Dissertations / Theses on the topic 'Criteria for health reform'
To see the other types of publications on this topic, follow the link: Criteria for health reform.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Criteria for health reform.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Donato, Ron. "The economics of health care finance and reform : implications of market-based health reform in Australia /." Title page, table of contents and abstract only, 1996. http://web4.library.adelaide.edu.au/theses/09ECM/09ecmd677.pdf.
Full text
2
Metwally, El-sayed. "Egyptian health sector reform : an exploration." Thesis, University of Aberdeen, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.499654.
Full textAbstract:
In 1996, the Egyptian government, through the Egyptian Ministry of Health and Population (MOHP) introduced the Egyptian Health Sector Reform Programme (EHSRP). It was stated that the EHSRP was introduced to overcome problems of the Egyptian health care system including issues with health outcomes, access, efficiency, quality, and clinical effectiveness and consumer satisfaction (MOHP, 2003). The MOHP piloted the EHSRP in three governorates: Monofia; Alexandria; and Sohag. Based on piloting results, the intention is to roll-out the EHSRP to other governorates. Actual implementation of reform in pilot governorates did not start until 2000/2001 due to delay in the preparation of action plans (Master Plans). The first stage of the EHSRP focused on improving the quality of PHC services (MOHP, 2003). The EHSRP aims to introduce the Family Medicine Approach (FMA) that relies on the Family Doctor (FD). Financing health sector reform in Egypt is supported by a number of foreign donors including: the World Bank; the European Commission (EC); the United States Agency for International Development (USAID); and the African Development Bank (ADB). The study aimed to explore motivations for and attitudes to health care reform in Egypt, to explore the change process and make suggestions about enhancements and improvements. A qualitative research strategy was employed using a multiple-embedded case approach. Studying reform implementation in the pilot governorates suggested that implementation of the FHM was associated with many challenges and difficulties. This makes it essential to look for possible solutions to improve the implementation of FHM. Other implementation problems were related to the management level and communication between different stakeholders.
3
Percival, Valerie. "Health reform in post conflict Kosovo." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2008. http://researchonline.lshtm.ac.uk/682374/.
Full textAbstract:
The international community undertakes complex interventions in states emerging from war. These interventions include broad efforts to reform the political and institutional structures of the state. After the United Nations took political control of Kosovo in June 1999, it embarked on such a reform program, extremely ambitious in nature. This thesis examines the efforts to rehabilitate and reform the health sector. The immediate post-conflict environment in Kosovo was extremely chaotic. Hundreds of millions of dollars poured into the province, funding the operations of several hundred non-governmental organisations. The initial efforts of the international community in the health sector were focused on coordinating resources and the activities of these organisations. However, Kosovo' s health system was in clear need of widespread reform. The system had been devastated by years of neglect and months of conflict. A reform program was undertaken, with the objectives of establishing a primary care based system, increasing the quality of secondary and tertiary care, modernizing the public health system, and ensuring a cost-effective, equitable health system. By 2004, the reform program had largely failed to meet these objectives. This study examines the reasons that health reform was so difficult utilizing a combination of methods, i.e. a review of literature on peacebuilding, health and conflict, and health reform; analysis of the implementation of reform utilizing primary evidence such as policy documents and health data; and interviews with key stakeholders. Results show two important lessons for other post-conflict interventions. First, the reform program neglected building the capacity of government institutions. If the state does not have the capacity to implement reforms, the sustainability of the health reform process will be undermined. And second, the Kosovo reform program failed to build the foundation for reform before initiating ambitious projects to modernize the health sector.
4
Zemanová, Iva. "Health Care Reform in the USA." Master's thesis, Vysoká škola ekonomická v Praze, 2011. http://www.nusl.cz/ntk/nusl-71683.
Full textAbstract:
This thesis is concerned with US health care. It is focused especially on the health insurance market. It introduces basic characteristics of the US insurance system and discusses its main problems. The goal of this thesis is to determine whether voluntary private insurance is the main source of problems that the US health care system currently experiences. In order to do that, greatest deficiencies of US insurance policies, especially private ones, are identified based on the efficiency criterion. It is also briefly evaluated if identified deficiencies are going to be affected by the current health care reform.
5
Sorensen, Ros Public Health & Community Medicine Faculty of Medicine UNSW. "The dilemma of health reform : managing the limits of policymaking, managerialism and professionalism in health care reform." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2002. http://handle.unsw.edu.au/1959.4/33194.
Full textAbstract:
Hospitals worldwide are under pressure to perform and models abound to remedy poor performance. Reform, however, is contested, uneven and slow. One reason is that few models address a core issue in reform: the management of clinical work. A further reason is that stakeholder groups, specifically policymakers, managers and clinicians, limit opportunities for collaborative problem solving as they seek to impose their own frame of reference in the struggle for control. I hypothesise that performance will be relatively better in hospitals that have in place strategies of agreement to set the objectives of reform, such as participative problem identification, problem solving and decision making, together with a method to manage clinical work. This hypothesis was tested in twelve public hospitals in three Australian states between 1999 and 2001 using both quantitative and qualitative research methods. Government and hospital policy documents were assessed and semi-structured interviews were conducted to gauge the attitudes and practices of managers and clinicians regarding health care reform. The results of the research show that hospitals with inclusive strategies for change, principally strategies of agreement, joint education and skills development, team-based incentives to direct and reward effort and a method of clinical work management, performed better than those without. Findings indicate that policy was developed and communicated as a rational top-down process that tended to exclude diverse views. Although the effect of different jurisdictional policy processes on hospital performance was not clear, they had considerable impact on the environment of reform. Cost containment and patient safety dominated as policy objectives. These alone did not engage clinician interest or address service quality. The connection between the quality of care and its cost did not appear to be understood. Organisational structures and processes necessary to support reform, that is communication forums for objective setting and performance review, integrated clinical and corporate accountability systems and organisational capacity building were not in place in the majority of hospitals studied. An organisational model of clinical work management was developed to improve cost-effectiveness by balancing clinical autonomy and clinical accountability based on the research results.
6
Ferguson, Lorraine J. "Health care reform and structural interests: Casemix as a tool for reform in the Australian health industry." Thesis, Queensland University of Technology, 2000. https://eprints.qut.edu.au/36766/1/36766_Digitised%20Thesis.pdf.
Full textAbstract:
This thesis uses a policy research framework to examine the development, implementation and evaluation of the casemix-based health care reform policies that were embedded within the 1988 and 1993 Medicare Agreements between the Commonwealth Department of Health and states and territories of Australia. Alford's (1975) conceptual framework of structural interests is used to examine the power of strategically placed interests in health care, and the barriers and challenges those interests pose to reform of the hospital system in particular. Alford (1975:14) argued that health systems must be understood in terms of the continuing struggle between the dominant structural interests (mainly doctors) and the challenging structural interests (government bureaucrats, health administrators, health planners and academic researchers) who try to reform the health system. Casemix-based hospital management information and funding systems provide tools for understanding hospital activity and costs and in doing so, provide incentives for improving efficiency and reforming clinical practice.
The aims of the study were to gain a better understanding of the processes used in developing the reform policies; to explain in an analytical way, who influenced what was decided in relation to policy development and implementation; to examine the impact of the implementation of casemix-based funding policies in two Australian states from the points of view of the structural interests in health care; and to summarise the implications for future health care reform policy development m Australia. The data collection methods used for this study include depth interviews with fifteen casemix 'elites', a focused synthesis of important documents related to casemix policy, and secondary analysis of hospital activity data to evaluate the impact of casemix-based funding in the States of Victoria and South Australia.
