Dissertations / Theses on the topic 'Health care system'

Senior Health Care System (SHCS) is created for users to enter participants' conditions and store information in a central database. When users are ready for quarterly assessments the system generates a simple summary that can be reviewed, modified, and saved as part of the summary assessments, which are required by Federal and California law.

The health system in Tanzania follows the pattern of government structures of leadership in the form of hierarchy. The national health care system has a pyramidal structure that prioritized primary care at affordable costs to majority of people. It consists of the Village Health Service, District Hospitals, Regional Hospitals, Consultant Hospitals. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/33768

This thesis address one of the most important topics for the human being; health. Specifically, the research is about the deficiencies of the health system in Mexico. This paper shows the importance, how the system works and its current situation in the country. The purpose of this research is, based on the Pareto principle (20% vs 80%), to find how to solve most problems with the least possible investment.   It was found that the common denominator in the problems was the process and flow of information of the patients; specifically, the health records. The researchers address the issue at first explaining in a deep way the health records to highlight their importance in the health care system. In order to corroborate this finding in the literature; The researchers designed an interview, which was applied to physicians from the two main health institutions in Mexico in order to collect the necessary information to develop the thesis.   Since the design of the research is qualitative; the necessary social context is given to be able to understand the analysis and the results; likewise, the authors explain in detail the methodology used.   In spite of other important factors that were found such as the lack of results despite the investment and deficiencies in the infrastructure; It was concluded that, in fact, most of the problems were derived from the problems of health records. These results are important because it gives a parameter of what must be corrected first in order to have the expected results and a better health system.

Primary health care as a model for the provision of health services was introduced by the World Health Organization In the mid 1970s. Initially viewed as a means of health promotion and advancement of wellness in developing countries., it was soon to be adopted by industrialised countries to assist in relieving the demand on acute care services. This was to be achieved through education of the community towards good health practices and the preparation of nurses to practice in the community, outside of the acute care environment Australian nurses were slow to respond to this philosophy of health care and this study has sought to examine why this is so. It has been found that there are a multitude of reasons for the lack of action In the decade or more following the Declaration of Alma Ata and the major Issues have been identified and elaborated. Some of the major reports of the time that were associated with and had some Influence on health care and nurse education have been examined to identify recommendations and how much they support the ethos of primary health care. These include the Sax committee report of 1978 and a submission by the Department of Employment and Industrial Relations In 1987. As part of the investigation, nursing curricula from around Australia in the mid 1980s have been examined to determine the degree of the primary health care content according to guidelines recommended by the World Health Organization. It was found that generally at that time, there was a deficit In the preparation of undergraduate students of nursing for practice In the area of primary health care when the world, including industrialised nations, was making moves towards this model of health care delivery. Factors Influencing the slow response of nursing have been examined and finally recommendations for further studies have been put forward.

Thesis (M.S.)--West Virginia University, 2000.
Title from document title page. Document formatted into pages; contains vi, 94 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 92-93).

Background: Nepal was an early adopter of World Health Organization's (WHO) Primary Health Care (PHC) approach with Community Participation (CP) for delivery of basic health care service. These approaches have formed the mainstay of efforts related to provision of health care services in Nepal. However, it has struggled with its implementation because of developmental challenges, poverty, civil war and geography. Hence, it becomes important to seek to understand the dynamics around CP and PHC and how these relate to broader development challenges in the country. The main aim of this research is to understand how various Health System Actors participate in PHC in Nepal and what its implications are in PHC Methods: In order to understand CP in PHC a qualitative case study method was undertaken. Forty-one semi-structured interviews, four focus group discussions (FGD) and observation were conducted with 26 groups of grass root level and district level health systems actors in two Village Development Committees (VDC) of Sindhupalchok district of Nepal in 2014. This study examined how these actors understand PHC and CP, how they participate in it and what motivates or hinders them to participate in PHC. The results are based on data collected from interviews, FGDs, observation and the field notes. Results: There was very low understanding about PHC and CP among actors in these VDCs. Often, CP for these actors was a 'tokenistic participation' which was limited to material contribution, voluntary labour and financial donation in PHC infrastructure development and maintenance. Participation in Health Facility Management Committees and Female Community Health Volunteer were the only mechanisms of CP in PHC, which rarely represented community views. Existing traditional health system was not taken into account. Decisions were imposed top down without considering local context, practices and without involvement of local actors. The main motivations for CP amongst participants were material benefit, social recognition and religious merits whereas geography, opportunity cost, lack of awareness and socio-cultural discrimination, were barriers to participation. Discussions/Conclusions: PHC with CP needs to be contextualized to accommodate, learn and benefit from the existing traditional health system. Similarly, a stronger policy measure is needed to minimize if not to eradicate the discrimination against gender, caste, ethnicity and poverty to increase CP in PHC. In the current socio political situation, geography and current status of infrastructural development in Nepal, neither the government nor the nongovernmental / private sector alone are able to address the increased health care need. Therefore, a wider broad partnership based PHC with CP is recommended as a way forward to ensure basic health care service in Nepal. This has been even more important where reconstruction of the health system is underway after the devastating 2015 earthquake, for the community to feel ownership of local health system.

A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor of Philosophy (Community Psychology) in the Department of Psychology at the University Of Zululand, 2017
Health is a human need and considered to be a human right across all societies. Access to health care services is not a problem for those who can afford it, but, for those who cannot provide for themselves, legislation needs to protect their rights. Although there is legislation in place to protect these vulnerable populations, it is ultimately the health care practitioners’ job to protect and improve the health of their communities. It is these health care practitioners who were the inspiration for and focus of the present study. The present study emerged as a separate, but expanded version of the researcher’s limited 2011 study, which specifically focused on medical practitioners’ experiences of the current health care delivery system. Results from this 2011 study suggested that a broader spectrum of health care practitioners may be similarly affected by the current health care system and that their experiences may ultimately contribute towards a better understanding of the dynamics within which health care practitioners work and function. Therefore, the present phenomenologically-oriented study aimed to describe, explicate, interpret and analyse the experiences of a broad sample of health care practitioners through their lived, day-to-day realities in both the public and private health care sectors. Data were collected from a non-probability, purposive, convenience sample of 30 adult registered health care practitioners in public and private hospitals, clinics and private practices in the uThungulu District of Kwa-Zulu Natal, South Africa. There were 15 participants from the public and 15 from the private sector. An open-ended questionnaire was used to ascertain and understand their experiences, knowledge and exposure to the relatively new national health insurance (NHI) system, what they perceived as key objectives for effective transformation of the South African health care system, possible reasons for considering emigration in light of the current staff shortages and their views on the new NHI policy, in order to find solutions to problems. The overall data analysis consisted of three levels of subsidiary data analysis, descriptive, social constructionist and interpretive paradigms, each contributing to the whole, both “vertically and horizontally”, where participants’ experiences were described, explicated and interpreted. Research findings indicated persisting large divisions and fragmentation in and between the public and private health care sectors. Yet there was unity in responses concerning the poor and disadvantaged members of society and the challenges of their access to health care services. Sensitivity to human rights standards, past socio-political influences and awareness of health as a human right and need were evident in all participant responses. Valuable solutions to improve the health care delivery system were offered by health care practitioners as key stakeholders in the future of health care delivery in South Africa. Public health care practitioners’ experiences were dominated by overall expressions of unhappiness, anger and frustration related to poor service delivery, lack of resources, inadequate management structures, wages, inadequate consultation, fear for personal (and family) safety and the future of health care. Concern for the poor, vulnerable and the majority of citizens who use health care services, coupled with the burgeoning burden of disease, were perceived as a major stressor and source of anger towards the government and bureaucracy in general. Chronic stress and anxiety, suggestive of burnout and other negative psychological states, were also apparent. The inability to service long patient queues, inadequate communication structures/channels and lack of cohesive team practices, ethics and standards created a sense of emotional overburden and other negative affective states. These, and the uncertain future of health care under the new NHI, exerted extra stress on already overworked health care personnel. Education and effective consultation about the NHI were expressed as being inadequate and incomplete. Despite these factors, health care practitioners offered various valuable solutions and suggestions for the improvement of health care service delivery. Despite also being stressed, participants who work in the private sector were generally happier and they evinced less negative psychological states. Although a stressful environment with its own problems, within the private sector the NHI was considered to be a good concept in principle, although many participants doubted its feasibility and felt that regulatory changes often took place without adequate consultation. Given the nature and transparency of the present study, across multidisciplinary teams of health care practitioners, the researcher is of the opinion that the present study created a platform for discussion and debate around the context of a changing health care system within South Africa’s culturally diverse society. In conclusion, a critical review of the present study and recommendations for management structures, health care practitioners themselves and future research is provided.

