Dissertations / Theses on the topic 'Accessibility cost'
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Sadatsafavi, Mohsen. "Advancing the methods and accessibility of cost-effectiveness and value of information analyses in health care." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/40867.
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This thesis comprises three methodological advancements that address important issues related to cost-effectiveness analysis (CEA) and expected value of information (EVI) analysis in health technology assessment. Aims: 1) To develop a practical sampling scheme for the incorporation of external evidence in CEAs conducted alongside randomized controlled trials (RCT); 2) To develop non-parametric methods for the calculation of the expected value of sample information (EVSI) for RCT-based CEAs; 3) To develop a computationally efficient algorithm for the calculation of single-parameter expected value of partial perfect information (EVPPI) for RCT-based and model-based CEAs. The theories and methods laid out in this work are accompanied by real-world CEA and EVI analyses of the Canadian Optimal Therapy of Chronic Obstructive Pulmonary Diseases (OPTIMAL) trial, a RCT on combination pharmaceutical therapies in chronic obstructive pulmonary diseases (COPD). Results: 1) The ‘vetted bootstrap’ is a semi-parametric algorithm based on rejection sampling and bootstrapping that allows the incorporation of external evidence into RCT-based CEAs. Implementing this method to incorporate external information on the effect size of treatment in the OPTIMAL trial required only minor modifications to the original CEA algorithm. 2) A Bayesian interpretation of the bootstrap allows non-parametric calculation of EVSI through two-level resampling. In the case study, incorporation of missing value imputation and adjustment for covariate imbalance in EVI calculations generated EVSI and the expected value of perfect information (EVPI) values that were significantly different than those calculated conventionally, demonstrating the flexibility of this method and the potential impact of modeling such aspects of the analysis on EVI calculations. 3) The new method enabled the calculation of EVPPI for the effect size of treatment for the exemplary RCT data, and showed a significant (up to 25 times in terms of root-mean-squared error) improvement in efficiency compared to the conventional EVPPI calculation methods in a series of simulations. Summary: This thesis provides several original advancements in the methodology of the CEA and EVI analysis of RCTs and enables several analytical approaches that have hitherto been available only through parametric modeling of RCT data.
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Lundin, Susan. "Utredning av merkostnader för höjning av tillgänglighetsnivån från normal till höjd nivå enligt SS 91 42 21:2006 samt 91 42 22:2006." Thesis, Umeå universitet, Institutionen för tillämpad fysik och elektronik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-90014.
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Detta arbete grundar sig på en befintlig ritning projekterad av Arkinova Arkitekter och uppfyller normal tillgänglighetsnivå. Ritningen består av ett lägenhetsplan med fem lägenheter vilka har en boarea mellan 36-64 m2. I detta arbete omprojekterades dessa lägenheter till höjd tillgänglighetsnivå enligt SS med avsikt att förbättra tillgängligheten för funktionshindrade grupper. Omprojekteringen utfördes med hjälp av BIM-programmet Revit Architecture 2013 med utgångspunkt från standarderna, SS 91 42 21:2006 samt SS 91 42 22:2006, vilka utgör underlag för projektering av bostäder. Syftet med denna studie var att utreda de merkostnader som är förknippade med en tillgänglighetsökning, dessa merkostnader beräknades i kalkylprogrammet BidCon. Resultatet visade att för att uppfylla SS rekommendationer kring ökad tillgänglighet, var en ökning av bruttoarean med 84 m2 i den ursprungliga ritningen oundviklig. Detta innebar en total ökning av bruttoarean med 25 %, vilket resulterade i merkostnader som uppgick till 126 014 SEK för lägenhetsplanet i höjd nivå. Dessa merkostnader inkluderar materialet i väggar, dörrar samt golvbjälklaget. Den procentuella kostnadsökningen för materialet blev således 22 %.This work is based on an existing drawing designed by Arkinova Arkitekter, and is adapted to normal level of accessibility. The drawing consists of five apartments, with each apartment covering a total floor area between 36-64 m2. To improve accessibility for disabled groups, the apartments have been re-designed to a higher level of accessibility using BIM software Revit Architecture based on SS (Swedish Standard) 91 42 21:2006 and 91 42 22:2006. The purpose of this study was to investigate the additional costs associated with an increased accessibility; these additional costs were calculated in the spreadsheet program BidCon. The result showed that in order to comply with SS’ recommendation around increased accessibility, the floor area in the original drawing had to be increased by 84 m2 to allow increased mobility. This corresponds to a total increase of 25 %, which resulted in an additional costs of 126 014 SEK (22 % increase) including material for walls, doors and floor slab.
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Meng, Qingyue. "Health care pricing and payment reforms in China: the implications for health service delivery and cost containment /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-576-3/.
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Ström, Lind Anna, Hanna Silfver, and Eleonor Bengtsson. "Tillgänglighetskrav i nyproduktion - På vilket sätt påverkar tillgänglighetskraven nyproduktionen av bostäder?" Thesis, Malmö universitet, Fakulteten för kultur och samhälle (KS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-23066.
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Sveriges byggregler grundar sig i FN:s konventioner och FN har beslutats att allnyproduktion ska vara tillgänglig för alla. Huruvida tillgänglighetskraven påverkarfastighetsutvecklingen i Sverige är en omdiskuterad fråga. Aktörer i branschen menar attbyggreglerna är för detaljerade och att utvecklingsmöjligheterna i fastighetsbranschen är små.Uppsatsens syfte är att undersöka om tillgänglighetskraven påverkar nyproduktionen avbostäder samt att ta reda på om tillgänglighetskraven medför konsekvenser på byggandet.Uppsatsen genomfördes med hjälp av en kvalitativ metod och innehåller intervjuer av totalttretton bolag som alla arbetar på olika sätt inom fastighetsbranschen.Bolagen är överens om att tillgänglighetskraven är en faktor som påverkar och kan hämmabyggprocessen men menar att det inte enbart är de som påverkar, utan det finns krav sompåverkar ännu mer till exempel kravet på buller och dagsljus. Ytterligare ett problem sombolagen upplever är det stora tolkningsutrymmet som tillgänglighetskraven öppnar upp för,men Boverket menar att tolkningsutrymmet gällande tillgänglighetskraven inte är större än iandra krav.Idag går trenden mot mindre bostäder men det kan upplevas som att tillgänglighetskravenhämmar byggandet utav dem. Boverket har ingen direkt uppfattning om vad som faktisktefterfrågas på marknaden. Bolagen har blandade meningar gällande om all nyproduktion börvara tillgänglig för alla eller om det räcker med att en andel av byggnationerna följertillgänglighetskraven. Det har Boverket ingen kommentar på, lagarna är tvingande.Sweden's building regulations are based on UNs conventions and it has been determined thatall new construction should be accessible to everyone. Whether the accessibility requirementsaffect property development in Sweden is a well debated issue. Industry actors believe thatthe building regulations are too detailed and that the development opportunities in the realestate industry are small.The purpose of the thesis is to investigate whether the accessibility requirements affect thenew construction of housing and to find out whether the accessibility requirements entailconsequences on the new construction of housing. The study was conducted using aqualitative method and contains interviews of a total of thirteen companies that all work inthe real estate industry.The companies agree that the accessibility requirements are a factor that influences and caninhibit the construction process, but they believe that it is not the solely factor, but there arerequirements that affect even more, for example the requirement for noise and daylight.Another problem that the companies experience is that the great scope for interpretation, butthe National Board of Housing believes that the scope for interpretations regardingaccessibility requirements is not greater than in other requirements.It is agreed that the trend today goes towards smaller housing, but many experiences that theaccessibility requirements obstruct their construction on this type of smaller housing. Thenational Board of Housing has no direct perception on how the actual demand is on the realestate market. The companies have mixed opinions regarding whether all new constructionshould be available to everyone or if it is sufficient that a proportion of the constructionfollows the accessibility requirements. The National Board of Housing has no comment onthis matter but claims that the laws are mandatory.
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Silvestre, Cerdà Joan Albert. "Different Contributions to Cost-Effective Transcription and Translation of Video Lectures." Doctoral thesis, Universitat Politècnica de València, 2016. http://hdl.handle.net/10251/62194.
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[EN] In recent years, on-line multimedia repositories have experiencied a strong
growth that have made them consolidated as essential knowledge assets, especially
in the area of education, where large repositories of video lectures have been
built in order to complement or even replace traditional teaching methods.
However, most of these video lectures are neither transcribed nor translated
due to a lack of cost-effective solutions to do so in a way that gives accurate
enough results. Solutions of this kind are clearly necessary in order to make
these lectures accessible to speakers of different languages and to people with
hearing disabilities. They would also facilitate lecture searchability and
analysis functions, such as classification, recommendation or plagiarism
detection, as well as the development of advanced educational functionalities
like content summarisation to assist student note-taking.
For this reason, the main aim of this thesis is to develop a cost-effective
solution capable of transcribing and translating video lectures to a reasonable
degree of accuracy. More specifically, we address the integration of
state-of-the-art techniques in Automatic Speech Recognition and Machine
Translation into large video lecture repositories to generate high-quality
multilingual video subtitles without human intervention and at a reduced
computational cost. Also, we explore the potential benefits of the exploitation
of the information that we know a priori about these repositories, that is,
lecture-specific knowledge such as speaker, topic or slides, to create
specialised, in-domain transcription and translation systems by means of
massive adaptation techniques.
The proposed solutions have been tested in real-life scenarios by carrying out
several objective and subjective evaluations, obtaining very positive results.