The findings clearly demonstrate that the inclusion of the casemix-based reform policies into the 1988 Medicare Agreements was a deliberate approach by the challenging structural interests to signal a new era of reform and accountability for the Australian public hospital system. The use of the Casemix Development Program as a policy instrument was seen by the stakeholders to have a positive impact in terms getting commitment to policy direction and for developing expertise in casemix-based systems, but it was criticised for a lack of research priorities and the subsequent waste of funds.
Casemix-based funding systems were seen by the stakeholders to have both positive and negative aspects. Both the challenging and dominant structural interests agreed that there was an improvement in management information and financial systems, giving them better information for budget allocation and resource management. This resulted in improved hospital access and efficiency, as measured by patient throughput, length of stay and average cost per casemix-adjusted separation. The dominant structural interests found that with better information and more accountability for resource use there was an improved focus on team work and patient management. Despite these improvements, there was a belief among the dominant structural interests that quality of care had deteriorated under casemix-based funding.
Negative aspects of casemix-based funding systems were seen to include a focus on technical efficiency at the expense of allocative efficiency and an emphasis on acute hospital services and throughput without consideration of the resources required for other services; particularly community services which had to deal with early discharges. Stakeholders also felt that there was increased pressure on bedside clinical staff with the increases in patient throughput and acuity, and that these pressures threatened the ability of so called teaching hospitals to adequately train health professionals and to conduct research.
While the casemix-based reform policies resulted in a coalition of the challenging and dominant structural interests to improve health care delivery in Australia, there is no evidence to suggest that there has been any real change in the social, economic and political structures which reinforce medical dominance in health care in Australia.
Recommendations for future policy research and policy learning are made with a view to improving the nature of health care reform policy and its impact on the health of the Australian population.
7
Yilmaz, Volkan. "Health reform and new politics of health care in Turkey." Thesis, University of Leeds, 2014. http://etheses.whiterose.ac.uk/7635/.
Full textAbstract:
The health care system in Turkey has undergone a transformation process since the Health Transformation Programme (HTP) launched in 2003 and significantly increased marketization in health care provision. This study asks the following questions: What political dynamics enabled the introduction of health care reform in Turkey? What kind of political conflicts did the reform generate? How and to whose benefit have these conflicts been resolved? As a historically grounded, single country case study, this study draws on 33 in-depth interviews conducted with major political actors who were involved in the HTP. This study concludes that the reform under consideration was a product of two factors: the World Bank’s pro-market approach to health reforms that became internalised in the health care bureaucracy in Turkey after the mid-1980s, and the controlled populism of the Justice and Development Party (the AK Party). With the introduction of the HTP, the power distribution upon which Turkey’s health care system is based has been changing in three ways. First, the Turkish Medical Association (TTB) lost its leverage in health care policies. Excluded from the reform process, the only success of the TTB was using judicial activism to block the government’s attempts to introduce a full time work requirement for medical doctors. Second, the reform gave birth to the emergence of a new political actor in health care politics, namely private health care provider organisations. Private health care provider organisations, which avoided confrontational discourse in their relations with the government due to the financial dependency of the sector on the state, succeeded in altering the legal and administrative limits that the reform put on their opportunities for capital accumulation. Finally, the transformation of the AK Party from a catchall party to a cartel party that undermines the electoral competition in Turkey might put the representation of the citizens’ interests on health care policies at risk.
8
Reddy, Brian P. "Multiple criteria approaches to public health decision-making." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/16605/.
Full text
9
Lesser, Warren P. "Physician decision criteria regarding omega-3 dietary supplements." Thesis, Walden University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3611495.
Full textAbstract:
American Heart Association officials and other expert cardiologists recommend omega-3 (n-3) dietary supplementation for the secondary prevention of cardiovascular disease, a prevalent health problem in the United States. Physicians' lack of understanding of possible n-3 preventive health benefits results in underprescribing n-3 dietary supplements and lower n-3 dietary supplement product sales. N-3 dietary supplement marketers do not understand physician n-3 prescribing decision criteria enough to optimize high-impact communication to physicians to increase n-3 dietary supplement product use. The purpose of this phenomenological research study was to improve n-3 marketers' understanding of how physicians reach decisions to prescribe or recommend products including n-3 dietary supplements. Argyris' ladder of inference theory provided the study framework to facilitate understanding physicians' decision criteria. Rich data collected and analyzed from 20 primary care physician interviews in Kentucky, Indiana, and Tennessee revealed physicians use similar decision criteria for drugs and n-3s. Three essential influencers of physician decisions included clinical evidence, personal experience, and cost. Other influencers were opinions of peers, pharmaceutical representatives, samples, direct-to-consumer advertising, and knowledge of dietary supplements. Study outcomes may inform pharmaceutical marketers regarding presentation of clinical evidence, cost emphasis, and pharmaceutical representative skills and may facilitate competitive advantage for n-3 marketers. The social benefit of this study is improved physician understanding of n-3s may result in more accurate and appropriate prescribing to augment positive health outcomes.
10
Lowe, James. "Residential mobility, mental health and welfare reform." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/411299/.
Full textAbstract:
This thesis qualitatively examines the interplay between service users’ residential mobility and mental health and assesses the ways in which each is influenced or determined by the other. Twenty-five service users in England were over a period of eighteen months interviewed in depth about their experiences of both residential mobility and mental health. These interviews were conducted against the backdrop of the on-going austerity-driven reforms to the welfare state that have witnessed the rapid promulgation of policies designed to spur service user entry into the formal labour market, via the use of restrictions on continued eligibility for particular sickness, disability, and housing benefits, and reductions in their monetary value. Evidence from the interviews is used to test two of the primary models through which the residential mobility patterns of service users have been explained: displacement from unstable lodgings resulting in circulation through disparate residential settings; and entrapment in low quality accommodation in predominately deprived areas. The thesis finds evidence of both scenarios, and reports on the negative health experiences encountered therein. It demonstrates that the extent to which residential circumstances have a negative impact on mental health rests upon whether service users feel unable to exercise any control over their residential choices. The exercise of which is being further compromised by a hastily reformed system for determining on-going eligibility to welfare benefits and a wider retrenchment of the services and facilities around which users have often orientated their lives. Here, invasive and ineffectual medical assessments destabilise service users and threaten a reduction in income, enforced changes in accommodation, and the rupture of their carefully calibrated wellness strategies which, in the absence of wider service provision, are increasingly emplaced in and around users’ own homes. The findings raise considerable questions about the operation of the welfare system and its impact for service users’ health and residential stability.
11
Kotelban, A. V. "Dental health of children according to the EGOHID criteria." Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19125.
Full text
12
WURZELBACHER, STEVEN JOSEPH. "CRITERIA FOR EVALUATING AN OCCUPATIONAL SAFETY AND HEALTH PROGRAM." University of Cincinnati / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1139333722.
Full text
13
Mooney, Ellen. "Towards an end result comprehensive health care reform in Massachusetts and California /." Diss., Connect to the thesis, 2007. http://hdl.handle.net/10066/1263.
Full text
14
Belli, Paolo Carlo. "Incentives and the reform of health care systems." Thesis, London School of Economics and Political Science (University of London), 2006. http://etheses.lse.ac.uk/1854/.
