - in particular geographic accessibility. This study provides a model for representing the evolution of the relationship between public and a particular type of non-state provider over time, characterising the historical development of the health system, which should be considered in efforts to strengthen and develop the Ghanaian health system, and other relatable LMIC health systems.
20
Nguyen, Mai Phuong. "Contribution of private healthcare to universal health coverage: an investigation of private over public health service utilisation in Vietnam." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/225903/1/Mai%20Phuong_Nguyen_Thesis.pdf.
Full textAbstract:
Achievement of Universal Health Coverage (UHC) is a desirable goal for all countries. Complementary public and private services are essential. This study examined factors that influence consumer choice for private and public health care services in Vietnam. Thirty senior healthcare professionals were interviewed and secondary data on over 35,000 episodes of healthcare gathered during national health surveys in households were analyzed. For Vietnam and similar low and middle-income countries to achieve UHC, it is necessary to overcome incomplete social health insurance coverage, variable quality of private and public health services, unregulated quality in advertising and inefficient competition between sectors.
21
Asomaning, Antwi Abena. "The pathway of achieving the universal health coverage in Ghana : the role of social determinants of health and “health in all policies”." Thesis, Lille, 2019. http://www.theses.fr/2019LIL1A002.
Full textAbstract:
Le concept de Couverture Santé Universelle (CSU) est désormais mondialement accepté comme un moyen de fournir équitablement des soins de santé aux populations. Découlant du troisième Objectif de développement durable des Nations Unies (ODD). Le Ghana, a lancé en 2003 sa propre forme de couverture sanitaire universelle en créant un Régime national d’assurance maladie et la mise en œuvre de services de santé extrahospitaliers de proximité (community-based). Cependant, après plus d'une décennie de mise en œuvre, la CSU ghanéenne a stagné. Afin de comprendre et d’expliquer ce phénomène, cette recherche examine la mise en œuvre du Régime national d’assurance maladie ghanéen du point de vue des déterminants sociaux de la santé. Il étudie ses implications pour la croissance (en termes d’inscription et de renouvellement) dans le cas où le principe complémentaire de promotion de la santé dans toutes les politiques publiques, pour prendre en compte le rôle des déterminants sociaux de santé. L’étude repose sur une méthode essentiellement qualitative, complétée par des données quantitatives. L’analyse permet de soutenir empiriquement l’argument d’une meilleure prise en compte des déterminants sociaux de santé au Ghana. La recherche montre également que l’existence d’une tension entre une approche purement volontaire de la mise en œuvre de la Couverture Santé Universelle et l’approche quasi obligatoire adoptée au Ghana. En conclusion, la recherche montre que la stratégie actuelle adoptée par le Ghana, n’est pas financièrement soutenable<br>The Universal Health Coverage (UHC) has become a globally accepted concept and medium of providing healthcare to populations equitably and it’s a goal from the third Sustainable Development Goals (SDG), to be achieved by 2030. It has been described as one of the most progressive concepts to transform lives. Ghana in 2003 initiated its own form of the UHC through the establishment of the National Health Insurance Scheme (NHIS) and the continuation of the Community Health-Based Planning and Services (CHPS) implementation. It was a political decision which brought together different interest groups. The implementation of this decision saw healthcare expenditure shoot up to 10.6 percent as a share of Gross Domestic Product (GDP) in 2007. After more than a decade, the UHC (NHIS) has stagnated in growth. This study looks at the NHIS’ implementation from the point of view of the Social Determinants of Health (SDH) and what it could mean for growth if the Health in All Policies (HiAP) concept was applied. Through the use of Kingdon’s theoretical framework in terms of multiple-streams framework and agendas, alternatives and public policies, the policy process and environment are assessed. The research method used was qualitative case study. Some of the research outcomes were that there are undercurrents of tensions existing between a purely voluntary approach to the implementation of the UHC policy and the quasi-compulsory approach adopted by the country. In conclusion, the research finds that financially, it is not feasible to continue with the current strategy. There is the need to seek better institutional complementarities in pursuant of the UHC and adoption of the SDH
22
Goeiman, Hilary Denice. "Developing a comprehensive nutrition workforce planning framework for the public health sector to respond to the nutrition-related burden in South Africa." University of the Western Cape, 2018. http://hdl.handle.net/11394/6900.
Full textAbstract:
Philosophiae Doctor - PhD<br>South Africa has not responded well to recommendations in national evaluation reports to address human resource challenges associated with the implementation of nutrition programmes and improved service delivery. Twenty-four years have passed since the dawning of democracy and the nutrition situation within the population has actually deteriorated, with persistently high levels of stunting in young children and the growing prevalence of overweight and obesity in all age groups. These conditions not only rob people of their potential, but they carry a high cost for the state and society as a whole. This study aimed to develop a comprehensive and empirically sound nutrition workforce development planning framework for the public health sector so that it is better equipped to address the nutrition-related burden of disease in South Africa.
The study explored the provision of nutrition services in South Africa, focusing on the nutrition-specific work components of health personnel ‒ doctors, nurses, dietitians, nutritionists, health promoters and community health workers working at the primary health care level in the public health sector. Evidence-based workforce information was collected through a mixed methodology comprising: literature reviews, document reviews, analysis of scopes of practice, job descriptions, competencies, workforce surveys, key informant interviews and consensus assessments through the application of the Delphi technique. Permission was obtained to adapt and use questionnaires from an Australian workforce study. Ethical approval, permission to conduct the study and informed consent were obtained prior to the commencement of the interviews. Data was then analysed using descriptive statistics, content and thematic analysis and triangulation of all findings, followed by consensus assessments to describe the nutrition workforce and delineate the roles and functions thereof. The comprehensive planning framework that was developed was applied to the Western Cape province.
23
Socías, María Eugenia. "Access to health care among women sex workers in Vancouver, Canada : universal health coverage in a criminalized sex work environment." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/55505.
Full textAbstract:
Background: Universal access to health care is a critical determinant of health. Despite the numerous health inequities faced by women sex workers, research on access to health services among this population remains limited, particularly on the role of social-structural factors. This thesis sought to investigate sex workers experiences along the continuum of health care access in a setting with universal health coverage.
Methods: Data was dawn from “An Evaluation of Sex Workers’ Health Access”(AESHA), an open prospective cohort of women sex workers in Vancouver, Canada. Logistic regression analyses were employed to evaluate correlates of institutional barriers to care (using generalized estimating equations for longitudinal data), and to assess baseline engagement in the HCV continuum of care. Extended cox regression analyses, with a confounder model approach, were used to examine the independent effect of depot medroxyprogesterone on HSV-2 acquisition.
Results: These analyses demonstrated inequities faced by sex workers all along the continuum of health care access, from trying to reach health services (Chapter 2), to utilizing these services (Chapter 3), to the impacts of inadequate and sub-optimal care on their health outcomes (Chapter 4). Among 723 participants, 70.4% reported institutional barriers to health care, only half (52.9%) of 552 HCV-seronegative participants having a recent HCV test, and less than 1% of the 302 women living with HCV receiving treatment. Further, high incidence rates of HSV-2 were documented, with depot medroxyprogesterone use independently associated with approximately 4-times increased risk. Importantly, barriers to care appeared to be exacerbated among most vulnerable women, including sexual/gender minorities, migrants, women of Aboriginal Ancestry, uninsured and those with previous experiences of violence.
Conclusions: Findings from this research revealed systemic and persistent barriers to appropriate and quality care among sex workers, highlighting the crucial role played by structural factors in shaping their health care seeking patterns and outcomes. These results further underscore the need to explore new models of care, as well as broader institutional and legal changes to fulfill women sex workers health and human rights, and fully realize the aims of the Canadian universal health system.<br>Graduate and Postdoctoral Studies<br>Graduate
24
Awawda, Sameera. "A roadmap to attain universal health coverage in developing countries : a microsimulation-based dynamic general equilibrium model." Thesis, Aix-Marseille, 2019. http://theses.univ-amu.fr.lama.univ-amu.fr/190925_AWAWDA_480wiwc30esmfbi673fafoz83y_TH.pdf.