The main outcome derived from this thesis, The transLectures-UPV
Platform, has been publicly released as an open-source software, and, at the
time of writing, it is serving automatic transcriptions and translations for
several thousands of video lectures in many Spanish and European
universities and institutions.[ES] Durante estos últimos años, los repositorios multimedia on-line han experimentado un gran crecimiento que les ha hecho establecerse como fuentes fundamentales de conocimiento, especialmente en el área de la educación, donde se han creado grandes repositorios de vídeo charlas educativas para complementar e incluso reemplazar los métodos de enseñanza tradicionales. No obstante, la mayoría de estas charlas no están transcritas ni traducidas debido a la ausencia de soluciones de bajo coste que sean capaces de hacerlo garantizando una calidad mínima aceptable. Soluciones de este tipo son claramente necesarias para hacer que las vídeo charlas sean más accesibles para hablantes de otras lenguas o para personas con discapacidades auditivas. Además, dichas soluciones podrían facilitar la aplicación de funciones de búsqueda y de análisis tales como clasificación, recomendación o detección de plagios, así como el desarrollo de funcionalidades educativas avanzadas, como por ejemplo la generación de resúmenes automáticos de contenidos para ayudar al estudiante a tomar apuntes. Por este motivo, el principal objetivo de esta tesis es desarrollar una solución de bajo coste capaz de transcribir y traducir vídeo charlas con un nivel de calidad razonable. Más específicamente, abordamos la integración de técnicas estado del arte de Reconocimiento del Habla Automático y Traducción Automática en grandes repositorios de vídeo charlas educativas para la generación de subtítulos multilingües de alta calidad sin requerir intervención humana y con un reducido coste computacional. Además, también exploramos los beneficios potenciales que conllevaría la explotación de la información de la que disponemos a priori sobre estos repositorios, es decir, conocimientos específicos sobre las charlas tales como el locutor, la temática o las transparencias, para crear sistemas de transcripción y traducción especializados mediante técnicas de adaptación masiva. Las soluciones propuestas en esta tesis han sido testeadas en escenarios reales llevando a cabo nombrosas evaluaciones objetivas y subjetivas, obteniendo muy buenos resultados. El principal legado de esta tesis, The transLectures-UPV Platform, ha sido liberado públicamente como software de código abierto, y, en el momento de escribir estas líneas, está sirviendo transcripciones y traducciones automáticas para diversos miles de vídeo charlas educativas en nombrosas universidades e instituciones Españolas y Europeas.
[CAT] Durant aquests darrers anys, els repositoris multimèdia on-line han experimentat un gran creixement que els ha fet consolidar-se com a fonts fonamentals de coneixement, especialment a l'àrea de l'educació, on s'han creat grans repositoris de vídeo xarrades educatives per tal de complementar o inclús reemplaçar els mètodes d'ensenyament tradicionals. No obstant això, la majoria d'aquestes xarrades no estan transcrites ni traduïdes degut a l'absència de solucions de baix cost capaces de fer-ho garantint una qualitat mínima acceptable. Solucions d'aquest tipus són clarament necessàries per a fer que les vídeo xarres siguen més accessibles per a parlants d'altres llengües o per a persones amb discapacitats auditives. A més, aquestes solucions podrien facilitar l'aplicació de funcions de cerca i d'anàlisi tals com classificació, recomanació o detecció de plagis, així com el desenvolupament de funcionalitats educatives avançades, com per exemple la generació de resums automàtics de continguts per ajudar a l'estudiant a prendre anotacions. Per aquest motiu, el principal objectiu d'aquesta tesi és desenvolupar una solució de baix cost capaç de transcriure i traduir vídeo xarrades amb un nivell de qualitat raonable. Més específicament, abordem la integració de tècniques estat de l'art de Reconeixement de la Parla Automàtic i Traducció Automàtica en grans repositoris de vídeo xarrades educatives per a la generació de subtítols multilingües d'alta qualitat sense requerir intervenció humana i amb un reduït cost computacional. A més, també explorem els beneficis potencials que comportaria l'explotació de la informació de la que disposem a priori sobre aquests repositoris, és a dir, coneixements específics sobre les xarrades tals com el locutor, la temàtica o les transparències, per a crear sistemes de transcripció i traducció especialitzats mitjançant tècniques d'adaptació massiva. Les solucions proposades en aquesta tesi han estat testejades en escenaris reals duent a terme nombroses avaluacions objectives i subjectives, obtenint molt bons resultats. El principal llegat d'aquesta tesi, The transLectures-UPV Platform, ha sigut alliberat públicament com a programari de codi obert, i, en el moment d'escriure aquestes línies, està servint transcripcions i traduccions automàtiques per a diversos milers de vídeo xarrades educatives en nombroses universitats i institucions Espanyoles i Europees.
Silvestre Cerdà, JA. (2016). Different Contributions to Cost-Effective Transcription and Translation of Video Lectures [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/62194
TESIS
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Dzuranin, Ann C. "Mitigating Escalation of Commitment: An Investigation of the Effects of Priming and Decision-Making Setting in Capital Project Continuation Decisions." [Tampa, Fla.] : University of South Florida, 2009. http://digital.lib.usf.edu/?e14.2942.
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Qiu, Waishan. "Increasing Saudi females' accessibility to employment via car-pooling in Riyadh : measure the realistic commute cost by network computing methods and investigate the share-ability based on actual taxi trip data." Thesis, Massachusetts Institute of Technology, 2017. http://hdl.handle.net/1721.1/111478.
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Thesis: M.C.P., Massachusetts Institute of Technology, Department of Urban Studies and Planning, 2017.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 121-124).
Due to the driving ban as well as to social restrictions on their movement with male drivers, Saudi women have to rely on either male family members or the employer's shuttle bus; otherwise they would hire a driver or take the taxi. These few options pose high commute cost on Saudi females, hence their access to economic opportunities is restrained, especially among lower car ownership segments. Such restrictions have negative influence on Saudi females' employment. The employment rate of Saudi women is only 22%. However, no previous research has quantitatively investigated the commute cost as a financial burden and barrier to job participation for Saudi females. Taking the capital city Riyadh as a case study, this study will (1) develop the method to measure the realistic commute cost (in terms of time and money) by different transportation options for Saudi female residents in different job sectors; (2) examine the spatial mismatch between Saudi females' concentration and their job markets using the notion of accessibility; (3) demonstrate ridesharing's capacity of providing greater access for Saudi women based on spatial analysis of the current commute demands and behaviors; (4) and also look at the feasibility of developing ridesharing programs based on network analysis of current taxi trips. This study sheds light on implications for policy makers and ridesharing service companies to reduce Saudi females' commute cost so as to increase their access to economic opportunities.
by Waishan Qiu.
M.C.P.
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Rydell, Emma, and Jennifer Andersson. "Social hållbarhet – en tillgänglighetsinventering i Jönköping." Thesis, Tekniska Högskolan, Högskolan i Jönköping, JTH, Byggnadsteknik, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-41167.
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Purpose: This thesis investigates the accessibility in the existing housing stock in Jönköping. The inventory was carried out with the help of the handbook Accessibility in Existing Housing abbreviated as TIBB. The aim is to investigate the extent of accessibility problems based on the selection in Jönköping city with TIBB, and to calculate costs for eliminating these problems. This provides a basis that contributes to improving social sustainability. To achieve the goal, the following questions were asked: (1) How many multi-family houses from the selection of 40, 50 and 60s in Jönköping, have problems with accessibility according to TIBB? (2) What is the occurrence of different types of accessibility problems in the surveyed apartment buildings? (3) What might the cost estimate be to meet the requirements of TIBB, with and without subsidization for an elevator? Method: The main method that was used for this thesis where a case-study with observation. A total of 15 real estate’s where investigated and gave data that was analyzed and gave results through data processing. A document analysis was made for cost estimate to use the same calculations to obtain generalizable figures, as well as compare costs. To give background to the problem a literature study has been accomplished which confirms that there are accessibility problems in the existing housing stock. Findings: The findings that shows that all investigated multifamily housing in the city of Jönköping have accessibility problems. Since they only reach the lowest level in TIBB. The most common accessibility problems for the investigated housing are that the lowest and highest step of stairs aren’t marked, no place for a walker outside and inside the entry, no elevator and the thresholds are higher than 15 mm. To address accessibility problems with the highest possible accessibility level for each property, the cost was estimated to amount to approximately SEK 20.0 million without subsidization when installing an elevator. The cost amounts to approximately SEK 10.4 million with subsidization when installing a elevator. Implications: The conclusions drawn are that the identified the accessibility problems based on the selection in Jönköping's city must be addressed to accommodate housing for the increasing proportion of elderly people in the future. Real estate companies may raise the rent by a maximum of SEK 450 per month if an elevator is installed. For real estate companies to be able to adapt their properties, which contributes to improved social sustainability, the proposal for subsidization when installing an elevator needs to go through, otherwise property companies will lose at a loss if they address accessibility problems. Limitations: Limitations in the thesis is for the year’s forties, fifties and sixties and only five multifamily houses from each decade has been inventoried. Costs relate to many different factors from a socio-economic perspective and will be limited to reasonable rent increases according to the property managers.Syfte: Detta arbete undersöker tillgängligheten av det befintliga bostadsbeståndet i Jönköping stad. Inventeringen utfördes med hjälp av handboken Tillgänglighet i befintligt bostadsbestånd, TIBB. Målet är att undersöka omfattningen av tillgänglighetsproblem utifrån urvalet i Jönköping stad med TIBB, samt att beräkna kostnader för att eliminera dessa problem. Detta ger ett underlag som bidrar till en förbättring av den sociala hållbarheten. För att uppnå målet ställdes följande frågeställningar: (1) Hur många flerbostadshus utifrån urvalet från 40-, 50- och 60-tal i Jönköping stad, har problem med tillgängligheten enligt TIBB? (2) Vad är förekomsten av olika typer av tillgänglighetsproblem i de undersökta flerbostadshusen? (3) Vad kan kostnadsuppskattningen vara för att uppfylla kraven i TIBB, med och utan subventionering för en hiss? Metod: Antalet fastigheter som undersökts var 15 stycken. En fallstudie med observation gav rådata som analyserats och gett resultat genom databearbetning. En dokumentanalys gjordes inför kostnadsuppskattningen för att använda sig av samma beräkningar för att kunna få fram generaliserbara siffror, samt jämföra kostnader. För att ge bakgrund till problemet har en litteraturstudie utförts vilket bekräftar att det finns tillgänglighetsproblem i det befintliga bostadsbeståndet. Resultat: Resultatet utifrån arbetet visade att samtliga undersökta flerbostadshusen i Jönköping har problem med tillgängligheten då de endast uppnådde den lägsta nivån enligt TIBB. De vanligaste tillgänglighetsproblemen för de undersökta flerbostadshusen är att trappans nedersta och övertas steg är ej markerade, avsaknad av uppställningsplats för rollator utanför och innanför entrén, hiss saknas samt är trösklarna över 15 mm. För att åtgärda tillgänglighetsproblemen med högsta möjliga tillgänglighetsnivå för respektive fastighet beräknades kostnaden fram till cirka 20,0 miljoner kronor utan subventionering vid installation av hiss. Kostnaden uppgår till cirka 10,4 miljoner kronor med subventionering vid installation av hiss. Konsekvenser: Slutsatserna som dras är att de identifierade tillgänglighetsproblemen utifrån urvalet i Jönköpings stad måste åtgärdas för att tillgodose bostäder för den ökande andelen äldre människor i framtiden. Fastighetsföretagen får höja hyran med max 450 kronor i månaden om hiss installeras. För att fastighetsbolagen ska kunna tillgänglighetsanpassa sina fastigheter, vilket bidrar till en förbättrad social hållbarhet, behöver förslaget till subventionering vid installering av hiss gå igenom, annars kommer fastighetsbolagen gå med förlust om de åtgärdar tillgänglighetsproblemen. Begränsningar: Avgränsningar i arbetet är utifrån årtal, 40-, 50- och 60-talet samt att enbart fem objekt från varje tidsepok inventeras. Kostnader berör många olika faktorer inom ett samhällsekonomiskt perspektiv och kommer i arbetet begränsas till rimliga hyreshöjningar enligt fastighetsförvaltarna.
