Dissertations / Theses on the topic 'Discrimination in medical care'
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Blanchard, Janice C. "Discrimination and health care utilization." Santa Monica, CA : RAND, 2006. http://www.rand.org/pubs/rgs_dissertations/RGSD198/.
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Mokoboto, Dipalesa. "The impact of dual loyalty on health care practitioners' decisions." Diss., University of Pretoria, 2019. http://hdl.handle.net/2263/76725.
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While ethical codes have been established for practitioners, there is a possibility that dual loyalty affects occupational medical practitioners’ (OMPs) decisions in determining fitness status of employees. Literature indicates dual loyalty of OMPs leads to ethical dilemmas. The study’s main objective is to determine if dual loyalty participates in OMPs’ decisions and influences OMPs to breach medical ethics required in their profession, resulting in employees unfairly losing their jobs.
The study interrogates literature review on dual loyalty and adopts a multi-layered approach focussing on the Constitution; relevant Acts and guidelines; case law and ethical principles. Case studies from the Medical Inspector’s archives are interrogated to determine the influence dual loyalty has on OMPs’ decision-making.
Case law indicates that conflict of interest is the source of dual loyalty. Occupational medical practitioners have fiduciary duties and need to serve the best interests of the employees. From case studies discussed, the study shows that OMPs are affected by dual loyalty and tend to disregard medical ethics. They may be conflicted when making decisions concerning employees’ fitness to work, especially when individualised assessments are not conducted.
A guideline addressing ethical obligations and human rights should be drafted for OMPs, guiding them on dealing with dual loyalty. Employers will need awareness training in various institutions so that OMPs are supported and encouraged to have sound medical ethics. This will promote best practice in doctor-patient relationships, avoiding dual loyalty dilemmas.Mini Dissertation (MPhil)--University of Pretoria, 2019.
Public Law
MPhil
Unrestricted
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Sinclair, Andrew James, and n/a. "The primary health care experiences of gay men in Australia." Swinburne University of Technology, 2006. http://adt.lib.swin.edu.au./public/adt-VSWT20060713.084655.
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The present research, consisting of two studies, was designed to examine the
primary health care experiences of gay men in Australia and assess doctors? attitudes and
training with regard to gay men and their health care. In the first study, 195 gay men were
surveyed regarding their health issues and their primary health care experiences. The
most important health concerns of gay men were stress and depression followed by
HIV/AIDS, body image disorder and other sexually transmissible infections. Including
those participants who were unsure, approximately one-half reported experiencing
homophobia and almost one?quarter reported experiencing discrimination in the
provision of health care. Despite this, respondents were generally satisfied with their
primary health care, although respondents felt that all GPs should receive additional
undergraduate medical education regarding gay men?s health. In the second study, 25
doctors (13 gay specialists and 12 non-gay specialists) were surveyed regarding their
knowledge of gay men?s health and their comfort working with gay men. Non-gay
specialist GPs were less comfortable treating gay men, reported poorer communication
and were more homophobic than their gay specialist counterparts. Further, doctors
perceived their medical education regarding gay men?s health has been inadequate.
Together, the results of the two current studies suggest that disclosure of sexuality is an
important issue for both gay men and doctors, and has the potential to impact on the
quality of health care that gay men receive. In order to improve the level of disclosure,
the pervasiveness of homophobia and discrimination in primary health care must be
reduced. Finally, the results indicate that medical education must be updated to reflect
current knowledge regarding the health issues of gay men. Failure to address these issues
will condemn gay men to continued health inequality.
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Prempreeda, Pramoj Na Ayutthaya Pimpawun Boonmongkon. "Fluidity of Thai queer sexualities and their experiences of accessing sexual health care /." Abstract, 2007. http://mulinet3.li.mahidol.ac.th/thesis/2550/cd400/4838738.pdf.
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Smith, Caroline Kristine. "Racial Disparities in a State Based Workers' Compensation System." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/4831.
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Racial, ethnic, and linguistic minority workers suffer higher rates of work-related injuries and illnesses in the United States compared to their White counterparts. Explanations for these higher rates include potential socioeconomic causes (education, income, and wealth) and occupational segregation into more dangerous occupations. What is less studied are the post-injury sequelae for minority workers, which is their experiences in the workers' compensation system, as well as their health and return to paid employment. What is known comes primarily from qualitative literature, which includes themes of racial discrimination (from employers, health care providers, and workers' compensation employees), a lack of information on how to navigate the workers' compensation system, and linguistically inappropriate communication with those whose first language is not the majority language. In addition, qualitative studies have found differences in the treatment of minority workers, delays in receiving partial wage payments, and worse health outcomes. Most studies examining minority workers in the workers' compensation system have not provided a theoretical framework from which to test hypotheses as to why differences exist in a social insurance system based on race, ethnicity, and language.
The purpose of this dissertation was to test the role of racial discrimination in creating worse post-injury workers' compensation outcomes for minorities, compared to English speaking Whites. This dissertation utilized fundamental cause theory to frame the hypotheses and analyses in a cross-sectional investigation of differences in workers' compensation system outcomes, using both administrative data from the workers' compensation agency, as well as survey responses from a sample of 488 injured workers in Washington State.
The survey, conducted by Washington State University Social and Economic Science Research Center (SESRC), provided many variables not available in the WC administrative data including measures of perceived racial discrimination to test the hypotheses that racial discrimination is a fundamental cause of worse workers' compensation outcomes for minorities. Fundamental cause theory suggests that there are basic or fundamental reasons for health disparities that are not caused by mechanisms linking the fundamental cause with a health outcome; in fact, these mechanisms can and do change, but the relationship between the primary cause and the health disparity outcome will remain. In addition, a fundamental cause affects multiple outcomes via multiple mechanisms. Access to resources such as income, wealth, prestige, knowledge, and beneficial social connections can reduce the impact of a disease once it occurs.
The analytic chapters in this dissertation are organized first, to address racial discrimination in health care provider outcomes; second, to address racial discrimination in workers' compensation agency outcomes; and third, to address the role of pre-injury racial discrimination in post-injury return to work outcomes. Racial discrimination was tested in this dissertation as the fundamental cause of health-care provider disparities in timeliness of follow-up care, adequacy of care, and patient satisfaction. Racial discrimination was tested in the workers' compensation agency as the fundamental cause of administrative delays and difficulties: delays in diagnostic approval and wage replacement payments, as well as language appropriate communication, and higher counts of independent medical exams.
Racial discrimination was also tested as the fundamental cause of poor return-to-work outcomes (feeling a worker returned to work too early and overall general health). Workplace support, as a possible resource (social connection), was tested as a mediator in the relationship between racial discrimination and workplace outcomes.
Due to the survey nature of the study design, replicate weights were calculated based upon information available in both the surveyed and not-surveyed population to account for non-response bias, and all analyses were bootstrapped using Stata survey software. The results support the role of racial discrimination as a fundamental cause of outcomes for hypotheses in the workers' compensation agency with clear differences in delays for diagnostic services, a higher number of independent medical exams, as well as linguistically inappropriate communication for language minorities. Racial discrimination (prior to injury) was found to be significant in overall general health for minority workers, and for feeling they had returned to work too early. Workplace support (a potential social resource), was found to mitigate the role of racial discrimination in the workplace return-to-work outcomes. This study is an initial effort to examine racial discrimination as a fundamental cause of disparities in occupational health after an injury. As the majority of adults will spend one-fifth to one-third of their lives in paid employment, the ability to heal and return to full and active employment after a work-related injury is critical to ones' self-worth, as well as to the economic stability of individuals, families, and societies. If racial, ethnic, and language minorities suffer worse outcomes in their post-injury sequelae, these results will have long-lasting implications in any quest for a more equitable society.