Full textAbstract:
La couverture sanitaire universelle (CSU) est considérée comme un pilier des objectifs de développement durable 2015-2030. Cette thèse se propose d’éclairer le débat sur la soutenabilité financière de la CSU et son impact sur des variables micro- et macro-économiques à l’aide d’un modèle dynamique d’équilibre général calculable, associé à des techniques de microsimulation. Le premier chapitre présente le modèle théorique calibré pour refléter les principales caractéristiques des pays en développement. Les résultats montrent, pour deux modalités du financement de la CSU, comment peut varier le degré de protection financière contre les risques maladies. Dans le deuxième chapitre, nous adaptons le modèle général au contexte particulier de la Palestine pour analyser l’effet de la mise en œuvre de la CSU sur le budget du gouvernent et le bien-être de la population. Les résultats démontrent qu’une expansion en parallèle de la CSU sur la population et les services de soins peut améliorer le bien-être des ménages. Néanmoins, dans des conditions d'espace budgétaire limité, cette expansion s’avère insoutenable à long-terme, appelant ainsi à un ajustement de la politique fiscale. Le troisième chapitre se consacre à l’évaluation des inégalités intergénérationnelles induites par le choix des politiques visant à assurer la pérennité de la CSU. Nous proposons une mesure permettant d’évaluer les transferts intergénérationnels liés au fardeau de la CSU. Les résultats montrent que, dans des conditions d'espace budgétaire limité, le choix des politiques peut impliquer un arbitrage entre la soutenabilité financière de la CSU et différents degrés d’inégalités intergénérationnelles<br>Universal Health Coverage (UHC) has received during the last decade a revived interest by policy-makers, international organizations and researchers worldwide. There has been hitherto no theoretical-empirical work that can enable to assess the feasibility of UHC and its potential effects at both micro- and macro-economic levels. This thesis presents an operationalizing theoretical framework that is capable of addressing the above issues using dynamic stochastic general equilibrium (DSGE) model and microsimulation technique. The first chapter presents the DSGE model that is calibrated to capture the salient features of an archetype developing economy. Results illustrate how the degree of financial-risk protection can vary with the financing-mix used to implement the UHC reform. The second chapter assesses the macro-fiscal conduciveness of UHC reforms and its impact on welfare and public finance in the particular context of Palestine. Results show that while UHC can enhance welfare, a parallel expansion of the breadth and width of coverage may not be feasible unless a policy adjustment is undertaken. The third chapter examines the potential impact of UHC reforms on intergenerational inequalities in view of fiscal sustainability. The question of who bears the burden of the UHC is addressed using an overlapping generation model, while a convenient measure to assess the social impact of UHC-financing strategies is proposed. Results show that under conditions of limited fiscal space, the choice between deferred-debt and current UHC-financing implies a trade-off between fiscal sustainability against intergenerational inequality, with which the policy-maker will have to confront
25
Nguyen, Duc Thanh. "The impact of the health insurance program on the near-poor in Vietnam." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/86081/1/Thanh_Nguyen_Duc_Thesis.pdf.
Full textAbstract:
This thesis is a cross-sectional study of a health insurance scheme for a representative sample of the near-poor in Cao Lanh district, Dong Thap province, Vietnam. It examines insurance coverage, health service utilisation, out-of-pocket expenditures and their associated factors. The research findings contribute evidence for policy makers who seek to improve the health insurance scheme for socioeconomically disadvantaged people in Vietnam, which is an important component of national efforts to implement universal health insurance. This community-level research adds to the evidence-base needed to improve the insurance system and thereby influence the quality of health care services.
26
James, Candice. "The impact and constitutionality of the proposed National Health Insurance scheme with regard to the provision of health services by subnational governments." University of Western Cape, 2020. http://hdl.handle.net/11394/7345.
Full textAbstract:
Magister Legum - LLM<br>In South Africa, there are two health systems through which health services are delivered,1 namely private and public. These two systems were inherited from the apartheid regime.2 With South Africa’s political change from a system of parliamentary sovereignty to a constitutionally supreme system in 1996, huge changes were bound to come including changes to the health sector.3 This meant the overhauling of health legislation, as the right of access to health care services became guaranteed in the Constitution of the Republic of South Africa, 1996.4 In 1997, the White Paper on the Transformation of the Health System (White Paper on Health)5 was introduced with the aim of developing a national health system.6 There has been a lot of progress made in reforming the health sector, however there are still many cracks that the national government aims to remedy through the realisation of universal health coverage (UHC).
27
Davidian, Andreza. "Crafting Universal Health : bureaucratic Agency in the Evolution of Brazil’s Health System." Electronic Thesis or Diss., Rennes, École des hautes études en santé publique, 2024. http://www.theses.fr/2024HESP0003.
Full textAbstract:
Le système public de santé brésilien couvre plus de 150 millions de personnes sur le plus grand territoire d’Amérique du Sud, ce qui en fait l’un des plus grands systèmes universels au monde. La compréhension de ce processus peut fournir des enseignements précieux sur la manière de mettre en place un système de santé universel et décentralisé, notamment dans un pays autrefois considéré comme l’un des plus inégalitaires de la planète. Cette thèse examine le rôle des gestionnaires publics fédéraux, en particulier au sein du Ministère de la Santé, ainsi que celui des spécialistes de la santé publique, les sanitaristas, qui ont constamment œuvré au sein de l’État pour construire et consolider le Système Unique de Santé (SUS). La recherche adopte une étude de cas retraçant le parcours de l’universalisation de la santé depuis les années 1970, lorsque le processus de réforme a commencé à prendre de l’ampleur, jusqu’à la crise politique de 2016. L’approche théorique s’appuie sur les théories du changement institutionnel et sur un cadre analytique centré sur les acteurs dans l'analyse des politiques publiques, dans le contexte plus large des débats sur le développement de la protection sociale en Amérique latine. Cela remet en question (i) la vision sceptique selon laquelle des changements significatifs dans les régimes de politiques sociales sont improbables sans un large soutien politique populaire ou des mouvements sociaux de grande envergure, et (ii) l’hypothèse selon laquelle les bureaucrates progressistes sont impuissants dans des systèmes paralysés par l’inertie de l’État, le clientélisme enraciné et le patronage généralisé – caractéristiques souvent attribuées au Brésil. Cette recherche soutient au contraire que l’intervention stratégique des sanitaristas, tant avant qu’après la modification constitutionnelle de 1988, a été cruciale pour le développement de la capacité d’agir collective et de la capacité institutionnelle dans le secteur. Ces professionnels, loin d’être de simples bureaucrates, ont conçu des instruments de politique innovants pour améliorer le système, en mobilisant des ressources telles que l’expertise technique, les compétences managériales, le sens politique et des liens étroits avec la communauté de la santé publique. L’étude montre également comment les spécialistes de la santé publique se sont adaptés à des environnements politiques en mutation, en naviguant à travers la transition démocratique et trois cycles gouvernementaux distincts. En plus de contribuer à la conception de politiques qui ont façonné la décentralisation et le financement de la santé, les sanitaristas ont veillé à ce que les soins primaires demeurent l'épine dorsale du système de santé brésilien. Leurs compétences ont été essentielles pour relever les défis et soutenir l’agenda expansionniste de la réforme de la santé au fil des décennies. En soulignant leur influence sous différentes administrations, la recherche met également en lumière le rôle croissant du Ministère de la Santé dans les négociations politiques et les coalitions, notamment grâce à son contrôle sur des politiques qui touchent directement toutes les municipalités du pays<br>The Brazilian universal health system provides comprehensive healthcare services to over 150 million people across South America's largest territorial area, making it one of the largest in the world. Understanding how this was accomplished offers insight into the process through which a universal and decentralized health system was established in a country once labeled as the most unequal in the world. This dissertation examines the role of the federal bureaucracy within the Ministry of Health and the public health experts (sanitaristas) who have consistently operated within the state to build and consolidate the Unified Health System (SUS). To address this, the study conducts a case analysis tracing the trajectory of healthcare universalization from the 1970s – when the gradual reform process began to gain momentum – through the political crisis of 2016. Building on theories of institutional change and an agency-based framework for public policies, and set against the backdrop of discussions on welfare development in Latin America, this research