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Seagrave, Susanne M. "The role of expensive technologies in the new medical marketplace /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 1998. http://wwwlib.umi.com/cr/ucsd/fullcit?p9906474.
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Park, Yongha. "Studies in Airline and Aviation Efficiency." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu149261466159752.
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Mulindahabi, Charline. "Democratic decentralisation in Rwanda." University of the Western Cape, 2002. http://hdl.handle.net/11394/7887.
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Masters in Public Administration - MPARwandan local government system is currently making an important turning point with the introduction of democratic decentralisation. This study was carried out in order to find out the prospects and challenges of democratic decentralisation in Rwandan context. From Rwanda's independence in 1962 up to the 1999 administrative reforms, local governments, namely communes, have largely failed in their mission of being basic development units. Democratic decentralisation was then introduced to bridge gaps and correct weaknesses that undemined local governance in the past. There are some challenges like generalised poverty in the country, the nonparticipation, and dependence syndrome among citizens that need to be overcome. However, there are also opportunities that ought to be taken advantage if democratic decentralisation is to really take root in Rwanda. The main opportunity is commitment to to democracy and decentralisation by all stakeholders, the national leadership, local authorities and citizens in general. However, democratic decentralisation cannot be attained quickly. It is achieved gradually depending on citizens' understanding and to the availability of the resources. authorities and citizens in general
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Reid, Denise P. "Stuck Between a Rock and a Hard Place: Exploring the Lived Experiences of College Students Who Do Not Request Accommodations." Chapman University Digital Commons, 2014. http://digitalcommons.chapman.edu/ces_dissertations/1.
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For this phenomenological study, thirteen participants from two private universities, located in the western region of the United States shared their lived experiences of being a college student who does not request accommodations. The author used recursive analysis to analyze qualitative data from semistructured interviews. Initial codes were combined to create interconnected families of codes. A second level of analysis resulted in seven spaces in which participants described their lived experiences. Findings suggest participants experience various tensions, ranging from incompatible options to competing perspectives, as they negotiate their identify and environment. including the principle of opportunity cost. Recommendations for college administrators and faculty, including Universal Design in higher education are included.
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Joaquim, José Amilton. "Financiamento do ensino superior em Moçambique : a comparticipação dos estudantes/famílias na província de Gaza." Doctoral thesis, Instituto Superior de Economia e Gestão, 2020. http://hdl.handle.net/10400.5/20787.
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Doutoramento em Sociologia Económica e das OrganizaçõesO crescimento massivo da população estudantil nas instituições de ensino superior tem desafiado as modalidades tradicionais de financiamento público. E as políticas de partilha de custos têm sido uma das opções recorridas pelos governos. Nessa partilha, é importante que, em função das características sociais e económicas dos estudantes e famílias, as questões relacionadas com a equidade e acessibilidade sejam acauteladas. Este estudo procura compreender como é que as políticas de partilha de custos, tendo em conta os custos diretos, de frequência de ensino superior, indiretos, outras despesas de vida e as características sociais e económicas dos moçambicanos, podem ajudar ou obstruir a acessibilidade ao ensino superior em Moçambique. Para o efeito, fizemos uma combinação de abordagens metodológicas, qualitativa e quantitativa, recorrendo as técnicas do inquérito por questionário aos estudantes do ensino superior na província de Gaza e a análise documental sobre o financiamento do ensino superior em Moçambique e no mundo. Os resultados revelaram que em Moçambique o modelo de partilha de custos no financiamento do ensino superior é misto, público e privado, e apesar do Estado continuar a assegurar parte do financiamento do ensino superior como forma de garantir o acesso, ainda está muito aquém de satisfazer as reais necessidades dos estudantes e famílias moçambicanas, pelo número de instituições do ensino superior que continuam sendo reduzidas. Pelos custos onerosos de educação e de vida durante a frequência do ensino superior, que estão muito acima dos rendimentos dos estudantes. As bolsas de estudos para além de serem reduzidas, constituem o único meio de apoio social, o processo de atribuição é ineficiente e as condições das bolsas não satisfazem os custos reais acarretados pelos estudantes. O que coloca em causa as questões de equidade e acessibilidade ao ensino superior, principalmente para as famílias com as condições sócio económicas modestas no país.
The massive growth of the student population in higher education institutions has challenged traditional forms of public funding. And cost-sharing policies have been one of the options that governments use. In this sharing, it is important that, due to the social and economic characteristics of students and families, issues related to equity and accessibility are addressed. This study seeks to understand how cost-sharing policies, taking into account direct costs, higher education attendance, indirect costs, other living expenses and the social and economic characteristics of Mozambicans, can help or hinder accessibility to higher education in Mozambique. To this end, we have combined methodological, qualitative and quantitative approaches using survey questionnaire techniques for higher education students in Gaza province and document analysis on higher education funding in Mozambique and around the world. The results showed that in Mozambique the cost-sharing model for higher education funding is mixed, public and private, and while the state continues to provide part of higher education funding as a means of securing access, it is still far from satisfying the real needs of Mozambican students and families by the number of higher education institutions that continue to be reduced. The costly education and living costs during higher education, which are far above student incomes. In addition to being small, scholarships are the only means of social support, the process of awarding them is inefficient and the conditions of the scholarships do not meet the real costs incurred by students. This calls into question the issues of equity and accessibility to higher education, especially for families with modest socio-economic conditions in the country.
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Song, Ying. "Green Accessibility: Estimating the Environmental Costs of Space-time Prisms for Sustainable Transportation Planning." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1437344275.
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Ellis, S. D. "The economics of the provision of rural transport services in developing countries." Thesis, Cranfield University, 1996. http://dspace.lib.cranfield.ac.uk/handle/1826/3297.
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Rural accessibility planning in developing countries over the last few decades has primarily focused on increasing rural communities access to rural roads. It has been considered that road building improves access to health, education, markets and employment opportunities, and hence promotes economic development. It is argued in this thesis that accessibility, particularly in Sub-Saharan Africa, has not improved to the desired extent because the problem of mobility, in terms of access to vehicle services, has not been addressed. The provision of rural roads and transport services have been taken as synonymous with each other, but in reality this has not proved to be the case. This thesis attempts to redress that balance by seeking to change the mindset of policy makers to think about mobility and increase the emphasis placed on the promotion of transport services, both motorised and non-motorised. The findings relate to surveys undertaken in Thailand, Sri Lanka, Ghana, Zimbabwe and Pakistan where data were collected on vehicle operating costs (VOC's) and performance for a wide range of commonly used rural vehicles. These included human porterage and non-motorised vehicles such as bicycles and animal transport, as well as motorised vehicles such as conventional trucks and pickups, agricultural tractors and simple engine-powered vehicles. Analysis of the data demonstrated large differences in the VOC's and transport charges for rural transport services between the generally efficient systems in the Asian countries and the inefficient ones in the African countries studied. These findings form the foundation for the development of the Rural Transport Planner (RTP) and the framework which identifies the relationships between transport charges, VOC's, and factors relating to the vehicles operating environment. The RTP provides the first known attempt at producing a model for rural vehicle selection and for recommending interventions to improve the operating environment for rural transport services.
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Pezzi, Francesco. "Valutazione dei costi dell'accessibilità del Web." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amslaurea.unibo.it/1948/.
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Davén, Jonatan. "Free Primary Education in Tanzania? : A case study on costs and accessibility of primary education in Babati town." Thesis, Södertörn University College, School of Life Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-1833.
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In 2002 Tanzania initiated the implementation of the Primary Education Development Plan (PEDP), in which a substantial capacity expansion and quality improvement of primary education was outlined. The most important measure in the plan was to make primary school free and accessible to all, irrespective of financial capabilities. This thesis is a qualitative policy study, which aims at finding out whether or not primary education is free and equally accessible to all in Tanzania. Besides establishing if it is in fact free and accessible, the thesis identifies the main costs and restraints to access and also brings forward the children’s perceptions on these restraints. The answers to these questions were sought in a case study, conducted in Babati District in Northern Tanzania. Data were collected through semi-structured interviews with households, school staff and primary school children and their responses has been compared to the national policy on primary education. The main conclusions of the study are that: Primary education is not free in Tanzania, as there are significant costs involved to send a child to primary school, such as school uniform, school material and various contributions to the running costs of the school. Neither is primary education equally accessible to all, as children from households, which cannot pay these costs, are sent home from school on a regular basis. Lastly, being sent home has a damaging effect on the children’s school performances and self-esteem.