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Slade, Catherine Putnam. "Does patient-centered care affect racial disparities in health?" Diss., Atlanta, Ga. : Georgia Institute of Technology, 2008. http://hdl.handle.net/1853/22569.
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Thesis (Ph. D.)--Public Policy, Georgia Institute of Technology, 2008.Committee Chair: Robert J. Eger III, Ph.D.; Committee Member: Christopher M. Weible, Ph.D.; Committee Member: Gregory B. Lewis, Ph.D.; Committee Member: Monica M. Gaughan, Ph.D.; Committee Member: Valerie A. Hepburn, Ph.D.
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Paradies, Yin Carl. "Race, racism, stress and indigenous health /." Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002514.
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Zhang, Yan-Jun. "Racial and ethnic disparities in quality of health care among adults with diabetes in the United States /." Connect to full text in OhioLINK ETD Center, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=toledo1242473857.
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Thesis (M.S.)--University of Toledo, 2009.Typescript. "Submitted as partial fulfillment of the requirements for The Master of Science in Pharmaceutical Sciences degree, Administrative Pharmacy option." "A thesis entitled"--at head of title. Bibliography: leaves 66-70.
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Singh, Shail. "The effects of perceived discrimination on Samoan health." CSUSB ScholarWorks, 2007. https://scholarworks.lib.csusb.edu/etd-project/3260.
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The purpose of this study was to examine the effect of perceived discrimination on Samoan health. This study employed purposive data collection and was conducted quantitatively using a questionnaire format, which measured everyday perceived discrimination, depression, and physical health.
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Philip, Ajith John. "An assessment of equity in geographical allocation of resources relative to need, in public primary healthcare services in the Northern Cape in South Africa." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.
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Thomas, Duane J. "Racist white stereotypes and physician race : factors influencing black health care related responses /." Electronic version (PDF), 2005. http://dl.uncw.edu/etd/2005/thomasd/duanethomas.pdf.
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Cuevas, Adolfo Gabriel. "Exploring Four Barriers Experienced by African Americans in Healthcare: Perceived Discrimination, Medical Mistrust, Race Discordance, and Poor Communication." PDXScholar, 2013. https://pdxscholar.library.pdx.edu/open_access_etds/615.
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For many health conditions, African Americans bear a disproportionate burden of disease, injury, death, and disability compared to European Americans. African Americans also use health services less frequently than do European Americans and this underuse of services contributes to health disparities in the United States. Studies have shown that some disparities are present not as a result of poor access to care, but, to a certain extent, as a result of the experiences patients have at their doctors' offices. It is, therefore, essential to understand African American patients' perspectives and experiences with healthcare providers. Past studies have shown that four barriers affect the quality of patient-provider relationships for African Americans: perceived discrimination, medical mistrust, race discordance, and poor communication. The studies, however, have not looked at how these barriers manifest when African Americans speak about their perspectives and experiences with health care providers. This project was a secondary data analysis of qualitative data provided by adult African American community members from Portland, Oregon with diabetes or hypertension or both, each of whom participated in one of 10 focus groups. The focus groups were conducted as part of a study that applied community based participatory research (CBPR) principles to understand patients' experiences with their doctors. Using a deductive approach, this analysis enhanced the understanding of how the barriers play a role in patient-provider relationships. Further, the analysis showed how the barriers are interrelated. In learning African American patients' experiences and perspectives on these four key barriers, the investigator proposes recommendations for healthcare providers as to how they can best deliver quality care for African Americans.
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Baylor, Rita Atkins. "Nurses' attitudes toward caring for patients with AIDS." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/845956.
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The main purpose of this study was to examine nurses' attitudes toward caring for patients with Acquired Immune Deficiency Syndrome (AIDS). The study also compared the attitudes of nurses who had cared for AIDS patients with the attitudes of nurses who had not cared for AIDS patients. Educational background was also examined to see if education influences attitudes. The Ajzen-Fishbein Model of Reasoned Action was the framework used for this study.A descriptive design was used for the purpose of gaining more information regarding nurses' attitudes toward caring for patients with AIDS. A random sample of all registered nurses in the state of Indiana was used for this study. The data obtained were analyzed using frequency distributions, independent t-tests, and analysis of variance.Nurses in general are sill uncomfortable with caring for AIDS patients. Between 40% and 50% of nurses are fearful of contracting the AIDS virus and fearful of putting their family at risk. On the other hand, approximately the same percentage are comfortable caring for AIDS patients. Furthermore, nurses believe that health care agencies should care for AIDS patients, but believe that nurses should have the right to refuse to care for AIDS patients.Results of this study indicated that educational background does not influence nurses' attitudes toward caring for patients with AIDS. However, as nurses have more experience caring for patients with AIDS, they appear to develop more positive attitudes.School of Nursing
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MacLaren, David. "Angels without mercy : the African-American fight against the Red Cross's blood donor discrimination, 1941-1945." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1115760.
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On the eve of World War II, the American Red Cross (ARC) excluded African-American blood donors. The instructions from the Army and the Navy implied that the armed forces did not want the allegedly "inferior" blood of Blacks in the veins of "superior" White soldiers. The ARC's exclusionary policy, as mandated by defense officials in the War Department, continued the tradition of relegating African-Americans to second-class citizenship.Black newspaper editors and individual protest leaders on the national and local levels pressured the armed forces to change its blood donor policy. On January 29, 1942, the ARC started to accept blood donations from Blacks but followed a national policy of segregation. The ARC labeled and stored African-American blood donations apart from those of Whites and maintained Jim Crow blood banks throughout the war even though medical experts found no factual basis to differentiate blood by race.This paper examines how Black newspapers and individuals such as Asa Philip Randolph, Walter Francis White, William Henry Hastie, Mabel Keaton Staupers, and the Black community of Indianapolis responded to the ARC's initial policy of exclusion and then segregating AfricanAmerican blood donations. The paper attempts to modify the popular interpretation that the war constituted a watershed for African-Americans. My research indicates that while many Black leaders and protest organizations on the national and local levels challenged the ARC's blood donor policies, African-Americans did not win a fundamental change in military policy. Thus, while the fight against blood donor discrimination was a manifestation of the wartime "Double V" campaign it also represented its limitations.The paper draws on secondary sources, African-American newspapers, and the manuscript collections of the National Association for the Advancement of Colored People, the National Association of Colored Graduate Nurses, Claude A. Barnett, William Henry Hastie, Asa Philip Randolph, and the Indianapolis Area Chapter of the ARC as well as the papers of African-American physicians in Indianapolis, Walter H. Maddux and Harvey N. Middleton of the Flanner House and the Morgan Health Center.Department of History
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Slade, Catherine Putnam. "Does Patient-Centered Care affect Racial Disparities in Health?" Digital Archive @ GSU, 2007. http://digitalarchive.gsu.edu/pmap_diss/24.