challenges (i) skeptical views suggesting that significant changes in social policy regimes are unlikely without broad mass political support or large-scale social movements, and (ii) assumptions that progressive bureaucrats are powerless in systems undermined by state inertia, entrenched patronage, and pervasive clientelism, as seen in Brazil. Instead, it argues that the strategic intervention of the public health experts, both before and after the 1988 reform, was crucial in developing collective agency and institutional capacity within the sector. Far from being mere bureaucrats, they crafted innovative policy instruments to improve the system, leveraging resources such as technical expertise, managerial skill, political acumen, and strong ties to the public health community. The study also demonstrates how public health experts adapted to shifting political environments, navigating a democratic transition and three different governmental cycles. These professionals not only contributed to the design of policy instruments that shaped decentralization and health financing but also ensured that primary care remained the backbone of Brazil’s health system. Their capacities were essential for addressing challenges and sustaining the expansionist agenda of health reform over decades. By highlighting their influence across different administrations, the research also underscores the Ministry of Health's increasing importance in coalition negotiations, particularly given its oversight of policies that impact every municipality in the country<br>O sistema público de saúde brasileiro oferece cobertura a mais de 150 milhões de pessoas no maior território da América do Sul, o que o torna um dos maiores sistemas universais do mundo. A compreensão desse processo pode oferecer valiosos insights sobre como estabelecer um sistema de saúde universal e descentralizado, especialmente em um país outrora considerado um dos mais desiguais do planeta. Esta dissertação examina o papel da burocracia federal, especificamente no âmbito do Ministério da Saúde, e dos especialistas em saúde pública, os sanitaristas, que consistentemente atuaram dentro do Estado para construir e consolidar o Sistema Único de Saúde (SUS). A pesquisa adota um estudo de caso que traça a trajetória da universalização da saúde desde os anos 1970 – quando o processo de reforma começou a ganhar força – até a crise política de 2016. A abordagem teórica está ancorada em teorias de mudança institucional e em um arcabouço analítico centrado na agência para análise das políticas públicas, situando-se no contexto mais amplo dos debates sobre o desenvolvimento do bem-estar social na América Latina. Esta pesquisa desafia (i) visões céticas sugerindo que mudanças significativas nos regimes de políticas sociais são improváveis sem amplo apoio político de massas ou movimentos sociais em grande escala, e (ii) suposições de que burocratas progressistas são impotentes em sistemas comprometidos pela inércia estatal, pelo clientelismo enraizado e pela patronagem generalizada –características frequentemente atribuídas ao caso brasileiro. Ao contrário, a pesquisa sustenta que a intervenção estratégica dos sanitaristas, tanto antes quanto depois da mudança constitucional promovida em 1988, foi crucial para o desenvolvimento da agência coletiva e da capacidade institucional dentro do setor. Estes profissionais, longe de serem meros burocratas, elaboraram instrumentos de política inovadores para aprimorar o sistema, dispondo de recursos como expertise técnica, habilidades gerenciais, astúcia política e fortes laços com a comunidade de saúde pública. O estudo também demonstra como os especialistas em saúde pública se adaptaram a ambientes políticos em transformação, navegando pela transição democrática e por três ciclos governamentais distintos. Além de contribuir para o desenho de políticas que moldaram a descentralização e o financiamento da saúde, os sanitaristas garantiram que a atenção primária permanecesse o alicerce do sistema de saúde brasileiro. Suas capacidades foram essenciais para enfrentar desafios e sustentar a agenda expansionista da reforma da saúde ao longo de décadas. Ao destacar sua influência nas diferentes gestões governamentais, a pesquisa sublinha o crescente papel do Ministério da Saúde nas negociações políticas e de coalizão, especialmente por meio do controle sobre políticas que afetam diretamente todos os municípios do país
28
Nguyen, Thi Thuy Nga. "Family-based social health insurance for informal workers in Vietnam: Willingness to pay and its determinants." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/119003/1/Thi%20Thuy%20Nga_Nguyen_Thesis.pdf.
Full textAbstract:
This project aimed to estimate the willingness to pay for family-based Health insurance among informal sector workers in Vietnam in the interests of achieving universal health coverage. Applying a mixed method design, the study indicates that 48.8% of 391 uninsured households were willing to pay for family health insurance. The main barriers to enrolment are the inability to pay premiums, inadequate understanding of the HI scheme, ineffective enrolment procedures, and poor perception of the quality of health care services. A premium subsidised by the government and improvements of the quality of primary health care are crucial strategies for HI expansion.
29
GENOVESE, ELEONORA. "Towards universal health coverage and health system equity. Estimating health outcomes and healthcare access in undocumented migrants. Key issues in maternal & perinatal health and the COVID-19 pandemic." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2022. http://hdl.handle.net/10281/392355.
Full textAbstract:
Le popolazioni migranti presentano uno stato di salute carente con esiti peggiori rispetto alla popolazione generale. Vulnerabilità e diseguaglianza sono esacerbate nei migranti irregolari, i più invisibili ai sistemi sanitari. Questa sfida di salute pubblica necessita di azione per la copertura sanitaria universale e l'equità del sistema sanitario.
Obiettivi: Stimare i bisogni di salute nei migranti irregolari nelle aree di salute materna & perinatale e di COVID-19; Testare metodologie di monitoraggio e valutazione sistematici.
Metodi: Questa ricerca si basa su tre studi retrospettivi (coorte e trasversali ) con fonti complementari per cogliere la complessità degli esiti di salute e dell’accesso alle cure nei migranti irregolari: i flussi sanitari amministrativi nazionali/regionali, i sistemi d’informazione delle strutture sanitarie del terzo settore, e le inchieste presso un campione di strutture sanitarie.
Coorte: I migranti irregolari che hanno avuto accesso a: (i) percorso nascita tramite Servizio Sanitario Nazionale/Regionale nella Regione Lombardia (Italia) dal 2016 al 2020; (ii) cure sanitarie attraverso una struttura del terzo settore a Milano (Italia) dal 24 febbraio al 24 maggio 2020; (iii) cure sanitarie tramite strutture selezionate in Svizzera (Regione di Ginevra), Stati Uniti (Città di Baltimora), Italia (Regione Lombardia), e Francia (Regione di Paris) da febbraio a maggio 2021.
Risultati: (i) Lo studio sulla salute materno-perinatale ha incluso 1595 donne migranti irregolari e i loro neonati. Il 57.37% delle donne ha avuto ≥4 visite ostetriche, 68.21% la prima entro la 12a settimana di gravidanza, 63.45% ≥2 ecografie di cui la prima entro la 12a sett. di gravidanza, e 6.21% esami di laboratorio completi. I parti cesarei totali sono stati il 26.89%, le rianimazioni neonatali in urgenza per asfissia alla nascita il 2.63%, l’allattamento materno entro 2 ore dalla nascita il 49.03%. L’80.56% delle gravidanze ha avuto decorso fisiologico ma 2.26% emorragia grave (>1000ml). Il 4.76% dei feti ha riportato difetto di accrescimento, 9.28% dei neonati è nato pre-termine, 17.24% risultato piccolo per età gestazionale, 7.2% nato sotto-peso (<2.5Kg), 1.44% riportato un punteggio Apgar sfavorevole, e 3.07% malformazioni. (ii) Lo studio sulla malattia da COVID-19 ha incluso 272 migranti irregolari. I fattori di rischio sono risultati frequenti, tra cui ipertensione, immunodepressione, precedente contatto stretto con caso di COVID-19. I sintomi sono risultati peggiori rispetto a pazienti con altre patologie respiratorie. (iii) Lo studio sulla propensione alla vaccinazione contro COVID-19 ha incluso 812 migranti irregolari. Il 14.1% ha dichiarato precedente infezione da SARS-CoV-2, 29.5% fattori di rischio, 26.2% paura di sviluppare malattia grave. L’accessibilità percepita alla vaccinazione anti COVID-19 è risultata elevata (86.4%), ma la propensione a vaccinarsi scarsa (41.1%) in correlazione con età, co-morbidità, e opinioni positive sulla vaccinazione. Queste sono risultate migliori per la vaccinazione in generale (77.3%) rispetto alla vaccinazione anti COVID-19 (56.5%). Le fonti di informazione sono risultate prevalentemente i media tradizionali e sociali.
Conclusioni: Gli esiti di salute e l’accesso alle cure nei migranti sono risultati carenti, indicando vulnerabilità e diseguaglianza rispetto alla popolazione generale. I fattori di rischio quali la fragilità socio-economica insieme alle barriere legali e linguistiche alle cure sanitarie necessitano interventi mirati: la promozione della salute a livello comunitario, la formazione del personale sanitario, la mediazione linguistico-culturale, e corsi di lingua funzionale. Inoltre, è necessario un sistema di monitoraggio continuo per raccogliere, integrare, e analizzare dati essenziali tramite i flussi sanitari amministrativi e le strutture del terzo settore, da complementare tramite inchieste per dati specifici.<br>Migrant populations experience poor health, and their outcomes tend to be poorer in comparison with the general population. Vulnerability and inequality are further exacerbated in undocumented migrants, as the most invisible to healthcare systems. This a public health challenge requiring tailored action towards universal health coverage and health system equity.