The Patient Protection and Affordable Care Act (PPACA) is slowly transforming the U.S. Health Care System from a fee-for-service structure, which reimburses providers based on the quantity of patient encounters, to a new structure that emphasizes the value of care. Since value can be interpreted differently among various stakeholders, quality measures have been established by government and nonprofit sources. These quality measures serve as agreed-upon criteria by which to measure the achievement of value in health care. While these measures help to improve the quality of health care, they can also be burdensome to physicians and health care organizations. Implementation of quality measurement programs requires the involvement of highly intelligent people who think about what to measure, what to focus on, and how to accomplish outcomes. Thus, the process of selecting measures and compiling recommendations (reports) can be time consuming, complicated, and expensive. Applying SELP coursework fundamentals, key process activities outlined by INCOSE, and the DoD Architectural Framework, a quality measure information system was developed. The primary business objective (top level requirement) of the project was to reduce the cost and improve the quality of the measure selection and report generation processes. First, fundamental systems engineering principles were applied to understand the problem, conduct a lean analysis, identify stakeholders' needs, and derive a set of requirements to meet the primary business objective. Subsequently, five alternative solutions were evaluated to identify a preferred solution that could best meet the primary business objective while minimizing risk. The DoD Architectural Framework and course material from Integration of Hybrid Hardware and Software Systems (SELP 560) was then applied to develop, represent, and understand the information system architecture. Finally, leveraging Management Information Systems Coursework (MBAA 609), a system prototype was created utilizing Microsoft Access. The system prototype demonstrated a capability to reduce the cost and improve the quality of the health care quality measure selection and report generation processes. Utilizing pre-selected associations between various quality measures and categories of care, comprehensive quality measure reports can be generated in a matter of seconds for many categories of medical care. These comprehensive reports serve to educate users about various quality measures and to aid administrators in the development of comprehensive quality measurement programs. In one particular example, health care organizations will utilize the generated quality measure reports for the purpose of redesigning compensation and incentive pay for physicians and health care executives. In this particular example, estimates show that the system prototype is expected to reduce the labor associated with measure research and selection by approximately 49%, resulting in thousands of dollars of estimated savings. Additionally, the system will automate complicated measure search processes, which will increase the quality and consistency of the reported data.

This thesis examines, from a sociological perspective, the careers of doctors from a developing country without its own medical school or strongly organised medical profession. It argues that the interplay between the socio-economic and political forces and doctors' experiences internalised over the years at medical school, contribute to medical migration in Botswana from the public sector to private practice, and abroad. First, the thesis examines the influences that come into play when Botswana citizens choose a medical career. Then, the study explores students' medical school socialisation outside Botswana, and how this interfaces with subsequent workplace experience in Botswana. The retention efforts within the public health service and the 'pull' factors to the industrialised nations and international agencies are also studied. Data collection for this study was mainly through in-depth interviews with citizen doctors in the public and private sectors in Botswana. For doctors abroad, computer assisted interviewing was utilised. The data reveal that, in choosing a career in medicine, doctors came under varied and sometimes conflicting influences, at the family, community and institutional levels. While studying abroad, doctors were exposed to the modem technologies and facilities and an environment perceived as being conducive to work and study at the same time. These come to be pull factors when doctors, thus trained and socialised, wish to apply their skills and knowledge in practice on their return home. What obtains in medical practice, and the expectations from the state and the public for the medical profession are different from those the doctors have been socialised to expect. This situation leads to complaints and resignations by doctors. In themselves, such complaints are not peculiar to Botswana, but Batswana doctors are relatively well placed to leave the public sector. The study suggests that the solutions devised to address doctors' concerns should go beyond tinkering with monetary incentives

In the late 20th century, the management of care came under the control of large health care conglomerates, like the Carilion Health System in Roanoke, Virginia. This study examines the evolution of Carilion from its beginning in 1988 to the present and analyzes Carilion as a complex system by using analytical tools drawn from a variety of STS scholars. Carilion's mission began with its hospitals. From 1954-1988, Carilion's predecessor, the Roanoke Hospital Association, developed a network for delivering care, training programs and management to small community hospitals throughout southwest Virginia. In 1988, the Roanoke Hospital Association was officially renamed the Carilion Health System. In its initial phase, 1988-1992, Carilion expanded its hospital network into as many communities as possible. The thesis of this work is that Carilion and communities came together to see if they could build a corporation to manage care and, at the same time, maintain local traditions of care. From 1992-1996, Carilion transformed itself from a hospital organization to a health care system and finally to a managed care system in order to compete with rival Columbia/HCA. This transformation required the creation of a physician management company and a health plans division. In 1995, Carilion's administrators began a reengineering program which redefined services and strategies for corporate growth. This included construction of a state-of-the-art facility situated between two competing Columbia/HCA hospitals in the New River Valley. In 1998-2000, Carilion engaged in a massive advertising blitz to garner additional market share from Columbia/HCA. Carilion's marketing strategies show that health care has changed dramatically under a business model, in spite of corporate America's assurances that it would not. This study gives voice to health care workers who describe exactly how their experiences have changed since corporations, such as Carilion, began managing their work. Drawing on interviews with Carilion physicians, hospital administrators, board members and medical staffs, the day-to-day activities taking place within hospitals and physician practices comes to life. The narrations describe how difficult it is for groups working within Carilion's facilities to carry out Carilion's growth strategies while at the same time maintaining communities' traditions of care. Since 1999, Carilion moved in three new directions: the creation of the Carilion Biomedical Institute incorporating biotechnology and biomedicine; the institution of a hospital partial-ownership program, which meant Carilion did not have to assume full ownership and expenses of some facilities; and the installation of an electronic medical records system in physician practices to manage patients' data, physicians' costs and physicians' productivity. These new directions illustrate how Carilion envisions a different paradigm of care delivery. While the study addresses how Carilion became a managed care organization, this work represents foremost an analysis of system building in America today. Like most corporate systems, Carilion exemplifies a mix of social, economic and technological components that have been assembled to form a corporate entity. This work explains how corporate systems come to manage traditions, values and resources within communities and for communities.
Ph. D.

Despite attempts to contain health care cost, healthcare expenditure has been surging worldwide. Healthcare financing remains high on the political agenda and nations are struggling hard to balance cost containment with service quality, accessibility, efficiency, etc (Froetschel 2011). Hong Kong, of no exception, faces increasing pressure to raise public expenditure on health and is seeking new ways to finance healthcare. This paper attempts to provide an overview of Hong Kong’s existing health financing system and identify possible reform options.
published_or_final_version
Politics and Public Administration
Master
Master of Public Administration

Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2009.
Includes bibliographical references (p. 75-78).
The ailing U.S. health care system faces two tremendous challenges: a rising health care bill and a growing number of uninsured individuals. Several policies have been enacted to tackle these challenges but they are short-term patchwork solutions rather than long-term holistic solutions needed to address structural issues. Despite the market-based aspect of the U.S. healthcare system, self-correction of structural inefficiencies is unlikely to happen. A new care model has to disrupt the current care system. In line with this observation, we propose to analyze the potential of a new primary care delivery as a solution to address the two key challenges threatening to destabilize the U.S. health care. Based on our analysis of the literature, we note that chronic diseases account for a large proportion of the health care bill. Yet, the delivery model to provide chronic care, where primary care plays a central role, is inefficient, fragmented and insufficient. Compounding these ailments, primary care is facing its own crisis resulting from the shortage of generalist doctors and the inflating demand for primary care services. As primary care is critical for the continuity and coordination of medical care, resolving the urgent situation facing this branch of practice should be a top priority to improve quality of care while reducing health care costs. Every stakeholder in the current health care system should collectively contribute to the primary care model redesign endeavor.
(cont.) To this end, we apply an engineering system approach to devise an appropriate course of actions for health care businesses, health care providers and policy-makers in redesigning primary care. We discuss insights gained through a collaborative project with a local hospital to model and simulate a new primary care practice. These insights were geared to guide decision-makers in the design of care processes, resources allocation and appointment rules. In conclusion, we show that primary care has a critical role to play in the much-needed revolution of the U.S. health care system. It will require active collaboration of health care providers, business leaders and policy-makers to enable this disruptive change.
by Stéphane Chong.
S.M.in Technology and Policy

Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl'€™s five stream confluence policy process theory and Lipsky's street level bureaucracy theory provided the foundation to explore the perceptions of the CHWs about their integration into the behavioral health care system; the problems, policies, processes, and programs that impacted their ability to be integrated into the behavioral health team; and their function as a street level bureaucrat to facilitate their integration. A deductive iterative coding approach was used, culminating in the identification of the following 6 themes: health system utilization of CHW behavioral health integration, official policy recognition of the CHW profession, accountability for CHW integration, CHW practice support, integrated health care team management of physical and mental health and behavior, and building the CHW profession. The social change implications of this study are that CHWs'€™ integration into the broadly defined, integrated, physical and mental behavioral health team can support having a more cost-effective way toward having healthy people and communities because they link the community to health and social services and advocate for quality care.

Thesis (MEng)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Telemedicine is de ned as an electronic exchange of medical information and/or the delivery of clinical health care over a distance, by means of Information and Communication Technology (ICT). South Africa is faced with the problem of providing health care to a population in urban, as well as across vast rural areas. In addition to this, the South African health care system must deal with economical imbalances and a shortage of human resources to provide quality health care. Telemedicine services could provide a solution. Since the introduction of the rst national telemedicine services initiative in the late 1990s, a number of South African telemedicine services have been implemented in the public health care system. The majority of these telemedicine services have been prone to failure and many were prematurely terminated. The circumstances which in uence the failure or success of these services are not unknown. The lack of insight, and the high failure rate of telemedicine services implemented in the South Africa were the reasons for conducting this study. The purpose of the study is to assess telemedicine services implemented in the Western Cape public health care sector. The purpose is also to provide recommendations for improving the current and future telemedicine services in the Western Cape and other provinces. A telemedicine services assessment was conducted on a total of 26 telemedicine services identi ed at 6 health care facilities located in the Western Cape. The assessments were based on the TeleMedicine Services Maturity Model (TMSMM), which was developed speci cally for the purpose of assessing telemedicine services. The TMSMM capability statements were used as a yardstick to assess the maturity of each of the elements of telemedicine services in terms of the three service level groups (micro-,meso- and macro-level) and ve telemedicine domains (man, machine, material, method and money). The assessment process included: (i) the identi cation of telemedicine services at the selected health care facilities; (ii) the gathering of the relevant telemedicine service data by means of structured interviews; (iii) the transformation of the complex ow of information into Data Flow Diagrams (DFDs); (iv) the loading of telemedicine services data into a data warehouse; and (v) the analysis of data by means of On-Line Analytical Processing (OLAP), as well as box-and-whisker plots and statistical correlations. Based on the results of the TMSMM assessment, an electronic questionnaire was developed and administered amongst health care workers throughout the entire Western Cape. The questionnaire con rmed that the ndings from the TMSMM assessment are indeed representative of the entire Western Cape. The assessment of the telemedicine services provides information about the elements which a ect the success or failure of these services. This therefore addresses the initial research problem and ful ls the purpose of the study. These results were used as an input to the analysis of strengths, weaknesses, opportunities and threats (SWOT) of the delivery of telemedicine services in the Western Cape public health sector. For future references and studies, the SWOT analysis provides a point of departure for a strategic telemedicine services framework for a province like the Western Cape.
AFRIKAANSE OPSOMMING: Telegeneeskunde, per de nisie, behels die deel van mediese inligting en/of die lewering van kliniese gesondheidsdienste oor 'n afstand, deur middel van inligting en kommunikasie tegnologie (ICT). Telegeneeskunde dienste is moontlik een van die oplossings vir die lewering van gesondheidsdienste vir 'n bevolking wat versprei is oor 'n groot landelike gebied binne 'n publieke gesondheidsektor wat mense hulpbronne kort om kwaliteit gesondheidsorg te lewer. Die publieke gesondeheidstelsel van Suid Afrika het 'n drie-dubbele las van siektes, ekonomiese wanbalans and 'n tekort aan mediese praktisyns. Sedert die eerste nasionale inisiatief vir telegeneeskunde dienste in die laat 1990s bekend gestel is, is 'n paar telegeneeskunde dienste in die publieke gesondheidsektor van Suid Afrika geïmplementeer. Die meerderheid van hierdie dienste blyk onsuksesvol te wees. The faktore wat die implementeringsukses beïnvloed is nog nie goed nagevors nie. Die doel van hierdie studie is om telegeneeskunde dienste wat in die Wes- Kaap publieke gesondheidsektor geïmplementeer is te ondersoek. Die doel is verdermeer om aanbevelings te maak met die oog op die verbetering van bestaande en toekomstige dienste in die Wes-Kaap asook ander provinsies. Eerstens is 'n telegeneeskunde diens assessering uitgevoer op 'n totaal van 26 dienste 6 fasiliteite. Hierdie assesserings is gebasseer of the Telegeneeskunde Diens Volwassenheidsmodel (TMSMM), wat ontwikkel is spesi ek met die doel om telegeneeskunde dienste te assesseer. Dit word gedoen deur die dienste te meet in terme van drie vlakke (mikro-, meso- en macrovlak) en vyf domeine (man, masjien, materiaal, metode en geld). Die TMSMM vermoeë-stellings word as maatstaaf gebruik. Die assesseringsproses sluit in (i) die identi sering van telegeneeskunde dienste by die aangewese gesondheidsfasiliteite; (ii) die versameling van relevante telegeneeskunde data deur middel van gestruktureerde onderhoude; (iii) die transformasie van komplekse inligtings vloei na data vloeidiagramme (DFDs); (iv) die laai van telegeneeskundige dinste data in 'n databasis; and (v) die analyse van data deur middel van aanlyn analitiese verwerking (OLAP) sowel as boxen- snorbaard gra k en statistiese korrelasies. Gebasseer op die resultate van die TMSMM assesseringsproses, is 'n elektroniese vraelys ontwikkel en geadministreer onder gesondheidswerkers regoor die Wes-Kaap ten einde te bevestig of die gevolgtrekkings van die TMSMM assessering die hele provinsie verteenwoordig. Die assessering van die telegeneeskundige dienste verskaf inligting in terme van die faktore wat die sukses van telegeneeskundie dienste beïnvloed. Sodoende word die aanvanklike navorsingsprobleem aangespreek. Hierdie resultate is toe gebruik as inset vir die analise van die sterk punte, swak punte, geleenthede en bedreigings (SWOT) in die publieke gesondheidsektor van die Wes-Kaap in terme van telegeneeskundige dienste. Hierdie SWOT-analise kan in die toekoms gebruik word as vertrekpunt vir die ontwikkeling van strategiese raamwerk vir die implementering van telegeneeskundige dienste in 'n provinsie soos die Wes-Kaap.