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This thesis presents a challenge to policy initiatives that presume that patient-centered care will reduce racial disparities in health. Data from the Medical Expenditure Panel Survey were used to test patient assessment of provider behavior defined as patient-centered care according to the National Health Disparities Report of the Agency for Healthcare Research and Quality of the Department of Health and Human Services. Results indicated patient-centered care improves self-rated health status, but blacks still report worse health status than whites experiencing comparable patient-centered care. Further, black-white differences in patient-centered care had no affect on health status. Rival theories of black-white differences in health, including social class and health literacy, provided better explanations of disparities than assessment of provider behaviors. These findings suggest that policies designed to financially incentivize patient-centered care practices by providers should be considered with caution. While patient-centered care is better quality care, financial incentives could have a negative effect on minority health if providers are deterred from practices that serve disproportionate numbers of poor and less literate patients and their families. Measurement of the concept of patient-centered care in future health disparities research was also discussed.
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Cuevas, Adolfo Gabriel. "Mistrust: An Exploration of African Americans' Attitudes and Perspectives Toward Healthcare." PDXScholar, 2015. http://pdxscholar.library.pdx.edu/open_access_etds/2459.
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This dissertation explored mistrust through focus group discussions (study 1), responses to standardized laboratory vignettes (study 2), and survey questionnaires (study 3). In the first study, I found that African American community members (N=60) experienced perceived discrimination, medical mistrust, and poor communication in numerous and interrelated ways. For example, medical mistrust occurred when clinicians did not convey respect to patients, leaving patients to wonder whether their clinician's treatment was discriminatory or not. Based on these findings, I wanted to see whether these experiences of perceived discrimination and mistrust were related to other dimensions of Black experience, such as racial identity. I conducted a secondary analysis of data from a laboratory study (Somnath Saha, PI) in which 104 primary care patients viewed video-recorded, standardized vignettes depicting a cardiologist recommending heart bypass surgery to a patient diagnosed with angina and 3-vessel coronary artery disease. In this study, those who viewed a video of European American cardiologist-actors had lower physician mistrust and lower hypothetical likelihood of having bypass surgery compared to those who viewed the video of African American cardiologist-actors. However, racial centrality did not moderate the relationship between ethnicity of the cardiologist-actor and patients' decision making. The third study explored other dimensions of racial identity (e.g., unfavorable public regard for African Americans) and mistrust (e.g., medical mistrust), while also exploring their association with perceived healthcare discrimination among African American community members (N=210). In this study, perceived discrimination was positively associated with racial centrality, but not associated with unfavorable public regard. Perceived discrimination was also positively associated with medical mistrust and physician mistrust. Although racial centrality and unfavorable public regard were not significant moderators between perceived discrimination and the two dimensions of mistrust, they were positively associated with medical mistrust. Together, these studies provide a better understanding of African Americans' healthcare attitudes and experiences, particularly mistrust toward medical institutions and clinicians. For example, the association between racial centrality and perceived discrimination may suggest that past experience of discrimination in healthcare may influence a person to seek others who experience similar stressors, giving way to identifying more with her or his racial group. Racial centrality may influence a person's trust towards healthcare, prior to entering the doctor's office. However, once the person enters the doctor's office, racial centrality may play a less significant role the patient's trust towards her or his provider. These findings generated new questions to explore for future studies. For example, future studies should explore the relationship between racial centrality and African Americans' healthcare behavioral responses. In addition, the current studies only focused only on attitudes and perspectives; future studies should investigate how the construct medical mistrust may influence health-related outcomes such as adherence in race-discordant patient-provider relationships.
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Murphy, Richard. "Health professionals and ethnic Pakistanis in Britain : risk, thalassaemia and audit culture." Thesis, University of St Andrews, 2005. http://hdl.handle.net/10023/2802.
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The central theme or 'red-thread' that I consider in this thesis is the concept of risk as it is perceived by and affects the two sides of the medical encounter -in this instance ethnic Pakistanis and Health Professionals- in Britain. Each side very often perceives risk quite distinctively, relating to the balance between the spiritual and temporal realms. This is particularly germane in matters to do with possible congenital defects within the prenatal realm for the ethnic Pakistani, and predominantly Muslim, side of this encounter. Thus one of the factors considered in this thesis is how senses of Islam impact upon the two sides. By ethnic Pakistanis Islam is seen as central to all life decisions, whilst Health Professionals view Islam with some considerable trepidation, little understanding it or its centrality to the former's decision-making processes. This is particularly significant with regard to attitudes to health and health care. In the initial stages of the project I had thought first cousin marriage (FCM), seen by ethnic Pakistanis as desirable and by Health Professionals as putting ethnic Pakistanis at-risk to be central to the argument, but concluded that concerns around FCM were a 'red herring', merely a trope for the tensions between the two sides -at once both British and at-risk from audit culture. Although no longer central, FCM remains a viable touchstone in consideration of the two sides' perceptions of genetic risk. In this thesis the medical encounter between ethnic Pakistanis and Health Professionals is performed within the realm of the so called New Genetics. Here the respective understandings of the New Genetics are informed by the enculturation processes that shape the two sides' world view. Furthermore, I will agree with Lord Robert Winston's and others' concern that any attempt to eradicate an adaptive genetic mutation, in this instance, thalassaemia, from the gene pool is not only undesirable in the short term, but also that such eradications may have an adverse, and far reaching, effect on whole population groups in the future. The main thrust of my argument is that audit culture not only compounds risk for both sides, but also perpetuates institutional racism within the National Health Service (NHS), by promulgating what I have called the language myth. That is to say that much institutional racism is the unwanted by-product of the NHS's attempts to become more patient centred and its continuing efforts to develop systems of best practice. This professionalisation process within the NHS can be seen to impact most strongly in relation to communication -particularly the claimed language barrier between the two sides. This 'barrier' has worrying policy implications for any meaningful communication between the two sides, notably relating to obtaining informed consent from ethnic Pakistani patients -with a resultant increase in risk for the two sides and clear economic consequences for the NHS.
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Malmström, Felicia. "Hiv/Aids patienters erfarenheter av stigma i mötet med vårdpersonal." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26876.
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Bakgrund: Det är en förhållandevis liten andel personer som lever med diagnostiserad hiv-infektion i Sverige, men eftersom flertalet av dessa personer kommer från högendemiska länder är det som blivande sjuksköterska av intresse att undersöka vad stigmatisering kan innebära i mötet med vårdpersonal. Syfte: Syftet med litteraturstudien var att sammanställa hiv/aids-patienters erfarenheter av stigma i mötet med vårdpersonal. Metod: Litteraturstudie är baserad på femton empiriska studier med kvalitativ ansats. Artikelsökningar gjordes i databaserna PubMed och CINAHL. Vid kvalitetsgranskning användes SBU;s kvalitetsgranskningsmall. Som analysmetod användes Graneheim & Lundman 2004. Resultat: Fem kategorier framkom från analysen; bristande integritet, fördomar, rädsla, bortprioritering och okunskap. Konklusion: Hivstigma utgör ett hinder för patienters tillgång till behandling samt riskerar vidare smittspridning. Stigma inom vården kan leda till att patienter undviker att delge sin hiv-status eller undviker att söka vårdtjänster. Detta utgör en risk för såväl patienten som vårdgivaren. Sårbara riskgrupper bland hiv-patienter är framför allt migranter och unga kvinnor, vilket kan vara viktigt att uppmärksamma.Background: There is a relatively small proportion of people living with HIV infection in Sweden, but since most of these people come from high endemic countries, it is interesting as a prospective nurse, to explore what stigmatization can mean in the meeting with healthcare professionals. Aim: The aim of the literature study was to compile HIV/AIDS patients' experiences of stigma in meeting with healthcare professionals. Method: A literature study based on fifteen empirical studies with qualitative approach. Article searches were made through the PubMed and CINAHL databases. Quality review was done with SBU's quality review template. As an analytical method, Graneheim & Lundman 2004 was used. Results: Five categories emerged from the analysis; lack of integrity, prejudice, fear, prioritization and ignorance. Conclusions: HIV stigma constitutes to be a barrier to patients' access to treatment and prevent continued spread of the infection. Stigma in healthcare can lead to patients not willing to disclose their HIV status or avoiding seeking health care services. These are risk factors for both the patient and the healthcare provider. Vulnerable risk groups among HIV patients are mainly migrants and young women.