Objectives: To estimate health needs among undocumented migrants in the areas of maternal & perinatal health and COVID-19; and to test a combination of methodologies for systematic monitoring and evaluation.
Methods: This research is based on three retrospective studies (cohort and cross-sectional) using a combination of diverse and complementary data sources to reflect the complex nature of health outcomes and healthcare access in undocumented migrants, including: national/regional health management information systems, third sector healthcare provider health information systems, and surveys at selected healthcare facilities.
Cohort: Undocumented migrants having accessed: (i) maternity healthcare through National/Regional Health Services in Lombardy Region (Italy) from 2016 to 2020; (ii) healthcare through a third sector healthcare providers in Milan (Italy) from February 24th to May 24th, 2020; (iii) healthcare through participating healthcare providers in Switzerland (Geneva Canton), USA (Baltimore City), Italy (Lombardy Region), and France (Paris Region) from February to May 2021.
Results: (i) The study on maternal and perinatal health included 1595 undocumented migrant women and their neonates. 57.37% women had ≥4 antenatal visits, 68.21% the first one within 12 weeks of gestation, 63.45% at least two ultrasound tests including one within 12 weeks of gestation, and 6.21% complete laboratory tests. Total cesarean sections were 26.89%. Emergency neonatal resuscitation for birth asphyxia was conducted in 2.63% births, and 49.03% neonates initiated breastfeeding within 2 hours from birth. 80.56% pregnancies were physiological though severe hemorrhage (>1000ml) occurred in 2.26% women. Intra-uterine growth retardation affected 4.76% fetuses, 9.28% neonates were pre-term, 17.24% small for gestational age, 7.2% had a low weight at birth (<2.5Kg), 1.44% poor Apgar score, and 3.07% malformations. (ii) The study on COVID-19 illness included 272 undocumented migrants. Risk factors were frequent and included hypertension, immune depression, and prior close contact with COVID-19 cases. Presenting symptoms were worse, compared with patients with other respiratory conditions. (iii) The study on COVID-19 vaccination demand included 812 undocumented migrants. Overall, 14.1% of participants reported prior COVID-19 infection, 29.5% risk factors, and 26.2% fear of developing severe COVID-19 infection. Self-perceived accessibility of COVID-19 vaccination was high (86.4%), yet demand was low (41.1%) correlating with age, co-morbidity, and views on vaccination which were better for vaccination in general (77.3%) than vaccination against COVID-19 (56.5%) Participants mainly searched for information about vaccination in the traditional and social media.
Conclusions: Health outcomes and healthcare access were poor in undocumented migrants. Socio-economic and health outcomes showed vulnerability and inequality in comparison to general population. Known risk factors including fragile socio-economic conditions along with legal and linguistic barriers to healthcare need to be addressed through tailored interventions including outreach health promotion focusing, healthcare provider training, cultural mediation, translation, and functional language learning. Furthermore, a systematic monitoring and evaluation system is needed to routinely collect, integrate, and analyze data on key indicators from both National/Regional Health Services in combination with ad hoc surveys for specific data outside routine information systems.
30
Benrós, Rosilda Isabel de Carvalho Ferreira Lima. "O financiamento do sector da saúde em Cabo Verde." Master's thesis, Instituto Superior de Economia e Gestão, 2018. http://hdl.handle.net/10400.5/16644.
Full textAbstract:
Mestrado em Desenvolvimento e Cooperação Internacional<br>A dissertação analisa o sistema de saúde cabo-verdiano, com o objetivo de compreender o seu modelo de financiamento atual. Começa por fazer uma revisão da literatura teórica sobre sistemas de saúde, financiamento e cobertura universal dos cuidados de saúde, enquanto suporte para o desenvolvimento analítico do tema. A seguir, introduz um conjunto de informações sobre o caso de Cabo Verde, como a evolução dos indicadores de saúde e a organização do Serviço Nacional de Saúde. Com base nos elementos anteriormente tratados e numa leitura comparada de experiências de outros países insulares, a dissertação procura responder a questões como a organização do financiamento da saúde em Cabo Verde e seus componentes, a capacidade de mobilização de fundos financeiros e a situação da cobertura universal dos cuidados de saúde, indispensáveis para uma melhor avaliação do modelo de financiamento.<br>The dissertation analyzes Cape Verde health system, in order to understand its current financing model. We will begin with a literature review on the health system theoretical work and on the financing and universal coverage of health care, as a support for the analytical development of the subject. Next, we will introduce a set of information about the Cape Verde case, such as the analysis of the socioeconomic situation, the evolution of the health indicators and the organization of the Nacional Health Service.
Based on the previously discussed elements and on a comparative reading of experiences from other island countries, this dissertation seeks to answer questions such as the organization of health financing in Cape Verde and its components, the capacity to mobilize financial funds and the situation of universal coverage health care, essential for a better assessment of the funding model.<br>info:eu-repo/semantics/publishedVersion
31
Göppel, Christine [Verfasser]. "Universal and equitable health coverage for adults aged 50 years or older with chronic illness in middle income countries / Christine Göppel." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2017. http://d-nb.info/1133074596/34.
Full text
32
Urrunaga-Pastor, Diego, Vicente A. Benites-Zapata, and Edward Mezones-Holguín. "Factors associated with self-medication in users of drugstores and pharmacies in Peru: An analysis of the national survey on user satisfaction of health services, ENSUSALUD 2015." F1000 Research Ltd, 2020. http://hdl.handle.net/10757/652460.
Full textAbstract:
Background: Irresponsible self-medication is a problem for health systems in developing countries. We aimed to estimate the frequency of self-medication and associated factors in users of drugstores and pharmacies in Peru. Methods: We performed a secondary data analysis of the 2015 National Survey on User Satisfaction of Health Services (ENSUSALUD), a two-stage probabilistic sample of all regions of Peru. Non self-medication (NSM), responsible self-medication (RSM) and irresponsible self-medication (ISM) were defined as the outcome categories. Demographic, social, cultural and health system variables were included as covariates. We calculated relative prevalence ratios (RPR) with their 95% confidence intervals (95%CI) using crude and adjusted multinomial logistic regression models for complex samples with NSM as the referent category. Results: 2582 participants were included. The average age was 41.4 years and the frequencies of NSM, RSM and ISM were 25.2%, 23.8% and 51.0%; respectively. The factors associated with RSM were male gender (RPR: 1.35; 95%CI: 1.06-1.72), being between 40 and 59 years old (RPR: 0.53; 95%IC: 0.39-0.72), being 60 or older (RPR: 0.39; 95%IC: 0.25-0.59), not having health insurance (RPR: 1.89; 95%CI: 1.31-2.71) and living in the Highlands region (RPR: 2.27; 95%CI: 1.23-4.21). The factors associated with ISM were male gender (RPR: 1.41; 95%CI: 1.16-1.72), being between 40 and 59 years old (RPR: 0.68; 95%IC: 0.53-0.88), being 60 or older (RPR: 0.65; 95%IC: 0.48-0.88) and not having health insurance (RPR: 2.03; 95%CI: 1.46-2.83). Conclusion: Around half of the population practiced ISM, which was associated with demographic and health system factors. These outcomes are the preliminary evidence that could contribute to the development of health policies in Peru.<br>Revisión por pares
33
Velásquez, Aníbal, Dalia Suarez, and Edgardo Nepo-Linares. "Reforma del sector salud en el Perú: Derecho, gobernanza, cobertura universal y respuesta contra riesgos sanitarios." Instituto Nacional de Salud (INS), 2016. http://hdl.handle.net/10757/622347.
Full textAbstract:
In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions.<br>In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions.
34
Cortes, Antoine. "Une vision socialiste de la politique contemporaine de santé : la couverture maladie universelle." Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM1095.