Full textAbstract:
This thesis is a study of the reform of health systems from an international and an economic perspective. Its main unifying theme is to investigate the role played by incentives in the performance of health systems and their reform. In the first part, the thesis reconsiders the economic reasons that form the basis for public intervention in health markets, both in financing as well as in service provision. In fact, one of the key elements introduced with health reforms in the last few years has been greater competition in health insurance and provision, among private as well as public providers. It is thus interesting to start the analysis by revisiting the effects of competition in health markets on the basis of more recent contributions in microeconomic theory, our aim being to ascertain what would be the major deficiencies of unregulated markets, and to investigate into the impact of different public corrective measures. Chapter 2 looks at the effects of competition in the health insurance market and at the impact of different forms of public intervention to correct market failures. Chapter 3 presents a model of oligopolistic competition between two health providers, and it investigates the potential role of quality and/or price regulation as a means to extend coverage/improve quality beyond the point reached in correspondence to the market equilibrium. Then, the thesis focuses on the new resource allocation, contracting mechanisms and payment systems for providers (RAP reforms) implemented over the last few years, within the public sector, or intended to discipline the relationship with health care providers. Chapters 4 gives an introduction to the RAP reforms, their justification and main components. Chapter 5 focuses on payment systems and on efficiency issues, while Chapter 6 on the equity consequences of RAP reforms. Chapter 7 and 8 look at the health reforms implemented over the last decade in the former socialist countries. The evolution of health systems in those countries provides interesting lessons, illuminating the major weaknesses and limitations of the health reform model that has been prevailing and proposed world-wide over the last decade. Chapter 8 presents a qualitative study of the impact of the health reforms in Georgia, focusing specifically on the phenomenon of out-of-pocket payments, formal and informal, which currently are the prevalent source of funding for health in the region. A concluding chapter (Chapter 9) summarises some of the main findings of the thesis.
15
Gieri, William J. "Health care reform and the deficit, 1993-1996." Monterey, California. Naval Postgraduate School, 1997. http://hdl.handle.net/10945/8460.
Full textAbstract:
Approved for public release; distribution is unlimitedHealth care reform in the 103rd and 104th Congresses has run the gambit from extremely ambitious to less than ambitious undertakings. Proposals have engendered partisan debates, because of the scope and complexity of the issues involved and their implications for the federal deficit. Estimating the budget consequences of health care reform has become critical because of the strong link between health care programs and the growth in the deficit. This thesis examines the major health care reform proposals considered by Congress during the period 1993-1996. These included the comprehensive bills considered in response to President Clinton's proposed overhaul in 1993-94, the cuts included in the Republican-led balanced budget plan in 1995 and the Kassebaum- Kennedy Bill, which became law in 1996. In each case, the thesis examined the deficit situation facing Congress at the time health care reform was engaged, plans to address the deficit, and the impact of each health care reform on the federal deficit. Data was obtained from congressional reports and periodicals, journals and Congressional Budget Office documentation. The major finding was that health care legislation which portends minimal impact on beneficiaries, providers and the deficit is much more likely to succeed, while legislation which has a much broader effect will not receive the same support
16
Atchison, Robert Bryan 1970. "U.S. health care reform and medical privacy rights." Thesis, Massachusetts Institute of Technology, 1994. http://hdl.handle.net/1721.1/35424.
Full textAbstract:
Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Civil and Environmental Engineering, 1994.Vita.
Includes bibliographical references (leaves 87-99).
by Robert Bryan Atchison.
M.S.
17
Nganda, Benjamin Musembi. "Structural reform of the Kenyan health care system." Thesis, University of York, 1994. http://etheses.whiterose.ac.uk/14168/.
Full text
18
Horrocks, Clare Louise. "Proselytising public health reform in Punch, 1841-1858." Thesis, Liverpool John Moores University, 2009. http://researchonline.ljmu.ac.uk/5924/.
Full textAbstract:
It is the purpose of this thesis, by analysing the context of public health reform in the nineteenth century, to reconsider the methods, both verbal and visual, by which Punch proselytised reform. Drawing on a range of primary data, this thesis uses a thematic case study to undertake a systematic re-examination of Punch's distinctive stylistic form from 1841 to 1858. This will also assist in identifying how the `character' of the magazine evolved. Case study chapters will focus specifically on the campaigns surrounding the removal of Smithfield Market and the amelioration of the polluted River Thames, providing a point of comparison from which to study the growth of a range of shared motifs developed for discussing reform and social change. Taking a chronological approach, it will be argued that from the close of the 1840st here was a simultaneous shift in both the organisation of the Punch `brotherhood' and in scientific understandings of the cause of disease and pollution. From 1849 the problems of how to communicate the need for reform begin to be resolved due to the increased profile the topic of public health received in the public sphere, particularly through periodicals like Punch. This change is evident from an analysis of the references logged in the Punch Database on Public Health (Appendix Two).
19
Vogt, Karen Fay. "The use of technology in meeting science reform criteria: Can web-based instruction promote scientific literacy?" CSUSB ScholarWorks, 1999. https://scholarworks.lib.csusb.edu/etd-project/1861.
Full textAbstract:
Science educators are currently facing the challenge of reforming the practices of science education. Publications of various science and educational organizations have established new criteria for accomplishing this goal. The new goal of science educators is scientific literacy for all.
20
Bukhman, Gene. "Reform and resistance in post-Soviet tuberculosis control." Diss., The University of Arizona, 2001. http://hdl.handle.net/10150/279923.
Full textAbstract:
This dissertation analyzes the process of international negotiation over tuberculosis (TB) control in the Former Soviet Union (FSU) during the 1990s. Relying on archival research, interview data, survey research, and ethnographic fieldwork, this dissertation shows the relevance of political economy, bioethics, and the sociology of knowledge to TB reform in Central Asia, Russia, the Caucuses, and other regions of the FSU. This dissertation shows how debates around TB reform in the FSU have revealed the roles of national governments, multilateral institutions, and nongovernmental organizations in a world system of international health policy structured during the cold war.
21
Sparkes, Susan Powers. "The Political Economy of Health Reform: Turkey's Health Transformation Program, 2003-2012." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121146.
Full textAbstract:
This dissertation explores the political economy of Turkey’s large-scale health systems reform, known as the Health Transformation Program (HTP) (2003 – 2012). It does this by analyzing the role of institutions, physicians, and patients in the Ministry of Health’s efforts to adopt and implement changes to the country’s health financing, health workforce, and primary care systems. In the first chapter, I present a qualitative case study that uses primary interview data to explain how Turkey adopted a universal and unified health coverage system between 2003 and 2008. By applying Immergut’s institutional veto points theory, I show Minister of Health Akdağ (2002-2013) and his team of advisors used targeted strategies to overcome obstacles at critical veto points blocking adoption. This analysis fills an important gap in the literature on universal health coverage by providing a theory-based explanation for how a reform can be accomplished. The second paper then looks at how Minister Akdağ overcame opposition from an organized physician group, the Turkish Medical Association (TMA), to adopt legislation that banned physician dual practice. This analysis contributes to the literature on the role of physicians in health reform by presenting a case study where an organized physicians association was not able to act exert veto power to block policy adoption. Rather, I argue that Minister Akdağ used a divide and then conquer political strategy, where he acted to exploit coordination problems among physicians by appealing to their individual interests and undermining the authority of TMA and its base of university physicians, to create a favorable political environment to ban dual practice and strengthen service delivery capacity. The fourth chapter considers how the HTP affected public opinion of Turkey’s reformed primary health care system, known as the Family Medicine System. I take advantage of the staged-rolled out of the Family Medicine System at the provincial level to estimate its effect on patient satisfaction using provincially-representative patient exit survey data from 2010, 2011 and 2012. This study provides some of the first national level evidence that primary health care reform underpinned by the FM system can effectively improve patient satisfaction - a health system goal. The final chapter summarizes the main results of Chapters 2, 3, and 4, discusses their limitations, and presents policy implications that can be derived from this research.Global Health and Population
22
Lesser, Warren P. "Physician decision criteria regarding omega-3 dietary supplements." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1113.