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Crawford, Thomas C. "Navigating the Health Care Labyrinth: Portraits of the Socioeconomically Disadvantaged." Antioch University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1391617138.
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Wildschut, Angelique Colleen. "A feminist investigation into the reasons for attrition of women doctors from the South African medical profession and practice : exploring the case of UCT medical school between 1996 and 2005." Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6508.
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Thesis (DPhil)--University of Stellenbosch, 2011.ENGLISH ABSTRACT: This dissertation aims to establish the reasons underlying possible gendered attrition trends in the South African medical profession between 1996 and 2005. Noting the international trend of the increasing feminisation of medical education and the profession, the dissertation illustrates that this is also a reality in our national context, and frames this phenomenon as being plagued by difficulties very similar to those encountered in other traditionally male-dominated fields. The particular relevance for further research and debate is illustrated through the noticed discrepancy between women’s representation in enrolment and graduation at medical schools in South Africa, and their representation in the profession itself. The decision to approach this investigation from a feministorganisational perspective was based on the fact that this would not only be a novel, but indeed also an appropriate, research approach to the study of gendered trends in medical education and the profession within the South African context. The research project thus sets out three main objectives relevant to this investigation. Objective 1 aims to establish the sex composition of the cohort of medical graduates that have not entered, or decided to exit, the medical profession. In terms of this objective, findings show an increasing rate of progression of men into the profession, accompanied by a decreasing rate of progression of women into the profession. Objective 2 attempts to establish the reasons behind sex trends in South African medical schools and in the profession. Thus, in an effort to comprehensively investigate the issues underlying attrition, I employ a mixed-methods approach to the primary data collection and analysis. Firstly, the findings show, through a quantitative analysis of the interview data, that this sample of women felt that both institutional and societal factors influenced a women doctor’s propensity to remain in the profession. Secondly, it is established that whether these respondents felt that they had appropriate role models in the profession was the most important factor in terms of their identification with, and propensity to stay in, the profession. Thirdly, it was also found that the respondents felt strongly that the culture of the medical profession impacts negatively on a woman doctor’s propensity to stay in the profession, but similar to the findings of other studies, this does not bring us closer to an understanding of what that culture constitutes. Thus, lastly, through a qualitative analysis of the interview data I find that the respondents clearly recognise the presence of a gendered substructure in medicine in the South African context, and identify some elements of this structure as most commonly linked to attrition. Objective 3, based on the outcomes of the previous objectives, aims to provide recommendations for the retention of medical doctors in general, and women doctors specifically, in the South African context. It concludes that flexibility1 in the medical profession is paramount to the retention of doctors, and women doctors specifically. This is a difficult challenge to overcome, as central values such as the importance of continuity of care in the medical profession would suggest that providing increased flexibility to medical doctors would impact negatively on patient care. However, it appears that there is increasing recognition amongst scholars, policy makers and medical practitioners themselves of the importance of acknowledging alternative work patterns. On the basis of the outcomes of my research, it is clear that the national gender attrition trends are a cause for concern in terms of resourcing the National Health System against the backdrop of a widely acknowledged shortage of doctors in South Africa and elsewhere. If women doctors do not progress effectively into the system, but form the majority of graduates, this is a tragic loss, as well as a waste of resources during training. This aspect also has policy implications, because it appears that the government, in trying to retain doctors, has increasingly turned to measures that are restrictive (compulsory community service, restrictions on foreign doctors), rather than focusing on ways in which to make doctors want to stay. The dissertation thus closes by suggesting two main areas within which these findings and recommendations would be employed most usefully: 1) medical schools/ training/education, and 2) the medical profession/culture.
AFRIKAANSE OPSOMMING: Hierdie proefskrif het ten doel om die redes onderliggende aan geslagsverskille in die verlies van vroue uit die Suid-Afrikaanse mediese beroep tussen 1996 en 2005 vas te stel. Die internasionale tendens van die toenemende vervrouliking van mediese opleiding en die mediese beroep wys dat dit ook ‘n realiteit in die Suid-Afrikaanse nasionale konteks is. Hierdie verskynsel word veroorsaak deur probleme soortgelyk aan dié wat in ander, tradisioneel manlik gedomineerde beroepe ondervind word. Die spesifieke relevansie vir verdere navorsing en debat word geïllustreer deur die aangetoonde proporsionele verskil tussen vroue se inskrywing en graduering in mediese skole in Suid-Afrika, en hul verteenwoordiging in die beroep self. Die besluit om hierdie ondersoek uit ‘n feministies-organisatoriese perspektief te benader, is nie net omdat dit ‘n oorspronklike benadering sou wees nie, maar ook gepas vir ‘n studie van geslagstendense in die mediese onderwys en professie binne die Suid- Afrikaans konteks. Die navorsingsprojek bevestig dus drie hoofdoelstellings wat relevant tot hierdie ondersoek is. Doelstelling een probeer om die geslagsamestelling van die kohort van mediese gegradueerdes wat nie tot die beroep toegetree het nie, of dié wat besluit het om die beroep te verlaat, te bepaal. Daar is bevind dat daar ‘n verhoogde koers van vordering van mans tot die beroep is, gepaardgaande met ‘n verlaagde koers van vordering van vroue tot die beroep. Doelstelling twee probeer om die redes onderliggende aan die geslagstendense in die mediese skool en die beroep vas te stel. Dus, om ‘n omvattende ondersoek te doen om uit te vind wat onderliggend aan die verlies is, het ek van ‘n gemengde metode benadering tot data insameling en analise gebruik gemaak. Die resultate van die onderhoud data wys dat hierdie vroue voel dat beide institusionele en sosiale faktore ‘n vroulike dokter se besluit om in die beroep te bly, beïnvloed. Tweedens is daar vasgestel dat geskikte rolmodelle in die beroep die belangrikste faktor is in vroue se identifikasie met die beroep, en hulle besluit om in die beroep te bly. Derdens is gevind dat die respondente baie sterk voel dat die kultuur van die mediese beroep ’n negatiewe impak het op ‘n vroulike dokter se besluit om in die beroep te bly, maar soos ook in ander studies bevind is, bring dit ons nie nader aan ‘n begrip van die aard van die kultuur nie. Ten slotte is daar dus met die onderhoud data gevind dat die respondente duidelik bewus is van die teenwoordigheid van ‘n geslagsubstruktuur in die mediese beroep in Suid-Afrika. Ek identifiseer ook sekere elemente van hierdie struktuur wat bydra tot die verlies van vroulike dokters uit die mediese beroep. Doelstelling drie, gebaseer op die uitkomste van die vorige doelstellings, probeer om aanbevelings te maak vir die behoud van mediese dokters in die algemeen, en vroulike dokters spesifiek. Die gevolgtrekking is dat buigsaamheid in die werkskultuur van die mediese beroep van kardinale belang is vir die behoud van dokters in die algemeen, en vroulike dokters meer spesifiek. Dit is ‘n moeilike uitdaging om te oorkom omdat sentrale waardes, soos die belang van kontinuïteit van versorging in die beroep, persepsies laat ontstaan dat meer buigsaamheid in werksomstandighede ‘n negatiewe impak op die versorging van pasiënte sou hê. Dit blyk egter ook dat daar ‘n toenemende erkenning is deur akademici, beleidsontwerpers en mediese praktisyns self van die belang van alternatiewe werkspatrone. Gebaseer op die resultate van die ondersoek is dit duidelik dat die nasionale geslagsverliestendense ‘n rede tot kommer vir die verskaffing van menslike hulpbronne vir die nasionale gesondheidstelsel is, veral teen die agtergrond van ‘n algemeen erkende tekort aan dokters in Suid-Afrika. As vroulike dokters nie effektief in die stelsel opgeneem word nie, hoewel hulle die meerderheid van gegradueerdes is, is dit ‘n tragiese verlies en vermorsing van hulpbronne wat vir opleiding gebruik is. Dit het ook implikasies vir beleid omdat dit blyk dat die Suid-Afrikaanse regering, in sy pogings om dokters te behou, meermale maatreëls gebruik wat perke stel (verpligte gemeenskapsdiens, beperkings vir buitelandse dokters, ens.), waar hulle eerder behoort te fokus op maniere om dokters in Suid-Afrika te hou. Ten slotte stel die proefskrif twee hoofareas voor waarin hierdie bevindings en aanbevelings aangewend kan word: 1) mediese skole/opleiding/onderwys, en 2) die mediese beroep/kultuur.