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McClellan, Craig S. "Perspectives of 12th grade students, their families, and school officials related to affordability and accessibility of the West Virginia PROMISE Scholarship program at Logan High School." Morgantown, W. Va. : [West Virginia University Libraries], 2006. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=4908.
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Thesis (Ed. D.)--West Virginia University, 2006.Title from document title page. Document formatted into pages; contains viii, 211 p. Includes abstract. Includes bibliographical references (p. 202-209).
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Skelton, Ross Alexander. "The impact of home loan key facts sheets on borrowers' comparisons of loan costs." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/91053/4/Ross_Skelton_Thesis.pdf.
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This thesis evaluates the effectiveness of the prescribed design and distribution requirements of the Australian Government's home loan key facts sheets (KFS) aimed at helping borrowers compare loan costs. The findings show that despite effectively improving borrower decision-making, few borrowers were aware of their existence and function. It was also demonstrated that KFS have had limited market impact over the four year window since introduction, likely due to the requirement that KFS provision is not required unless formally requested by a borrower. Recommendations include transferring the burden of disclosure to lenders in the first instance to address this information gap.
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Ma, Kexin. "Superannuation member disengagement and fund efficiency: the impact of the fees and costs section in superannuation fund product disclosure statements." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/235045/1/Kexin_Ma_Thesis.pdf.
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This thesis adopts behavioural finance as the theoretical framework to investigate whether the fees and costs section in Product Disclosure Statements (PDSs), following two regulatory changes affecting this section, engage members and enhance superannuation fund efficiency. By using a mixed-method, this research shows that the fees and costs section in PDSs examined over seven years (2013 to 2019) are readable by the general public but are not accessible. More importantly, the fees and costs section in PDSs do not effectively engage superannuation members or enhance fund efficiency, even though this section has undergone different regulatory changes to achieve these goals.
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Büttner, Benjamin [Verfasser], Gebhard [Akademischer Betreuer] [Gutachter] Wulfhorst, Yves [Gutachter] Crozet, and Michael [Gutachter] Wegener. "Consequences of sharp increases in mobility costs on accessibility : Suggestions for individual and public development strategies / Benjamin Büttner ; Gutachter: Yves Crozet, Michael Wegener, Gebhard Wulfhorst ; Betreuer: Gebhard Wulfhorst." München : Universitätsbibliothek der TU München, 2016. http://d-nb.info/1124590951/34.
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Büttner, Benjamin Christoph [Verfasser], Gebhard [Akademischer Betreuer] [Gutachter] Wulfhorst, Yves [Gutachter] Crozet, and Michael [Gutachter] Wegener. "Consequences of sharp increases in mobility costs on accessibility : Suggestions for individual and public development strategies / Benjamin Büttner ; Gutachter: Yves Crozet, Michael Wegener, Gebhard Wulfhorst ; Betreuer: Gebhard Wulfhorst." München : Universitätsbibliothek der TU München, 2016. http://d-nb.info/1124590951/34.
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Meissner, Roy, Kurt Junghanns, and Michael Martin. "A Decentralized and Remote Controlled Webinar Approach, Utilizing Client-side Capabilities: To Increase Participant Limits and Reduce Operating Costs." ScitePress, 2018. https://ul.qucosa.de/id/qucosa%3A32159.
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We present a concept and implementation on increasing the efficiency of webinar software by a remote control approach using the technology WebRTC. This technology enables strong security and privacy, is crossdevice usable, uses open-source technology and enables a new level of interactiveness to webinars. We used SlideWiki, WebRTC, and browser speech to text engines to provide innovative accessibility features like multilingual presentations and live subtitles. Our solution was rated for real world usage aspects, tested within the SlideWiki project and we determined technological limits. Such measurements are currently not available and show that our approach outperforms open-source market competitors by efficiency and costs.
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Chen, Minghui. "Analyse de la concurrence intermodale : l'évaluation de la qualité des dessertes ferroviaires et aériennes." Thesis, Lyon, 2019. http://www.theses.fr/2019LYSE2080.
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Sur la liaison Paris-Bordeaux, le temps de parcours en train est réduit de 1 heure grâce à la mise en service commerciale de la LGV SEA (Ligne à Grande Vitesse Sud Europe Atlantique) le 2 juillet 2017. Les effets envisagés sont une amélioration de la compétitivité du transport ferroviaire et un report modal en faveur du train. Dans cette thèse, nous nous intéressons aux effets de cette infrastructure ferroviaire sur les comportements de choix modal des voyageurs. En particulier, nous nous intéressons à la qualité des dessertes et les impacts de celle-ci sur les comportements des voyageurs.La qualité des dessertes est un sujet important pour les différents acteurs concernés par la nouvelle infrastructure ferroviaire. La seule prise en compte du nombre total des trains ou des arrêts intermédiaires n’est pas suffisante pour une évaluation pertinente de la qualité des dessertes. La présente thèse de doctorat a pour objet de montrer, d’un point de vue théorique et empirique, que l’approche pertinente doit être fondée sur les programmes d’activités et pas seulement sur l’offre de transport.Nous présentons des indicateurs permettant de mieux maîtriser les effets liés à la qualité des dessertes sur le choix modal des voyageurs. L’analyse commence par les indicateurs qui fournissent des informations complémentaires aux indicateurs standard comme la fréquence de service et l’intervalle de service vers un modèle plus sophistiqué capable de prendre en compte le programme d’activités et les caractéristiques des opportunités à destination. Nous nous orientons vers une approche désagrégée tout en assurant la mesurabilité des indicateurs.Les deux méthodes présentées dans cette thèse sont les indicateurs de temps utile à destination et le modèle combiné choix modal – choix d’horaires. A l’aide de la première méthode, nous améliorons notre connaissance aux effets de la qualité des dessertes avec un nouveau module intégré dans un modèle de choix modal. Grâce à la deuxième méthode, nous traitons la question de recherche avec une structure du modèle combiné qui explique à la fois le choix modal et le choix d’horaires des voyageurs. Ces méthodes sont élaborées sur la base des modèles de choix discrets.Nous effectuons une modélisation de la demande des voyageurs sur la liaison Paris - Bordeaux avec des données d’enquêtes « voyageurs ». Nous montrons que les questions conçues spécifiquement dans le questionnaire sont pertinentes pour évaluer la qualité des dessertes. Cette thèse est organisée de manière suivante :Dans la première partie, nous présentons les questions de concurrence dans le marché des transports. Parmi les différentes formes de concurrence, nous nous intéressons à la concurrence intermodale. Cette partie permet de comprendre de quoi il s’agit et pourquoi cette question est importante. Il s’agit d’une partie théorique qui comprend une revue de littérature nous permettant d’élaborer notre problématique.Nous présentons, dans la deuxième partie, nos méthodes pour évaluer la qualité des dessertes: le temps utile à destination et le modèle combiné choix modal – choix d’horaires. Nous présentons aussi les principes de la théorie de choix discrets qui est la base de nos approches.Le contexte de l’offre et la demande de transport sur la liaison Paris-Bordeaux, les données utilisées et les résultats de nos modèles sont présentés dans la troisième partie. Les avantages et les inconvénients de nos méthodes sont aussi présentés dans cette partieThe high speed line (Ligne à Grande Vitesse Sud Europe Atlantique) that has been operating since July 2, 2017, reduced train travel time by 1 hour on the Paris-Bordeaux line. The expected impacts are an improvement of the competitiveness of rail transport and a modal shift from plane to train. In this thesis, we are interested in the effects of this new railway infrastructure on travellers’ modal choice behaviour. In particular, we are interested in the quality of transport timetable and their impact on the travel behaviour.The quality of transport timetable is an important issue for the various relevant stakeholders. The total number of trains or intermediate stops are not sufficient for a relevant evaluation. The objective of this doctoral thesis is to demonstrate, from the theoretical and empirical point of view, that the relevant approach must be based on activity programs and not just on transport supply.We presented indicators for a better evaluation of the effects related to the quality of transport timetable on travellers’ modal choice. The analysis begins with indicators that provide complementary information to the standard indicators to a more sophisticated model that are able to take into account the characteristics of opportunities in destination. We directed our research to a disaggregated approach while ensuring the measurability of the indicators.Two methods are presented in this thesis: indicators of useful time at destination and the combined modal choice – schedule choice model. Using the first method, we improve our knowledge of the effects related to the quality of transport timetable with a new module integrated in modal choice models. With the second method, we study the research problem with a combined model structure that explains both the modal choice and the schedule choice. These methods are developed on the basis of discrete choice models.We performed an econometric analysis of passenger demand on the Paris - Bordeaux route with "passenger" survey data. We show that the variables specifically constructed for the evaluation of the quality of transport timetable are relevant to explain the travellers’ modal choice.This thesis is organized as follows:In the first part, we present the competition issues in the transport market. Among the different forms of competition, we are interested in intermodal competition. It helps us to understand what is involved in competition questions in the transport market and why this issue is important. This theoretical part includes a literature review that helped us to elaborate our research problem.We present, in the second part, our methods to study the quality of transport timetable: the useful time at destination and the combined modal choice – schedule choice model. In this methodological part, we also present the principles based on discrete choice theory that are the basis of our analysis.The context of our case study, the data and the results are presented in the third part. The advantages and disadvantages of our method are presented in this part of this thesis
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Ba, Zrampieu Sarah. "Qualité et accessibilité aux services de soins maternels et infantiles dans un contexte d’exemption de paiement : cas de la Côte-d’Ivoire." Thesis, Lille 1, 2017. http://www.theses.fr/2017LIL12012.
