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Balnave, Nikola Robyn. "Industrial Welfarism in Australia 1890-1965." University of Sydney. Work and Organisational Studies, 2002. http://hdl.handle.net/2123/572.
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This thesis examines industrial welfarism in Australia from 1890 to 1965. This period witnessed the gradual spread of the welfarism movement throughout Australian industry as employers sought ways to increase productivity and control in the face of external challenges. Once reaching its peak in the immediate post-War period, the welfarism movement was gradually subsumed as part of the increasing formalisation of personnel management. Waves of interest in welfare provision coincided with periods of labour shortage and/or labour militancy in Australia, indicating its dual role in the management of labour. Firstly, by offering benefits and services beyond that made necessary by the law or industrial awards, welfarism was designed to create a pool of good quality workers for management to draw from. Secondly, managers sought to enhance their control over these workers and their productive effort, using welfarism as a technique to build worker consent to managerial authority. This could be achieved through subtle methods aimed at boosting loyalty and morale, or through more direct programs designed to increase worker dependency on the company. In both ways, individual and collective worker resistance could be minimised, thereby reinforcing managerial prerogative. Despite its adoption by a variety of companies, a number of economic, political and institutional factors limited the extent of industrial welfarism in Australia. These include the small-scale of most enterprises prior to the Second World War, state involvement in the area of industrial relations and welfare provision, and the strength of organised labour. While the welfarism movement did not reach the heights experienced overseas, it nonetheless provided an important contribution to the development of formal labour management in Australia.
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Straten, Annemieke van. "Quality of hospital care and health outcomes after stroke." Proefschrift, [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/83805.
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Gungor, Alper. "Occupational Health And Safety Management Tool." Phd thesis, METU, 2004. http://etd.lib.metu.edu.tr/upload/3/12604694/index.pdf.
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Labor protection, that is prevention of occupational disease and reducing the frequency of accident, has always been a matter of major concern of mining industry. Management and the government should promote and maintain high safety standards through some measures and tools to reduce frequency of accidents and occupational diseases.
This thesis describes the development of a national occupational health and safety management tool that is composed of educational, statistical and database interfaces for mine safety and health administration.
The detailed analysis of an accident requires knowledge of many parameters such as location, time, type, cost of the accident, victim information, nature of injury, result of the accident etc. that can be obtained from a standard coded accident report form. So, database interface of the management tool is developed with this sense to realize collecting accident data in a nationally used format to produce a common safety reporting system.
Prepared database maintains user-friendly environment on Internet to submit accident information. Dynamic structure and ease of use of the developed database allow administered user to expand it without detailed computer programming knowledge. This was achieved by prepared modules to change or register new data fields within the database.
Created database is also secure since only gives data input access rights to registered users. Database administrator is able to create registered users. Registered users could be safety engineer or manager of a mine who is responsible from the submission of data to the ministry of labor. So, standard and secure accident data collected rapidly through Internet connection.
The other feature of the database is that, it is open to all people to query accidents with many aspects.
Prepared management tool also includes educational interface, content of which can also be enlarged, as the new ideas, information or solutions for accidents are improved. This information is also open to all people since educating workers and managers about accidents and prevention techniques can improve working conditions and increase awareness.
Knowing the fact that submitted accident data is still collected in hard copies in folders, the need for a kind of management tool, which is completed in this study, is obvious. Application of this kind of management tool will be able to prevent the collection of accident data in dusty shelves and share the accident data information with all people who are interested in with this subject.
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Karimi, Pour Fatemeh. "Health-aware predictive control schemes based on industrial processes." Doctoral thesis, TDX (Tesis Doctorals en Xarxa), 2020. http://hdl.handle.net/10803/673045.
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The research is motivated by real applications, such as pasteurization plant, water networks and autonomous system, which each of them require a specific control system to provide proper management able to take into account their particular features and operating limits in presence of uncertainties related to their operation and failures from component breakdowns. According to that most of the real systems have nonlinear behaviors, it can be approximated them by polytopic linear uncertain models such as Linear Parameter Varying (LPV) and Takagi-Sugeno (TS) models. Therefore, a new economic Model Predictive Control (MPC) approach based on LPV/TS models is proposed and the stability of the proposed approach is certified by using a region constraint on the terminal state. Besides, the MPC-LPV strategy is extended based on the system with varying delays affecting states and inputs. The control approach allows the controller to accommodate the scheduling parameters and delay change. By computing the prediction of the state variables and delay along a prediction time horizon, the system model can be modified according to the evaluation of the estimated state and delay at each time instant. To increase the system reliability, anticipate the appearance of faults and reduce the operational costs, actuator health monitoring should be considered. Regarding several types of system failures, different strategies are studied for obtaining system failures. First, the damage is assessed with the rainflow-counting algorithm that allows estimating the component’s fatigue and control objective is modified by adding an extra criterion that takes into account the accumulated damage. Besides, two different health-aware economic predictive control strategies that aim to minimize the damage of components are presented. Then, economic health-aware MPC controller is developed to compute the components and system reliability in the MPC model using an LPV modeling approach and maximizes the availability of the system by estimating system reliability. Additionally, another improvement considers chance-constraint programming to compute an optimal list replenishment policy based on a desired risk acceptability level, managing to dynamically designate safety stocks in flowbased networks to satisfy non-stationary flow demands. Finally, an innovative health-aware control approach for autonomous racing vehicles to simultaneously control it to the driving limits and to follow the desired path based on maximization of the battery RUL. The proposed approach is formulated as an optimal on-line robust LMI based MPC driven from Lyapunov stability and controller gain synthesis solved by LPV-LQR problem in LMI formulation with integral action for tracking the trajectory.Esta tesis pretende proporcionar contribuciones teóricas y prácticas sobre seguridad y control de sistemas industriales, especialmente en la forma maten ática de sistemas inciertos. La investigación está motivada por aplicaciones reales, como la planta de pasteurización, las redes de agua y el sistema autónomo, cada uno de los cuales requiere un sistema de control específico para proporcionar una gestión adecuada capaz de tener en cuenta sus características particulares y limites o de operación en presencia de incertidumbres relacionadas con su operación y fallas de averías de componentes. De acuerdo con que la mayoría de los sistemas reales tienen comportamientos no lineales, puede aproximarse a ellos mediante modelos inciertos lineales politopicos como los modelos de Lineal Variación de Parámetros (LPV) y Takagi-Sugeno (TS). Por lo tanto, se propone un nuevo enfoque de Control Predictivo del Modelo (MPC) económico basado en modelos LPV/TS y la estabilidad del enfoque propuesto se certifica mediante el uso de una restricción de región en el estado terminal. Además, la estrategia MPC-LPV se extiende en función del sistema con diferentes demoras que afectan los estados y las entradas. El enfoque de control permite al controlador acomodar los parámetros de programación y retrasar el cambio. Al calcular la predicción de las variables de estado y el retraso a lo largo de un horizonte de tiempo de predicción, el modelo del sistema se puede modificar de acuerdo con la evaluación del estado estimado y el retraso en cada instante de tiempo. Para aumentar la confiabilidad del sistema, anticipar la aparición de fallas y reducir los costos operativos, se debe considerar el monitoreo del estado del actuador. Con respecto a varios tipos de fallas del sistema, se estudian diferentes estrategias para obtener fallas del sistema. Primero, el daño se evalúa con el algoritmo de conteo de flujo de lluvia que permite estimar la fatiga del componente y el objetivo de control se modifica agregando un criterio adicional que tiene en cuenta el daño acumulado. Además, se presentan dos estrategias diferentes de control predictivo económico que tienen en cuenta la salud y tienen como objetivo minimizar el daño de los componentes. Luego, se desarrolla un controlador MPC económico con conciencia de salud para calcular los componentes y la confiabilidad del sistema en el modelo MPC utilizando un enfoque de modelado LPV y maximiza la disponibilidad del sistema mediante la estimación de la confiabilidad del sistema. Además, otra mejora considera la programación de restricción de posibilidades para calcular una política ´optima de reposición de listas basada en un nivel de aceptabilidad de riesgo deseado, logrando designar dinámicamente existencias de seguridad en redes basadas en flujo para satisfacer demandas de flujo no estacionarias. Finalmente, un enfoque innovador de control consciente de la salud para vehículos de carreras autónomos para controlarlo simultáneamente hasta los límites de conducción y seguir el camino deseado basado en la maximización de la bacteria RUL. El diseño del control se divide en dos capas con diferentes escalas de tiempo, planificador de ruta y controlador. El enfoque propuesto está formulado como un MPC robusto en línea optimo basado en LMI impulsado por la estabilidad de Lyapunov y la síntesis de ganancia del controlador resuelta por el problema LPV-LQR en la formulación de LMI con acción integral para el seguimiento de la trayectoria.