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Nnajiofor, Chinyere Fidelia. "HIV/AIDS-Related Stigma and Discrimination Toward Women Living With HIV/AIDS in Enugu, Nigeria." Thesis, Walden University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10143549.
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HIV/AIDS-related stigma and discrimination (S&D), lack of social support, poverty, and gender inequalities have been identified as factors in the increased prevalence rate of HIV transmission in Enugu, Nigeria, especially among women ages 15 to 49 years. Despite the funding of reduction programs, HIV/AIDS-related S&D remain a major driving force in the increased rate of new HIV cases in Enugu. This study addressed a perceived need for behavioral change intervention approaches that span all societal factors to reduce the HIV infection rate in Enugu Nigeria. The study was guided by Goffman’s (1963) social S&D theory. The sample was composed of 132 women living with HIV/AIDS WLWHA ages 21 to 54 years, purposefully sampled from the 4 HIV and AIDS comprehensive initiatives care centers in Enugu, Nigeria. Fifteen WLWHA were interviewed and 114 participated in an online survey. The descriptive statistics and a multiple linear regression analysis and comparison revealed a convergent significant relationship between the S&D determinants (social, political, psychological, environmental, and cultural) and HIV/AIDS-related S&D towards WLWHA in Enugu F (4,109) = 45.09, p <.001). It also revealed that the cultural determinant of S&D was a significant predictor of HIV/AIDS-related S&D towards WLWHA in Enugu (? = 0.81, p < 0.001). The implications for positive social change include providing public health professionals evidence-based data to inform policy change, plan and to implement programs that will change societal attitudes and mobilize broad-based community actions to eradicate HIV/AIDS–related S&D toward WLWHA in Enugu, Nigeria, and in Sub-Saharan African Countries.
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Bannister, Tarryn. "The right to have access to health care services for survivors of gender-based violence." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71802.
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Thesis (LLM)--Stellenbosch University, 2012.Includes bibliography
ENGLISH ABSTRACT: In South Africa gender-based violence (hereafter “GBV”) has reached extreme levels. This violent manifestation of gender inequality is compounded by the fact that women are disproportionately affected by poverty, the HIV/AIDS epidemic and inadequate health care services. This is in spite of South Africa’s progressive constitutional and legislative framework which appears highly conducive to combating gender inequality and GBV. For example, the Constitution protects the right to equality (section 9), human dignity (section 10), life (section 11), freedom and security of the person (section 12) and the right to have access to health care services, including reproductive health (section 27(1)(a)). Extensive legislation has also been enacted for the protection of women. For example, the preamble to the Domestic Violence Act 116 of 1998 (hereafter “DVA”) recognises domestic violence as a serious social evil. While the DVA is notably silent as to the role of the health care sector, the DVA is progressive in that it contains a broad definition of domestic violence, and recognises a wide range of relationships. The Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007 also seeks to afford complainants of sexual offences “the maximum and least traumatising protection that the law can provide”. In addition to this, South Africa has international law obligations to address GBV and gender inequality. For example, under the Convention on the Elimination of All Forms of Discrimination against Women (1979), States are obliged to address private acts of violence and to remove discrimination against women in all fields, including health. However, despite this progressive framework of rights, some interpretations of these integral rights have been unduly formalistic, in addition to being disengaged from the lived reality of many women. There is also a substantial gap between policy and practice, with the implementation of existing legislation a continuing problem. It is therefore imperative that we analyse the right to have access to health care services through a gender lens so as to transcend a purely legalistic perspective and to interrogate gendered social processes and power relations. This thesis analyses how existing law and policy can be transformed so as to be more responsive to these lived realities and needs of survivors of GBV.
AFRIKAANSE OPSOMMING: Geslagsgebaseerde geweld (hierna ‘GGG’) in Suid-Afrika het uiterste vlakke bereik. Hierdie gewelddadige manifestasie van geslagsongelykheid word vererger deur die feit dat vroue buite verhouding erg deur armoede, die MIV/vigs-epidemie en ontoereikende gesondheidsorgdienste geraak word. Dit is ondanks Suid-Afrika se vooruitstrewende grondwetlike en wetsraamwerk wat op die oog af hoogs bevorderlik vir die bestryding van geslagsongelykheid en GGG voorkom. Die Grondwet verskans, byvoorbeeld, die reg op gelykheid (artikel 9), menswaardigheid (artikel 10), lewe (artikel 11), vryheid en sekerheid van die persoon (artikel 12) en toegang tot gesondheidsorgdienste, met inbegrip van reproduktiewe gesondheidsorg (artikel 27(1)(a)). Omvattende wetgewing oor vrouebeskerming is ook reeds uitgevaardig. Die aanhef tot die Wet op Gesinsgeweld 116 van 1998 (hierna die ‘WGG’) identifiseer, byvoorbeeld, huishoudelike geweld as ’n ernstige maatskaplike euwel. Hoewel die WGG swyg oor die rol van die gesondheidsorgsektor, is dit nietemin vooruitstrewend aangesien dit ’n uitgebreide omskrywing van huishoudelike geweld bevat en ’n wye verskeidenheid verhoudings erken. Die Wysigingswet op die Strafreg (Seksuele Misdrywe en Verwante Aangeleenthede) 32 van 2007 is ook daarop afgestem om klaagsters van seksuele oortredings “die omvattendste en mins traumatiese beskerming te gee wat die wet kan bied”. Daarbenewens verkeer Suid-Afrika onder internasionale regsverpligtinge om GGG en geslagsongelykheid aan te spreek. Ingevolge die Konvensie vir die Uitwissing van Alle Vorme van Diskriminasie teen Vroue (1979), byvoorbeeld, is state verplig om privaat geweldsdade teen te staan en diskriminasie teen vroue op alle gebiede te verwyder, insluitend gesondheid. Nietemin, benewens hierdie vooruitstrewende menseregteraamwerk is sommige interpretasies van hierdie onafskeidbare regte nie net oormatig formalisties nie, maar ook verwyderd van die daaglikse realiteit van baie vroue. Daar is ook ʼn wesenlike gaping tussen beleidsmaatreëls en die praktyk, terwyl die uitvoering van bestaande wetgewing ʼn voortgesette probleem verteenwoordig. Dit is dus gebiedend om die reg op toegang tot gesondheidsorgdienste deur ʼn geslagslens te analiseer om sodoende ʼn bloot regsgedrewe perspektief te bo te gaan en om maatskaplike prosesse en magsverhoudinge in oënskou te neem. Hierdie tesis analiseer hoe bestaande wetsraamwerke en beleidsmaatreëls getransformeer kan word om beter te reageer op die realiteite en behoeftes van oorlewendes van GGG.