Full textAbstract:
American Heart Association officials and other expert cardiologists recommend omega-3 (n-3) dietary supplementation for the secondary prevention of cardiovascular disease, a prevalent health problem in the United States. Physicians' lack of understanding of possible n-3 preventive health benefits results in underprescribing n-3 dietary supplements and lower n-3 dietary supplement product sales. N-3 dietary supplement marketers do not understand physician n-3 prescribing decision criteria enough to optimize high-impact communication to physicians to increase n-3 dietary supplement product use. The purpose of this phenomenological research study was to improve n-3 marketers' understanding of how physicians reach decisions to prescribe or recommend products including n-3 dietary supplements. Argyris' ladder of inference theory provided the study framework to facilitate understanding physicians' decision criteria. Rich data collected and analyzed from 20 primary care physician interviews in Kentucky, Indiana, and Tennessee revealed physicians use similar decision criteria for drugs and n-3s. Three essential influencers of physician decisions included clinical evidence, personal experience, and cost. Other influencers were opinions of peers, pharmaceutical representatives, samples, direct-to-consumer advertising, and knowledge of dietary supplements. Study outcomes may inform pharmaceutical marketers regarding presentation of clinical evidence, cost emphasis, and pharmaceutical representative skills and may facilitate competitive advantage for n-3 marketers. The social benefit of this study is improved physician understanding of n-3s may result in more accurate and appropriate prescribing to augment positive health outcomes.
23
Paulo, Cynthia Ann. "Validation of criteria for use in health and safety program administration." CSUSB ScholarWorks, 1992. https://scholarworks.lib.csusb.edu/etd-project/3034.
Full text
24
Chamness, Brenda E. "Establishing criteria for evaluating health-related World Wide Web sites." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1115734.
Full textAbstract:
The problem of the study was to establish valid criteria for evaluating health-related World Wide Web [WWW] sites. From a table of specifications, a pool of 39 items was developed into a Criteria List. A nine member jury of experts composed of professionals from the discipline of Library and Information Science was used to determine content validity of the items. The items on the Criteria List were sent to the expert panel of jurors for the first review. To determine which items would be retained, revised or eliminated, the items were subjected to both a quantitative and qualitative review. The revised Criteria List was then sent to the expert panel of jurors for the second review. Responses from the second review were also subjected to qualitative and quantitative analysis. However, this time the quantitative review included the use of the Content-Validity Ratio [CVR]. All items on the Criteria List that were not statistically significant at p <.05 were eliminated. The final Criteria List contained 27 items from the 39 originally proposed items.Department of Physiology and Health Science
25
Nguyen, Lieu T. "The derivation and application of risk tolerability criteria." Thesis, Aston University, 2001. http://publications.aston.ac.uk/13335/.
Full textAbstract:
This research involves a study of the questions, "what is considered safe", how are safety levels defined or decided, and according to whom. Tolerable or acceptable risk questions raise various issues: about values and assumptions inherent in such levels; about decision-making frameworks at the highest level of policy making as well as on the individual level; and about the suitability and competency of decision-makers to decide and to communicate their decisions. The wide-ranging topics covering philosophical and practical concerns examined in the literature review reveal the multi-disciplined scope of this research. To support this theoretical study empirical research was undertaken at the European Space Research and Technology Centre (ESTEC) of the European Space Agency (ESA). ESTEC is a large, multi-nationality, high technology organisation which presented an ideal case study for exploring how decisions are made with respect to safety from a personal as well as organisational aspect. A qualitative methodology was employed to gather, analyse and report the findings of this research. Significant findings reveal how experts perceive risks and the prevalence of informal decision-making processes partly due to the inadequacy of formal methods for deciding risk tolerability. In the field of occupational health and safety, this research has highlighted the importance and need for criteria to decide whether a risk is great enough to warrant attention in setting standards and priorities for risk control and resources. From a wider perspective and with the recognition that risk is an inherent part of life, the establishment of tolerability risk levels can be viewed as cornerstones indicating our progress, expectations and values, of life and work, in an increasingly litigious, knowledgeable and global society.
26
Månsdotter, Anna. "Health, economics, and feminism : on judging fairness and reform." Doctoral thesis, Umeå universitet, Epidemiologi och folkhälsovetenskap, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-731.
Full textAbstract:
Introduction: The point of departure in this thesis is that women live longer than men, while men have more power, influence and resources, and probably better health-related quality of life, than women. In order to judge and act from this situation, the classical idea that both facts and values are needed for conclusion is adopted. The diverse positions of the sexes are mainly assumed to depend on the gender system, i.e. the societal structure organising human activities and relations, ultimately privileges and burdens, by sex. Hence, abolition of gender is held to be associated with decreased differences in health. The handling of facts and values is divided into two principal questions: 1) how to compare women and men within a particular state of the world, and 2) how to choose from their positions between states. Aims: The overall aim is to propose a public health framework for judging fairness and change from the positions of women and men. The specific aims are to: illustrate how the choice of normative approach affects judgements on fairness and resource allocation (I), explor public health views regarding various ethical principles (II), study the relationship between aspects of gender equality in public/domestic and health (III), estimate costs, savings and health gains, associated with the Swedish parental insurance reform (IV). Methods: The methods used are: ethical analysis based on the normative theories of welfarism, extrawelfarism, egalitarianism, and feminism; and the notions of justice by separate spheres, equity as choice and attainment/shortfall principles (I), survey among public health workers regarding within-state and between-states ethical views (II), epidemiologic study on death and sickness leave among traditional, equal, and untraditional Swedish couples who had their first child in 1978 (III), cost-effectiveness analysis based on men who took paternity leave 1978-1979 (IV). Results: The selected normative theories are likely to claim different opinions on fairness regarding women and men, and different proposals on resource allocations (I). Most public health workers support the idea of judging fairness by separate spheres, end-points, and shortfall equity. The rejection of health maximisation, and support for equality in life span and income, are convincing; although females and males differ significantly in judging societal change (II). In comparison to being equal in the public sphere, traditional women have lower risks of death and sickness, while traditional men tend to have higher risks. Being equal in the domestic sphere seems to be associated with lower risks among both sexes (III). Men who took paternity leave run significant lower death risks than other men. Base case cost-effectiveness of the reform is 6,000 EUR, and worst case 40,000 EUR, per gained QALY (IV). Conclusions: A public health framework for judging fairness and reform by women and men could look as follows: 1) identify facts at present and from past, 2) ask whether the situation is fair by within-state rules, 3) claim or refuse change, 4) identify consequences from reform, 5) consider whether the change was satisfying by between-states rules. The gains from more ethical analyses of public health based on sex/gender should overcome the many tricky issues involved. Since there is no common understanding on how to judge fairness and change from female/male differences in health and wealth, added research and exchange of views are called for. At Swedish state of gender (in)equality, it seems public health relevant to support further similarity in child-care. Provided an effective fraction of 25 percent, the entitlement to paternity leave is probably approved of by common welfarist, egalitarian, and feminist goals.
27
Davidson, Alan Reginald. "Health care reform in British Columbia : dynamics without change?" Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0019/NQ48624.pdf.
Full text
28
Månsdotter, Anna. "Health, economics, and feminism : on judging fairness and reform /." Umeå : Public Health and Clinical Medicine, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-731.
Full text
29
Kofman, Olga Loraine. "Deinstitutionalization and Its Discontents: American Mental Health Policy Reform." Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/cmc_theses/342.