Esta tesis estudia la interacción entre el sistema público y el sector privado en la provisión de servicios de salud. Consta de una introducción y tres capítulos. El primero es teórico y utiliza un modelo de diferenciación vertical de producto donde el bien en cuestión es sanidad. Los consumidores difieren en su nivel de renta y la disposición a pagar de los menos ricos no cubre su coste marginal. La provisión mediante un oligopolio mixto con un agente público que maximiza el bienestar. El sector público proporciona servicios de menor calidad pero asequibles a toda la población y el privado cubre la demanda de calidad alta. El segundo capítulo es empírico, utiliza la Encuesta de Presupuestos Familiares 90-91 y analiza si incrementar el gasto público en sanidad provoca una expansión de los recursos globales dedicados a bienes de salud. El resultado es afirmativo. El incremento de gasto público en salud tiene un efecto sustitución pero no suficiente para contrarrestar la expansión del gasto.El tercer capítulo es empírico y estudia la calidad como anexo de unión entre proveedores público y privados. La base de datos utilizada es la Encuesta Nacional de Salud de 1993 y, complementariamente, la de presupuestos Familiares 90-91.

Using Wireless Sensor Networks (WSNs) in health care system has yielded a tremendous effort in recent years. However, in most of these researches tasks like sensor data processing, health states decision making and emergency messages sending are done by a remote server. Numbers of patient with large scale of sensor data consume a lot of communication resource, bring a burden to the remote server and delay the decision time and notification time. In this paper, we present a prototype of a smart gateway that we have implemented. This gateway is an interconnection and services management platform especially for WSN health care systems at home environments, by building a bridge between WSN and public communication networks, compatible with an on-board data decision system (DDS) and a lightweight database, which enable to make the patient’s health states decision in the gateway in order to get faster response time to the emergencies. We have also designed the communication protocols between WSN, gateway and remote servers. Additionally Ethernet, Wi-Fi and GSM/GPRS communication module are integrated into the smart gateway in order to report and notify information to care-givers.  We have conducted experiments on the proposed smart gateway by performing it together with a wireless home e-health care sensor network. The results show that it is reliable and has low latency and low power consumption.

A Thesis presented on Improving and Redefining the Supply Chain in Healthcare, defining existing problems with current Supply Chain applications, and reviewing current applications and trends in the Supply Chain culture within the Manufacturing Industries and Healthcare Industries. Research of successful applications of new, and improvements to existing supply chain methodologies are presented. The concept of a future Supply Chain Management System, extending the boundaries of conventional Healthcare Supply Chain to include both conventional customer (Healthcare Materiel and Capital Assets Requestors and Distributors) and the nonconventional (the Healthcare Beneficiary), is presented in detail. Final discussions and conclusions of this concept are offered as a review of this concept for the reader of this manuscript.

Includes bibliographical references.
In this thesis, equality is considered as the absence of differences in utilization among individuals of different socioeconomic status while equity is taken to mean that individuals in equal need of health care should use the same amount of care, irrespective of their socioeconomic status. Using the above definitions, this thesis, examines equity/inequality in the utilization of public health care in Zambia. Concentration curves, concentration indices and horizontal equity indices were used for this purpose. This thesis focuses specifically on public health care that is subsidized by the Government. It is anticipated that the findings of this thesis will broaden the knowledge base on health care utilization inequities in Africa.

Older people with dementia are significant users of both long-term care and acute care services. The transitions between these services are not always smooth and very little is known about the meaning that such transitions have for people with dementia. This study aimed to explore the journeys of residential aged care facility (RACF) residents with dementia as they transition through the acute care system, and to investigate the system features and continuity of care (COC) issues that serve to shape the meanings that these transitions have for these people. The study addresses the following two research questions: 1. What meanings do people with dementia construct from their multiple transition experiences? 2. What are the factors that affect COC, and therefore, have an impact on the transition experiences of people with dementia through the system? This study was guided by a critical social constructionism paradigm and employed a whole-system design and narrative methods. This approach enabled the researcher to explore ‘the person in the system’. Data were collected through mixed methods including transfer tracking, formal interviews, observations, chart audit, and document review. Data analysis was undertaken using a narrative analysis approach that acknowledged people’s ability to construct their own meaning within particular contexts.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing
Griffith Health
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Introduction: Primary Health care refers to care which is based on the needs of population. Mental health care provided within general primary care services is the first level of care within the formal health system. There is no research in King Sabata Dalindyebo, carried out on issues around integration of mental health with primary health care. The present study is initiated to overcome this gap. Aim of the study: The aim of the study was to investigate the level of knowledge, implementation and barriers of integrating mental health care services into primary health care system at King Sabata Dalindyebo clinics, in Mthatha region. Methods: This descriptive cross-sectional study was conducted at King Sabata Dalindyebo Clinics, between January 2010 and December 2011. A 10% random sample of all health professionals from King Sabata Dalindyebo was interviewed concerning their demographic characteristics, education/ qualifications, general and further training in psychiatry, awareness about Mental Health Care Act 17 of 2002 and mental health care services characteristic related to the integration of mental health care services into primary health care system. For data analysis, the means of continuous variables across 2 groups were compared using Student-t test. The proportions (%) of the categorical variable across 2 groups were compared using Chi-square test. Results: A total of 52 health professionals (40.4% males, 59.6 females, 59.6 married, 3 doctors, 49 nurses, mean age 36.9± 8 years range 23 years-52 years), were surveyed. The participants were characterized by low level of qualification in specialization, further training in psychiatry, and by very low awareness about Mental Health Care Act 17 of 2002. Furthermore, there was no implication of expects (Regional psychiatrist, psychologist, social worker) and co-ordination of mental health care services. Working in remote and disadvantaged area, health workers with lower education qualification, absence of a coordinator for mental health care services and absence of workshop on Mental Health Care Act 17 of 2002 were determinants of lower awareness about Mental Health Care Act 17 of 2002. However, there was a good to excellent framework for potential implementation of mental health care services into primary health care system. The government support in infrastructures, drugs availability, transport and equipment was evident. Patients were helped within abroad based ethical, human rights and psycho-social framework. Conclusion: There is a lack of improving human capacity for mental health in terms of continuous training in mental health issues, policies, organisation and development. Globally, the integration of mental health care service in King Sabata Dalindyebo is non-optimal.

Health care system reforming in Ukraine is one of the priorities of modern social policy and an integral part of social and economic reorganization of Ukrainian state as a whole. The main objective of medical services reform is to improve population health, to provide equal and fair access to quality medical care for all citizens. The programme and other policy documents define ways and mechanism of the reforms, namely: structural reorganization of the field, demarcation of medical care between the levels (primary, secondary and tertiary); bed capacity optimization. The aim of the study was to analyze the real influence of medical and preventive treatment institutions on the state of health of Sumy city population. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/36367

In this dissertation System Dynamics is used as a modelling approach to model health care systems to gain a better understanding of the system’s behaviour. This improved understanding can be used to better manage the system and in turn will translate to improved health outcomes. The characteristics of complex systems were reviewed to define a health system as a complex system. Four appropriate modelling approaches was studied that could be used to model complex systems. These modelling approaches included: Monte Carlo Simulation, Discrete Event Simulation, System Dynamics and Agent Based Modelling. System Dynamics was identified as being the most appropriate modelling methodology to be used for the framework. Before the framework was developed health system performance measurement was reviewed to further the understanding of health system measurement. The framework was developed according to the insights gained from the previous reviews. Specifically the elements identification was customised to the health care environment based on available health indicators. The framework was applied in a case study where a section of the South Africa health care system was modelled to focus interventions for human immunodeficiency virus (HIV). The outcomes of the case studies delivered an increased understanding of the system behaviour and also showed appropriates of the framework.
Dissertation (MEng)--University of Pretoria, 2012.
Industrial and Systems Engineering
unrestricted

The National Healthcare System in the UK allows every resident of the country to receive the necessary medical care for free. Despite certain shortcomings, the system is a great conquest of the country.

The main theme of the thesis is managed care system description and definition. The first part is focused on managed care history, development in this system, and types of organizations providing this medical and hospital services. There is also chapter concerned with problems of resource management and managed care quality. The next chapter describes medical and health services and managed care in the USA, the only country offering these services in free mareket economy. For comparison in the next chapter there are presented someEuropean states, which try to introduce managed care as a tool for reduction of redundant and duplicate health services costs, include Czech Republic. At the conclusion, the comparison of some economic indicator of medical and health services among some European contries and the USA has been done.