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Depuis avril 2011, les autorités ivoiriennes ont décidé l’adoption de l’exemption de paiement des frais médicaux à l’intention des usagers des établissements sanitaires publics et à base communautaire. En février 2012, la mesure d’exemption totale de paiement des frais médicaux prend fin et laisse place à la gratuité des soins, ciblée aux femmes enceintes et aux enfants de moins de cinq ans. Depuis son adoption en février 2012, la politique d’exemption de paiement direct des soins de santé ciblée aux femmes enceintes et aux enfants de moins de cinq ans est-elle effectivement appliquée en Côte-d’Ivoire ? Quelles sont les conséquences de la mise en œuvre de cette politique sur la qualité et l’accessibilité aux services de soins maternels et infantiles de Côte-d’Ivoire ? Dans l’objectif de répondre à ces questions de recherche, nous avons réalisé l’analyse quantitative de données issues des Enquêtes Niveau de Vie des ménages, réalisées par l’Institut National de la Statistique de Côte-d’Ivoire, en 2008 et 2015. D’autre part, nous avons réalisé, durant les mois de mai 2016 et janvier 2017, des entretiens qualitatifs auprès des patientes, des prestataires des services de soins maternels et infantiles et d’individus résidant proches des centres de santé sélectionnés. Les principaux résultats sont l’application partielle de l’exemption de paiement direct aux services de soins maternels et infantiles, le maintien de la qualité et de l’accessibilité aux services de soins maternels et infantiles, en contexte d’exemption de paiement, et enfin, la difficile transition vers la Couverture Maladie UniverselleFrom April 2011, Ivorian authorities decided adoption of the exemption from payment of medical fees for users of public health institutions and community based. In February 2012, measure of total exemption from payment of medical fees takes end and leaves room to free care, targeted to pregnant women and children under five. This targeted free represents transitional step toward the establishment of universal health coverage. Also, since its adoption in February 2012, the policy of exemption of direct payment targeted to pregnant women and children under five is applied in Côte-d’Ivoire? What are the consequences of the implementation of this policy on the quality and accessibility of maternal and child care in Côte-d’Ivoire? These are the question to which our research will try to answer from a theoretical framework, mainly based on economic theories. These theories are theory of informational asymmetry, Lancasterian theory and approach by capabilities. In order to meet our research questions, we have achieved quantitative analysis of data from surveys of living standards of households carried out by National Institute of Statistics of Côte-d’Ivoire in 2008 and 2015. On the other hand, we realized structured and in-depth interviews, during May 2016 and January 2017, with patients, health providers, and individuals who live close to health centres selected. The main results of our analyses concern partial application of exemption from direct payment, maintaining quality and accessibility to maternal and child healthcare services, and finally, difficult transition to universal health coverage
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Mil, Rémy de. "Efficience de programmes de santé publique visant à réduire les inégalités de participation au dépistage organisé des cancers." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMC415/document.
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Contexte. L’augmentation de la participation au dépistage organisé des cancers et la réduction des inégalités sociales et géographiques de participation représentent un enjeu de santé publique majeur. Objectifs. Evaluer l’efficience de 2 interventions visant à augmenter la participation et à réduire les inégalités dans le dépistage organisé des cancers en France. Méthodes. Nous avons réalisé une analyse coût-efficacité du point de vue du financeur: 1) d’une invitation à une unité de mammographie mobile (MM) dans le dépistage du cancer du sein à partir de données rétrospectives (n=37461), 2) d’un accompagnement personnalisé (AP) («patient navigation») dans le dépistage du cancer colorectal à partir d’un essai contrôlé randomisé (n=16250). Résultats. Le coût incrémentiel par dépistage supplémentaire comparé au dépistage habituel était: 1) de 611€ [492-821] pour l‘invitation au MM (+3.8% [2,8-4,8], +23.21€ [22.64-23.78]), et 2) de 1212€ [872-1978] pour l‘AP (+3.3% [1.5-5.0], +39.70€). L’efficacité et l’efficience étaient plus importantes dans les zones défavorisées et dans les zones éloignées pour le MM, alors qu’elles étaient moins favorables dans les zones défavorisées pour l’AP. Conclusion. La MM et l’AP peuvent réduire les inégalités en étant plus efficient dans les zones éloignées et les zones défavorisées pour la MM, alors que pour y parvenir, l’AP devrait cibler les sujets défavorisés, bien que n’étant pas la stratégie la plus efficiente. Les recherches doivent être poursuivies pour déterminer les conditions optimales de l’intégration du MM dans le dépistage, et pour améliorer l’efficacité et l’efficience de l’AP, qui ne peut être recommandé en l’état pour l’instantBackground. Increasing participation in organized cancers screening and reducing social and geographical inequalities in participation represent a major public health issue. Objectives. To determine the costeffectiveness of 2 interventions aiming at increasing participation and reducing inequalities in organized cancer screening in France Methods. We conducted a cost-effectiveness analysis from the payer's perspective: 1) of an invitation to a mobile mammography unit (MM) unit for breast cancer screening from retrospective data (n = 37461), 2) of a patient navigation program (PN) for colorectal cancer screening from a randomized controlled trial (n = 16250). Results. The incremental cost per additional screen compared with usual screening was: 1) € 611 [492-821] for the invitation to the MM (+ 3.8% [2.8-4.8], + € 23.21 [22.64-23.78] ), and 2) of € 1 212 [872-1 978] for PN (+ 3.3% [1.5-5.0], + 39.70 €). Effectiveness and cost-effectiveness were greater in deprived areas and in remote areas for MM, whereas they were less favorable in deprived areas for PN. Conclusion. MM and PN can reduce inequalities while being more efficient in remote areas and in deprived areas for MM, while, to achieve this, PN should target deprived people, even if being not the most efficient strategy. Research needs to be pursued to determine the optimal conditions for MM integration in organized breast cancer screening, and to improve the effectiveness and cost-effectiveness of PN, which can not be recommended as experimented for now
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Guerreiro, Pablo José Martinelli. "Adequação de calçadas e travessias às condições mínimas de acessibilidade : um procedimento para estimativa de custos de serviços e obras." Universidade Federal de São Carlos, 2008. https://repositorio.ufscar.br/handle/ufscar/4271.
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Previous issue date: 2008-12-22Financiadora de Estudos e Projetos
Abstract: This study presents a procedure used to determine the cost of adapting sidewalks and urban crossings through cost quantification of work needed to repair or rebuild a sidewalk segment and to adapt its crossing. The necessary work was estimated in accordance with Calçada Cidadã standards, a project elaborated by the city administration of Vitória, ES, Brazil. The sidewalk quality was assessed by determining the level of required work according to procedures and recommendations described in Ferreira & Sanches (2005). Based on these sidewalk and quality assessment models a computer program prototype was developed to assess the quality of public spaces and to determine the necessary amount of work, and its corresponding cost, to make them more accessible. In order to test the prototype and assess its viability a case study was carried out in São Carlos, SP, Brazil. It assessed the conditions of a sidewalk segment of this city s downtown streets and determined the cost of improvement work needed to make it accessible to all pedestrians.
Esta dissertação apresenta um procedimento para determinação de custos de adequação de calçadas e travessias urbanas através da quantificação dos custos dos serviços necessários a realização das obras de reparos ou da reconstrução total de um trecho de calçada, além da adequação da travessia. O levantamento dos serviços necessários foi feito utilizando-se como padrão de projeto as especificações constantes do manual do projeto Calçada Cidadã da Prefeitura Municipal de Vitória ES. A avaliação da qualidade da calçada através da determinação do seu nível de serviço foi feita segundo os procedimentos e recomendações constantes da metodologia de avaliação do nível de serviço de calçadas desenvolvida por FERREIRA E SANCHES (2005). Adotado o padrão de projeto para a calçada ideal e o modelo de avaliação da qualidade foi desenvolvido um protótipo de um programa de computador que avalia a qualidade dos espaços públicos e, a partir da avaliação da situação real, determina os serviços necessários e os seus respectivos custos para transformar este espaço em uma condição de acessibilidade melhor. Para a aferição do protótipo e da viabilidade de sua utilização foi realizado um estudo de caso na cidade de São Carlos visando avaliar as condições de um trecho de calçadas da malha viária da região central da cidade e da determinação dos custos dos serviços e obras de melhorias, necessários para tornar este trecho em condições de acessibilidades adequadas.
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Gottfried, Fabrice. "Vers un outil d'aide à la décision en ingénierie territoriale appliqué à la géolocalisation de centres de santé." Thesis, Strasbourg, 2019. http://www.theses.fr/2019STRAH012.
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Dans une société occidentale vieillissante avec des personnes âgées grandes consommatrices de soins de santé et dont les coûts s’envolent d’année en année, les gestionnaires des politiques de santé doivent faire face à des défis contradictoires : comment offrir une protection de la santé à la pointe de la recherche pour tous, à un coût acceptable par chacun et supportable pour la collectivité. Une gestion trop rigoureuse se limitant à la seule comptabilité des dépenses de santé risquerait de nuire à la solidarité intergénérationnelle en sacrifiant sur l’hôtel de la rentabilité certaines populations vulnérables. Dans cet esprit, notre outil d’aide à la décision devrait permettre à nos décisionnaires et politiques de trouver des solutions alternatives pour rétablir une certaine équité, dans notre cas d’accessibilité aux soins, et ainsi garantir une justice sociale durable, liant de toute société développée. Nous avons testé notre outil sur deux territoires aux caractéristiques géographiques et démographiques très différentes, le département du Bas-Rhin situé à l’est de la France, densément peuplé, et la région administrative de l’Estrie, située au sud-est de la province du Québec au Canada, avec une densité de population nettement moindre. Notre outil n’est très certainement qu’une partie de la réponse aux enjeux de santé évoqués, mais son intérêt et son originalité résident aussi dans le fait qu’il peut être aisément transférable à d’autres milieux organisationnelsEveryone knows that our western societies are getting older. Our elderly use also a lot of health care where costs go up and up year after year. Thus, health managers have to face conflicting challenges : how to offer top health protection for all at a reasonable cost for each of us and at an acceptable cost for our local health authorities. A health management that is too rigorous limited to the sole expenditure may undermine intergenerational solidarity by sacrificing the most vulnerable populations. In this way of mind, our aid decision tool could help health managers and politics find alternative solutions to restore some equity, in our case health care accessibility, to ensure sustainable social justice, the cement of all advanced societies. We have tested our tool with 2 territories having very different geographical and demographic characteristics : the densely populated Bas-Rhin region located in the Eastern part of France and the less densely populated region of Estrie located in the South-eastern Province of Quebec (Canada). Our tool may only be part of the solution to these health care costs mentioned above but, its utility and originality are also easily transferable to other possible organizational environments
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Gerike, Regine. "Wie kann das Leitbild nachhaltiger Verkehrsentwicklung konkretisiert werden?" Doctoral thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2005. http://nbn-resolving.de/urn:nbn:de:swb:14-1132862870193-12708.