Full textAbstract:
In 1963, President John F. Kennedy signed the Mental Retardation and Community Mental Health Centers Construction Act, establishing the beginnings of deinstitutionalization in the United States. By some counts, this Act was a stupendous policy success—by others, a dismal failure. 50 years later, no cohesive national mental health care policy has emerged to deal with increased rates of mental illness among the homeless and the incarcerated. However, California has made enormous strides to create a state policy which provides adequate services to the mildly, moderately, and severely mentally ill as well as adequate funding for those services through Proposition 63, the Mental Health Services Act, passed in 2004. This paper reviews mental health policy history from Colonial America to the present, paying special attention to JFK's deinstitutionalization in 1963 and the discontents that followed. It takes a special look at California's mental health care policy history and the strides the state has made to better serve the mentally ill.
30
Schofield, Robert James. "Public health legislation and constitutional reform 1832 to 1894." Thesis, University of Reading, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.515773.
Full text
31
Goodwin, Simon Christopher. "Community care : the reform of the mental health services?" Thesis, University of Sheffield, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387717.
Full text
32
Greenberg, Garred Samuel. "Impact of Massachusetts Health Care Reform on Asthma Mortality." Thesis, Boston College, 2013. http://hdl.handle.net/2345/3138.
Full textAbstract:
Thesis advisor: Marvin KrausThesis advisor: Matt Rutledge
The state of Massachusetts implemented a health care reform in 2006 that induced a number of changes to its health care system. Studies regarding this reform bear a certain degree of predictive power on the national scale because the reform was used as a model for the Affordable Care Act, the highly controversial national health care reform law passed in 2010. Most of the research on health care reform focuses on the costs, not the quality, of health care. I utilized a difference-in-differences statistical design to isolate the impact of the Massachusetts reform on the state's asthma mortality rate, a health care quality indicator. Given certain assumptions, my empirical results indicate that the reform led to a 45.38% reduction in asthma mortality in Massachusetts. Due to the similarity between the Massachusetts and the national health care reform laws, I drew the conclusion that national asthma mortality rates will decrease after 2014 when certain key provisions of the national reform come into play
Thesis (BA) — Boston College, 2013
Submitted to: Boston College. College of Arts and Sciences
Discipline: Economics Honors Program
Discipline: Economics
33
Bernardi, Roberta. "Health information systems reform in Kenya : an institutionalist perspective." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/51354/.
Full textAbstract:
The development outcome of ICT and information systems in developing countries is often influenced by international development policies and the action of international actors such as donor agencies. In particular, ICT adoptions and implementations in developing countries may be influenced by the contradictions arising mainly from the tension between international managerialist development policies and the main rationalities of actors in the local implementation context. Based on the case study of health information systems in Kenya, the objective of this thesis is to increase the understanding of how these contradictions may affect the development and change potential of health information systems and ICTs in developing countries in relation to international development policies. Drawing on a dialectical perspective on institutional work, the thesis argues that the change and development trajectories arising from the implementation and usage of health information systems depend on how actors involved in the restructuring of health information systems – i.e. donor partners, national decision makers and local health information systems managers and users – respond to the ongoing dialectic between global and local pressures of institutional change and stability. The main findings of the research presented in this thesis point to the importance of analysing political donor relations and the institutional entrepreneurship of local actors in order to understand the change and development outcomes of health information systems and ICT in developing countries.
34
Gomes, Diego Braz Pereira. "Essays on health care reform, wealth inequality, and demography." reponame:Repositório Institucional do FGV, 2016. http://hdl.handle.net/10438/16498.
Full textAbstract:
Submitted by Diego Gomes (diego.gomes@gmail.com) on 2016-04-26T18:23:39Z
No. of bitstreams: 1
Thesis_Diego Braz Pereira Gomes.pdf: 1441990 bytes, checksum: eaa77253b29a0fe0108cafc8657d9327 (MD5)Approved for entry into archive by Maria Almeida (maria.socorro@fgv.br) on 2016-05-09T12:55:02Z (GMT) No. of bitstreams: 1 Thesis_Diego Braz Pereira Gomes.pdf: 1441990 bytes, checksum: eaa77253b29a0fe0108cafc8657d9327 (MD5)
Approved for entry into archive by Maria Almeida (maria.socorro@fgv.br) on 2016-05-09T12:55:18Z (GMT) No. of bitstreams: 1 Thesis_Diego Braz Pereira Gomes.pdf: 1441990 bytes, checksum: eaa77253b29a0fe0108cafc8657d9327 (MD5)
Made available in DSpace on 2016-05-09T12:56:21Z (GMT). No. of bitstreams: 1 Thesis_Diego Braz Pereira Gomes.pdf: 1441990 bytes, checksum: eaa77253b29a0fe0108cafc8657d9327 (MD5) Previous issue date: 2013-01-13
This thesis contains three chapters. The first chapter uses a general equilibrium framework to simulate and compare the long run effects of the Patient Protection and Affordable Care Act (PPACA) and of health care costs reduction policies on macroeconomic variables, government budget, and welfare of individuals. We found that all policies were able to reduce uninsured population, with the PPACA being more effective than cost reductions. The PPACA increased public deficit mainly due to the Medicaid expansion, forcing tax hikes. On the other hand, cost reductions alleviated the fiscal burden of public insurance, reducing public deficit and taxes. Regarding welfare effects, the PPACA as a whole and cost reductions are welfare improving. High welfare gains would be achieved if the U.S. medical costs followed the same trend of OECD countries. Besides, feasible cost reductions are more welfare improving than most of the PPACA components, proving to be a good alternative. The second chapter documents that life cycle general equilibrium models with heterogeneous agents have a very hard time reproducing the American wealth distribution. A common assumption made in this literature is that all young adults enter the economy with no initial assets. In this chapter, we relax this assumption – not supported by the data – and evaluate the ability of an otherwise standard life cycle model to account for the U.S. wealth inequality. The new feature of the model is that agents enter the economy with assets drawn from an initial distribution of assets. We found that heterogeneity with respect to initial wealth is key for this class of models to replicate the data. According to our results, American inequality can be explained almost entirely by the fact that some individuals are lucky enough to be born into wealth, while others are born with few or no assets. The third chapter documents that a common assumption adopted in life cycle general equilibrium models is that the population is stable at steady state, that is, its relative age distribution becomes constant over time. An open question is whether the demographic assumptions commonly adopted in these models in fact imply that the population becomes stable. In this chapter we prove the existence of a stable population in a demographic environment where both the age-specific mortality rates and the population growth rate are constant over time, the setup commonly adopted in life cycle general equilibrium models. Hence, the stability of the population do not need to be taken as assumption in these models.