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Riordan, Geraldine M. "Triage in Health Department of Western Australia accident and emergency departments." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1995. https://ro.ecu.edu.au/theses/1182.
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A survey of triage systems used in Health Department of Western Australia accident and emergency departments was undertaken to examine differences in practices between departments with and without designated triage nurses (TNs). One questionnaire surveyed 93 nurses in seven departments with TNs, a similar second questionnaire surveyed 89 nurses in 16 departments without TNs, and a third questionnaire was used in a structured telephone interview of receptionists in hospitals without TNs. Data were analysed using frequencies, percentages, means, standard deviations and ranges with common themes identified for open ended questions. The study was guided by Donabedian's systems evaluation model. The structures and processes of triage within each department were examined in relation to the outcome standards recommended by the Australian Council on Healthcare Standards. The study results revealed that triage nurses were employed in all departments where patient attendances exceeded 300 per week and nursing staff coverage in the department was higher than five per day. Three departments had introduced triage on weekends only, and these departments had the lowest nurse-patient ratio of one nurse per day to 74 patients per week. The highest nurse-patient ratio was in departments with TNs (1-35). Conclusions drawn from the findings suggest that when receptionists are the first person to see patients, they triage patients using an unsatisfactory two category priority system. The average waiting time to see nursing staff is too long in departments without TNs, 7.6 minutes, as compared to 3. 7 minutes in department with TNs. Nursing staff perceived that triage systems could be improved by having only experienced staff as the triageur. The surveillance of patients entering the department is unsatisfactory as 81% of departments without TNs and 43% of departments with TNs are unable to provide nurse surveillance. The surveillance of the waiting room is similarly unsatisfactory in many departments. All triage areas are inadequate, as facilities for private conversation, hand washing and physical assessment are not always available. The majority of departments without TNs do not have a satisfactory triage priority category system in place. The average time taken by nursing staff to triage patients is an acceptable 3.2 minutes in departments with TNs, and 5.3 minutes in departments without TNs. The practice of redirecting patients away from the department could compromise patient safety as patients are redirected away from most departments by any level of staff employed in the department, without any written documentation kept or any written criteria for the redirection of these non-urgent patients. The practice of ordering investigations and treating minor problems without referring to a doctor could also compromise patient safety, as most departments do not have written policies and guidelines to cover this practice. Most departments offer an inadequate triage training program of preceptoring only. Recommendations are focused on the reviewing of existing triage practices to comply with the standards identified.
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Stavric, Verna. "Muscle power after stroke a thesis submitted to Auckland University of Technology in partial fulfilment of the requirements for the degree of Master of Health Science (MHSc), 2007 /." ScholarlyCommons@AUT : Muscle power after stroke, 2007. http://aut.researchgateway.ac.nz/handle/10292/131.
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Medin, Jennie. "Stroke among people of working age : from a public health and working life perspective /." Linköping : Univ, 2006. http://www.bibl.liu.se/liupubl/disp/disp2006/med930s.pdf.
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Lui, Wai-sing, and 呂偉成. "Development of a nuclear accident health/eclogical consequence model for Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B31213418.
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Lui, Wai-sing. "Development of a nuclear accident health/eclogical consequence model for Hong Kong /." Hong Kong : University of Hong Kong, 1996. http://sunzi.lib.hku.hk/hkuto/record.jsp?B16027036.
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Byrne, Geraldine. "The accident and emergency department : nurses' priorities and patients' anxieties." Thesis, Northumbria University, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316497.
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This study investigated the sources of anxiety for patients in the Accident and Emergency Department and explored how patients' anxiety was influenced by their experiences in the department and the attitudes, behaviour and communication patterns of nurses and other staff. The research was carried out in twO Accident and Emergency Departments and consisted of three stages. Stage One employed structured interviews with 96 patients to identify sources of anxiety for patients in the Accident and Emergency Department and to examine the relationship between anxiety and the patient variables of age, sex, condition and department. In Stage Two in-depth interviews were conducted with 21 qualified nurses to explore their perceptions of their work and patients. Stage Three was an observational study, involving 23 patients, which examined the nature of nurse-patient communication in the Accident and Emergency Department. A Symbolic Interactionist framework was used in order to understand events from the perspective of those involved. Patients appeared to view their stay in the Accident and Emergency Department as an event occurring within the wider context of their daily lives and were concerned with social factors related to admission and the consequences of their illness or injury. Nurses held a different perspective and were more concerned with physical care and the organisation of the patients' stay in the department. In contrast to the patients, the nurses were concerned with short-term problems. Interaction between nurses and patients consisted predominantly of brief encounters which focused on the patients' illness or injury and their progress through the department. There was little attention explicitly directed towards dealing with patients' anxieties. A complex range of factors - interpersonal, cultural, interprofessional and structural - were found to influence communication. A number of recommendations are made identifying ways to enhance nurses' ability to deal with patients' anxieties.
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Dent, Ann Leslie. "Support for families whose child dies suddenly from accident or illness." Thesis, University of Bristol, 2000. http://hdl.handle.net/1983/3527a355-4008-4d20-af05-01121630e2e1.
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Sabi, William Kwasi. "Mandatory community-based health insurance schemes in Ghana : prospects and challenges." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/9437.
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Includes bibliographical references (leaves 119-124).Community-Based Health Insurance Schemes are new forms of health financing that can increase resources available for a national health system. These schemes are often regarded as not feasible. Evidence from recent experiences however; show that , if they are appropriately designed and managed they can be feasible and sustainable. The successes achieved by such schemes in Ghana motivated the government to make them a mandatory system of health financing. The main objective is that every resident of Ghana shall belong to a health insurance scheme that adequately covers him or her against "cash and carry" (i.e. user fees) in order to obtain access to a defined package of acceptable quality needed health services without having to pay at the point of receiving service. This study sought to undertake a critical comparative study of the performance of voluntary and mandatory community health financing schemes in Ghana and assess their prospects and challenges in their effort to improve efficiency, equity and the schemes' sustainability. The study, a qualitative one, employed descriptive survey techniques to evaluate the ability of schemes to finance their activities from their own sources and mechanisms put in place to cater for the poor and vulnerable, i.e. to evaluate with sustainability and equity respectively. The study also considered control measures to minimize cost escalation to assess efficiency. Focus group discussions, key informant interviews and document reviews were used to examine performance of voluntary and mandatory schemes in meeting those criteria. The study found that both voluntary and mandatory schemes were not self-sustainable due to low coverage and inadequate funds mobilized by the schemes. The main reasons for the general low enrolments are poverty, poor quality health service and limited benefit packages. The study showed that including out-patient (OPD) services in the benefit package and quality improvements in health service improve members' acceptability of insurance hence increase membership rates which will eventually increase schemes' sustainability. Efficient and effective administration of risk equalization fund will help reduce differences in districts' ability to raise revenue owing to different levels of economic activities as well as local morbidities. The study showed further that small community-based health insurance schemes (CBHIS) could be sub-district level financial intermediaries for the District Health Insurance Schemes. It was found in this study that a practical means testing mechanism to declare one poor in order to quality for exemption from contribution should be adopted. The study also suggests that alternative reimbursement mechanisms to fee-for-service need to be considered. The study suggests further research on equity in access and means testing. Such study should consider coming up with mechanisms for identifying the very poor in the communities and to put in place workable and sustainable measure to tackle the financial barriers to health care they face.
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Ali, Mohammad Wijayanuddin bin. "Development of risk assessment framework for major accident hazards to the environment." Thesis, University of Sheffield, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.267203.