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Ausgangspunkt der Arbeit ist das Leitbild nachhaltiger Verkehrsentwicklung. Voraussetzung für die Umsetzung dieses qualitativen Leitbilds ist seine Operationalisierung, eine Aufgabe, die sich auf Grund des Prozesscharakters des Begriffs nachhaltiger Entwicklung als schwierig erweist. Eine Beschreibung dieses Begriffs durch konkrete, messbare Indikatoren ist aber notwendig, will man den Status quo sowie durchgeführte Maßnahmen anhand dieses Ziels bewerten. Die vorliegende Arbeit versucht, den Widerspruch zwischen dem Prozesscharakter nachhaltiger Entwicklung und der Notwendigkeit, diese durch konkrete Indikatoren zu beschreiben, für den Verkehrsbereich einer Lösung näher zu bringen. Folgende zentrale Fragen ergeben sich für die Arbeit: Wie kann das Leitbild nachhaltiger Verkehrsentwicklung konkretisiert und dabei gleichzeitig dem Prozesscharakter des Nachhaltigkeitsbegriffs Rechnung getragen werden? Welche Empfehlungen lassen sich für Maßnahmen zur Förderung nachhaltiger Verkehrsentwicklung ableiten? Zur Beantwortung der Fragen wird zunächst der Begriff nachhaltiger Entwicklung für die Arbeit abgegrenzt. Als Ergebnis dieses Arbeitsschritts wird der Begriff der Bedürfnisse in den Mittelpunkt der weiteren Arbeit gestellt: Nachhaltige Entwicklung wird als eine an den Bedürfnissen der Menschen orientierte Entwicklung betrachtet. Auf Basis einer bedürfnistheoretischen Diskussion werden anschließend die folgenden Aufgabenbereiche erarbeitet: Sozialer Aufgabenbereich: Auf Grund der Widersprüchlichkeit und Wandelbarkeit menschlicher Bedürfnisse ist die Befriedigung sämtlicher Bedürfnisse der Menschen als Ziel von Maßnahmen im Verkehrsbereich ungeeignet. Basis einer nachhaltigen Verkehrsentwicklung und Ziel des sozialen Aufgabenbereichs ist daher ein staatliches Angebot einer verkehrlichen Grundversorgung, durch welches die Befriedigung grundlegender Bedürfnisse gewährleistet wird. Dieses Angebot wird über Mindeststandards beschrieben und durch anwendungsspezifische Planungen ergänzt. Allokationsbereich: Der Markt ist ein geeignetes Instrument zur Realisierung aller über die im sozialen Aufgabenbereich festzulegende Grundversorgung hinausgehenden Mobilitätswünsche. Er ermittelt und befriedigt Bedürfnisse gut, allerdings mit Einschränkungen, welche durch den sozialen Aufgabenbereich sowie den Ressourcenbereich zu kompensieren sind. Das Ziel dieses Aufgabenbereichs besteht im Abbau von Marktunvollkommenheiten. Ressourcenbereich: Aus der mangelnden Berücksichtigung von Verteilungsfragen durch den Marktmechanismus ergeben sich verteilungspolitische Aufgabenbereiche nachhaltiger Verkehrsentwicklung: Soziale Fragen werden durch den sozialen Aufgabenbereich abgedeckt. Gegenstand des Ressourcenbereichs ist die Regelung der Verteilung natürlicher Ressourcen als Anfangsausstattung für den Prozess zur Erstellung der Verkehrsleistungen. Die erarbeiteten Aufgabenbereiche werden zu einem Entwicklungskorridor zusammengeführt: Die untere Begrenzung wird durch die im Rahmen des sozialen Aufgabenbereichs zu gewährleistende verkehrliche Grundversorgung gebildet. Diese sollte nicht unterschritten werden. Im Rahmen des Ressourcenbereichs zu formulierende Tragfähigkeitsgrenzen bilden die obere Begrenzung des Korridors und sollten nicht überschritten werden. Die Regeln für alle Aktivitäten innerhalb der Grenzen werden durch den Allokationsbereich vorgegeben, dessen Ziel die Gewährleistung funktionsfähiger Marktmechanismen ist. Im Anschluss an die Erarbeitung des Entwicklungskorridors werden Optionen zu dessen Konkretisierung aufgezeigt. Werden Teile der erarbeiteten Optionen mit Hilfe einer gesellschaftlichen Diskussion ausgewählt, so ist damit für einzelne konkrete Anwendungsfälle eine abschließende Beschreibung des Ziels nachhaltiger Verkehrsentwicklung möglich. Abschließend werden im Rahmen einer beispielhaften Analyse des Status quo für den Freistaat Sachsen verkehrliche CO2-Emissionen sowie externe Kosten von Verkehr quantifiziert.
30
Gerike, Regine. "Wie kann das Leitbild nachhaltiger Verkehrsentwicklung konkretisiert werden?: Ableitung grundlegender Aufgabenbereiche." Doctoral thesis, Technische Universität Dresden, 2004. https://tud.qucosa.de/id/qucosa%3A24597.
Full textAbstract:
Ausgangspunkt der Arbeit ist das Leitbild nachhaltiger Verkehrsentwicklung. Voraussetzung für die Umsetzung dieses qualitativen Leitbilds ist seine Operationalisierung, eine Aufgabe, die sich auf Grund des Prozesscharakters des Begriffs nachhaltiger Entwicklung als schwierig erweist. Eine Beschreibung dieses Begriffs durch konkrete, messbare Indikatoren ist aber notwendig, will man den Status quo sowie durchgeführte Maßnahmen anhand dieses Ziels bewerten. Die vorliegende Arbeit versucht, den Widerspruch zwischen dem Prozesscharakter nachhaltiger Entwicklung und der Notwendigkeit, diese durch konkrete Indikatoren zu beschreiben, für den Verkehrsbereich einer Lösung näher zu bringen. Folgende zentrale Fragen ergeben sich für die Arbeit: Wie kann das Leitbild nachhaltiger Verkehrsentwicklung konkretisiert und dabei gleichzeitig dem Prozesscharakter des Nachhaltigkeitsbegriffs Rechnung getragen werden? Welche Empfehlungen lassen sich für Maßnahmen zur Förderung nachhaltiger Verkehrsentwicklung ableiten? Zur Beantwortung der Fragen wird zunächst der Begriff nachhaltiger Entwicklung für die Arbeit abgegrenzt. Als Ergebnis dieses Arbeitsschritts wird der Begriff der Bedürfnisse in den Mittelpunkt der weiteren Arbeit gestellt: Nachhaltige Entwicklung wird als eine an den Bedürfnissen der Menschen orientierte Entwicklung betrachtet. Auf Basis einer bedürfnistheoretischen Diskussion werden anschließend die folgenden Aufgabenbereiche erarbeitet: Sozialer Aufgabenbereich: Auf Grund der Widersprüchlichkeit und Wandelbarkeit menschlicher Bedürfnisse ist die Befriedigung sämtlicher Bedürfnisse der Menschen als Ziel von Maßnahmen im Verkehrsbereich ungeeignet. Basis einer nachhaltigen Verkehrsentwicklung und Ziel des sozialen Aufgabenbereichs ist daher ein staatliches Angebot einer verkehrlichen Grundversorgung, durch welches die Befriedigung grundlegender Bedürfnisse gewährleistet wird. Dieses Angebot wird über Mindeststandards beschrieben und durch anwendungsspezifische Planungen ergänzt. Allokationsbereich: Der Markt ist ein geeignetes Instrument zur Realisierung aller über die im sozialen Aufgabenbereich festzulegende Grundversorgung hinausgehenden Mobilitätswünsche. Er ermittelt und befriedigt Bedürfnisse gut, allerdings mit Einschränkungen, welche durch den sozialen Aufgabenbereich sowie den Ressourcenbereich zu kompensieren sind. Das Ziel dieses Aufgabenbereichs besteht im Abbau von Marktunvollkommenheiten. Ressourcenbereich: Aus der mangelnden Berücksichtigung von Verteilungsfragen durch den Marktmechanismus ergeben sich verteilungspolitische Aufgabenbereiche nachhaltiger Verkehrsentwicklung: Soziale Fragen werden durch den sozialen Aufgabenbereich abgedeckt. Gegenstand des Ressourcenbereichs ist die Regelung der Verteilung natürlicher Ressourcen als Anfangsausstattung für den Prozess zur Erstellung der Verkehrsleistungen. Die erarbeiteten Aufgabenbereiche werden zu einem Entwicklungskorridor zusammengeführt: Die untere Begrenzung wird durch die im Rahmen des sozialen Aufgabenbereichs zu gewährleistende verkehrliche Grundversorgung gebildet. Diese sollte nicht unterschritten werden. Im Rahmen des Ressourcenbereichs zu formulierende Tragfähigkeitsgrenzen bilden die obere Begrenzung des Korridors und sollten nicht überschritten werden. Die Regeln für alle Aktivitäten innerhalb der Grenzen werden durch den Allokationsbereich vorgegeben, dessen Ziel die Gewährleistung funktionsfähiger Marktmechanismen ist. Im Anschluss an die Erarbeitung des Entwicklungskorridors werden Optionen zu dessen Konkretisierung aufgezeigt. Werden Teile der erarbeiteten Optionen mit Hilfe einer gesellschaftlichen Diskussion ausgewählt, so ist damit für einzelne konkrete Anwendungsfälle eine abschließende Beschreibung des Ziels nachhaltiger Verkehrsentwicklung möglich. Abschließend werden im Rahmen einer beispielhaften Analyse des Status quo für den Freistaat Sachsen verkehrliche CO2-Emissionen sowie externe Kosten von Verkehr quantifiziert.