Esta tese contém três capítulos. O primeiro capítulo usa um modelo de equilíbrio geral para simular e comparar os efeitos de longo prazo do Patient Protection and Affordable Care Act (PPACA) e de reduções de custos de saúde sobre variáveis macroeconômicas, orçamento do governo e bem-estar dos indivíduos. Nós encontramos que todas as políticas foram capazes de reduzir a população sem seguro, com o PPACA sendo mais eficaz do que reduções de custos. O PPACA aumentou o déficit público, principalmente devido à expansão do Medicaid, forçando aumento de impostos. Por outro lado, as reduções de custos aliviaram os encargos fiscais com seguro público, reduzindo o déficit público e impostos. Com relação aos efeitos de bem-estar, o PPACA como um todo e as reduções de custos melhoram o bem-estar dos indivíduos. Elevados ganhos de bem-estar seriam alcançados se os custos médicos norte-americanos seguissem a mesma tendência dos países da OCDE. Além disso, reduções de custos melhoram mais o bem-estar do que a maioria dos componentes do PPACA, provando ser uma boa alternativa. O segundo capítulo documenta que modelos de equilíbrio geral com ciclo de vida e agentes heterogêneos possuem muita dificuldade em reproduzir a distribuição de riqueza Americana. Uma hipótese comum feita nesta literatura é que todos os jovens adultos entram na economia sem ativos iniciais. Neste capítulo, nós relaxamos essa hipótese – não suportada pelos dados – e avaliamos a capacidade de um modelo de ciclo de vida padrão em explicar a desigualdade de riqueza dos EUA. A nova característica do modelo é que os agentes entram na economia com ativos sorteados de uma distribuição inicial de ativos. Nós encontramos que a heterogeneidade em relação à riqueza inicial é chave para esta classe de modelos replicar os dados. De acordo com nossos resultados, a desigualdade Americana pode ser explicada quase que inteiramente pelo fato de que alguns indivíduos têm sorte de nascer com riqueza, enquanto outros nascem com pouco ou nenhum ativo. O terceiro capítulo documenta que uma hipótese comum adotada em modelos de equilíbrio geral com ciclo de vida é de que a população é estável no estado estacionário, ou seja, sua distribuição relativa de idades se torna constante ao longo do tempo. Uma questão em aberto é se as hipóteses demográficas comumente adotadas nesses modelos de fato implicam que a população se torna estável. Neste capítulo nós provamos a existência de uma população estável em um ambiente demográfico onde tanto as taxas de mortalidade por idade e a taxa de crescimento da população são constantes ao longo do tempo, a configuração comumente adotada em modelos de equilíbrio geral com ciclo de vida. Portanto, a estabilidade da população não precisa ser tomada como hipótese nestes modelos.
35
Baker, Timothy Alan. "Oregon Primary Care Physicians' Support for Health Care Reform." PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.
Full textAbstract:
This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI).
This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan.
Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive.
Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI).
While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program.
This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.
36
de, Araújo José Luiz. "Health sector reform in Brazil, 1995-1998 : an health policy analysis of a developing health system." Thesis, University of Leeds, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431546.
Full text
37
Reed, Chemika. "Mental illness in prison| Recidivism rates and diagnostic criteria." Thesis, University of Phoenix, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3727501.
Full textAbstract:
The purpose of the descriptive, quantitative study was to examine recidivism rates of mentally ill incarcerated individuals. With data provided by the Florida Department of Corrections, the current study sought to describe recidivism rates of mentally ill offenders who, within three years of release, returned to prison. The use of descriptive statistics provided information through means, modes, and frequencies, which led to incorporating logistic regression to provide further details concerning recidivism. The sample consisted initially of more than 120,000 offenders released, and narrowed to more than 20,000 released with a mental health diagnosis in the studied time frame, 2005 to 2008. The study consisted of 11 categorical and individual diagnoses while incorporating analyses of demographics, crimes committed, educational level, past incarcerations, and other variables in relation to mental health diagnoses. The results identified those with a mental health diagnosis were more apt to return to prison within the three-year time frame than those with no diagnosis. Specifically, those with a Schizophrenia diagnosis had a higher recidivism rate than the other diagnoses studied. Other variables found positive for recidivism were age, gender, and prior prison arrest record.
38
Jones, Vanessa. "Admission Criteria: A Focus on Using the Interview." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etd/3656.
Full textAbstract:
The growing number of candidates for allied health programs and the continued quest for identification of ideal candidates increases the pressure for allied health programs to continually improve their selection process. Despite past and recent research and the significant amount of literature on admission criteria for selective allied health programs, there is limited research on faculty perceptions of the interview as part of the admission criteria.
For this study, interviews were conducted with fifteen allied health faculty members who teach in a program with selective admissions. The interviews consisted of seven open-ended questions and were audio-recorded, then transcribed through Temi.com. The transcriptions were analyzed for common themes.
The participants agreed that an interview is an important component of the selective admissions criteria particularly for assessing the candidate’s ability to communicate and interact with others.
39
Song, Zirui. "Financial Incentives in Health Care Reform: Evaluating Payment Reform in Accountable Care Organizations and Competitive Bidding in Medicare." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10177.
Full textAbstract:
Amidst mounting federal debt, slowing the growth of health care spending is one of the nation’s top domestic priorities. This dissertation evaluates three current policy ideas: (1) global payment within an accountable care contracting model, (2) physician fee cuts, and (3) expanding the role of competitive bidding in Medicare. Chapter one studies the effect of global payment and pay-for-performance on health care spending and quality in accountable care organizations. I evaluate the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), which was implemented in 2009 with seven provider organizations comprising 380,000 enrollees. Using claims and quality data in a quasi-experimental difference-in-differences design, I find that the AQC was associated with a 1.9 percent reduction in medical spending and modest improvements in quality of chronic care management and pediatric care in year one. Chapter two studies Medicare’s elimination of payments for consultations in the 2010 Medicare Physician Fee Schedule. This targeted fee cut (largely to specialists) was accompanied by a fee increase for office visits (billed more often by primary care physicians). Using claims data for 2.2 million Medicare beneficiaries, I test for discontinuities in spending, volume, and coding of outpatient physician encounters with an interrupted time series design. I find that spending on physician encounters increased 6 percent after the policy, largely due to a coding effect and higher office visit fees. Slightly more than half of the increase was accounted for by primary care physician visits, with the rest by specialist visits. Chapter three examines competitive bidding, which is at the center of several proposals to reform Medicare into a premium support program. In competitive bidding, private plans submit prices (bids) they are willing to accept to insure a Medicare beneficiary. In perfect competition, plans bid costs and thus bids are insensitive to the benchmark. Under imperfect competition, bids may move with the benchmark. I study the effect of benchmark changes on plan bids using Medicare Advantage data in a longitudinal market-level model. I find that a $1 increase in the benchmark leads to about a $0.50 increase in bids among Medicare managed care plans.
40
Dowd, Courtney. "Sexual health education in the context of Quebec educational reform." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86998.
Full textAbstract:
Currently, Quebec's Ministry of Education is in the process of implementing broad curricular reforms that will fundamentally change the ways in which Quebec youth learn and come to develop academic, personal and social skills. As part of the broad reforms, the Ministry of Education has mandated that the delivery of sexual health education be reformed also. The former, more formal class allotment for sexual health education is being replaced by a more spontaneous and discussion based approach that spans across the curriculum and is the responsibility of the entire school community. Thus, there is a need to understand how both the educators and students are experiencing these changes. It is important to gain a better understanding of what these individuals believe is working and what they think needs improvement. In understanding better these realities, it will be possible to make suggestions for improvement or continued focus. Accordingly, this thesis is comprised of two main sections aimed at accomplishing these objectives. The first consists of an in depth literature review that looks closely at the context of sexual health education in both Quebec and Canada as well as the debate over best practices. The literature review also includes a document analysis that looks critically at the Ministry of Education document, Sex Education in the Context of Education Reform, intended to guide the reformation process. The second section of this thesis is a research article, which presents a phenomenological look at the experiences of educators and students as they adjust to sexual health curricular reforms at an independent secondary school in Quebec.Actuellement, le Ministère de l'Éducation du Québec est en processus d'implémenter de vaste réformes curriculaires qui changeront drastiquement la façon dont les jeunes Québécois apprennent et développent leurs outils académiques, personnels et sociaux. Dans ce vaste réforme, le Ministère de l'Éducation a mandaté que l'éducation à la santé sexuelle soit aussi réformé. La façon plus formelle d'enseigner l'éducation à la santé sexuelle sera remplacée par une approche plus spontanée, qui sera basée sur la discussion et touchera à toute les facettes du curriculum. Elle sera aussi la responsabilité de toute la communauté écolière. Ainsi, il y a un besoin à comprendre comment les éducateurs et les étudiants vivront ces changements. Il est important d'acquérir une meilleure compréhension de ce que ces individus croient fonctionne bien, ainsi que ce qui ne fonctionne pas. En comprenant mieux ces réalités, il sera possible de d'émettre des suggestions d'amélioration ainsi que de continuer le focus établi. En ce sens, cette thèse comprendra deux sections principales visant à accomplir ces objectifs. La première sera une revue en profondeur de la littérature qui regarde étroitement le contexte de l'éducation à la santé sexuelle au Québec et au Canada ainsi que les débats sur les meilleures pratiques. La revue littéraire inclura aussi l'analyse d'un document critiquant le document du Ministère de l'Éducation, «Sex Education in the Context of Education Reform », qui a pour but de guider la réforme. La deuxième section de cette thèse est un article de recherche, qui présente un regard phénoménologique sur les expériences des éducateurs et des étudiants pendant qu'ils s'ajustent aux réformes curriculaires dans une école secondaire indépendante au Québec. fr
41
Coyle, Natalie. "Primary Health Care Reform: Who joins a Family Medicine Group?" Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=106399.