The prevalence of heart failure is increasing. This is affecting the health care system; thus, making it important with change to meet the new demands. Many effective ways of treating heart failure exists, but changes are required in order to implement them. Before changes can be made, it is important to find current problem areas within the existing heart failure health care system. This study aimed to present an image of current problem areas within the heart failure health care system; in order to do so, it was necessary to speak with both care providers and heart failure patients. A total of 26 heart failure patients and 27 care providers working with heart failure patients in Stockholm County participated in the study. The participants answered survey questions concerning the heart failure care. The results from the care providers were consistent; they thought the patients’ heart failure awareness and the patient education they had received were problems within the heart failure care. In addition, they thought it was necessary for the patients to be active in their care and meet with different professions within the health care. Heart failure patients showed to be a diverse group of individuals; they wanted different kind of care and showed differences in how active they wanted to be. The results also showed differences between the care providers and patients’ perception of the heart failure care. The heart failure care needs to be more individualized to meet each heart failure patients’ needs. It is important with more patient education and to actively work with self-care. In addition, it is important that care providers get sufficient heart failure knowledge and to offer the patients the opportunity to meet with different care provider professions.
Utbredningen av hjärtsvikt ökar, vilket påverkar sjukvårdssystemet. För att möta de nya behoven är det nödvändigt med förändringar. Det finns idag många effektiva behandlingsmetoder för hjärtsvikt, men för att dessa behandlingsmetoder ska kunna implementeras behöver sjukvårdssystemet förändras. Innan dessa förändringar kan genomföras är det viktigt att identifiera problem inom hjärtsviktsvården. Målet med denna studie var att identifiera befintliga problemområden inom hjärtsviktsvården. För att kunna göra detta var det nödvändigt att prata med både sjukvårdspersonal och hjärtsviktspatienter. Sammanlagt har 26 patienter och 27 vårdgivare från Stockholms Län delaktigt. Alla delatagare har svarat på enkätfrågor rörande hjärtsviktsvården. Resultaten från vårdgivarna var konsekventa, de ansåg att patienternas kännedom om hjärtsvikt och den hjärtsviktsutbildning de fått var problemområden. Vårdgivarna ansåg vidare att det var viktigt för patienterna att vara delaktiga i sin vård, samt att de skulle få träffa olika typer av vårdgivare. Hjärtsviktspatienterna visade sig vara en blandad grupp, de ville ha olika typ av vård samt vara olika mycket aktiva i egenvård. Resultaten visade också att det fanns skillnader mellan vårdgivarnas och patienternas uppfattning av hjärtsviktsvården. Hjärtsviktsvården behöver bli mer individualiserad för att kunna tillgodose varje patients behov. Det är viktigt att utbilda patienterna samt att aktivt arbeta med egenvård. Det är även viktigt att vårdgivarna får tillräckligt med kunskap om hjärtsvikt, samt att patienterna erbjuds möjligheten till möten med olika typer av vårdgivare.

THE AUSTRALIAN HEALTH CARE SYSTEM has an overarching objective to improve the well-being of all Australians in an equitable and efficient manner. But like most developed economy health care systems, it has experienced a continual increase in demand for health care services along with increased pressure to improve efficiency, quality, and sustainability. To assist in health sector management, policy formulation, investment decisions and reform, the Australian government developed the National Health Performance Framework (NHPF). The NHPF employs performance indicators across nine dimensions of health care, including Effectiveness, Appropriateness, Efficiency, Responsiveness, Accessibility, Safety, Continuity, Capability, and Sustainability. While the National Health Performance Committee has recognised that performance indicators used within the NHPF are inadequate, this thesis argues that the solution is not a simple matter of collecting additional data and constructing new and ???improved??? indicators. Due to resource constraints within the health care system there is an implicit performance trade-off across dimensions. The NHPF must take into consideration the value individuals place on the health care dimensions to enable a shift of limited resources to those areas that are most valued. The starting point for the NHPF should be to determine what society wants out of a health system. The purpose of this thesis is to determine Australian society???s preferences for performance across the nine NHPF dimensions of health care. This is achieved using a choice modelling experiment, which describes the performance of the current health care system and alternative health care systems the government could work towards, and asks respondents to compare and choose which system they prefer. A mixed multinomial logit model is used to analyse respondent choices in order to incorporate alternative tastes across attributes, and correlation of tastes across alternatives and scenarios. Relative values attached to the nine NHPF dimensions of health care are calculated and preferences for the dimensions are ranked. The thesis concludes by exploring individual preferences derived form the choice modelling experiment in the context of social welfare theory. It also outlines the strengths and weaknesses of the methodology, provides suggestions for further research, and offers a use for social preferences in the development of performance frameworks within the Australian health care system.

Thesis (M.S.) University of Missouri-Columbia, 2006.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 23, 2007) Includes bibliographical references.

This Thesis focuses on the health care system in Lithuania and discusses the manifestations and reasons of its inefficiency. The major problems in this sector are inappropriate allocation of funds and inefficient use of resources possessed, which lead to quite low performance of the overall system. The aim of the Thesis is to find relations linking selected factors such as expenditure on pharmaceuticals or number of hospital beds to the health care spending, and to see, which resources are used in the most inefficient way. The empirical research is divided into costs dissection, done by applying fixed effects panel regression, and system efficiency examination, conducted using data envelopment analysis technique. The findings revealed that declining numbers of hospital beds and inpatient consultations do not lower health care spending and might even result in its increase. Meanwhile, data envelopment analysis confirmed that a large proportion of inefficiency in the health care sector can be addressed to overstaffing. It also showed that problems are much higher in Central and Eastern Europe countries, where the resources should be reduced by on average 30% compared to required reductions of 10% in Western Europe. On the other hand, the overall system efficiency analysis revealed that high spending does not necessarily lead to good performance of the system in terms of health status or country’s health care system’s rating. One of the conclusions drawn from the conducted... [to full text]
Šiame darbe yra aptariama Lietuvos sveikatos apsaugos sistema ir jos neefektyvumo apraiškos bei priežastys. Pagrindinės problemos, susijusios su analizuojama sritimi, yra netinkamas lėšų paskirstymas ir neefektyvus turimų išteklių panaudojimas, nulemiantys sistemos žemesnę kokybę. Atliekamo tyrimo tikslas – nustatyti ryšius, siejančius išlaidas sveikatos apsaugai ir įvairius sistemos elementus, kaip kad išlaidos vaistams ar ligoninių lovų skaičius, bei suprasti, kurie iš turimų išteklių panaudojami neefektyviausiu būdu. Empirinis tyrimas yra padalintas į išlaidų nagrinėjimą naudojant fiksuotų efektų panelinę regresiją bei sistemos efektyvumo tyrimą, vykdomą pasitelkiant duomenų apgaubimo analizės techniką. Gauti rezultatai atskleidė, jog mažėjantys ligoninių lovų ar ligonių apsilankymų stacionare skaičiai neskatina išlaidų sveikatos apsaugai smukimo, o netgi gali lemti jų išaugimą. Tuo tarpu duomenų apgaubimo analizė patvirtino tai, jog ypač didelę reikšmę sistemos neefektyvumui turi per didelis sveikatos apsaugos darbuotojų skaičius. Taip pat pastebėta, jog ši problema ypač didelė rytų Europos šalyse, kur ištekliai turėtų būti sumažinti vidutiniškai 30%, lyginant su 10% sumažinimu siūlomu vakarų šalims. Kita vertus, analizuojant bendrą sistemos efektyvumą nustatyta, kad didelės išlaidos sveikatai nebūtinai reiškia gerą gyventojų sveiktos būklę ar aukštus šalies rezultatus sveikatos apsaugos sistemų reitinguose. Viena iš šio darbo išvadų yra ta, jog prieš imantis kokių nors... [toliau žr. visą tekstą]

The transition to democracy in 1989 forced the Bulgarian health system to change. Falling government revenues and popular demand for a more transparent regime brought pressure for a new system of financing. The process of reform was slow and inconsistent. In part this reflected a lack of political will but there was also an absence of relevant information on the consequences of different options. This thesis seeks to fill this gap by means of an integrated series of studies to analyse the previous system and evaluate the options for change. The research uses literature review, documentary analysis, quantitative research (a population based survey) and qualitative research (interviews and focus groups). The research documents the scale of inequalities in health and health seeking behaviour. Self reported health varies considerably. Utilisation is more evenly distributed, although the poor access less care after allowance for their poorer health. They are also more likely to be cared for in lower tiers in the system. Informal transactions play an important role in the Bulgarian health care system. This has two components. One is a traditional 'culture of gifts which typically imposes no more than minor inconvenience and is not a prerequisite to receive care. A second has appeared more recently. It compensates for genuine shortages and reductions in salaries and does have an impact on access. The existing financing system is regressive and hospital stays can incur considerable expenditure. This is generally found from current income and there was little evidence of ill health leading to impoverishment. This was, however, largely because of the persistence of strong informal support mechanisms. The introduction of social insurance is seen as a solution to the problems of the existing system and receives widespread support, but it is poorly understood. The misconceptions threaten its sustainability. This thesis demonstrates how different methods can be integrated to evaluate a health care financing system and provides important new insights into payment for health care in countries in transition.