Full textAbstract:
La loi du 27 juillet 1999 portant création de la couverture maladie universelle est intervenue dans le cadre d'une politique générale de lutte contre l'exclusion. Afin d'améliorer l'accès aux soins d'un nombre croissant de personnes pauvres, les socialistes ont élaboré un dispositif comportant deux volets. Le premier volet visait la généralisation de l'assurance maladie, en permettant l'affiliation au régime général sur un critère subsidiaire de résidence. Le second volet avait pour ambition d'offrir une couverture santé complémentaire, aux millions de personnes qui n'en bénéficiaient pas. Cette prestation étant soumise au respect d'une condition de résidence et d'une condition de ressources. L'ensemble du dispositif instauré par la loi CMU s'est substitué à l'aide médicale départementale et à l'assurance personnelle. L'ampleur des inégalités de santé, touchant en premier lieu les individus les plus pauvres et les plus isolés de la société, a conduit au bon accueil général de la loi CMU. Cependant, bien que considérée comme une grande loi de santé publique, certaines mesures ont été le théâtre de débats et d'oppositions, tant sur la scène politique que dans la société. Cela a été le cas concernant l'effet de seuil induit par l'instauration d'un plafond de ressources, le risque de déresponsabilisation des bénéficiaires ayant accès gratuitement au dispositif, les règles de financement essentiellement basées sur des taxes et contributions publiques, le choix d'une gestion partenariale entre sécurité sociale et partenaires privés, ou encore concernant la réticence d'une minorité de professionnels de santé à l'égard du dispositif<br>The law of the bearing July 27th, 1999 creation of the universal health coverage intervened within the framework of a general policy of fight against exclusion. In order to improve the access to the care of a growing number of poor people, the Socialists worked out a device comprising two facets. The first facet aimed at the generalization of the health insurance, by allowing the affiliation the general scheme on a subsidiary criterion of residence. The second facet had as an ambition to offer a complementary coverage health, to the million people who did not profit from it. This service being subjected to the respect of a condition of residence and a condition of resources. The whole of the device founded by law CMU replaced for the departmental medical assistance and the personal insurance. The extent of the inequalities of health, concerning initially the poorest individuals and most isolated from the society, led to general warm welcome of law CMU. However, although regarded as a great law of public health, certain measurements were the theatre of debates and oppositions, as well on the political scene as in the society. That in particular was the case concerning the effect of threshold induced by the introduction of a ceiling of resources, the risk of deresponsabilisation of the recipients having access free to the device, rules of financing primarily based on public taxes and contributions, the choice of a partnership management between social security and private partners with in particular the organizations of complementary health, or concerning the reserve of a minority of health professionals with regard to the device leading to refusal of care
35
Pham, Tan Phu. "Differences in Access to Care and Healthcare Utilization Among Sexual Minorities: A Master's Thesis." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/719.
Full textAbstract:
BACKGROUND: The barriers in accessing healthcare for gay, lesbian and bisexuals individuals are not well explored. These challenges as well as a lack of knowledge concerning this understudied group has prompted the Institute of Medicine to create a research agenda to build a foundational understanding of gay, lesbian and bisexual health and the barriers they encounter.1 the primary aim of this study will be to compare the differences in health care access and utilization between gay/lesbian, bisexual and heterosexual individuals using a large, nationally representative dataset of the U.S. population.
METHODS: Data from 2001 to 2012 from the National Health and Nutrition Examination Survey was pooled. Using logistic regression, we calculated the unadjusted and adjusted odds ratios of having health insurance, having a routine place and seeing a provider at least one in the past year.
RESULTS: We found that gay men were more likely to have health insurance coverage (ORadj:2.13 95%CI: 1.15,3.92), while bisexual men were at a small disadvantage in having health insurance coverage (ORadj:0.82 95%CI: 0.46,1.46). Bisexual men were more likely to have received health care in the past 12 months (ORadj:3.11 95%CI: 1.74,5.55). Lesbian women were less likely to have health insurance coverage (ORadj-lesbian:0.58 95%CI: 0.34,0.97).
CONCLUSION: This study contributed to the limited knowledge on understanding the health care access and utilization among gay, lesbian and bisexual individuals, which was classified as a high priority by the Institute of Medicine. Expanding health insurance coverage through the Affordable Care Act and Universal Partnership Coverage may reduce the disparities among gay, lesbian and bisexual individuals.
36
Pham, Tan Phu. "Differences in Access to Care and Healthcare Utilization Among Sexual Minorities: A Master's Thesis." eScholarship@UMMS, 2006. http://escholarship.umassmed.edu/gsbs_diss/719.
Full textAbstract:
BACKGROUND: The barriers in accessing healthcare for gay, lesbian and bisexuals individuals are not well explored. These challenges as well as a lack of knowledge concerning this understudied group has prompted the Institute of Medicine to create a research agenda to build a foundational understanding of gay, lesbian and bisexual health and the barriers they encounter.1 the primary aim of this study will be to compare the differences in health care access and utilization between gay/lesbian, bisexual and heterosexual individuals using a large, nationally representative dataset of the U.S. population.
METHODS: Data from 2001 to 2012 from the National Health and Nutrition Examination Survey was pooled. Using logistic regression, we calculated the unadjusted and adjusted odds ratios of having health insurance, having a routine place and seeing a provider at least one in the past year.
RESULTS: We found that gay men were more likely to have health insurance coverage (ORadj:2.13 95%CI: 1.15,3.92), while bisexual men were at a small disadvantage in having health insurance coverage (ORadj:0.82 95%CI: 0.46,1.46). Bisexual men were more likely to have received health care in the past 12 months (ORadj:3.11 95%CI: 1.74,5.55). Lesbian women were less likely to have health insurance coverage (ORadj-lesbian:0.58 95%CI: 0.34,0.97).
CONCLUSION: This study contributed to the limited knowledge on understanding the health care access and utilization among gay, lesbian and bisexual individuals, which was classified as a high priority by the Institute of Medicine. Expanding health insurance coverage through the Affordable Care Act and Universal Partnership Coverage may reduce the disparities among gay, lesbian and bisexual individuals.
37
Jirakiattikul, Sopin. "Poverty and social protection : the case of Thailand." Thesis, Montpellier 1, 2010. http://www.theses.fr/2010MON10008.
Full textAbstract:
La Thaïlande connaît depuis le début des années 1960 une croissance remarquable accompagnée d'un développement économique qui se traduit par une réduction sensible de la pauvreté. En parallèle, la distribution des revenus est devenue moins inégalitaire, tout particulièrement au cours des dernières décennies. Depuis la crise financière asiatique de 1997, la protection sociale en Thaïlande s'est développée dans un cadre institutionnel en vue de réduire la pauvreté et la vulnérabilité de la population. La politique institutionnelle initiée intitulée « couverture santé universelle » s'accompagne de larges effets sur la qualité de vie de la population thaïlandaise. L'objet de cette thèse est de déterminer dans quelle mesure les politiques de bien-être social en particulier celle portant sur la généralisation de la protection sociale ont transformé la distribution des revenus dans un contexte de forte croissance économique. La problématique soulève trois questions (1) Le développement économique a-t-il conduit à accroître les inégalités ? (2) Quelles sont les retombées de la croissance économique sur les pauvres ? (3) Comment la protection sociale contribue t-elle à faire diminuer la pauvreté ? Dans cette thèse, le cadre conceptuel a été construit à partir des théories de l'inégalité et de l'exclusion sociale afin d'analyser la pauvreté, la distribution des revenus et d'évaluer la protection sociale de la santé. Nous avons mobilisé des informations issues d'enquêtes socio-économiques, de bases de données internationales et d'enquêtes directes sur le terrain pour étudier les inégalités et les conséquences de la pauvreté sur plusieurs catégories de pauvres. Les politiques publiques à destination des déshérités sont également considérées dans cette étude. Cette thèse nous permet de montrer que le modèle de croissance économique n'est plus aussi fortement orienté en faveur de la réduction de la pauvreté qu'au cours des périodes passées. Les mécanismes mis en oeuvre, tels que l'augmentation du bien-être social sont menacés, de sorte que les menaces liées à la crise économique actuelle sont de nature à affecter tout particulièrement les déshérités. Depuis 15 ans, la protection sociale est assurée à travers une politique de recouvrement des soins de santé soucieuse de réduire les dépenses de santé. L'inaccessibilité des soins demeure le problème majeur pour les plus vulnérables. En effet, la distribution des ressources publiques allouées aux pauvres est centralisée et est l'objet de dérives clientélistes<br>In the last four decades, Thailand's economic development has been accompanied with great reductions in absolute poverty but not relative poverty. After the Asian financial crisis in 1997, social protection in Thailand emerged as a policy framework employed to tackle poverty and vulnerability. In particular the policy entitled Universal health coverage for all was initiated and had broad effects on the quality of life of Thai people. The goal of this thesis is to understand how social and welfare policies have shaped income distribution in a context of rapid economic growth. To carry out this scope, we concentrate on three questions: (1) Does economic development in the early stages lead to increase inequalities? (2) How does economic growth affect poverty? And (3) Can social protection alleviate the poverty? This thesis is grounded in the concepts of the theories of inequality and social exclusion. It connects the multidimensional aspects of both poverty concepts and measures with the different conceptual bases of social protection. Using series drawn from socio-economic surveys, international databases, field studies, and the assessment of social protection in health, the inequality and social impacts which affect various groups of the poor are explored. State policies targeting the poor are also included in the study. The results show that the pattern of economic growth is not "pro-poor" anymore, as it has been in some periods in the past. Mechanisms of poverty reduction, such as social welfare policies, are threatened, thus the looming economic crisis could be particularly hard on the poor. Social health protection in the last fifteen years has relied on the universal healthcare coverage policy, which is aimed at relieving the pressure of health expenditures. However, the inaccessibility of health services remains a problem for vulnerable populations. Indeed, the allocation of public resources targeting the poor stays is centralized and subject to influence from special interests
38
Wandjowo, Rosie. "Exploring the Role of Aid in the Malawian and Zambian Health Sectors : To what extent does development assistance contribute to aid dependency in Malawi and Zambia?" Thesis, Södertörns högskola, Utveckling och internationellt samarbete, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-41309.