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Delcambre, Mark Lane. "Finite Difference Schemes for a Structured Model of Mycobacterium marinum." Thesis, University of Louisiana at Lafayette, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3622932.
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This work presents a novel size-structured model to mathematically describe the transmission dynamics of Mycobacterium marinum in an aquatic environment. Biological background on the formation of the model is discussed in Chapter 1. In Chapter 2, the model is developed and consisted of a system on nonlinear partial differential equations coupled to three nonlinear ordinary differential equations. The weak solution is defined and current numerical work on structured models is discussed.
In Chapter 3, a first-order method is developed to approximate the solution to the model, and in Chapter 4, a second-order high resolution method is developed. Theoretical foundations for both methods are established. Also, convergence to the unique weak solution is verified for both methods.
In Chapters 3 and 4, the numerical results begin with showing each method is in fact of the appropriate order for a simple version of the model, and then with the full nonlinear version. Chapter 3 continues the numerical results section with preliminary studies on the key features of this model, such as various forms of growth rates (indicative of possible theories of development), and conditions for competitive exclusion or coexistence as determined by reproductive fitness and genetic spread in the population. In Chapter 4, we compare the first and second-order methods to show the computational benefits that come with a second-order method. We also demonstrate that the model can be a tool to understand surprising or nonintuitive phenomena regarding competitive advantage in the context of biologically realistic growth, birth, and death rates.
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Harrison, John Christopher. "An examination of the attitudes of Accident & Emergency clinicians toward children who deliberately self-harm." Thesis, Liverpool John Moores University, 2005. http://researchonline.ljmu.ac.uk/5842/.
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Recent years have seen an increase in self-harm behaviours amongst children and young people. In tandem, the amount of research on the phenomenon has also grown. However, despite the evident importance of care staff attitudes in the treatment of those who self-harm, an examination of the literature indicated a limited number of studies on how clinicians view such behaviour in the young. The aim of this thesis was to examine the attitudes of health care staff toward child self-harm. Within the study, it is argued that factors pertaining to both patients (age, gender and rate of admission) and care staff (role and clinical experience), will influence how an incidence of child self-harm is viewed. To answer the question, both quantitative and qualitative methods were employed. Within the former, a questionnaire was developed that contained hypothetical case vignettes of child self-harm. Once constructed, the instrument was distributed to the care staff of four Accident and Emergency departments, each of which treated self-harming children. Examination of the completed questionnaires (n = 152), showed significant differences in both staff and patient variables, confirming that attitudes toward child self-harm should not be viewed as a single entity but rather as constituent parts of a whole phenomena, each worthy of examination in its own right. In order to explore these issues in more detail, a series of focus groups were undertaken amongst care staff. Use was made of a Foucauldian discourse analysis framework devised by Kendall and Wickham (1999). This revealed intrinsic differences in the way clinicians view self-harm in children and the constituent parts therein. Comparison of both experienced and inexperienced nurses and physicians produceda raft of reasonsw hy child self-harm elicited responsesp articular to each group, ranging from personal experiences to the use of medical jargon. In conclusion, this thesis has explored a particular aspect of the self-harm spectrum, touching on topics that appear to have been neglected by the literature. The dissemination of its results to a wider audience, it is hoped, will generate debate aroundt his sensitiveto pic andt husi ncreasea n understandinogf the needso f those clinicians who deal with such vulnerable patients.
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Heffner, Michael D. "Informing Decision-Making for Derailments Involving Hazmat| An Analysis of Phmsa Train Accident Data." Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10604290.
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A review of literature suggests that train derailments are a statistically relevant concern. While not all train derailments involve hazardous materials, those that do release chemicals pose a public health threat. This study challenges the decision-making mainstay tool of the hazardous materials response community – the Emergency Response Guidebook (ERG) – and its default strategy of evacuation through quantitative research that evaluates data from train derailments involving the release of hazardous materials. It explores whether there are correlations between a derailment’s variables and evacuation, as well as correlations between the number evacuated and the number of those injured or killed. Secondary data on train derailments from the Pipeline Hazardous Material Safety Administration revealed 358 incidents involving the release of 876 substances between October 12, 1989 through August 10, 2016. The resulting data analysis confirms a certain level of predictability between causal factors and worsening outcomes supporting expansion of decision-making tools in the ERG.
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Eastham, Joe. "Workload measurement and costs in a U.K. accident & emergency department : a health economics analysis." Thesis, Keele University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.421646.
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Vassilacopoulos, George. "Aspects of information management and resource allocation in hospitals with special reference to Accident and Emergency." Thesis, Royal Holloway, University of London, 1985. http://repository.royalholloway.ac.uk/items/25499417-0afb-49ea-b48d-8d21ff56e843/1/.
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The management and control process in an Accident and Emergency (A/E) department of a District General Hospital is investigated and the functional relationship between the A/E department and the inpatient hospital service is discussed. Attention is focused on resource allocation and methods are proposed towards reconciling levels of service and resource utilisation. Within the framework of control problems inside the A/E department, a computerised patient record system has been designed and implemented, on an experimental basis, to allow easy access to patient-related information for performance evaluation. Established statistical techniques are employed to demonstrate how such information can be utilised in medium-term management activities in the A/E department and to provide a sound basis for defining areas where specific problems arise. A method is developed, which uses patient data to the extent that they are routinely available through the patient record system, for allocating physicians to weekly shifts in a way which takes account of the fixed number of physician hours per week; of physician preferences with regard to shifts; and of the patient assessment of the service provided. With regard to the role of the A/E department as an essential link between the community at large and the hospital service, a simulation model is developed for determining the number of beds in hospital inpatient departments on the basis of expected demand and according to a pre-specified set of measures of hospital efficiency. The measures used are the rapid admission of emergency patients; high occupancy rates; and short lengths of waiting lists. A further study on bed capacity planning concerns the contemplated development of an observation ward in the A/E department. Owing to the increased uncertainty in planning for prospective units, approximation is accepted for the sake of procedural simplicity and an analytic infinite server queueing model is employed to evaluate various numbers of beds for the unit interms of the average occupancy rates and of hourly and daily service levels.
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Ouedraogo, Lisa-Marie [Verfasser]. "Approaching Universal Health Coverage in Kenya : the Potential of integrating Community Based Health Insurance Schemes / Lisa-Marie Ouedraogo." Greifswald : Universitätsbibliothek Greifswald, 2017. http://d-nb.info/1129900789/34.
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Keptner, Karen M. "RISK, FUNCTIONAL OUTCOMES, AND THE UTILIZATION OF REHABILITATION SERVICES AMONG SURVIVORS OF CEREBROVASCULAR ACCIDENT: A POOLED, CROSS-SECTIONAL POPULATION-BASED STUDY." Case Western Reserve University School of Graduate Studies / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=case1408357376.
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Manu, Patrick Ackom. "An investigation into the accident causal influence of construction project features." Thesis, University of Wolverhampton, 2012. http://hdl.handle.net/2436/265178.