Researchers have found that military members serving in war experienced changes in physical and mental health. Military members' healthcare is managed by the Department of Defense. The problem was that management practices of the system for providing long-term healthcare for employees of a contracting company working in foreign combat zones is either minimal or nonexistent. The purpose of this case study was to explore ways that contractor managers and government managers can work together to provide healthcare for those contract employees who will be deployed with the U.S. military. The primary research question was to determine what managers of contractors could do to improve the management practices to support their personnel who will serve in hostile environments. To analyze data, content analysis was used. Two theories were used in the conceptual framework for this case study, Bandura's self-efficacy theory and Kolb's experiential learning theory. Ten American contractor managers and 10 government managers were interviewed regarding the information they provided to their contract employees. One major finding identified was that contractor managers and government managers had little understanding about the disparity of information, services, and assistance available to contractors before participating in this study. Additional findings were that all managers understood they play a key role in the modification, development, and mitigation of any healthcare management systems for contractors in the future. Regarding social change, the contractor managers and government managers can use the findings to improve how the U.S. government and contractor management teams provide short term as well as long-term healthcare management system for future contractor personnel who serve in combat zones thus benefiting both contractors and their families.

Philosophiae Doctor - PhD
This thesis purposes to examine the impact of financial development on health outcomes, health care expenditure and financial protection in health in 46 selected sub-Saharan African (SSA) countries from 1995 to 2014. It also estimates the impact of health care expenditure on health outcomes. The thesis is premised on the hypothesis that health care expenditure is a critical transmission mechanism through which financial development leads to better health outcomes. The health care expenditure channel is conspicuously absent in the literature on financial development and health outcomes; hence the need for this study to fill the gap in the literature. The thesis explores the effects of both depth and access dimensions of financial development on health outcomes, expenditure and financial protection. Throughout the study, financial access is measured by the number of automated teller machines (ATMs) and commercial bank branches per 100 000 people, while financial depth is measured by the proportion of broad money and bank credit to the private sector, to Gross Domestic Product (GDP). The study uses fixed and random effects and the Two-Stage Least Squares estimation approaches. The Generalised Method of Moments (GMM) is also used to estimate the impact of health care expenditure and health outcomes given the absence of valid instrumental variables. The results of the regression analyses show that financial development leads to increased health care expenditure and health outcomes. The analysis also shows that health care expenditure leads to better health outcomes. Additionally, the study indicates that financial development leads to financial protection in health care by reducing out-of-pocket health care expenditure. Well-developed financial systems provide financial protection from the risk of catastrophic health care expenditure and impoverishment resulting from illness. The study shows that health care systems financed through prepaid mechanisms reduce neonatal, infant and under-five mortality rates and increase life expectancy, while those relying on out-of-pocket expenditure have adverse effects on health outcomes.