Full textAbstract:
Aid is an important topic in development sector current discussions are polarised thereby creating a need for further research. This essay assesses the role that Malawi and Zambia plays in realising its development outcomes including in the area of health. There is a need to appreciate the variables that contribute to the inability of most countries in sub-Saharan Africa to finance their domestic expenditure related to healthcare. In this situation, foreign aid which has received marked interest by scholars over the past decade and is used to supplement incomes of developing countries like Malawi and Zambia. Debate on the effectiveness of aid is polarised, while highly concerned scholars see aid as ineffective and a contributor to the poor performance of economies in developing countries, others see it as essential in the achievement of development outcomes. This thesis explores the extent to which development assistance contributes to dependency in Malawi and Zambia. It further examines the link between aid and the Malawian and Zambian health sectors. The study similarly considers the role of development assistance for health in realising outcomes related to maternal health in line with SDG 3.1. By identifying two countries in sub-Saharan Africa, this essay underscores the similarities between Malawi and Zambia analysed through a historical context, health systems structures, child and maternal mortality rates and health programme models. The essay concludesthat social, political and economic barriers present challenges in financing healthcare in Malawi and Zambia. Aid contributes to dependency in the study countries.
39
Coam, Guilherme Guimarães. "Universalidade da cobertura em saúde: limites jurídico-constitucionais." Universidade Presbiteriana Mackenzie, 2015. http://tede.mackenzie.br/jspui/handle/tede/1162.
Full textAbstract:
Made available in DSpace on 2016-03-15T19:34:25Z (GMT). No. of bitstreams: 1
Guilherme Guimaraes Coam.pdf: 1212998 bytes, checksum: 00923316eb8e03504303c42cdc605f1e (MD5)
Previous issue date: 2015-08-13<br>Universidade Presbiteriana Mackenzie<br>The Federal Constitution, in the article 196, states that health is everyone s right and duty of the State . In recent years, the said Constitutional device has been analyzed in isolation, with total disregard for all other constitutional and legal provisions on the matter, including the rest of the article 196 of the precept itself. Thus, despise up all legal and constitutional limits for granting health benefits, adopting the understanding that any kind of provision in health should be granted to any citizen who seeks the judiciary, regardless of public policies, appropriations budget, or any legal limits. The Judicial Activism has been exacerbated with court decisions clearly go against the constitutional principles and the ordinary law. In this thesis, we intend to explore the concept of universal coverage in health, in an attempt to demonstrate that the Constitution allows the ordinary legislator and public administrator, to impose legal limits on health benefits that the state must pay.<br>A Constituição Federal, no início do artigo 196, estabelece que saúde é direito de todos e dever do Estado . Nos últimos anos, o referido dispositivo Constitucional vem sendo analisado de forma isolada, com total desprezo por todas as demais disposições constitucionais e legais referentes à matéria, inclusive o restante do próprio preceito do artigo 196. Com isso, desprezam-se todos os limites jurídico-constitucionais à concessão de prestações em saúde, com adoção do entendimento de que qualquer espécie de prestação em saúde deverá ser concedida a qualquer cidadão que procure o Poder Judiciário, independentemente de políticas públicas, de dotações orçamentárias ou de quaisquer limites jurídicos. O ativismo judicial vem sendo exacerbado, com decisões judiciais claramente contrárias a princípios constitucionais e à lei ordinária. Pretende-se, na presente dissertação, explorar o conceito de universalidade da cobertura em saúde, na tentativa de demonstrar que a Constituição Federal permite, ao legislador ordinário e ao administrador público, a imposição de limites jurídicos às prestações de saúde que o Estado deve custear.
40
Bigdeli, Maryam. "Access to medicines in low- and middle-incomes countries: a health systems approach :conceptual framework and practical applications." Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209036.
Full text
41
Foe, Ndi Christophe. "La mise en oeuvre du droit à la santé au Cameroun." Thesis, Avignon, 2019. http://www.theses.fr/2019AVIG2064.
Full textAbstract:
L’Etat du Cameroun a pris un certain nombre d’engagements au plan international afin de garantir le droit à la santé de ses populations. Ensuite, il a procédé à la création d’institutions afin de rendre effectif ce droit. Bien qu’il subsiste encore quelques écarts entre les normes internationales et les mesures législatives et administratives prises au plan national, il est à présent opportun et nécessaire d’évaluer la capacité desdites mesures ainsi que celle des institutions qui les mettent en oeuvre, à garantir efficacement le droit à la santé. Cette évaluation conduit ainsi à poser le problème de la garantie du droit à la santé non plus sous l’angle de l’effectivité des normes et mécanismes, mais mieux sous l’angle de leur efficacité à prévenir les atteintes à la santé des populations.Cette démarche d’évaluation de l’efficacité amène à constater que les mécanismes juridictionnels et non juridictionnels contribuent de façon relative à la garantie du droit à la santé. Cependant, l’évaluation des stratégies et actions prises au plan national permet de conclure qu’il existe encore, en de nombreux aspects, d’énormes gaps avec les standards prescrits en la matière au plan international. Il en découle que malgré un cadre juridique et institutionnel assez étoffé, le Cameroun ne parvient pas toujours à protéger efficacement la santé de ses populations. Pour pallier ce problème, des réformes sont nécessaires dans l’approche et l’architecture du système de santé camerounais.Concernant l’approche du système de santé, il est nécessaire que ce système adopte une attitude plus proactive que réactive dans la protection de la santé des populations. En plus, le système de santé doit accorder plus de place aux déterminants de santé, donc à la dimension préventive, et non seulement à la dimension curative de la protection de la santé. S’agissant de son architecture, il apparaît aujourd’hui indispensable de mettre en place la couverture santé universelle afin de lutter contre l’exclusion des populations pauvres et vulnérables. Dans la même optique de garantie de l’accessibilité des populations aux services de santé,l’intégration de la médecine traditionnelle au système de santé camerounais contribuerait fortement à réduire les déserts médicaux et à alléger les coûts des soins et services de santé<br>The State of Cameroon has ratified numerous international instruments to guarantee the rightto health of its people. Further, it has created institutions with the aim of making this righteffective. Even though some gaps can still be observed between international norms andlegislative as well as administrative measures taken at the national level, the task now is toevaluate the capability of these national measures together with that of the institutionscharged with implementing them, in ensuring efficacy in the realization of the right to health.This approach therefore leads us to question the guarantee of this right no more in terms ofeffectiveness of norms and institutions, but rather in terms of their efficacy in preventinginfringements to the health of people.The efficacy-approach adopted in this evaluation brings us to acknowledge the fact that legaland non-legal mechanisms contribute in a relative manner in the guarantee of the right tohealth. However, the evaluation of the strategies and actions taken at the national level leadsto the conclusion that there still exists in various aspects, huge gaps with internationalstandards laid down in order to fully implement the right to health. Thus, it flows from whathas been mentioned above that even though the legal and institutional framework regardingthe right to health is rich, the State of Cameroon nevertheless does not succeed in protectingwith efficacy the health of its populations. To overcome this problem, some reforms arenecessary in the Cameroonian health system.Firstly, the Cameroonian health system needs to adopt a proactive rather than only a reactiveapproach in designing measures aimed at protecting people’s health. In addition, this systemshould take more into consideration health determinants, thus including the preventivedimension, and not only relying on the curative dimension of health’s protection. Secondly, itseems nowadays essential to put in place universal health coverage in order to fight againstthe exclusion of poor and vulnerable people. In the same vein of ensuring people’saccessibility to health care services, the integration of traditional medicine in the Cameroonianhealth system will deeply contribute to the reduction of medical deserts and to reduce thecosts of health services
42
Ralaidovy, Ambinintsoa Haritiana. "Efficiency in health ressource allocation : three empirical studies in Eastern Sub-Sahara Africa and Southeast Asia." Thesis, Université Clermont Auvergne (2017-2020), 2019. http://www.theses.fr/2019CLFAD016.