31
Adams, Kirk. "Journeys Through Rough Country: An Ethnographic Study of Blind Adults Successfully Employed in American Corporations." Antioch University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1552066999409903.
Full text
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Wang, Wei. "A spatial model analysing firms' decision on accessibility improvement." Thesis, 2014. http://hdl.handle.net/1885/13962.
Full textAbstract:
Firms can differentiate their products through improving their accessibilities so
that it costs less for the consumers to collect information on firms' products. In this
way, firms' products become more attractive to the consumers and thus more demand
will be generated. However, this improvement requires a fair amount of investment
from firms. This essay will use the spatial model, where two identical firms with fixed
locations engage in a symmetric and simultaneous game, to analyse whether, and if so,
when firms should invest to improve their accessibilities. Two cases where firms charge
mill pricing and discriminatory pricing will be looked into as well. We conclude that
firms should and will make the investment when, first, they have perfect information
on consumers and charge discriminatory prices; second, when the cost investment
incurred is sufficiently low. If, on the other hand, cost of investment is sufficiently
large, then it is most optimal, economically and socially, for both firms to stay out of
making such an investment.
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Kahler, Ashleigh Joy. "Mobilizing medicine: a design response to the accessibility and cost issues in health care." Thesis, 2014. http://hdl.handle.net/2152/25803.
Full textAbstract:
Nationally, there is increasing concern over the accessibility, cost, and quality of the American health care system. While the quality of the care given is generally out of the control of designers, it has received increased attention in recent years, as is
evidenced in the trends of healing gardens, private patient rooms, and improved social settings. As beneficial as these trends are to the patients they serve, they often have a negative effect on overall accessibility and cost of care due to the constant construction and renovations needed and their largely urban presence. While quality health care is
very important and should not suffer as a result, how can designers address nonenvironmental sustainability issues of cost and access in the American healthcare system?
Due to the trend in increasing cases of chronic illness, as opposed to more
pathogenic ailments of the past, the necessity for all healthcare settings to be highly controlled and sterile environments should be reevaluated. While less popular and not as
fully developed as the typical facilities most Americans are familiar with, an increase in mobilized health care units could be a solution to the lack of economic and social access
and sustainability in the current healthcare model while still providing safe, quality care. By examining current instances of mobile clinics, I will explore the design requirements
necessary to make mobile clinics accessible and cost effective. In addition, I will look for facilitators and barriers to these systems, such as improvements in mobile communication technologies and lack of stakeholder support.text
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Thompson, Brandy. "Cost Barriers to Dental Care in Canada." Thesis, 2012. http://hdl.handle.net/1807/33565.
Full textAbstract:
Objective: To determine who avoids the dentist and declines recommended dental treatment due to cost. Methods: A secondary data analysis was undertaken. Weights were utilized to ensure data were nationally representative. Univariate and bivariate descriptive statistics were calculated and logistic regressions were used to observe the characteristics that were predictive of reporting cost barriers to care. Results: Over 17 per cent of the Canadian population reported avoiding a dental professional due to cost, and 16.5 per cent reported declining recommended dental treatment due to cost. These individuals had a higher prevalence of needing treatment, had more untreated decay, missing teeth, and reported having poor oral health and oral pain often. Having no insurance, lower income, and reporting “poor to fair” oral health were the greatest predictors of reporting cost barriers to care. Conclusions: Individuals who report cost barriers experience more disease and treatment needs than those who do not.
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Spiller, Stephen Andrew. "Limited Means and What I Can't Buy: Resource Constraints and Resource Use Accessibility Drive Opportunity Cost Consideration." Diss., 2011. http://hdl.handle.net/10161/3939.
Full textAbstract:
Every consumer decision incurs a cost. An hour spent researching products is an hour not spent working. Vacation days used in the winter are vacation days not used in the summer. A dollar spent on a car payment is a dollar not spent dining out. What determines the extent to which consumers consider such opportunity costs when making decisions?
Although every purchase requires an outlay cost (i.e., spending dollars in order to obtain a good), outlay costs only have economic significance because some other good or service must be given up as a result. Consumers have unlimited wants but limited resources, so satisfying one want means not satisfying another (the opportunity cost). An opportunity cost is "the evaluation placed on the most highly valued of the rejected alternatives or opportunities" (Buchanan 2008) or "the loss of other alternatives when one alternative is chosen" (Oxford English Dictionary 2010). Opportunity costs are foundational to the science of economics and, normatively, consumers should account for opportunity costs in every decision they make. I define opportunity cost consideration as "considering alternative uses for one's resources when deciding whether to spend resources on a focal option."
Because consumers face opportunity costs, every purchase decision is effectively a choice among alternative resource uses, not just a decision of whether or not to make a particular purchase. When consumers consider their opportunity costs, alternative resource uses specify the broadest form of competition that products face: each resource use competes for share-of-wallet with all other potential resource uses. Understanding when consumers consider a purchase decision as an allocation across multiple options, and what those considered options are, allows researchers and practitioners to better understand why consumers make the purchases that they do, why they restrain from making the purchases that they do not, and how to influence purchases of focal options by increasing or decreasing consideration of alternative resource uses.
What determines when consumers consider opportunity costs? In Essay 1, I propose that consumers consider opportunity costs when they perceive immediate resource constraints. In Essay 2, I propose that consumers consider opportunity costs when the resource in use increases the accessibility of alternative resource uses in memory.
Beyond addressing when consumers consider opportunity costs, I address three additional questions. First, who is more likely to consider opportunity costs? Individuals with a high propensity to plan are likely to consider opportunity costs even when they are not immediately constrained. Second, which opportunity costs are consumers more likely to consider? Consumers are more likely to consider opportunity costs that are more typical of the category of possible resource uses than opportunity costs that are less typical of the category of possible resource uses. Third, what are the consequences of opportunity cost consideration? Individuals who consider their opportunity costs are more sensitive to their value than those who do not consider them. In addition to aiding our understanding of the consumer decision process, understanding opportunity cost consideration has important implications for consumers' sensitivities to the structure of the decision environment, understanding the nature of competition and cross-price elasticities, memory for foregone options, and construction of preferences.
Dissertation
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Santos, Andreia Sofia de Sampaio Nunes da Silva. "Telerradiologia: uma alternativa à radiologia presencial?" Master's thesis, 2012. http://hdl.handle.net/10071/4667.
Full textAbstract:
A telerradiologia emergiu com o avanço das tecnologias de informação, o aparecimento da
internet, da imagem digital e da transmissão em rede. É descrita como a transmissão de
imagens de exames de imagiologia de um local para outro distante, com a finalidade de estas
serem interpretadas por um médico especialista. Com o objectivo de aferir se a telerradiologia
é uma alternativa à radiologia presencial procedeu-se a um estudo de avaliação económica -
análise de custos. Após apurar todos os custos referentes ao Serviço de Imagiologia do
Hospital do Divino Espírito Santo e comparar os custos médios unitários dos exames
realizados em presença física e em telerradiologia, aferiu-se qual a solução que apresenta um
menor custo. Face à análise realizada foi possível concluir que a telerradiologia é uma
alternativa à radiologia presencial nos exames de TAC de Neuro, permitindo uma economia
significativa. No caso dos exames de raios-x a situação é diferente, sendo mais vantajosa a
sua realização em presença física. Para além das questões económicas há outros factores que
devem ser considerados aquando da implementação de um sistema de telerradiologia - a
maior capacidade de resposta dos Serviços de Imagiologia, a maior flexibilidade na gestão das
escalas de Médicos especialistas e a maior acessibilidade dos utentes residentes em zonas
geográficas rurais ou insulares, o que irá proporcionar uma melhor qualidade no diagnóstico.
A telerradiologia é uma ferramenta necessária e imprescindível no futuro cenário dos
cuidados de saúde e as previsões são de que continuará a expandir-se.Teleradiology has emerged with the advancement of information technologies, the arrival of the internet, digital imaging and network transmission. Teleradiology is described as the transmission of imaging studies from a distant place to another, for the purpose of being interpreted by a physician specialist. To evaluate if teleradiology is an alternative to visiting a radiologists service, a study of economic evaluation – cost analysis – was performed. After determining all costs relating a service of radiology at Hospital do Divino Espírito Santo (S. Miguel, Azores, Portugal), and comparing the average unit cost of studies of physical presence and teleradiology studies, an evaluation was made to determine which solution had a lower cost. This analysis concluded that teleradiology is a viable alternative to presence radiology, in Neuro CT Scans, allowing significant savings. Regarding x-ray the situation is, otherwise, more advantageous when performed in the physician’s presence. Apart from economic issues, there are others factors to be considered when implementing a system of teleradiology – a greater responsiveness of imaging services, a greater flexibility in physician specialist’s shifts management and greater patient’s accessibility in areas geographically rural or islands, which provides a better diagnosis. Teleradiology is a necessary and indispensable tool in the future landscape of healthcare and the predictions suggest continued expansion.
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Yao, Shi-sheng, and 姚希聖. "Cost Effects of Public Capital、Agglomeration Economies、and Accessibility on Local Industrial Development Disparities--A Case Study of the Counties in Taiwan." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/12736915306772729269.