Introducción La alta especialización en la provisión de la atención, los rápidos avances en la tecnología y la diversificación de los proveedores promueve que los pacientes sean atendidos por varios profesionales de diferentes disciplinas en organizaciones y servicios diferentes. Estas tendencias, junto con los cambios demográficos y epidemiológicos, hacen que el paciente, cada vez más, esté expuesto a una atención fragmentada. La atención fragmentada, o la atención coordinada insuficientemente entre los proveedores, pueden perjudicar al paciente, debido a la duplicación de pruebas diagnósticas, la poli-medicación inapropiada y los planes de tratamiento incompatibles. Los sistemas de salud y las organizaciones disponen de diferentes intervenciones que pueden implementar para facilitar la coordinación de servicios que se proveen a los individuos y la población, como por ejemplo la introducción de organizaciones sanitarias integradas. Estas organizaciones son definidas como un conjunto de proveedores de salud que ofrece una atención coordinada a través del continuo asistencial a una población determinada y se responsabiliza de los costes y resultados de salud de la población. Sus objetivos finales son la mejora de la eficiencia global, equidad en el acceso y la calidad de la atención, a través de la mejora de la coordinación y de la continuidad entre niveles asistenciales. La continuidad asistencial es la percepción del paciente sobre la coordinación de los servicios y se puede definir como el grado de coherencia y unión de las experiencias en la atención que percibe el usuario a lo largo del tiempo. Abarca tres tipos: la continuidad de gestión clínica y la continuidad de información entre niveles de atención y la continuidad de relación con el médico de atención primaria y el médico de atención especializada. En Cataluña (España), organizaciones sanitarias integradas emergieron como una respuesta a la diversidad de proveedores en la gestión de la atención primaria, secundaria y sociosanitaria. No obstante, su desempeño ha sido analizado principalmente desde la perspectiva de los proveedores, es decir, en relación a la coordinación entre niveles asistenciales. Los estudios sobre la percepción de la continuidad asistencial, los factores que influyen y las consecuencias desde el punto de vista de los usuarios del sistema nacional de salud de Cataluña siguen siendo escasos. Objetivo Explorar la percepción del usuario sobre la continuidad entre niveles asistenciales en las diferentes áreas del sistema nacional de salud catalán, así como los factores que influyen y las consecuencias sobre la calidad de la atención, con la finalidad de contribuir a su mejora en el sistema de salud. Métodos La investigación consistió en tres estudios que abordan diferentes aspectos de la continuidad asistencial. 1) Análisis de la evidencia internacional sobre la continuidad asistencial desde la perspectiva del paciente, mediante una meta-síntesis de estudios cualitativos basada en la búsqueda bibliográfica en diferentes bases de datos electrónicas (Medline, Web of Science y Cochrane Library Plus). La estrategia de búsqueda incluyó la combinación de "continuidad asistencial" o términos relacionados, estudios cualitativos y la perspectiva del paciente. 25 estudios originales, publicados entre 1999 y 2009 que cumplieron con los criterios de inclusión fueron incluidos en la síntesis. Se realizó un análisis de contenido mediante la identificación de temas y categorías y la agregación de los resultados de los tres tipos de continuidad asistencial. 2) Análisis de la percepción de la continuidad asistencial de los pacientes con EPOC atendidos en cuatro organizaciones sanitarias integradas del sistema nacional de salud de Cataluña, mediante un estudio de caso múltiple de los pacientes con EPOC. Se seleccionó una muestra teórica en dos etapas: (i) cuatro organizaciones sanitarias integradas, (ii) dos casos de estudio de cada organización que incluían un paciente con EPOC, su médico de atención primaria, su neumólogo y su historia clínica. La información fue recogida mediante entrevistas individuales semiestructuradas con los pacientes y sus médicos y la revisión de las historias clínicas. Todas las entrevistas fueron grabadas y transcritas literalmente. Se llevó a cabo un análisis temático de contenido, segmentando la información por organización y caso, con una triangulación de fuentes y la participación de diferentes analistas. 3) Análisis de la continuidad asistencial en las diferentes áreas sanitarias del sistema nacional de salud catalán, enfocando el análisis en los tres tipos de continuidad asistencial, los factores que influyen y las consecuencias en la calidad de la atención. Se seleccionó una muestra teórica en dos etapas: (i) contexto de estudio: tres áreas sanitarias que representan la diversidad de modelos de gestión para la provisión de los servicios sanitarios y (ii) los usuarios de los servicios sanitarios. Se realizaron entrevistas individuales semiestructuradas con los usuarios de los servicios sanitarios (de 14 a 18 por área) hasta alcanzar la saturación de la información. Todas las entrevistas fueron grabadas y transcritas textualmente. Se llevó a cabo un análisis de contenido temático, segmentando la información por área de estudio, con una generación mixta de categorías y la participación de diferentes analistas para garantizar la calidad de los resultados. Se obtuvo la aprobación ética de los protocolos de estudio. Resultados En general, los pacientes atendidos en el sistema nacional de salud catalán percibieron la existencia de los tres tipos de continuidad asistencial con algunos elementos de discontinuidad identificados en todas las áreas y organizaciones sanitarias integradas de estudio. Con relación a la continuidad de la gestión clínica entre niveles asistenciales, los pacientes percibieron que habían recibido el mismo diagnóstico y tratamiento por los médicos de los diferentes niveles asistenciales, sin repeticiones innecesarias de pruebas, y con las derivaciones oportunas al otro nivel de atención cuando era necesario. Además, los pacientes señalaron de manera consistente tiempos de espera adecuados a la atención especializada en casos urgentes, incluidos las exacerbaciones de los pacientes con EPOC, y después de una derivación. Sólo unos pocos pacientes de todas las áreas identificaron elementos de discontinuidad, por ejemplo las diferentes opiniones sobre su tratamiento, algunas duplicaciones de pruebas, falta de derivaciones a la atención especializada cuando las necesitaban y tiempos de espera excesivos para algunas pruebas específicas y la derivación a la atención especializada no urgente. En referencia a la continuidad de la información entre niveles asistenciales, los pacientes de ambos estudios realizados en Cataluña, en general, percibieron que la información clínica se registró, fue transferida entre niveles mediante el ordenador y utilizada por los médicos, con la excepción de un área de estudio (Ciutat Vella en Barcelona), donde se percibió que la información fue compartida parcialmente. Además, algunos pacientes de todas las áreas destacaron que alguna información no fue compartida a través del ordenador y que algunos médicos, especialmente los médicos de urgencias y los médicos suplentes, no siempre consultaron la información de la historia clínica. Finalmente, en cuanto a la continuidad de relación, la mayoría de los pacientes señalaron que en general fueron atendidos por el mismo médico de atención primaria durante un largo periodo y por médicos suplentes en algunas ocasiones. Sin embargo, los pacientes con EPOC de algunas organizaciones sanitarias integradas destacaron una alta rotación del personal de atención primaria. Con referencia a la atención especializada, numerosos pacientes de ambos estudios señalaron inconsistencias; aunque muchos pacientes no las identificaron como un problema al considerar que todos los médicos de la atención especializada eran competentes para tratar su problema de salud y que se compartía la información clínica. Casi todos los pacientes que percibieron una consistencia del personal también desarrollaron una relación continua basada en la confianza con los médicos y el conocimiento acumulado. Se identificaron varios factores que influyen en (la falta de) la continuidad asistencial, que se clasificaron en los factores relacionados con el sistema de salud, las organizaciones y los médicos. En relación con el sistema de salud, los pacientes de ambos estudios consideraron que la clara distribución de roles y responsabilidades entre los médicos de atención primaria y especializada favoreció la consistencia del diagnóstico y tratamiento y evitó incompatibilidades en la medicación prescrita y duplicaciones de pruebas. Sin embargo, según algunos pacientes, la función de puerta de entrada del médico de atención primaria podría también extender los tiempos de espera o incluso impedir el acceso a la atención especializada. Con respecto a las organizaciones sanitarias, los usuarios consideraron que los mecanismos de coordinación implementados (historia clínica compartida, reuniones presenciales), los mecanismos de comunicación informal (uso del correo electrónico y teléfono) y la colocalización de los médicos en el centro de atención primaria, que emergieron sólo en algunas áreas de estudio, influyeron positivamente en la recepción de un tratamiento consistente, la transferencia y uso de información adecuada y las derivaciones oportunas a la atención especializada. Por otro lado consideraron que los insuficientes los recursos disponibles, evidenciados por la falta de médicos, causó largos tiempos de espera para la atención secundaria y un uso insuficiente de la información clínica. En cuanto a la continuidad de relación, según los pacientes, los pequeños centros de atención primaria en dos áreas de estudio y un sistema para la obtención de citas adecuado favorecen la consistencia del personal; mientras que la re-organización de listas de pacientes la dificultan. Por último, en relación con los factores relacionados con los médicos, la competencia técnica del médico de atención primaria promovió derivaciones adecuadas y oportunas a la atención secundaria. Consideraron que la disposición del médico a colaborar influyó en el uso de la información y evitó duplicaciones de pruebas e inconsistencias en el tratamiento. La práctica médica adecuada, así como una comunicación médico-paciente efectiva favorecieron el desarrollo de una relación médico-paciente basada en la confianza y el conocimiento acumulado mutuo. El compromiso del médico en el cuidado del paciente pareció influir tanto en el uso de la información como en el establecimiento de una confianza mutua. Los pacientes identificaron diferentes consecuencias de los tres tipos de continuidad asistencial relacionadas con la calidad de la atención y, en menor medida, con los resultados de salud. Respecto con la continuidad de la gestión clínica, los pacientes percibieron que la falta de consistencia de la atención y de acceso entre niveles resultó en un uso inadecuado de recursos, debido a que se duplicaron visitas. Además produjo angustia y posibles efectos negativos para la salud, cuando se dieron largos tiempos de espera a la atención especializada después de una derivación, que llevó a que el paciente buscara atención médica privada. En cuanto a la continuidad de la información, los pacientes destacaron que el intercambio de la información clínica entre niveles evitó la duplicación de pruebas e intervenciones médicas y la prescripción de medicamentos incompatibles. Además, los pacientes no necesitaban guardar y llevar los resultados de las pruebas al médico del otro nivel de atención. Por último, en cuanto a la continuidad de relación, los pacientes relacionaron la consistencia del personal con menos derivaciones innecesarias, sin modificaciones en el plan de tratamiento que pudieran perjudicar al paciente ni duplicaciones de pruebas. Además, percibieron que una relación continúa basada en la confianza y el conocimiento acumulado facilitó el diagnóstico y dio lugar a una sensación de seguridad y comodidad así como que el paciente siguiera adecuadamente el plan de tratamiento. Conclusiones Esta tesis contribuye con el aporte de información sobre la continuidad asistencial, un tema escasamente analizado, mediante una mejor comprensión del fenómeno percibido por los usuarios de los servicios sanitarios del sistema nacional de salud de Cataluña. Los resultados sugieren que el paciente es capaz de percibir los tres tipos de continuidad asistencial refiriéndose a atributos concretos de cada dimensión. Los tres tipos de continuidad asistencial parecen estar relacionados entre sí; particularmente la continuidad de información afecta a la continuidad de gestión clínica, y la continuidad de relación juega un papel importante al influir en la continuidad de gestión clínica y de información. Los pacientes en general perciben la existencia de los tres tipos de continuidad asistencial. Sin embargo, también señalan algunas interrupciones en la continuidad en todas las áreas de estudio. Se identificaron varios factores que influyen en la (dis)continuidad asistencial, relacionados con el sistema de salud, las organizaciones sanitarias y los médicos. Como resultado del estudio, se identificaron diferentes consecuencias de los tres tipos de continuidad asistencial en la calidad de la atención y la salud del paciente. Los elementos de discontinuidad identificados sirven para indicar donde hay margen de mejora, y los factores que influyen en la continuidad pueden ofrecer información valiosa a los directivos y profesionales de las organizaciones sanitarias en estos y otros contextos sobre dónde dirigir sus esfuerzos de coordinación asistencial; que supuestamente también mejoraría la experiencia de una trayectoria fluida a lo largo del continuo asistencial del paciente.
Introduction: Specialization in health care, rapid advances in technology and the diversification of providers cause that patients receive care from several professionals of different disciplines in various settings and institutions. These trends together with demographic and epidemiological changes increasingly expose the patient to fragmented care delivery, which can be harmful to them due to duplication of diagnostic tests, inappropriate poly-pharmacy and conflicting care plans. Continuity of care is the patient’s perception of the coordination of services and can be defined as how one patient experiences care over time as coherent and linked. It embraces three types: continuity of clinical management and information across the care levels and continuity of relation with the primary and the secondary care physician. Studies on continuity of care from the point of view of healthcare users of the national health system of Catalonia are still scant. The objective is to explore the user’s perception of continuity of health care in different healthcare areas in the Catalan national health system, as well as its influencing factors and consequences on quality of care, in order to contribute to its improvement in the healthcare system. Methods: The research consisted of three individual studies addressing different aspects of continuity of care: 1) Analysis of the international evidence on continuity of care from the patient’s perspective, employing a meta-synthesis of qualitative studies based on a literature search in various electronic databases. 2) Analysis of COPD patients’ perceptions of continuity of care in four integrated health care networks of the national health system of Catalonia, using a multiple-case study of patients. Data were collected by means of individual semi-structured interviews with patients and physicians and the review of clinical records. 3) Analysis of continuity of care in different healthcare areas of the Catalan national health system (representing the diversity of management models for the delivery of service). Individual semi-structured interviews with healthcare users (49) were employed until data saturation was reached. Ethical approval of the study protocols was obtained. Results: Results suggest that patients are able to perceive the three types of continuity of care by referring to concrete attributes of each dimension. Patients served in the Catalan national health system generally perceived that the three types were existent with a few elements of discontinuity identified in all study areas including the integrated health care networks. A number of factors influencing (dis)continuity of care were identified, which were classified into factors related to the healthcare system, the organizations and the physicians. Different consequences of continuity of care for quality of care and the patient’s health emerged from the study findings. The three types of continuity of care appeared to be interrelated; particularly continuity of information affecting continuity of clinical management, and relational continuity playing an important role by influencing the other two types. Conclusions: This thesis contributes to filling the existing knowledge gap on continuity of care by providing a better understanding of the phenomenon as perceived by users of the national health system of Catalonia. The identified elements of discontinuity serve to indicate where there is room for improvement, and the factors influencing continuity can offer valuable insights to managers and professionals of health care organizations in these and other contexts on where to direct their care coordination efforts; which supposedly would also enhance the patient’s experience of a smooth trajectory along the care continuum. Introducción: La alta especialización en la provisión de la atención, los rápidos avances en la tecnología y la diversificación de los proveedores promueve que los pacientes sean atendidos por varios profesionales de diferentes disciplinas en diferentes organizaciones y servicios. Estas tendencias, junto con los cambios demográficos y epidemiológicos, hacen que el paciente, cada vez más, esté expuesto a una atención fragmentada, lo que le puede perjudicar debido a la duplicación de pruebas diagnósticas, la poli-medicación inapropiada y los planes de tratamiento incompatibles. La continuidad asistencial es la percepción del paciente sobre la coordinación de los servicios y se puede definir como el grado de coherencia y unión de las experiencias en la atención que percibe a lo largo del tiempo. Abarca tres tipos: la continuidad de gestión clínica y la continuidad de información entre niveles de atención y la continuidad de relación con el médico de atención primaria y el médico de atención especializada. Los estudios sobre la continuidad asistencial desde el punto de vista de los usuarios del sistema nacional de salud de Cataluña son escasos. El objetivo es explorar la percepción del usuario sobre la continuidad asistencial en las diferentes áreas del sistema nacional de salud catalán, así como los factores que influyen y las consecuencias sobre la calidad de la atención, con la finalidad de contribuir a su mejora en el sistema de salud. Métodos: La investigación consistió en tres estudios que abordan diferentes aspectos de la continuidad asistencial: 1) Análisis de la evidencia internacional sobre la continuidad asistencial mediante una meta-síntesis de estudios cualitativos basada en la búsqueda bibliográfica en diferentes bases de datos electrónicas. 2) Análisis de la percepción de la continuidad asistencial de los pacientes con EPOC atendidos en cuatro organizaciones sanitarias integradas del sistema nacional de salud de Cataluña, mediante un estudio de caso múltiple de los pacientes. La información fue recogida mediante entrevistas individuales semiestructuradas con los pacientes y sus médicos y la revisión de las historias clínicas. 3) Análisis de la continuidad asistencial en diferentes áreas sanitarias (representando la diversidad de modelos de gestión para la provisión de servicios sanitarios). Se realizaron entrevistas individuales semiestructuradas con usuarios de los servicios sanitarios (49) hasta alcanzar la saturación de la información. Se obtuvo la aprobación ética de los protocolos de estudio. Resultados: Los resultados sugieren que los pacientes son capaces de percibir los tres tipos de continuidad asistencial refiriéndose a atributos concretos de cada dimensión. En general, los pacientes atendidos en el sistema nacional de salud catalán percibieron la existencia de los tres tipos de continuidad con algunos elementos de discontinuidad identificados en todas las áreas y organizaciones sanitarias integradas de estudio. Se identificaron varios factores que influyen en la (dis)continuidad, relacionados con el sistema de salud, las organizaciones sanitarias y los médicos. Se identificaron diferentes consecuencias en la calidad asistencial y la salud del paciente. Los tres tipos parecen estar relacionados entre sí; particularmente la continuidad de información afecta a la continuidad de gestión clínica, y la continuidad de relación juega un papel importante al influir en los otros dos tipos. Conclusiones: Esta tesis contribuye al conocimiento sobre la continuidad asistencial, un tema escasamente analizado, mediante una mejor comprensión del fenómeno percibido por los usuarios del sistema nacional de salud catalán. Los elementos de discontinuidad identificados sirven para indicar donde hay margen de mejora, y los factores que influyen pueden ofrecer información valiosa a los directivos y profesionales de las organizaciones sanitarias en estos y otros contextos sobre dónde dirigir sus esfuerzos de coordinación asistencial; que supuestamente también mejoraría la experiencia de una trayectoria fluida a lo largo del continuo asistencial.