Full textAbstract:
Reorganization of primary health care is being actively pursued and new models of primary health care delivery are being developed in the U.S. and in several Canadian provinces. In Quebec, Family Medicine Groups (FMGs) were created in 2002 in order to provide enhanced access and better coordination of care through a team based approach to primary care. Previous research on new models of primary health care has often failed to evaluate their effects within a causal inference framework, and little attention has been paid to the type of physicians and patients that voluntarily join them. Understanding who is attracted to new models is not only important to adjust for selection bias, but it may affect future reforms by helping to elucidate what would happen if FMGs were implemented on a population level. This thesis attempts to understand the voluntary selection of patients and physicians into Family Medicine Groups in Quebec, Canada. A longitudinal administrative dataset of vulnerable patients (elderly or chronically ill) from the Régie de l'assurance maladie du Québec (RAMQ) has been divided between FMG and non-FMG users, and includes information on demographic characteristics, chronic illnesses and ambulatory and tertiary health service use before the advent of FMGs. Physicians of these patients are characterized by their FMG status, demographics, and practice and patient characteristics before FMGs are in place. Multivariate regression is used to identify key predictors of joining a FMG among both patients and physicians. Lastly, comparable physician and patient populations are created using propensity scores in order to set up the evaluation of health outcomes, utilization of services and costs in the years after joining a FMG. The distribution of propensity scores and their ability to balance key covariates after different matching and weighting techniques was investigated. Results of the analysis reveal that geographic location, socio-economic status, visits in an ambulatory setting, emergency room visits, hospitalizations and having a usual provider of care are all factors which affect the probability of a patient joining a FMG. Specifically, residents of remote regions, low socio-economic status and those who use emergency rooms and hospitals more often are more likely to be enrolled, whereas patients that use ambulatory services and have a usual provider of care are less likely to be enrolled. Similarly, it is shown that factors that affect a physician's likelihood of joining a FMG include time since graduation, geographic region and revenue from traditional fee-for-service vs. other sources. Younger physicians and those who practice in a local community centre (CLSC) and short term/acute inpatient hospital care (CHSCD) are more likely to participate. Propensity scores were able to balance the pre-treatment differences, and this finding is robust across different mechanisms of adjusting for the propensity score. Overall, it was shown that participation in a FMG is not a random process and any further research on the effect of FMGs, or any other type of primary health care reform, should consider this. Accounting for the type of patients that join different models, by using propensity score analysis for example, will be critical to forming evidence based policy recommendations. Particular consideration for geographic location, patients' morbidity, socio-economic status, health service use, as well as physicians' age and experience working in other settings is needed.La réorganisation des soins de santé primaires est un objectif qui suscite un intérêt considérable au moment où de nouveaux modèles de prestation de soins de santé primaires sont mis en place aux États-Unis et dans plusieurs provinces canadiennes. Au Québec, les Groupes de médecine de famille (GMF) sont créés en 2002 afin de fournir un accès aux soins élargi et une meilleure coordination grâce à une approche des soins de santé primaires favorisant le travail en équipe. Les études antérieures sur les nouveaux modèles de soins de santé primaires n'incluaient généralement pas d'évaluation de leurs effets sous l'angle de l'inférence causale et peu d'attention a été accordée au type de médecins et de patients qui y participaient volontairement. Cerner le profil des personnes qui sont attirées par ces modèles est important, pas seulement pour ajuster les biais de sélection, mais cela peut aussi affecter les réformes à venir en permettant d'établir ce qui se passerait si les GMF étaient mis en place au niveau de la population entière. Cette thèse cherche à comprendre le principe de la sélection volontaire des patients et des médecins dans les Groupes de médecine de famille au Québec. Un ensemble de données administratives longitudinales sur des patients vulnérables (personnes âgées ou malades chroniques), émanant de la Régie de l'assurance maladie du Québec (RAMQ) a été divisé entre les inscrits dans les GMF et les non-inscrits. Les données comportent des informations sur les caractéristiques démographiques, les maladies chroniques ainsi que sur l'utilisation de services de santé ambulatoires et tertiaires avant la mise en place des GMF. Les médecins de ces patients sont caractérisés par leur statut de GMF, leurs données démographiques ainsi que par les spécificités de leur cabinet et de leurs patients avant la mise en place des GMF. Une régression multidimensionnelle est utilisée afin de définir les prédicteurs clés à l'inscription aux GMF à la fois pour les patients et pour les médecins. Enfin, des populations comparables de médecins et de patients sont créées en utilisant des scores de propension afin de mettre au point l'évaluation des résultats pour la santé, de l'utilisation des services et des coûts dans les années suivant l'inscription à un GMF. La distribution des scores de propension et leur capacité à équilibrer les covariables à la suite de différentes techniques de regroupement et pondération, a été examinée. Les résultats de l'analyse révèlent que la situation géographique, le statut socio-économique, les visites dans un service ambulatoire, les visites dans les salles d'urgence, les hospitalisations et le fait d'avoir un prestataire de soins habituel sont tous des facteurs qui affectent la probabilité d'inscription à un GMF. Il est aussi démontré que les facteurs qui affectent la probabilité qu'un médecin soit membre d'un GMF incluent le nombre d'années écoulées depuis l'obtention du diplôme, la situation géographique et le revenu des traditionnelles rémunérations à l'acte par rapport à celui d'autres sources. Les scores de propension ont permis d'équilibrer les différences avant traitement, ce résultat est robuste par rapport à différents mécanismes d'ajustement du score de propension. Dans l'ensemble, il est démontré que la participation à un GMF ne relève pas du hasard, ce que toute recherche additionnelle sur l'effet des GMF ou toute autre réforme des soins de santé primaires, devrait prendre en considération. La comptabilisation du type de patients qui s'inscrit dans les différents modèles, par exemple en utilisant les scores de propension, sera critique dans l'élaboration de recommandations basées sur des faits établis. La prise en compte particulière de la situation géographique, de la morbidité des patients, du statut socioéconomique, de l'utilisation des services de santé ainsi que de l'âge des médecins et de leur expérience de travail dans divers environnements apparaît nécessaire.
42
Corbett, L. E. "Recipient health in response to welfare reform, Ontario 1994-1999." Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.597992.