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The United Kingdom (UK) construction industry is one of the worst industries in the UK in terms of health and safety (H&S) performance. Numerous injuries, deaths, dangerous occurrences and work related illnesses are reported annually in the industry, and these are associated with huge economic and social costs which make the need for H&S improvement inevitable. The pursuit of improvement has triggered studies into construction accident causation which have emphasised the need to pay attention to underlying accident causal factors which emanate from the pre-construction stage in order to have sustained improvement in H&S. Construction project features (CPFs), such as nature of project, method of construction, site restriction, procurement method, project duration, level of construction, design complexity, and subcontracting, which are organisational, physical, and operational characteristics of projects emanating from pre-construction decisions fall in this category of underlying causal factors. However, despite the significance of underlying causal factors to H&S, not much attention by way of research has been given to CPFs. As a result, insight into how CPFs influence accident occurrence, the degree of their inherent potential to influence accident occurrence (i.e. their potential to cause accident) and their associated degree of H&S risk (i.e. the likelihood of accident occurrence due to CPFs) remain elusive in the extant construction H&S literature. This research was thus undertaken to empirically investigate the mechanism by which CPFs influence accident occurrence and assess their degree of potential to influence accident occurrence and their associated H&S risk. Adopting a mixed method approach, the accident causal influence of CPFs was investigated. Following a conceptualisation of how CPFs influence accident occurrence based on systems models of accident causation, a qualitative inquiry involving semi-structured interviews with experienced construction professionals was undertaken to provide empirical verification of the conceptualised view. Subsequent to the qualitative inquiry, a questionnaire survey was undertaken to elicit relevant data from experienced professionals in construction management roles to enable the assessment of the degree of potential of CPFs to influence accident occurrence and their associated H&S risk. From the analysis of data, it was found that CPFs, emanating from pre-construction decisions, influence accident occurrence by their inherent introduction of certain associated H&S issues (which can be termed as proximal accident factors) into the construction phase of projects to give rise to accidents. There are also causal interactions between CPFs and the proximal factors which can reduce or increase the presence of proximal factors. CPFs have varying degrees of potential to influence accident occurrence which can generally be high or moderate and is influenced by: the extent to which their proximal factor(s) is common (in other words prevalent) within them; and the degree of potential of the proximal factor(s) to influence accident occurrence. Where CPFs apply on a project, they are generally associated with medium risk or high risk. Whereas with medium-risk CPFs some risk control measures would suffice in mitigating risk, with high-risk CPFs substantial measures are required. As a consolidation of the research findings, a toolkit, called CRiMT, has been developed. CRiMT provides H&S risk information regarding CPFs and it has the potential of assisting pre-construction project participants in managing the accident causal influence of CPFs from the early stage of project procurement. In view of the findings, the accident causal influence of CPFs should thus not be ignored or underestimated in construction project delivery. Pre-construction project participants, especially those whose decisions determine CPFs, ought to take into consideration the H&S effects of CPFs when making decisions which determine CPFs. Also, pre-construction project participants ought to plan and implement commensurate risk control measures in the early stage of projects to eliminate or mitigate the H&S risk posed by CPFs.
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Majmudar, Meghna. "The financial implications of legislated prescribed minimum benefits for HIV/AIDS on South African Medical Schemes." Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/9446.
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Miller, Brian L. K. "Financing the "Valley of Death" : an evaluation of incentive schemes for global health businesses." Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/54591.
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Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2009.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 80-84).
Many early-stage biotech companies face a significant funding gap when trying to develop a new drug from preclinical development to a proof of concept clinical trial. This funding gap is sometimes referred to as the "valley of death", a reflection of the vast number of companies that are unable to raise the needed capital to progress into the clinic. The suggestion behind the "valley of death" phrase is that companies that should be able to attract investment do not get funded, because (1) the technical risks inherent in taking a new drug through clinical trials are high, (2) a significant amount of capital is needed to finance clinical development, and (3) the time horizon of investment is on the order of 6-8 years. Ultimately, the valley of death reflects the perceived imbalance of risk and reward for an investment at this stage as well as the resulting difficulty for a biotech company in raising capital during this time. For companies focused on a neglected disease, this risk/reward profile is even more skewed, with significantly greater market risks and fewer exit opportunities for an investor. As a result, the "valley of death" phenomenon for a global health company developing a therapeutic for a neglected disease is even more pronounced As a result, private sector funding for translational research of neglected disease therapeutics has beeri severely lacking. In an effort to spur more private sector investment into the development of neglected disease therapeutics, several market design mechanisms have been developed including Advanced Market Commitments (AMCs) and Priority Review Vouchers (PRVs). These market design mechanisms are new and unproven.
(cont.) To date venture capital has not yet flowed in a meaningful way into startup companies focusing on neglected diseases. This is partially attributable to uncertainties surrounding the credibility and value of the incentives, but it also raises the question of whether these incentives will be sufficient to attract venture investment to a small biotech company focused on neglected diseases. The objective of this thesis is to explore the potential impact of these market design mechanisms on the financial prospects of early stage, pre-revenue biotech companies focused on neglected diseases, including an evaluation of whether the incentives will be sufficient to attract venture investment to the company. To accomplish this, a simulation model was created to compare the relative impacts of these incentive schemes on a small biotech company focused exclusively on a neglected disease therapeutic. The simulation data presented herein reflect the inherent tensions between the social benefit of a neglected disease therapeutic and the need for investors to pursue a financial return commensurate with the risk of the investment. I conclude that, while market design mechanisms like PRVs and AMCs are an intriguing first step, a dual market strategy is likely still necessary for a neglected disease company to attract private investment.
by Brian L. K. Miller.
S.M.
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Guldbrandsson, Karin. "Child health promotion : analyses of activities and policy processes in 25 Swedish municipalities /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-399-X/.
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Sripa, Saksit. "Variation in drug utilisation and quality of prescribing across different health insurance schemes in Thailand." Thesis, University of Aberdeen, 2013. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=203535.
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Introduction: In 2001, the Universal Coverage (UC) policy was introduced in Thailand. This policy aimed to provide equal access to health care regardless of socioeconomic status. There are now three different health care schemes serving Thai people including the Civil Servant Medical Benefit Scheme (CSMBS), the Social Security Scheme (SSS), and the UC Scheme. Soon after the introduction of the UC there was evidence of health inequalities among beneficiaries of different schemes. The purpose of this thesis is to explore the utilisation patterns of drugs and quality of prescribing across the different health insurance schemes in order to investigate whether there are any differences or inequalities in access to health care for people covered by the different schemes. Aims: 1. Investigate whether routinely collected data held by Thai hospitals can be used to examine the drug utilisation patterns and quality of prescribing. 2. Investigate the published criteria for assessment of prescribing quality and its applicability to apply to the Thai datasets. 3. Explore the patterns of drug utilisation for patients under the different health insurance schemes. 4. Determine the extent of potentially inappropriate prescribing across the different health insurance schemes. 5. Explore the UC patients' opinions of quality of health care and prescribing. Methods: The programme of work was grouped into two main studies: i) drug utilisation study; and ii) prescribing quality study. There are six sub studies which contribute to address the study aims. A national survey of routinely collected data held in Thai hospitals was conducted to gain information of the types of data collected and types of operating software employed. Also, the survey was used as a way to engage with hospitals to ask if they would be interested in participating in the main drug utilisation study. The drug utilisation study is the main study in this programme of work with aim to illustrate patterns of drug utilisation across the different health insurance schemes and trends of drug use in the years since the introduction of the UC. Drug use in patients with diabetes and hypertension were selected as a sample to show the utilisation of drug across the schemes. A purposive sample of four hospitals was selected with respect to geographical location (north, south, north east, and central) and hospital type (regional and general) and informed by a previous national survey. Separate drug utilisation studies were undertaken at each hospital for the fiscal year 2008 using routinely acquired data. A detailed analysis was undertaken for a subsample of patients with diabetes and hypertension. The Anatomical Therapeutic Chemical classification and the Defined Daily Dose (ATC/DDD) system were used to categorise and to quantify volume of drug prescribed. The findings from the four studies were then meta-analysed to provide additional information to give more insight about the national drug utilisation and comparison across the schemes. The meta-analysis was done for only year 2008 data, seven years after the introduction of the UC. The systematic review was undertaken to provide information of the published criteria for assessing quality of prescribing on theirs development, reliability and validity, applicability, association with health-related outcomes, as well as to identified published criteria to be applied to Thai electronic datasets. The relevant drugs were selected from the drug-to-avoid list from the