Stellenbosch University Hope Project
Bradlow Foundation
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Donato, Francis A. "Reforming health care through managed care." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1995. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).
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Yeung, Yee-hung Stella. "Sustainable healthcare delivery in Hong Kong : organizational initiatives and strategic financing /." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B23295776.
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Higgins, Peter McRorie. "Medical care in English prisons." Thesis, Open University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406489.
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Wright, Hollis G. "Means, ends and medical care /." view abstract or download file of text, 2002. http://wwwlib.umi.com/cr/uoregon/fullcit?p3055725.
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Thesis (Ph. D.)--University of Oregon, 2002.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 272-280). Also available for download via the World Wide Web; free to University of Oregon users. Address: http://wwwlib.umi.com/cr/uoregon/fullcit?p3055725.
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Childerhose, Janet Elizabeth. "Genetic discrimination: genealogy of an American problem." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86665.
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Genetic discrimination has been transformed from an isolated concern of a handful of professionals into a pressing civil rights and public policy problem in the United States over the last twenty years. My dissertation is a genealogical account of how genetic discrimination has been shaped into a problem of this stature. It answers two questions: Where did the problem come from? How has the problem changed over time?In Part One, I trace the history of concerns about discrimination from the 1970s to the present. Drawing from oral histories with key actors and organizations that shaped early public understanding of the problem, I show that concerns about genetic discrimination originated in diverse practices. These practices include workplace genetic screening, insurer discrimination against individuals with AIDS, the rapid commercialization of genetic tests in the 1980s, and health care reform.
In Part Two, I present findings from a three-year ethnographic study of public policy hearings on genomic medicine in the United States that illustrate how new actors have been defining the problem of genetic discrimination since 1995. The hearings of the Secretary's Advisory Committee on Genetics, Health and Society were a site where participants legitimized genetic discrimination as a civil rights problem and developed lobbying tools to persuade Congress to pass federal nondiscrimination legislation. Participants framed fear of discrimination as a barrier to the nation's scientific progress and a significant threat to the lives of Americans.
I use the construct of genomic citizenship to draw out claims about the rights and duties of Americans in contemporary discourse on genetic discrimination. Passing federal nondiscrimination legislation is one way in which the civil rights of Americans appear to be expanding, while their responsibilities to act genetically are increasing. Advocates of nondiscrimination legislation, who use the language of genetic defect to argue that everyone is vulnerable to discrimination, geneticize all Americans by enrolling them into the biosociality of the flawed, transparent genome, with attendant duties. What these advocates do not also champion is the right of Americans to refuse to think or act genetically.
La discrimination génétique est passée du statut de préoccupation isolée parmi un petit nombre de professionnels à celui d'un urgent problème de droits civils et de politique publique aux État-Unis, depuis les vingt dernières années. Ma thèse est un compte rendu généalogique de la transformation de la discrimination génétique en un problème d'une telle envergure. Elle répond à deux questions : Quelle est l'origine du problème? Comment le problème a-t-il changé avec les années?
Dans la première partie, je retrace l'histoire des préoccupations au sujet de la discrimination, des années 70 à aujourd'hui. Je puise dans la tradition orale chez des acteurs clés et des organismes de premier plan qui ont informé la compréhension initiale du problème par le public. Je montre comment les préoccupations entourant la discrimination génétique sont issues de différentes pratiques.
Dans la deuxième partie, je présente les résultats d'une étude ethnographique d'une durée de trois ans, traitant des audiences publiques sur la médecine génomique aux États-Unis, et illustrant comment de nouveaux acteurs ont défini le problème de la discrimination génétique depuis 1995. Dans le cadre des audiences du Secretary's Advisory Committee on Genetics, Health and Society, les participants ont identifié la peur de la discrimination comme un obstacle au progrès scientifique de la nation, de même qu'une menace significative pour la vie des Américains et des Américaines.
J'ai recours à la construction de citoyenneté génomique dans le but de dégager des revendications au sujet des droits et devoirs des Américains et des Américaines, en rapport avec le discours actuel sur la discrimination génétique. L'adoption d'une législation de non discrimination semble contribuer à l'élargissement des droits civils des Américains et des Américaines, tandis que s'accroît leur responsabilité d'agir sur le plan génétique. Les défenseurs de la législation de non discrimination emploient le langage des défaut génétiques pour soutenir que toute la population est sujette à la discrimination. Selon ces mêmes défenseurs, les Américains et Américaines n'ont pas le droit de refuser de penser ou d'agir en termes génétiques.
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Hong, Wing-yee Veronica. "A comparative study of healthcare financing systems in US, UK and HK." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41709858.
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Chan, Yee-ying Michelle. "The formulation and implementation of healthcare reform in Hong Kong." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B2329470x.
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Mykhalovskiy, Eric. "Knowing health care / governing health care exploring health services research as social practice /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0018/NQ56249.pdf.
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Chouaibi, Meriam. "Droits du patient : étude comparée entre la France et la Tunisie." Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM1055.
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Le système juridique français accorde une grande importance aux droits du patient, essentiellement à travers la loi du 4 mars 2002. Ce texte a été construit de manière à placer le patient au centre du dispositif et à lui attribuer des droits liés à sa qualité de sujet de droit. Cette idée est quasiment absente dans la législation tunisienne. En Tunisie, la législation relative aux droits des patients est insuffisante. Il est vrai que le législateur tunisien a défini certains droits pour le patient. Cependant, ces consécrations législatives ne nous permettent pas de confirmer l’idée selon laquelle le patient est le centre de la relation médicale, particulièrement parce que le paternalisme médical trouve encore une consécration en Tunisie. L’étude comparative a montré certaines convergences entre les deux systèmes juridiques mais aussi d’importantes divergences. Ainsi, pour un pays, comme la Tunisie, dont le système sanitaire confronte des difficultés intenses non seulement sur le plan infra-structurel mais également législatif, le code de la santé publique en général et la loi du 4 mars 2002 pour les droits des malades, en particulier, peuvent constituer une source efficace pour des changements en profondeur. Cependant, si en France la loi du 4 mars 2002 occupe une place primordiale dans le corpus des règles du droit de la santé, on ne peut nier que les droits du patient confrontent aujourd’hui des difficultés de mise en œuvre. En effet, même si le souci du législateur français était de protéger au maximum les droits des patients, certaines failles restent à signalerThe french legal system attaches great importance to patient rights, mainly through the law of 4 March 2002. This text was constructed to place the patient at the center of the device and assigning the rights to as a subject of law. This idea is almost absent in tunisian law. In Tunisia, legislation on the rights of patients is inadequate : the rights of patients are devoted so scattered in several legal texts. It is true that the tunisian legislature has defined certain rights for patients. However, these legislative consecrations do not allow us to confirm the idea that the patient is the center of the medical relationship, particularly because medical paternalism still finds consecration in Tunisia. The comparative study showed some convergence between the two legal systems but also important differences. Thus, for a country like Tunisia, whose health system confronts severe difficulties not only its infrastructure but also the legislative, the code of public health in general and the law of 4 March 2002 for the rights of patients, particular, can be an effective source for in-depth changes. However, if in France the Law of 4 March 2002 occupies a prominent place in the corpus of rules of health law, there is no denying that the patient's rights today facing implementation difficulties. Even if the concern of the french parliament was to maximally protect the rights of patients, some flaws still to report
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Penfold, Christopher M. "Patient copayments in primary medical care." Thesis, Cardiff University, 2011. http://orca.cf.ac.uk/54411/.