Full textAbstract:
博士國立成功大學
都市計劃學系
90
Abstract This study, based on the endogenous growth theory, constructs the industrial cost function by introducing three input factors including the public capital stocks, the agglomeration economy, and the accessibility that may affect production efficiency. Adopting the theorem of duality, the first factor, i.e. the public capital stocks, is treated as an unpaid factor of production and the last two factors are treated as the environment technology conditions affecting operations of firms. The data for empirical analysis is based on the Wealth Census of Taiwan where public economic and social capital stocks for counties in Taiwan are estimated by the distribution of major public investment to counties for central authority and provincial government and the annual expenditure of counties. Through the socioeconomic data for regions to establish the index of agglomeration economies by principal analysis, the road-network and traffics for roads above provincial level to establish the index of road-network accessibility, and the data of industrial operations for regions collecting by the Industrial & Commercial Census. The industrial cost function of Translog function type is constructed. The estimation results are used to analyze the effects that those of production environment conditions affect industrial production efficiency for business, transportation-communication & manufacturing, and services industry. Through the empirical analysis, the return to scale for industries are between 1.27 and 1.92 in Taiwan. It is found that the relationship for public economic capital to labors and that for public economic capital to capital factors are substitute but those for public social capital to labors and to capital factors are complementary for industries of business or services, while the relationships for public economic capital to those two kinds of factors are complementary but those for public social capital are substitute respectively for transportation-communication & manufacturing. In relation to the shadow price of public capitals for unit firm, the largest is 0.0452 in new Taiwan dollars for public economic capital of transportation-communication & manufacturing, while the least is 0.00058 for social public capital of business. It is found that the technological change of each industry is not Hick''s neutral. For business during the period of 1986~1991, the growth rate of total factor productivity (TFP), which arrives at 0.4076, is the largest among industries, while that for transportation-communication & manufacturing, arriving at 0.0544, is the least respectively. By comparisons between county clusters for industries, it is shown that the growth rates of TFP for clustered regions differ significantly and that the effect of production environment conditions on industrial production depends on the development degree of regions. For business as an example, in the former two clusters of counties, the main contributions to TFP growth are the effects of scale economies, technological change, public economic investment, and agglomeration economies, while, in the last three clusters of counties, sources to the growth rate of TFP include only in scale economies and in public economic capital. Another example is the services, the magnification of agglomeration economies contributes to the increase in the growth rate of TFP only in regions besides Taipei, Taichung, and Kaoshung. About the disparities in the effect of production environment conditions on development degree for regions, some important properties are found. These include: the production efficiency is significantly raised by the public economic investment for business and services; considering about the effect for agglomeration economies in saving production cost, the property seems significant on condition that, for business, the development degree for regions have to arrive at the lowest threshold of development degree while that for services cannot go beyond the highest threshold; the production efficiency of transportation-communication & manufacturing is significantly raised by public social investment, and the effect increases as the development degree of regions decreases; and the effect of road-network accessibility in saving production cost is significant only for transportation- communication & manufacturing, and the effect is stronger if the region is where this kind of industry is relatively inferior. In view of disparities in effect of production environment conditions on industries and regions, it is suggested that the short-run and middle-run development projects should be reevaluated in considering the spatial characteristics among regions. Key words: public capital, agglomeration economies, road-network accessibility, Translog cost function, total factor productivity
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Somega, Selamawit Adnew. "Views of women about accessibility of safe abortion care services in Addis Ababa, Ethiopia." Diss., 2013. http://hdl.handle.net/10500/13064.
Full textAbstract:
Background: In many developing countries, maternal deaths occur mainly as a result of unsafe abortions, a situation reflecting the inaccessibility of safe abortion services in such countries. In Ethiopia, unsafe abortion accounts for 32% of maternal deaths and almost 60% of gynaecological admissions, and is one of the top ten causes of general hospital admissions.
Purpose: The purpose of this study was to assess the views of women about the accessibility of safe abortion services in governmental health centres.
Methods: A quantitative cross-sectional descriptive and non-experimental study using structured questionnaires was conducted. 342 women who had received abortion care services in governmental health centres participated.
Findings: 46.8% of the participants do not know about the penal code regarding safe abortion care. 52.9% of the participants viewed safe abortion care as inaccessible because there are various and competing factors which make abortion service to be viewed as accessible or inaccessible and these include distance to nearest health centre, the time it takes to receive the service, the cost of the service, and the lack of appropriate skills in the service providers.
Conclusion: An improvement in the accessibility of abortion services will prevent deaths resulting from unsafe abortionsHealth Studies
M.A. (Public Health)
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Laliberté, Benoît. "La télémédecine en radiothérapie : développement d’un modèle et analyse des coûts." Thèse, 2011. http://hdl.handle.net/1866/6285.
Full textAbstract:
But : La radiothérapie (RT) est disponible seulement dans les grandes villes au Québec. Les patients atteints de cancer vivant en zone rurale doivent voyager pour obtenir ces soins. Toute proportion gardée, moins de ces patients accèdent à la RT. L’accessibilité serait améliorée en instaurant de petits centres de RT qui dépendraient de la télémédecine (téléRT). Cette étude tente (1) de décrire un modèle (population visée et technologie) réaliste de téléRT; (2) d’en estimer les coûts, comparativement à la situation actuelle où les patients voyagent (itineRT).
Méthode : (1) À l’aide de données probantes, le modèle de téléRT a été développé selon des critères de : faisabilité, sécurité, absence de transfert des patients et minimisation du personnel. (2) Les coûts ont été estimés du point de vue du payeur unique en utilisant une méthode publiée qui tient compte des coûts en capitaux, de la main d’oeuvre et des frais généraux.
Résultats : (1) Le modèle de téléRT proposé se limiterait aux traitements palliatifs à 250 patients par année. (2) Les coûts sont de 5918$/patient (95% I.C. 4985 à 7095$) pour téléRT comparativement à 4541$/patient (95%I.C. 4351 à 4739$) pour itineRT. Les coûts annuels de téléRT sont de 1,48 M$ (d.s. 0,6 M$), avec une augmentation des coûts nets de seulement 0,54 M$ (d.s. 0,26 M$) comparativement à itineRT. Si on modifiait certaines conditions, le service de téléRT pourrait s’étendre au traitement curatif du cancer de prostate et du sein, à coûts similaires à itineRT.
Conclusion : Ce modèle de téléRT pourrait améliorer l’accessibilité et l’équité aux soins, à des coûts modestes.Purpose: Radiotherapy (RT) is centralized in urban areas in Quebec. Patients with cancer living in remote areas must travel to receive RT, and the proportion of RT patients is inferior to that of urban patients. Telemedicine could allow a minimally staffed RT unit to operate at reasonable costs in a rural setting. This study aims (1) to outline a feasible structure and target population for a tele-radiotherapy unit (teleRT); and (2) to estimate the costs of teleRT, compared to the current situation based on travel to urban centres (travelRT). Methods and Materials: (1) We developed an evidence-based teleRT model meeting the criteria of: feasibility & safety, elimination of patient travel, and minimisation of staff migration. (2) Costs were estimated from the public payor perspective using a previously published activity-based costing model for RT. The model included annualized capital costs, labour, and overhead. Results: (1) In our model, teleRT was restricted to 250 palliative care patients per year. (2) The public payor cost of teleRT was 5918$/patient (95% C.I. 4985 to 7095$) as compared to 4541$/patient (95%C.I. 4351 to 4739$) for travelRT. Yearly costs of the teleRT unit was 1,48 M$ (s.d. 0,6 M$), with a net cost increase to the payor of 0,54 M$ (s.d. 0,26 M$) compared to travelRT. Under less stringent conditions, breast and prostate cancer patients could also benefit from teleRT at similar costs to travelRT. Conclusion: Establishing a teleRT unit to treat a small rural population of palliative care patients results in a modest net increase in cost to the public payor and could lead to increased accessibility and equity.
40
Williams-Jones, Bryn. "Genetic testing for sale : implications of commercial BRCA testing in Canada." Thesis, 2002. http://hdl.handle.net/2429/13580.
Full textAbstract:
Ongoing research in the fields of genetics and biotechnology hold the promise of improved
diagnosis and treatment of genetic diseases, and potentially the development of individually
tailored pharmaceuticals and gene therapies. Difficulty, however, arises in determining how
these services are to be evaluated and integrated equitably into public health care systems
such as Canada's. The current context is one of increasing fiscal restraint on the part of
governments, limited financial resources being dedicated to health care, and rising costs for
new health care services and technologies. This has led to increasing public debate in the last
few years about how to reform public health care, and whether we should prohibit, permit or
perhaps even encourage private purchase of health care services.
In Canada, some of these concerns have crystallized around the issue of gene patents and
commercial genetic testing, in particular as illustrated by the case of Myriad Genetics'
patented BRACAnalysis test for hereditary breast and ovarian cancer. While most Canadians
who currently access genetic services do so through the public health care system, for those
with the means, private purchase is becoming an option. This situation raises serious
concerns - about justice in access to health care; about continued access to safe and reliable
genetic testing supported by unbiased patient information; and about the broader effects of
commercialization for ongoing research and the Canadian public health care system.
Commercial genetic testing presents a challenge to health care professionals, policy analysts,
and academics concerned with the social, ethical and policy implications of new genetic
technologies. Using the Myriad case as an exemplar, tools from moral philosophy, the social
sciences, and health policy and law will be brought to bear on the larger issues of how as a
society we should regulate commercial research and product development, and more
coherently decide which services to cover under public health insurance and which to leave
to private purchase. Generally, the thesis is concerned with the question of "how best to bring
capital, morality, and knowledge into a productive and ethical relationship" (Rabinow 1999,
20).
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Zuma, Sibusiso Memory. "Framework for provision of essential medicines for the district health services." Thesis, 2016. http://hdl.handle.net/10500/22792.
Full textAbstract:
The purpose of this study was to develop a framework for provision of essential medicines for the district health services. A qualitative descriptive, exploratory and contextual action research design was followed. The data collection was conducted through site visits and semi structured interviews targeting the responsible pharmacists who were purposively selected on the basis of their expert knowledge and experiences from the eight of the nine provinces of the Republic of South Africa which is a developing country with limited resources for provision of healthcare services.
The study found that there was no standardised framework for provision of essential medicines for the District Health Services. Based on the site visits and action research findings a proposed framework covering the selection, procurement, warehousing, distribution and management support components for provision of essential medicines for district health services was developed and subjected to national pharmaceutical experts and district health services managers review and critique which is finally presented, after taking into consideration the experts inputs as a proposed framework emanating from the study. The proposed framework will contribute towards improving the provisioning and availability of essential medicines within the district health services.Health Studies
D.Litt. et Phil. (Health Studies)
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Bélanger, Dominique. "Perception des cliniciens, gestionnaires et usagers à l’égard des interventions de groupe offertes pendant la réadaptation en déficience physique." Thèse, 2018. http://hdl.handle.net/1866/21400.
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