most widely recognised criteria, to determine the extent of potentially inappropriate drug use in patients with diabetes and hypertension who aged 65 and older. The comparison between the schemes were analysed using the year 2008 data the seventh year after the UC introduction to provide additional information for the drug utilisation study. The qualitative interview study was considered to gain more in-depth understanding about UC patients' views on quality of health care and prescribing. Patients with diabetes or hypertension were included in the interview. The thematic framework approach was applied. This study provides additional information on patients' perspectives and clearer insight on access to health care and equality which is the ultimate goal of this thesis. Results: The findings from the national survey revealed that dispensing data and patient data were routinely collected in electronic format in all hospitals. Dispensing and patient databases could be linked in most hospitals. There were 20 different software used for computerised hospital information systems. Fifty four percent of hospitals indicated their interest in participating in the study of drug utilisation. The results of the drug utilisation study identified that the number of outpatient visits increased during the period, whilst the number of inpatient hospitalisations rose moderately. Female and older people were more likely to make hospital visits than male and younger people. People under the CSMBS were more likely to visit outpatient services at the hospital than those under the UC and SSS, whilst the UC people appear to have higher admission rates than that of the CSMBS. The mean cost of all drugs prescribed per patient per year for the CSMBS was the highest, while the mean drug cost per patient per year for the SSS and the UC was similar. The mean drug costs per patient per year for patients with diabetes and hypertension show similar patterns to general population; with a substantial increase in drug cost for the CSMBS and a slight increase for the SSS and the UC. The mean DDDs of dispensed antidiabetic drug per diabetic patient per year for the different schemes after adjustment were not significantly different throughout the year. Similarly, the DDDs of dispensed cardiovascular drugs for patients with hypertension under the three schemes were not significantly different during the period. The CSMBS patients were more likely to be prescribed the newer and expensive drugs such as glitazones, atorvastatin, and ARB, with very small amounts of those prescribed to patients under the SSS and UC. The SSS and the UC patients were more likely to receive older and cheaper drugs such as glibenclamide and beta blockers. The findings from meta-analysis of summary findings from four hospitals have confirmed the drug utilisation study. These findings suggest that variation in drug utilisation across the three schemes exist. The systematic review identified published criteria for assessing quality of prescribing. The Beers criteria have been proved valid through many consensus studies, and widely adopted in many countries and settings. The criteria also have been applied with electronic data in many studies. The STOPP criteria have been proved reliable and valid. The STOPP criteria also have used up-to-date evidence in the criteria development. The extent of potentially inappropriate drug use in people aged 65 and older identified according the published drug-to-avoid lists from the Beers and the STOPP criteria varied across the hospitals. The main problematic drug prescribed to elderly patients was glibenclamide ranging from 2.1%-6.1% of elderly people. The CSMBS patients were less often prescribed drugs to avoid than UC and SSS patients. Female, older, and patients with more hospital visits were more likely to receive the problematic drugs. Twenty nine patients were interviewed. The majority of participants was female, aged over 60 years old, had elementary school education, and worked in agricultural roles. Most interviewees felt the doctors treated them well, and they had great confidence in their doctors. They felt that the treatment they received was of high quality. They also believed that their prescribed medications were good and would control their diseases. Most participants perceived that the UC had reduced the financial burden of health care for them and led to an increase in accessible health care. They also believed that they received similar treatment and services compared to those who were under the alternative schemes. Only those participants with a higher socioeconomic status were dissatisfied with the service and medications under the UC and believed that it was worse than the services under the other schemes. Conclusion: The thesis has demonstrated the existence of inequalities in drug utilisation and prevalence of inappropriate drug use across health insurance schemes after the introduction of UC. The CSMBS members are the better-off with the highest drug cost and are more likely to receive the high-cost drugs. The drug utilisation and prevalence of potentially inappropriate drug use are similar for the UC and the SSS. A more indepth study to examine clinical outcomes of the differences in drug selection under different schemes should be conducted in the future. On another side, generally, people under the UC expressed their satisfaction with the quality of health care and prescribing. The hospitals and the doctors were reliable, responsive, and trustworthy. Policy or programmes at both hospital and national level in order to address the variation in drug prescribing should be implemented.
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Lerer, Leonard Brian. "Forensic epidemiology : the interface between forensic science and public health." Master's thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/25827.
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Botha, Pieter. "The profile and cost of end-of-life care in South Africa - the medical schemes' experience." Master's thesis, University of Cape Town, 2020. http://hdl.handle.net/11427/32460.
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South African medical schemes spend billions of Rands each year on medical care costs for their beneficiaries near their end of life. Hospi-centric benefit design, fee-for-service reimbursement arrangements and fragmented, silo-based delivery of care result in high, often unnecessary spending near the end of life. Factors including an ageing population, increasing incidence rates of cancer and other non-communicable diseases, and high levels of multi-morbidity among beneficiaries near their end of life further drive end-of-life care costs. Low levels of hospice or palliative care utilisation, a high proportion of deaths in-hospital and chemotherapy use in the last weeks of life point to potentially poor-quality care near the end of life. The usual care pathway for serious illness near the end of life acts like a funnel into private hospitals. This often entails resource intensive care that includes aggressive care interventions right up until death. The result is potentially sub-optimal care and poor healthcare outcomes for many scheme beneficiaries and their surviving relatives. Understanding the complex nature of the end of life, the different care pathways, the available insurance benefits, the interactions between key stakeholders and the multitude of factors that drive end-of-life care costs are vital to setting end-of-life care reform in motion. In order to increase value at the end of life, i.e. to increase quality and/or to reduce costs, benefit design reform, alternative reimbursement strategies, effective communication and multi-stakeholder buy-in is key.
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Paolucci, Francesco. "The design of basic and supplementary health care financing schemes: implications for efficiency and affordability." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10758.
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Dror, David Mark. "Why and how to apply re-insurance to community health schemes in low-income countries ?" Lyon 1, 2001. http://www.theses.fr/2001LYO19002.
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Dans les pays à faible revenu, la plupart des personnes appartenant au secteur informel se trouvent totalement dépourvues de couvertures médicales, en raison du financement insuffisant de services santé. Le rôle des communautés qui ont institué un partage des risques, décrites comme des groupes de micro-assurances, a été reconnu, et le nombre de ces initiatives est en croissance. Toutefois, les unités de micro-assurance sont rarement structurées comme une véritable assurance-maladie. Les causes de leur instabilité financière et les solutions qui s'offrent sont expliquées dans la dissertation, basées sur des données factuelles, notamment l'Ouganda et les Philippines, ainsi que des simulations de situations, pour examiner les arguments avancés et les solutions proposées. Cette dissertation porte sur l'adaptation de techniques de gestion du risque aux systèmes communautaires ; plus particulièrement, l'accent est mis sur le transfert de risque de groupe de micro-assurance à des systèmes de réassurance. Un modèle de réassurance a été élaboré, basé sur deux hypothèses : (i) que la réassurance couvre des risques "assurable" au-delà d'un seuil, contre le paiement d'une prime ; (ii) que les unités de micro-assurance soient responsables des paiements des risques jusqu'à ce seuil (plus prime de réassurance). Un algorithme est proposé pour distinguer les prestations assurables de ceux qui sont non assurables. Le principal enseignement de cette étude est que, lorsque les résultats financiers des groupes de micro-assurance peuvent être estimés, ils peuvent faire l'objet de traités de réassurance ce qui permet de les stabiliser dès la première année. Le deuxième enseignement est qu'il faut parfois que le pool de réassurance fonctionne pendant plusieurs années avant que l'on puisse parvenir à équilibrer les recettes et les coûts. Le troisième enseignement est que la taille de groupe de réassurés peut raccourcir cette période, ainsi que réduire le coût de prime du réassureur.
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Franzén-Dahlin, Åsa. "Psychological health and life situation in spouses of stroke patients /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-196-8/.
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Wright, David R. "Accident experience of Commonwealth Government employees in Western Australia : 1 June 1993 to 2 December 1995." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/1444.
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This quantitative study documents, analyses and discusses the accident experience of Commonwealth employees in Western Australia from 1 July 1993 to 2 December 1995 as recorded on 1663 accident report forms. The research addresses the problem of lack of knowledge of accidents in the Commonwealth sector of the Western Australian work force. Its purpose is to identify possible areas of health and safety improvement and highlight where accident frequency may be reduced. Risk management is adopted as a conceptual framework to explore categories of accident related data, including month of year, time of day, day of the week of accidents, number of years of job experience, age and gender of the worker, accident frequency and severity. Where applicable accident related data was subjected to Chi-square statistical tests. Important findings, amongst others, include the identification of the month of August as having a higher frequency of accidents, inexperienced Commonwealth workers incurring 80.5% of accidents, and 64% of accidents involving men. Such findings are of importance to the Commonwealth so that prevention strategies targeted at these areas can be developed. Additional research utilising national data is recommended.