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This research was carried out to assess the feasibility of studying the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care. Quantitative methods were used to investigate the impact of primary dental care copayments on patients and to compare predictors of primary medical and dental care uptake. Qualitative methods were used to investigate attitudes towards copayments for NHS primary health services and their extension to include primary medical consultations. Regression models, chi-square analyses and ANOVA were applied to the England and Wales sub-sample of nationally representative self-report data from the 1998 Adult Dental Health Survey (ADHS) (n=3628) to investigate the impact of copayments on primary dental care uptake. Regression models and chi-square analyses were applied to the England and Wales sub-sample of nationally representative self-report data from the 1997/98 British Household Panel Survey (BHPS) (n=8526) and the 1998 ADHS (n=3641) to compare predictors of primary medical and dental consultations. Semi- structured interviews were undertaken in Bristol and Somerset with purposively sampled frequent and infrequent primary medical care users (n=19). Predictors of primary medical and dental care utilisation differed across predisposing, enabling and illness level factors. Private and NHS dental copayments were perceived to be expensive and this perception was associated with lower preventive-led dental consultation rates, but not with treatment-led consultation rates. Copayments for services affected the nature of the patient-practitioner relationship. Findings were inconclusive regarding the effect of copayment exemption status on people's decisions to consult a dentist and on dental treatments received. It was not feasible to study the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care.
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Horton, Rachel. "Dignity and the legal justification of age discrimination in health care." Thesis, Middlesex University, 2016. http://eprints.mdx.ac.uk/18783/.
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Evidence shows that age discrimination in health care is still widespread. At the same time, there has been suggestion, both in the theoretical literature and in the jurisprudence, that age is ‘different’ to other protected characteristics such as sex and race and thus that age discrimination may sometimes be permissible in circumstances in which discrimination on other grounds, such as sex or race, may not. This is chiefly because, it is argued, if a ‘complete life view’ of equality is taken, age discrimination may not produce the same distributive inequalities as does discrimination on other grounds. This thesis responds to these arguments by asking what other – dignity-related - harms, age based distinctions in health care may cause. Dignity is widely agreed to be an important normative foundation for anti-discrimination law and features prominently in judicial and ethical debate on a range of issues in medical law. It is not an easy concept to define, however. There is no legal or theoretical consensus as to its meaning and legal uses of dignity involve appeal to a range of different and sometimes conflicting concepts. Rather than advocating one particular conception of dignity, the thesis identifies the variety of meanings of dignity evident in two contexts of close relevance to the problem at hand - equality law and medical law – and considers the answers to which these different meanings may give rise. The purpose of the discussion is to contribute to a debate as to the approach that courts should take in assessing whether particular instances of age discrimination in health care can be justified. It concludes that, on several conceptions of dignity, age-based distinctions may give rise to dignity harms which cannot be ignored or discounted by taking a complete life view of equality. As a result, courts should tread carefully before adopting a starting point which assumes age to be different and should develop their approach to justification accordingly.
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Anderson, Mindi S. "Integrating Emergency Medical Services Into the Patient-Centered Medical Home." Thesis, Capella University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10288192.
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Abstract Emergency medical services (EMS) for nonemergent or low-acuity calls is a new normal. EMS agencies spend a majority of time providing primary care services through the 911 system. They are utilized currently to fill the primary care gap subconsciously. The EMS system is activated as a patient navigator for primary care services. EMS agencies in the state where the research occurred have responded to the gap in care management by creating innovative programs such as community health emergency medical services (CHEMS). Creation of CHEMS programs have become one of the most monumental concepts for change in the field on both a state and national level. EMS has sought ways to meet the goals of the Triple Aim by exploring CHEMS as the state transitions to value-based care. Leaders are searching for innovative ways to close the gap in the primary health care system through a patient-centered medical home (PCMH) model. The action research study stimulated innovative thinking to support coordinated care across the evolving continuum of the health care system. The study captured the current awareness from community health care leaders who have had a recent opportunity to explore the idea of integrating EMS into the PCMH model through semi-structured interview sessions. Major findings in the thematical analysis discovered the current way both EMS and a PCMH function in a silo system that could potentially utilize each other to effectively provide managed care. Joint efforts could offset overutilization of EMS services for calls that have no apparent life threats. EMS would allow for a PCMH to conform to the Patient Protection and Affordable Care Act standards of care management, contributing to the integration of Triple Aim objectives. Collaboratively, EMS and an established PCMH will impact the delivery of preventative, quality and cost-efficient care. The theory of organizational culture change is based on three common characteristics: culture is shared, is intangible, and affects human behavior. The conceptual framework of the research study was based on the chronic care model. Patients with comorbidities potentially utilize the health care system more than a healthy patient to seek reassurance that their health is managed.
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Fong, Ho-nam. "A comparison of the colonial medical systems in British Hong Kong (1841-1914) and German Qingdao(1897-1914)." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/B35051073.
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Boles, Brian Nelson. "An examination of relationships among indicators of socioeconomic status, health status, and selected health care utilization for fund allocation /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq21255.pdf.
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Chan, Hung-yee. "Health care delivery and financing in Hong Kong." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B23294735.
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Wong, Chit-ming. "Risk modelling methods and their application to three health care studies /." [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13282566.
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Burton, Sarah L. "Logistic regression models and their application in medical discrimination and diagnosis." Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364332.
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Öhman, Mattias. "Essays on Cognitive Development and Medical Care." Doctoral thesis, Uppsala universitet, Nationalekonomiska institutionen, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-305627.