Full textAbstract:
La définition des priorités en matière de santé, dans le contexte de la couverture sanitaire universelle, met l'accent sur trois valeurs : améliorer la santé de la population, garantir l'égalité d'accès aux services et la qualité de ceux-ci et éviter l'appauvrissement des usagers ou la sous-utilisation des services par ceux-ci en raison de dépenses non remboursables. L’efficience allocative peut être mesurée par rapport à l'une quelconque de ces valeurs, ou par rapport à l'ensemble, par différentes variantes de l'analyse coût-efficacité. Dans cette thèse, nous utilisons la « Generalized Cost-Effectiveness Analysis », une approche normalisée développée par le programme « Choosing Interventions that are Cost-Effective » de l’Organisation Mondiale de la Santé, (WHO-CHOICE), qui peut être appliquée à toutes les interventions dans différents contextes. En utilisant cette approche, notre travail de thèse fournit une estimation quantitative de l'efficience allocative des ressources pour trois groupes de problèmes de santé : les maladies transmissibles, les maladies non transmissibles, les accidents de la circulation, en mettant l'accent sur deux régions économiquement et épidémiologiquement différentes : l'Afrique subsaharienne de l’Est et l'Asie du Sud-Est. Nos objectifs étant d’éclairer les débats sur les politiques de santé, d’améliorer le corpus mondial de connaissances sur le rapport coût-efficacité de différentes interventions en fournissant davantage d’informations sur l’efficience de l’allocation de ressources pour les trois groupes de problèmes de santé précités et de contribuer aux discussions sur l’élaboration des programmes de soins de santé universels<br>Priority setting in health, in the context of Universal Health Coverage, emphasizes three values: improving population health, ensuring equity in access to and quality of services and avoiding impoverishment or underutilization of services as a result of out-of-pocket expenditures. Allocative efficiency can be measured with respect to any one of these values, or with respect to all together by different variants of Cost-Effectiveness Analysis. In this thesis, we use the Generalized Cost-Effectiveness Analysis, a standardized approach developed by the World Health Organization’s programme, ‘Choosing Interventions that are Cost-Effective’ (WHO-CHOICE) that can be applied to all interventions in different settings. This thesis provides a quantitative assessment of allocative efficiency within three health categories: communicable diseases, noncommunicable diseases, and road traffic injuries, focusing on two economically and epidemiologically diverse regions: Eastern sub-Saharan Africa and Southeast Asia. Our objectives are to inform health policy debates, improve the world’s body of knowledge on the cost-effectiveness of different interventions by providing more information on the allocative efficiency in those three disease groups and contribute to discussions on Universal Health Care packages
43
"Pakistan’s progress towards Universal Health Coverage (UHC); an empirical assessment of determinants of catastrophic health expenditures, efficiency of sub provincial health systems, and inequities in UHC tracer indicators at the provincial level (2001-14)." Tulane University, 2017.
Find full textAbstract:
acase@tulane.edu<br>The Sustainable Development agenda, which will be driving the development discourse of the world in next fifteen years, has 17 goals and 169 target. Goal 3 is related to health and it has 13 targets. Target 3.8 states “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. This target - related to universal health coverage (UHC) is considered the linchpin of all other health targets. Although more than 100 countries across the world are pursuing UHC reforms, there is no one-size-fits-all approach to achieving UHC. It has been recommended that governments should develop approaches that fit the social, economic, demographic, and political context of their countries.
Pakistan, the sixth most populous country in the world, underwent its first democratic transition after elections 2013. The 18th constitutional amendment of devolution has made health a provincial subject in the country. As promised in election manifestoes, all the three major political parties ruling provincial governments have recently committed to health financing reforms for achieving UHC. Though the existing literature provides a few key health financing indicators at the national level, there is a paucity of evidence for planning and monitoring UHC reforms at the provincial level. This dissertation, comprised of three papers, addressed this gap by providing empirical evidence on: i) incidence and determinants of catastrophic health expenditure, ii), efficiency of division level health systems in producing UHC tracer indicators. and iii) provincial progress towards Universal health coverage and associated in-equities from 2001-14.<br>1<br>Faraz Khalid
44
Lucena, Rita Bobone de. "Universal Health Coverage : a useful endeavor? : an analysis on the progress of coverage in the CPLP countries." Master's thesis, 2015. http://hdl.handle.net/10400.14/18254.
Full textAbstract:
Long has healthcare been at the center of socio-economical and political priorities. Providing accessible care to all is undeniably one of the most basic needs all populations must have access to. In the light of this, the World Health Organization developed the concept of Universal Health Coverage promoting access to health interventions at affordable costs. Although the concept is still recent, major efforts are being made in this area, with countries sharing their experiences and investing deeply on innovative ways to improve their healthcare. The purpose of this dissertation is to provide an overview on the evolution of Universal Health Coverage in a group of countries, to understand what efforts are still to be done, and what major setbacks are countries facing. The CPLP was chosen for its heterogeneous composition, enabling an interesting data comparison and illustrating well the global diversity in health provision. Therefore, a major focus is given on what is universal coverage, how to measure and monitor it, as well as what are the main obstacles on its way. To support these literary findings, data on the countries was collected and analyzed with different indicators picturing the current expenses in healthcare and evolution of population growth and availability of resources. Finally, to understand the correlation between indicators, a statistical measure was made proving repeatedly how countries are improving in their pursuit of universal coverage but how there is still room for improvement.
45
"Who speaks for the uninsured? The nascent movement for universal health care coverage." THE JOHNS HOPKINS UNIVERSITY, 2008. http://pqdtopen.proquest.com/#viewpdf?dispub=3309808.
Full text
46
Mayes, Ben Richardson. "The elusive quest for universal health coverage : social security as leading asset and a liability /." 2000. http://wwwlib.umi.com/dissertations/fullcit/9954482.
Full text
47
Biedenbach, Christopher. "A theoretical exploration of the modern health care crisis in the United States and the lack of universal health care coverage." 2008. http://hdl.handle.net/10106/1900.
Full text
48
Brooks, Mohamad Ibrahim. "The effects of pro-poor health insurance on health facility delivery and skilled birth delivery in Indonesia: a mixed-methods evaluation." Thesis, 2016. https://hdl.handle.net/2144/17093.
Full textAbstract:
PROBLEM: As part of Indonesia’s strategy to achieve the goal of Universal Health Coverage (UHC), large investments have been made to increase health access for the poor. These have resulted in the implementation of various public health insurance (PHI) schemes, including Jamkesmas, the largest health insurance program in Indonesia in 2012, targeted towards the poor and near-poor. In the backdrop of Indonesia’s aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects poor women. With the implementation of various pro-poor PHI programs in Indonesia, there is limited understanding of how these programs impact maternal health services among poor women.
METHODS: This study used a mixed-methods design. The quantitative component entailed secondary analysis of the Indonesian Demographic and Health Survey (IDHS) from 2007 and 2012 on key outcomes of interest: health facility delivery (HFD) and skilled birth delivery (SBD). Qualitative interviews (n=55) were conducted from May-Aug 2015 in the province of Jakarta and Banten among community representatives and key stakeholders to describe the successes and challenges of health insurance membership and maternal health services among the poor.