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Nofziger, Erin J. "The effects of emotional support and physical help on the health of caregivers of stroke survivors." Connect to full-text via OhioLINK ETD Center, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=mco1149001064.
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Thesis (M.S.)--Medical University of Ohio, 2006."In partial fulfillment of the requirements for the degree of Master of Science in Nursing." Major advisor: Linda Pierce. Includes abstract. Document formatted into pages: vii, 68 p. Title from title page of PDF document. Title at ETD Web site: The effects of emotional support and physical help on the health of caregivers of persons with stroke. Includes bibliographical references (p. 59-65).
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Walsh, Mike. "A study of the use made by the general public of a large urban accident and emergency department." Thesis, University of the West of England, Bristol, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.386101.
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Dale, Jeremy. "Primary care in accident and emergency departments : the cost effectiveness and applicability of a new model of care." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://researchonline.lshtm.ac.uk/682264/.
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The thesis describes the development, research and evaluation of the applicability of a new model of care that involves GPs being employed on a sessional basis in A&E departments to treat patients attending with primary care needs. The main aim of the study was to research its cost and clinical effectiveness. A multi-faceted approach was taken to include consideration of patients' needs and preferences, professional concerns, organisational and structural issues within the health service, and planning and policy issues. Clinical, sociological, epidemiological, and economic perspectives are drawn upon, reflecting the context of the service development and to provide a firm base for discussion about the generalisability and applicability of the findings. The first two chapters provide a detailed review of the epidemiological, sociological, clinical, and organisational literature relating to the primary care/A&E interface. The incentives and disincentives that may act to increase or reduce demand and supply are explored, in addition to issues relating to the 'appropriateness' of demand, the organisational culture of A&E departments, and strategies used to curtail or cope with demand. The demand for primary care at A&E departments appears to cross national boundaries and hence, literature from other countries (particularly the USA) is included and its applicability to the UK considered. Relevant literature relating to the quality of A&E care, patient satisfaction, and the costing of care is also discussed. The main study was a prospective controlled trial that was conducted at King's College Hospital. This compared process variables, clinical outcome and costs of 'primary care' consultations performed by senior house officers (SHOs), registrars, and general practitioners working three-hour sessions in A&E. A new system of nurse triage was implemented to allow the prospective identification of patients presenting with primary care needs. A total of 27 SHOs, three registrars and one senior registrar were included, and the patient sample comprised 1702 patients seen by GPs, 2382 by SHOs, and 557 by registrars or the senior registrar. GPs were found to practice considerably less interventionist care than A&E medical staff, and the resource implications were substantial. The findings are discussed critically, and their applicability is considered drawing on empirical data from recent evaluations of A&E Primary Care Service developments in other parts of London. The policy and service implications of the study are considered and further research needs identified.
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Danso, Collins Akuamoah. "Critical evaluation of the role of community based health insurance schemes in extending health care coverage to the informal sector in Ghana." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/9343.
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Includes bibliographical references (leaves 83-92).One major challenge facing the international development community is how to finance and provide health care for the large informal sector in low and middle income countries. This is as a result of the inability of the traditional tax systems in most of these countries to generate the needed revenue to help meet the health needs of the citizens. In recent times, many countries in developing countries are increasingly depending on Community Based Insurance Schemes (CBHIS) as an alternative health care financing mechanism. In Ghana. the universal tax funded system of health care introduced in 1957 soon alter independence could not be sustained because of economic recession in the 1970's and 1980's forcing the government to introduce user fees in all public health institutions. User fees resulted in a decline in utilization of health services especially the poor and vulnerable group. This situation forced many communities to set up CBHIS meant to cover user fees charged at the health facilities. The success of some of these schemes and the fact that many Ghanaians do not have insurance cover led the government to introduce a National Health Insurance Scheme (NHIS) which is mandatory for all citizens. The law mandates all formal sector workers to contribute part of their social security contribution to the National Health Insurance Fund as premium, thus making it compulsory for them. Those in the informal sector are however required to voluntarily pay directly into their district schemes. Also, even though a proposal has been made to exempt the poor, no mechanism has been determined to identify poor households for subsidy. This study sought to undertake a critical evaluation of the role of CBHIS under the NHIS in extending health care coverage to the large informal sector (who are about 70% of the active labour force) in Ghana. Specifically, the study sought to determine factors that affect enrolment, to determine a practical mechanism to identify the poor and to gain an understanding of how other countries have increased health insurance coverage.
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Mazer, Barbara Lee. "Evaluation and retraining of driving skills in clients with stroke / Évaluation et réentraînement des habiletés à la conduite automobile de clients ayant subi un accident vasculaire cérébral." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=18253.
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An important component of the rehabilitation of clients with stroke is a referral by treating clinicians to a driving evaluation service in order to determine fitness to drive. However, the validity of the evaluation procedure has not been well established. In addition, while clinicians offer therapy to help improve the level of function in many areas of daily life, few rehabilitation centres have attempted to assist clients to return to independent driving. This thesis is comprised of three manuscripts examining both the methods used to evaluate driving performance as well as the effectiveness of a novel training program on the driving success of clients with stroke.Une composante importante du processus de réadaptation des clients ayant subi un accident vasculaire cérébral (AVC) est la référence à un service d’évaluation de conduite automobile, dans le but de déterminer la capacité à conduire du client. Toutefois, la validité de la procédure d’évaluation actuellement utilisée n’a pas encore été déterminée. De plus, même si les cliniciens offrent des thérapies visant à optimiser le niveau de fonctionnement dans plusieurs domaines d’activités de la vie quotidienne, peu de centres de réadaptation ont jusqu'à maintenant tenté d’aider leurs clients à réapprendre à conduire de façon autonome. La présente thèse est constituée de trois articles portant sur les méthodes d’évaluation des performances de conduite ainsi que sur l’efficacité d’un nouveau programme d’entraînement à la conduite automobile pour les clients ayant subi un AVC. fr
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Asfaw, Abay. "Costs of illness, demand for medical care, and the prospect of community health insurance schemes in the rural areas of Ethiopia /." Frankfurt am Main : Lang, 2003. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=010171224&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Clark, Jace, and Grant Skrepnek. "Student Assessment of Risk and Return of Publicly Traded Companies Providing Accident and Health Insurance and Medical Service Plans." The University of Arizona, 2011. http://hdl.handle.net/10150/614601.
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Class of 2011 AbstractOBJECTIVES: To assess the risk and return of publicly traded health insurance companies from 1986 through 2010. METHODS: Risk and return was assessed on these companies by identifying them with SIC 6231 and 6234 (Accident and Health Insurance and Medical Service Plans) along with their presence on the CRSP database. Risk and return was analyzed via alpha and beta for SIC 632x, which were calculated utilizing the CAPM, Fama-French 3 Factor and Carhart 4 Factor econometric models. Risk and return was further assessed by calculating a Sharpe ratio along with determining annualized mean excess return and volatility for SIC 632x and the overall market. Lastly, cumulative price paths for both SIC 632x and the overall market were calculated and a Monte Carlo simulation analysis in Matlab and Microsoft Excel was run to simulate 6500 portfolios to compare risk to return ratios for SIC 632x over the time period of 1986-2010 versus the time period of 2006-2010. RESULTS: Overall, 110 companies were identified with SIC 6321 and 6234 and 7938 observations were made. The results were reported in a cross sectional format with five time periods of five years each (1986-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2010 respectively). The descriptive statistics showed that SIC 632x had a higher rate of return than the overall market (1.21±14.15 compared to 0.88±4.49; however, they also had greater risk (0.89±14.15 vs 0.57±4.48). The CAPM model captured an overall alpha value of 0.44 while the 3 Factor model provided an overall alpha of -0.20 and the 4 Factor model provided an overall alpha of 0.31. The 4 Factor model had the highest overall r-squared value of 0.16. The overall annualized mean excess return was greater for SIC 632x than the overall market (10.71% vs 6.80%) while the volatility was also greater (20.30% vs 16.17%). Additionally, the Sharpe ratio was calculated and was greater overall for SIC 632x than the overall market (0.53 vs 0.42). Graphically, cumulative asset price paths were illustrated for both SIC 632x and market-based portfolios along with a mean variance efficient frontier for the SIC 623x portfolio set during the time periods of 1986-2010 and 2006-2010. These figures showed increased return for SIC 632x compared to the overall market while illustrating increasing risk and return rate trends for SIC 632x within the sector itself. CONCLUSION: Publicly traded companies providing accident and health insurance and medical service plans possess securities that have potentially higher returns but potentially higher risk relative to the overall market. Furthermore, the findings via the alpha, Sharpe ratio and Efficient Frontier simulation illustrated that the overall market provides a similar risk to return ratio compared to that of the analyzed companies in this study.