Full textAbstract:
Increasing attention is being paid to the common ground uniting income inequalities and health status by gauging how societal structures influence population health. Yet within this nascent literature, more work must be done to study the association between welfare policy and recipient health. To redress this lacuna, the introduction of the welfare reform initiative ‘Ontario Works’ in 1995 offered an apposite before-and-after scenario to gauge how neoliberal ideology affected welfare policy in Ontario. In turn, welfare benefit declines permitted an assessment of the effect that welfare state retrenchment had on recipient health. To achieve this end, Ontarians responding to the National Population Health Survey in 1994-1995 and 1998-1999 were assessed on self-reported health measures to determine whether diminishing welfare benefits predicted health declines. From the results it emerges that long-term welfare recipients reported significant health declines over the study interval, declines that proved particularly noteworthy given that the health status of welfare recipients was initially superior to that of the provincial sample. These findings may lend further credence to the assertion of welfare state apologists that state intervention ameliorates the health effects of wider neoliberal directives.
43
Qu, Xin Hua. "Health insurance reform in China : assessing policy impact using microsimulation." Thesis, University of Liverpool, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417244.
Full text
44
Humphreys, Trevor John. "English nurse education and National Health Service reform 1985-1997." Thesis, University of Greenwich, 2002. http://gala.gre.ac.uk/8738/.
Full textAbstract:
Between 1993 and 2002, I have produced 32 publications representing a coherent body of work examining the development and implementation of nurse education policy in England between 1985 and 1997. A selection of 16 of these are included in this submission. Some of the others are cited mainly for the purpose of demonstrating the impact of my work. The work examines questions about the fundamental characteristics of the arrangements for nurse education, how and why these changed as they did over the period in question and the implications of these changes for stake-holders and participants. Answering these questions has required a wide-ranging multidisciplinary research programme theoretically informed by a number of disciplines including education, economics, policy studies and sociology, and including empirical work and archive-based primary source analysis. During the period in question, profound changes occurred in the arrangements for English nurse education. These are explained in policy terms, with reference to the intersection of two distinct but overlapping policy processes, firstly a professional project and secondly, the radical reform of the NHS under the Thatcher government. Examination of the implications of these issues is wide in scope, ranging from the position of individual nurses and nurse trainers, through college management, qualitative and quantitative workforce supply issues through to life-long learning barriers in the NHS. International comparative studies provide explanatory insights and the impact of the work is demonstrated through numerous citations among other forms of recognition.
45
García, Núñez Luis. "Health Reform in the Social Security System: The Peruvian Case." Economía, 2012. http://repositorio.pucp.edu.pe/index/handle/123456789/117049.
Full textAbstract:
Desde mediados de 1997 se ha implementado una reforma en la seguridad social en salud conel objetivo de mejorar la eficiencia en el sector, elevar la calidad de los servicios y extender lacobertura de la seguridad social a aquellos sectores poblacionales no cubiertos, todo dentro de unesquema de solidaridad y equidad. Sin embargo, después de más de tres años de su implementación,el sistema está aún lejos de cumplir sus objetivos. Las actuales estadísticas muestran que muchosperuanos no cuentan con un seguro de salud y que el actual esquema Público-Privado no es losuficientemente amplio como para cubrir las necesidades de la población, especialmente los máspobres. Las compañías de seguros privadas (EPSs) aparentemente están orientadas a asegurar atrabajadores de empresas grandes, mientras que el seguro social de salud se estaría orientando atrabajadores de bajos ingresos. Otra característica de la reforma peruana es la escasa participación delas EPS en las provincias y su mínima participación en los seguros voluntarios. Estos hechossignificarían que la reforma está aún muy lejos de alcanzar sus objetivos.
46
Agartan, Tuba Inci. "Turkish health system in transition historical background and reform experience /." Diss., Online access via UMI:, 2008.
Find full text
47
Leethongdee, Songkramchai. "Health sector reform in Thailand : policy implementation in three provinces." Thesis, Swansea University, 2007. https://cronfa.swan.ac.uk/Record/cronfa42881.
Full textAbstract:
This thesis examines the implementation of the universal coverage (UC) health care reforms in Thailand, introduced from 2001 onwards. It aims to investigate the interaction between top-down and bottom-up influences on policy implementation in the local health system, based on comparative case studies of three provinces. The study was conceived as a 'policy ethnography', an approach which uses mixed methods to investigate the perspectives of local policy actors. The Thai Ministry of Public Health (MoPH) did not specify all aspects of the UC policy 'blueprint' in detail, and allowed provinces to make important decisions in certain areas, such as the choice of financing model. The research found that it was generally actors at the higher levels of the provincial health administrations who had actual potential to influence the way the reforms were implemented. However, there were interesting examples where middle-level provincial actors gained influence at particular junctures of the implementation process, usually either when they were in a strategic position with regard to the roll-out of a particular policy, or if they could get support from powerful allies higher up the MoPH hierarchy. The degree of engagement and knowledge of lowerlevel actors were more limited, and many at this level saw the reforms as overly top-down. Over the period covered by the study, the relative influence of top-down and bottom-up influences ebbed and flowed. There was a cycle whereby local adaptations usually led to a reaction at the centre, and further policy statements and top-down directions. Many problems arose in implementing the UC reforms, including difficulties in achieving progress on the original objectives of reducing geographical inequalities of funding and workforce distribution, problems in allocating resources fairly within the local health system, lack of progress in developing primary care, and tension between curative and preventative approaches.
48
Zhang, Wei, Lei Zhang, Ying Li, Yuling Tian, Yuling Tian, Xiaoran Li, Xue Zhang, et al. "Neglected Environmental Health Impacts of China's Supply-Side Structural Reform." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/2621.
Full textAbstract:
“Supply-side structural reform” (SSSR) has been the most important ongoing economic reform in China since 2015, but its important environmental health effects have not been properly assessed. The present study addresses that gap by focusing on reduction of overcapacity in the coal, steel, and iron sectors, combined with reduction of emissions of sulfur dioxide (SO2), nitrogen oxide (NOx), and fine particulate matter (PM2.5), and projecting resultant effects on air quality and public health across cities and regions in China. Modeling results indicate that effects on air quality and public health are visible and distributed unevenly across the country. This assessment provides quantitative evidence supporting projections of the transregional distribution of such effects. Such uneven transregional distribution complicates management of air quality and health risks in China. The results challenge approaches that rely solely on cities to improve air quality. The article concludes with suggestions on how to integrate SSSR measures with cities' air quality improvement attainment planning and management performance evaluation
49
Kabir, Shahnaz. "Reform strategies for management of vascular patients to reduce readmission and healthcare costs." Thesis, Utica College, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10250824.
Full textAbstract:
The capstone project reports the risk factors causing unplanned hospital readmission of vascular patients as well as the effects on healthcare cost. The methods for determining the risk factors include clinical indicators for risk prediction process, and the STAAR (State Action on Avoidable Rehospitalization) initiatives, which can be used as healthcare improvement projects to facilitate the cross-continuum team. The findings indicate a relationship between the patient’s engagement in the lower extremity vascular procedure, and effectiveness of follow-up after surgery in the reduction of hospital readmission and healthcare cost. Potential strategies to prevent the risk factors for readmission of vascular patients and to reduce the healthcare cost are discussed. Presenting unplanned readmission for vascular patients and reducing the cost associated with readmission is important for senior leaders and policy makers to improve health care outcome.
50
Edwards, Penny Suzanne. "Distress predicts success criteria and expectations for treatment the patient's perspective /." [Gainesville, Fla.] : University of Florida, 2004. http://purl.fcla.edu/fcla/etd/UFE0004181.
Full textAbstract:
Thesis (M.S.)--University of Florida, 2004.Typescript. Title from title page of source document. Document formatted into pages; contains 33 pages. Includes Vita. Includes bibliographical references.