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This thesis consists of four self-contained papers. Essay I (with Linuz Aggeborn): Fluoridation of the drinking water is a public policy whose aim is to improve dental health. Although the evidence is clear that fluoride is good for dental health, concerns have been raised regarding potential negative effects on cognitive development. We study the effects of fluoride exposure through the drinking water in early life on cognitive and non-cognitive ability, education and labor market outcomes in a large-scale setting. We use a rich Swedish register dataset for the cohorts born 1985-1992, together with drinking water fluoride data. To estimate the effects, we exploit intra-municipality variation of fluoride, stemming from an exogenous variation in the bedrock. First, we investigate and confirm the long-established positive relationship between fluoride and dental health. Second, we find precisely estimated zero-effects on cognitive ability, non-cognitive ability and education for fluoride levels below 1.5 mg/l. Third, we find evidence that fluoride improves later labor market outcomes, which indicates that good dental health is a positive factor on the labor market. Essay II: I study the associations between cognitive and non-cognitive abilities and mortality using a population-wide dataset of almost 700,000 Swedish men born between 1950 and 1965. The abilities were measured at the Swedish military enlistment at age 18-20. In addition, I investigate if income and education are good proxies for the abilities. The results suggest that both cognitive and non-cognitive abilities are strongly associated with mortality, but that non-cognitive ability is a stronger predictor. The associations are only partly mediated through income and education. For middle and high income earners and individuals with a college education there are no associations with mortality. However, for low income earners and individuals without a college education, both abilities are strongly associated with mortality. The associations are mainly driven by the bottom of the distributions. Essay III (with Matz Dahlberg, Kevin Mani and Anders Wanhainen): We examine how health information affects individuals' well-being using a regression discontinuity design on data from a screening program for an asymptomatic disease, abdominal aortic aneurysm (AAA). The information provided to the individuals is guided by the measured aorta size and its relation to pre-determined levels. When comparing individuals that receive information that they are healthy with those that receive information that they are in the risk zone for AAA, we find no effects. However, when comparing those that receive information that they have a small AAA, and will be under increased surveillance, with those who receive information that they are in the risk zone, we find a weak positive effect on well-being. This indicates that the positive information about increased surveillance may outweigh the negative information about worse health. Essay IV: I estimate the effect of SSRI antidepressants on the risk of mortality for myocardial infarction (MI) patients using Propensity Score Matching on individual health variables such as pharmaceutical drug prescription, patient history and severity of the MI. The effect of antidepressants on mortality is a heavily debated topic. MI patients have an elevated risk of developing depression, and antidepressants are among the most common treatments for depression and anxiety. However, there are indications that some classes of antidepressants may have drug-induced cardiovascular effects and could be harmful for individuals with heart problems, but there is a lack of large-scale studies using credible identification strategies. My findings indicate no increased risk of two-year mortality for MI patients using SSRI. The results are stable for several specifications and robustness checks.
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Byrd, Rebekah J. "Culturally competent medical care of LGBTQ patients." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/911.
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Cavalhieri, Klaus Eickhoff. "Experiences of Discrimination and Outcome Expectations as Predictors of Health Care Utilization." OpenSIUC, 2016. https://opensiuc.lib.siu.edu/theses/2006.
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This study is an investigation of how experiences of discrimination, self-efficacy, and the associated outcome expectations influence health care utilization of young college students. The relationships tested were informed by Andersen’s Behavioral Model of Health Services Use (Andersen, 2008), the most widely used model to understand and predict health care utilization. Andersen proposed that health care utilization is influenced by predisposing (i.e., personal characteristics), enabling (i.e., income, insurance), and need (i.e., perception of illness) factors. However, his model has been criticized for not taking in consideration social factors and oversimplifying the role of ethnicity as a predictor (Bradley et al., 2002). The purpose of this study is to expand the explanatory power of Andersen’s model, by including psychosocial variables (e.g., discrimination, self-efficacy). One hundred and eighty-five students completed a 20 minute online survey, which included measures of experiences of discrimination, outcome expectations, self-efficacy, attitudes, and demographic variables. Results indicated that self-efficacy to communicate with physicians was a significant predictor of health care utilization, although experiences of discrimination were not. The effects of discrimination on health care utilization were further found to be mediated by self-efficacy to communicate with physicians. The present study's finding provided support for the inclusion of psychosocial variables (i.e., self-efficacy) in Andersen's model to increase its explanatory power.
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Suen, Yuk-lam Kelvin. "A comparative study of the health care policies in Hong Kong and Singapore." Click to view the E-thesis via HKUTO, 2002. http://sunzi.lib.hku.hk/hkuto/record/B42576350.
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Armbruster, Susanne. "Versorgungsnetzwerke im französischen und deutschen Gesundheitswesen : eine vergleichende Studie unter Berücksichtigung rechts- und gesundheitswissenschaftlicher Aspekte /." Stuttgart : Ibidem-Verl, 2004. http://www.gbv.de/dms/sbb-berlin/46191977X.pdf.
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Levy, Elizabeth Giselle. "Therapeutic process in a managed care type setting : the working alliance, pre-treatment characteristics and outcome /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.
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Lindrooth, Richard C. "Selective contracting, cost sharing, and utilization management : a theoretical and empirical analysis of the market for health care /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/7463.
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McCreadie, Elizabeth Ann. "Doxa disability and discrimination." Thesis, University of Sussex, 2017. http://sro.sussex.ac.uk/id/eprint/66873/.
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This research considers the hypothesis that eugenic ideology still influences social work practice in contemporary Britain. Exploring the issues through a feminist perspective by utilizing a narrative approach with individuals with learning disabilities. For many people with learning disabilities access to 'Human Rights' is rather elusive and this work seeks to examine this through the lens of eugenic ideology and a Bourdieusian approach to social work. The purpose being to ascertain if eugenic ideology is still present, if only through the Bourdieusian concept of "doxa", if so how does this affect the life choices and human rights of the people in the research. Based on the 'lived experiences' of a number of individuals with learning disabilities, all of whom were members of a self-advocacy group in England. All participants had previously been involved as service users in the selection of Social Work students for a London university and were contributors to the programme in this capacity over a period of several years. Involvement of participants in the research with the self-advocacy group was by open invitation to the group members, and individual 'life stories ' were documented through recorded interviews by the researcher over a period of several months. Utilizing a narrative approach to the life stories from a feminist perspective the experiences were examined against the historical backdrop of eugenics, articles of the Human Rights Act and Bourdieu's theory of practice. The findings show oppression, inequality and a lack of 'Human Rights' experienced by the participants, this against a policy background of 'Valuing People' and 'Personalisation' which both set out to promote strategies of social inclusion and real opportunities for people with learning disabilities. The 'caring ' professions including social work are implicated in the continuing and ongoing oppression and symbolic violence of people with learning disabilities. Whilst the terminology of 'eugenics' is no longer an acceptable topic of conversation, the impact of the ideology continues to permeate the ‘collective unconsciousness' (doxa) of many including those who are involved in the decision making processes of individuals identified as learning disabled. The implications for practice is that awareness of the pernicious effects of the eugenic movement need to be taught as part of the history of social work and included in the curriculum, if we are to avoid repeating the horrors of the history of the eugenic movement. By utilizing Bourdieu's concepts of habitus, capital and field, together with doxa and hysteresis it is possible to arrive at a new model of Social Work practice to address discrimination and to promote anti oppressive practice. The "Hysteresis Wheel', is a model developed as a result of this research.
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Ho, Chi-hang Bruce. "Health care financing options for Hong Kong." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25139526.
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Wong, Lai-cheung. "A study of hospice care : [factors affecting] communication between the health care professionals and the patients /." [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13409475.
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Neumann, Khamille. "Medical pluralism in Guatemala." Pullman, Wash. : Washington State University, 2010. http://www.dissertations.wsu.edu/Thesis/Spring2010/k_neumann_020510.pdf.
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Thesis (M.A. in cultural anthropology)--Washington State University, May 2010.Title from PDF title page (viewed on June 2, 2010). "Department of Anthropology." Includes bibliographical references (p. 76-83).