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Osei-Akoto, Isaac. "The economics of rural health insurance : the effects of formal and informal risk-sharing schemes in Ghana /." Frankfurt am Main [u.a.] : Lang, 2004. http://www.gbv.de/dms/zbw/387833463.pdf.
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Yeung, Ka-lam Karen, and 楊嘉琳. "A comparison of the early stages of health care voucher schemes in United States and Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46943936.
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Crone, Diane. "Physical activity and mental health : a qualitative investigation into the experiences of participants on exercise referral schemes." Thesis, University of Leeds, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269929.
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Hansl, Birgit. "Adverse selection and risk selection in unregulated health insurance markets : empirical evidence from South Africa's medical schemes." Thesis, London School of Economics and Political Science (University of London), 2004. http://etheses.lse.ac.uk/2307/.
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Health insurance arrangements developed in various social settings as a means of pooling health risks and health resources in order to protect members' income against unpredictable health costs but also in order to guarantee their access to health care. Problems of unregulated health insurance markets, like adverse selection and risk selection, are frequently discussed in academic and political circles in the context of either inefficiency or inequity. Though interest in regulation as a health sector reform instrument is growing, empirical studies of unregulated health insurance markets are still rare, particularly, in low and middle-income country settings. This thesis contributes to the body of research and literature that attempts to identify empirical evidence for adverse selection and risk selection. It aims to examine the following research question: Are unregulated health insurance markets characterised by adverse selection and/ or risk selection and do they thereby create inefficiency or inequity. The objective is to demonstrate empirically whether or not these markets experience selection processes. First, this thesis derives a group method for empirical investigations into adverse selection and risk selection from which testable hypotheses can be derived. Second, this method is applied to case study data from a middle-income country. Longitudinal panel data is analysed, describing South Africa's health insurance market of medical schemes in the context of its post-deregulation experience over the four-year period 1995-1998, after premia risk-rating was legalised. The interpretation of the empirical results leads to three main findings. First, intense competition in the contested health insurance market causes favourable risk selection of low risks into and out of medical scheme plans. Second, unfavourable selection by medical scheme plans in the form of dumping high risks can be concluded. Third, there is no evidence for adverse selection and the typical adverse selection cycle cannot be observed. Exploring the policy relevance of the results, it is concluded that the effects of less health insurance regulation, in the context of middle-income country health sector reforms, conflicts with the common health policy objective of equity. More competition and efficiency comes at the price of less equity in health care access for the poor and sick, confirming the known efficiency-equity trade-off.
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Ranson, Michael Kent. "The consequences of health insurance for the informal sector : two non-governmental, non-profit schemes in Gujarat." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2003. http://researchonline.lshtm.ac.uk/682316/.
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Policy makers generally see community-based health insurance as a means of improving access to expensive medical care, particularly among the poor and preventing indebtedness secondary to medical expenidures. However, there is a paucity of empirical evidence on the impact of CBHI, and how its impact is influenced by a scheme's design, management and context. This research examined the cconornic and social impact of two CBHI schemes in Gujarat, India, and explored potential determinants of impact. A case study approach was employed. Data were collected using a variety of methodologies: a cross-sectional household survey,a review of insurance scheme utilisation data, focus group discussions, and in-depth interviews. The CBHI schemes had achieved minor successes. Both provided financial protection to those who actually used the schemes and one of the schemes was successful in including the poor. These successes, however, were overwhelmed by very low rates, of utilisation. Demand for membership in the schemes was determined in part by their strong links with larger parent organisations (a dairy co-operative and a worker's union) and by other services that were packaged with the health insurance. Factors responsible for low rates of health insurance utilisation included a lack of awareness among members of the schemes and their benefits, and perceived problems with the cost. quality and or accessibility of benefits provided. The findings support a cautious approach among those wishing, to foster CBHI in developing countries. Schemes should not be expected to contribute rapidly to broad health system goals. Consistent with past research on CBHI. this study finds that scheme design and management are of utmost importance in determining whether or not the scheme will have the desired impact. Specific areas are identified where government might intervene to optimise the impact of a CBHI scheme.
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Pettersson, Billie. "Lipid‐modifying and glucose-lowering therapies in clinical practice : The impact of guidelines and changing reimbursement schemes." Doctoral thesis, Linköpings universitet, Utvärdering och hälsoekonomi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-75545.
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cardiovascular disease, which is still a major cause of death that creates large burdens to society in terms of costs and morbidity. Dyslipidemia and type 2 diabetes mellitus are the main risk factors for cardiovascular disease, and national and international guidelines recommend lipid-modifying and glucose-lowering treatments for prevention. In 2010, about 836,000 (9% of the population) and 372,000 patients respectively were treated with these therapies in Sweden. Various pharmaceutical policies aimed at improving the efficiency of drug use have been introduced over the years. Health technology assessment (HTA) was introduced in Sweden in 2002 as a foundation for informing pricing and reimbursement decisions by the Dental and Pharmaceutical Benefits Agency (TLV). Following HTA reviews, new reimbursement schemes for lipid-modifying and glucose-lowering therapies were introduced in 2009 and 2010 respectively. To assess the impact of the changing reimbursement schemes on the use and costs of these therapies, we analyzed data from the Swedish drug registry, using a quasi-experimental design and interrupted time series analyses. Our results showed that the new reimbursement scheme for lipid-modifying treatment had a major effect on use; following the implementation of this scheme, there was a substantial increase in both discontinuation and switching to higher doses. Conversely, the new reimbursement scheme for glucose-lowering therapies had overall only a minor effect on use. Larger savings in the lipid market were anticipated but not fully realized, while even the minor anticipated changes in costs in the glucose-lowering market were not realized due to increased costs for insulins. We found that changes in reimbursement schemes might lead to unintended effects, which should be considered before implementation. Softer demand-side policies, such as recommendations and guidelines, might be a better option under some circumstances. Clinical and national guidelines are other policies aimed at improving quality of care and drug use. We assessed the impact of guidelines on the quality of lipid-modifying therapies, defined as proportions of patients attaining goal/normal levels according to guidelines for lipid management. A longitudinal retrospective observational study was carried out, covering time periods before and after initiation of lipid-modifying treatment. The findings show that about 40% of the patients attained the recommended low-density lipoprotein cholesterol goals following treatment, but only 18% attained goals/normal levels in all lipid parameters. Improvement in triglycerides was moderate, and low levels of high-density lipoprotein cholesterol persisted, showing only modest improvement following therapy. Treatment patterns were found to have a better degree of adherence to guidelines regarding low-density lipoprotein cholesterol as compared to other lipid parameters. The overall objective of treatment of type 2 diabetes mellitus is to improve glycemic control without negatively affecting quality of life. Hypoglycemia is a common side effect of intensive blood glucose control, mostly seen in patients treated with insulins. Earlier studies have suggested that hypoglycemia has a negative impact on quality of life, even in patients treated with oral glucose-lowering therapies. We carried out a cross-sectional retrospective study to assess the impact of self-reported experience of hypoglycemia on quality of life in Swedish adult patients with type 2 diabetes mellitus treated with a combination of metformin and sulfonylureas. The results showed that about 40% of the patients achieved the goal of glycemic control. About 19% reported experience of moderate or more severe hypoglycemia, and these patients were found to have lower quality of life than those patients reporting no or mild hypoglycemia, as measured by EQ-5D, a generic quality of life instrument. This could be important to consider in clinical practice.