RESULTS: Controlling for all independent variables, poor women with Jamkesmas were 21% (OR=1.21 [1.05–1.39]) more likely to have HFD and 20% (OR=1.20 [1.03–1.39]) more likely to have SBD compared to poor women without health insurance. Qualitative interviews provide some explanation to the modest effect of Jamkesmas health insurance on HFD and SBD seen in the quantitative analysis, including: the preference for pregnant women to deliver in their parents’ village; the use of traditional birth attendants; lack of proper documentation for health insurance registration, distance to health facilities; shortage of qualified health providers; overcrowded health facilities; and lack of health facility accreditation.
CONCLUSION: Poor women with Jamkesmas membership had a modest increase in HFD and SBD. These findings indicate that pro-poor PHI schemes may be able to reduce financial barriers to care. However, factors such as socio-cultural beliefs, accessibility, and quality of care are important elements that need to be addressed as part of the national UHC agenda to improve maternal health services in Indonesia.
49
Eunice, Bosede Avong. "Prescribing practices in the social health insurance programme at secondary hospitals in the federal capital territory, Abuja, Nigeria." Thesis, 2012. http://hdl.handle.net/11394/3956.
Full textAbstract:
Master of Public Health - MPH<br>The World Health Organisation estimates that more than 50% of medicines are inappropriately used globally. The situation is worst in developing countries such as Nigeria, where irrational prescribing practices account for wastage of resources, catastrophic medicines costs and poor access to health services. In 2005, the Social Health Insurance Programme was launched as a financially sustainable model to achieve cost effective and affordable health care services including medicines. This study investigated prescribing practices and availability of medicines in the Social Health Insurance Programme in accredited public sector secondary hospitals in the Federal Capital Territory, Nigeria.Methodology:The study is a descriptive, cross-sectional and retrospective survey of prescriptions of insured outpatients in the Federal Capital Territory, Nigeria. Four hospitals were selected by stratification of thirteen (13) public secondary hospitals in the territory into urban/peri-urban areas, followed by random selection of two hospitals from each stratum.A total of seven hundred and twenty (720) retrospective prescription encounters of insured outpatients were systematically selected from encounters between July 2009 and June 2010 at the selected facilities. Data on prescribing practices and the extent to which prescribed medicines were provided were assessed with the use of modified WHO/INRUD indicators. Descriptive statistics were generated with Epi-info (version 3.4.3) and SPSS (version 17.0)Results:
Out of the seven hundred and twenty (720) prescriptions that were assessed analgesics/NSAID, antibiotics, antimalarials and haematinics/vitamins collectively accounted for 67.4% of the medicines prescribed.A comparison of the results with WHO/Derived reference values showed that average number of medicines prescribed per prescription (3.5 ±1, p<0.001) and the rate of antibiotic prescribing (53.7%, p=0.009) were higher than the WHO recommended ranges of (1.6-1.8) and (20.0- 25.4%) respectively.The use of generic names in prescribing (50.9%, p<0.0009) and medicines prescribed from the Essential Medicine List (74.2%, p=0.05) were considerably lower than the standard (100%) However, the rate of injection prescribing (12.49%, p=0.4) was within the recommended range (10.1–17.0%).The study also found that 85.1%, (p=0.001) of prescribed medicines were dispensed, while 93.4% (p=0.256) of essential medicines were dispensed which was lower than the recommended standard (100%). Overall, only 58%,(p<0.0001) of patients had all prescribed medicines completely dispensed and this was significantly lower than the desired standard (100%.) in social health insurance programmes.Conclusions:The findings of this study show trends toward irrational prescribing practices as characterized by poly-pharmacy, overuse of antibiotics, sub-optimal generic prescribing, as well as poor adherence to the use of NHIS-Essential Medicine List. There was sub-optimal provision of prescribed medicines. These are potential threats to the scheme‟s goal of universal access to
health care in the year 2015. Pragmatic multi-component interventions are recommended to promote rational prescribing and improve equity in access to essential medicines.
50
"中國城鎮職工醫保覆蓋面影響因素的縱貫分析, 1999-2005". Thesis, 2009. http://library.cuhk.edu.hk/record=b6075320.
Full textAbstract:
The background variables, GDP per capita, marketization, industrialization and urbanization are used to control different levels of development across provinces. The role of the state is measured in the following ways. First, financial capacity, administrative capacity and coercive capacity are used to measure the role of state capacity in BMI extension. The study examines whether there is a difference in choosing different agencies to collect social insurance premiums: one is local taxation agency and the other is social insurance agency. Third, the performance of BMI is measured through the deposit rates of BMI funding which reflects governments' ability to manage the BMI program. In the current policy, employers are charged largely the social insurance fees. So their willingness and capabilities to pay will affect BMI coverage. The study investigates two kinds of employers: loss making State-Owned-Enterprises (SOE hereafter) and Foreign Invested Enterprises (FIE hereafter). On the employee's part, the percent of informal employment in total urban employment is used to measure the effect of adverse employment conditions on BMI coverage. Trade union density is used to estimate the labor organization strength.<br>The complicated process of extending coverage is related to three major stakeholders: state, employers and employees. These three stake-holders influence BMI progress. Also, the background factors (such as the economic growth) should be taken into account for the regional variations in development level. Since BMI is a typical social policy field, this study reviews major theories about social policy development: logic of industrialism, power resource theory and state-centered approach and so on. These theories help organize pieces of phenomena into a unified framework and testable hypotheses are also derived.<br>The contributions of this study can be twofold. First, from the theoretical aspect, this research tests several welfare state development theories using Chinese data. In this way, it does not only expand the scope conditions of theories, but also improves our understanding of the social policy development in China, an outlier of traditional western democracies. Second, this study tests some controversial issues on BMI development and the research findings provide knowledge support for the policy practice in the real world.<br>The low coverage of social health insurance is one of the causes of the problems in Chinese health care system which is criticized for the rising health cost, large share of out-of-pocket payments and health inequality issue. The Basic Medical Insurance for Urban Employees (BMI hereafter) was chosen as the subject of my investigation. It was established in 1998 for the working population and till now it has not achieved universal coverage yet. The Basic Medical Insurance for Urban Residents (BMI-R hereafter) was started in 2007 and it is still in pilot stage, therefore data are still inadequate. In rural areas, the New Cooperative Medical Scheme (NCMS hereafter) achieved almost full coverage in 2008. Thus extending coverage is not issue at concern for NCMS. Besides, the NCMS data at province level are quite limited. Considering the stages of policy development and data access, BMI-R and NCMS are not included in this study.<br>The proportion of winning lawsuit in labor disputes is used to measure the function of labor protection system. This study adopts the panel method. Data is ranging from the year 1999 to 2005 and the unit of analysis is province/year. They were collected from various official statistics and constructed into a panel database which can trace the development of BMI from its origin to most recent situation.<br>The research question is what are the determinants of BMI's coverage? It is originated from some puzzling observations: the NCMS achieved full coverage in four years and it is a voluntary participation insurance program. On the contrary, why the mandatory BMI did not reach universal coverage after almost ten years' development? Besides, the progress of BMI across different provinces varied greatly. Given the policy designing and starting points are rather similar, how can we explain these variations?<br>The research yields several interesting results. First, the roles of financial capacity and administrative capacity in BMI development are supported by data, especially the social insurance agency. Second, results show that using local taxation to collect social insurance premiums has better effects in extending coverage than the alternative approach. This result will give an end to the decade-long debate on choice of social insurance premiums collection agencies. Third, the deposit rates of BMI funding are negatively related with BMI coverage. It implies that governments should improve the performance of BMI so as to attract more people to enroll in this program. Fourth, the union density in the private sector is positively related with BMI coverage. This result disagrees with the conventional wisdom that the Chinese trade unions are useless. It implies that strengthening the organization of employees (even through the official channel) can protect the rights of employees in some degree.<br>劉軍強.<br>Adviser: Cheek-Kie Wong.<br>Source: Dissertation Abstracts International, Volume: 73-03, Section: A, page: .<br>Thesis (Ph.D.)--Chinese University of Hong Kong, 2009.<br>Includes bibliographical references (p. 198-222)<br>Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>Abstracts in Chinese and English.<br>Liu Junqiang.