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Shepherd, Faye. "The effect of a health intervention scheme on the mobility of dairy cows in the Southwest of England." Thesis, University of Plymouth, 2016. http://hdl.handle.net/10026.1/6564.
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Health intervention schemes have previously been used in order to improve animal welfare and to reduce and sometimes eradicate disease (Bell et al., 2009). This investigation looks at the success of one such scheme upon the incidence of cattle lameness. Farmers participating in the Healthy Livestock Scheme, which took place in the South West of England from November 2010- January 2014, had their cattle mobility scored before commencing any mentored training, to determine pre-intervention lameness prevalence and again after intervention. The results confirm there was a significant reduction in lameness, from an average 26.7% lame before any intervention to 20.4% after. This means there was on average, 23.6% fewer cases of lameness after farms had participated in the Healthy Livestock Scheme, than before. In an average 128 cow herd, this equates to seven fewer cows becoming lame each year and, based on a single case of lameness costing £180 (AHDB, 2016), this represents a significant saving of £1,283 per annum. Importantly, none of the independent variables had a significant effect upon the change in lameness seen between pre and post-intervention mobility scores. This means the Healthy Livestock scheme was effective at reducing lameness regardless of farming system, breed, herd size, housing, or number of FTEs. The wider implications of this mean that, crucially, this type of funded vet and farmer interaction reaps benefits for all farm types, regardless of these factors.
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Guelpen, Bethany van. "Folate in cancer and cardiovascular disease : prospective studies from the population-based northern Sweden health and disease study /." Umeå : Umeå University, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-850.
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McFarland, Sarah [Verfasser]. "Assessment of animal poisonings in Germany and severity scoring schemes: Needs for a One Health approach / Sarah McFarland." Hannover : Bibliothek der Tierärztlichen Hochschule Hannover, 2017. http://d-nb.info/1136292748/34.
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Freeman, Toby, and toby freeman@flinders edu au. "The Role of Health Professionals in the Prevention of Smoking- and Alcohol-Related Harms: Application of the Theory of Planned Behaviour to Work Behaviours." Flinders University. School of Psychology, 2007. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20070703.133715.
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Professional practice change and the transfer of research into practice are critical issues for the public health field. The program of research presented here investigated the potential for practice change in dental hygienists and Emergency Department nurses provision of brief interventions targeting smoking (of tobacco) and alcohol consumption respectively. Smoking and risky alcohol consumption are two high prevalence public health issues that have a substantial impact on the burden of death and illness in Australia.
Research on dental hygienists and nurses uptake of these interventions is limited and has largely focused on descriptions of perceived barriers. Little research has been conducted on the attitudes and motivations of health professionals to engage in these interventions. The present research was designed to address that gap. Specifically, two behaviours by dental hygienists and Emergency Department nurses were investigated: identification of patients at risk and provision of assistance to such patients.
The program of research applied the Theory of Planned Behaviour to these behaviours in order to:
1) examine the role of dental hygienists and Emergency Department nurses in the provision of brief interventions for smoking and alcohol consumption respectively,
2) assess the ability of the Theory of Planned Behaviour to understand and predict health professionals identifying and assisting behaviour,
3) assess the ability of the theory to account for the influence of organisational factors on workers behaviour, and
4) design and evaluate a Theory of Planned Behaviour-based professional practice change intervention.
This is the first research to apply the Theory of Planned Behaviour to these behaviours, to examine the potential of the theory to account for the influence of organisational factors on workers behaviour, and to trial an intervention targeting behaviour in an organisational setting.
The four studies undertaken provided a comprehensive application of the Theory of Planned Behaviour.
In the first study, a meta-analysis of published research examined the ability of the Theory of Planned Behaviour to predict behaviours in an organisational setting. This was the first meta-analysis of studies applying the Theory of Planned Behaviour applications to organisational settings. The findings were comparable to results of a meta-analysis of studies applying the theory to social and health behaviours, supporting the application of the theory to the organisational setting, and also highlighted the potential importance of perceived behavioural control for work behaviours. Studies 2 to 4 were designed to follow Ajzen and Fishbeins (1975) 3-step methodology for applying the theory.
In Study 2, the behavioural, normative, and control beliefs held by dental hygienists and Emergency Department nurses, and potentially relevant organisational factors, such as workload and available support, were identified through in-depth qualitative interviews.
Study 3 measured the ability of the Theory of Planned Behaviour to predict dental hygienists and Emergency Department nurses frequency of identifying and assisting. The theory was most successful in predicting dental hygienists frequency of assisting patients who smoke. The self-efficacy dimension of perceived behavioural control was the strongest predictor of this behaviour. The findings for Emergency Department nurses indicated that subjective norms were an important predictor of intentions to identify and assist patients. The Theory of Planned Behaviour accounted for the influence of organisational factors on behaviour for both dental hygienists and nurses.
Study 4 involved a randomised controlled trial which evaluated a professional intervention targeting dental hygienists assistance of patients who smoke. Trends indicated potential benefits of the intervention, but overall no significant changes in dental hygienists role adequacy, role legitimacy, and targeted control beliefs emerged. This outcome was attributed to ceiling effects and the influence of a media campaign that coincided with the intervention.
The research presented here provides partial support for the application of the Theory of Planned Behaviour to professional practice change efforts. Specifically, the ability of the theory to explain the impact of organisational factors and identify variables most predictive of behaviour may provide valuable insight for prioritising future professional practice change efforts.
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Kuchinskaya, Olga. ""We will die and become science" the production of invisibility and public knowledge about Chernobyl radiation effects in Belarus /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2007. http://wwwlib.umi.com/cr/ucsd/fullcit?p3274931.
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Thesis (Ph. D.)--University of California, San Diego, 2007.Title from first page of PDF file (viewed October 10, 2007). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 291-305).
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Karan, Anup. "Changing pattern of household expenditure on health and the role of public health insurance schemes for the poor in India : case of Rashtriya Swasthya Bima Yojana." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:0ad453e4-8974-48ad-8475-337e7d93d5b0.
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Background: In order to protect the poor from health shocks, the Government of India launched Rashtriya Swasthya Bima Yojna (RSBY) in 2008. The objectives of this study are: a) to assess the changes in the financial burden of health care on the poor population; b) to estimate the effects of RSBY in reducing the financial burden on the poor; and c) to examine the impact of RSBY on the labour supply of the poor. Methods: The study is based on data from the National Sample Survey Organisation (NSSO). The sample size is between 100-125 thousand households at the all-India level. The study uses pooled cross-section regression analysis to assess the changing pattern of out-of-pocket (OOP) payments on healthcare. The impact of RSBY on financial risk protection and labour force participation rate in India were estimated using the difference-in-differences (DID) method. Findings: My thesis consists of three papers. The findings in the first paper, changing pattern of out-of-pocket payments, reflect that the poorest 20% of households, compared to the richest 20%, realised a slower increase in out-of-pocket as a share of the household’s total expenditure (-0.5%) and catastrophic payments (-2%) during the period of 2000-2012. However, during the same period, Scheduled caste/tribe and Muslim households reported an increased burden of out-of-pocket. The second paper finds reduction in the probability of incurring ‘any inpatient expenditure’ and ‘catastrophic inpatient expenditure’ after RSBY intervention but marginal increase in the ‘per person monthly inpatient expenditure’ and insignificant change in ‘inpatient expenditure as a share of households’ total expenditure’. The effects of the scheme on the total out-of-pocket payment are negligible and non-drug expenditure reflected significant increase. The third paper finds that women’s labour supply increased (3% per annum) but the elderly labour supply declined (1.5%). Further, men switched from self-employment to casual work while women moved to wage-paid regular and casual jobs at the cost of being self-employed. Discussion and conclusion: The poor and other less advantaged population groups realised an increasing OOP burden mainly on account of two factors: i) outpatient care is not covered under RSBY; and ii) the benefit package under the scheme is very modest. Women’s labour supply increased and the elderly labour supply declined in favour of leisure because of possible improvements in health. However, the overall labour supply did not change. The Indian government needs to consider broadening the benefit package and including outpatient coverage under RSBY.