Blindness is a serious socioeconomic handicap and most causes of blindness are preventable. The Primary Health Care System has been identified by the World Health Organisation as the 'first line of defence' in tackling the health care problems of developing countries. This is as true for eye care as it is for the whole range of other diseases and illnesses that affect a country's population. The Primary Eye Care system is, therefore, essential in the prevention of many ocular disorders that may cause blindness. The aim of the thesis is to define the current status of primary eye care systems in the Kingdom of Saudi Arabia. It will concern itself with identifying and assessing the current resources and facilities that are available for eye patients at the primary health care level. It will also determine the strengths and weaknesses of the existing primary eye care system in the country according to geographical location, covering both urban and rural areas. Specific recommendations for action are formulated, in the light of the data collected, aimed at the reduction, control or elimination of avoidable and curable blindness. The ultimate goal of this thesis is, therefore, to add to the existing knowledge of eye care problems in the Kingdom and to put forward a series of recommendations to help in the prevention of blindness in the Kingdom of Saudi Arabia.

碩士
正修科技大學
電子工程研究所
102
Nowadays Taiwan has entered into the era of high elderly society. Almost every young man has to pay for their parents daily expenses. But the economy today makes people very hard to live, so ordinary people cannot afford to hire a home care, or depend on just one person to afford all the expenses. Due to the status we will need a simple system for the elderly to help themselves measure the condition of their own body. This paper is based on how to design a system that can make the elderly convenient to measure their own body condition at home, using a fast and easy method with a WiFi connection to upload their situation to the data base. Or they can upload their data via Bluetooth connection by using their cell phone, their family members can monitor their status anytime anywhere. Besides, by using this detection system, we can load the data for the doctors or medics to see without having to come the house and having to measure the senior themselves. By this, we can achieve the convenience of home care. Many experts and scholars have suggested the adults should measure and record their blood pressure every day and night, that can effectively prevent or control chronic diseases. Many experts and scholars have suggested that adults can sooner or later each time the measure and record blood pressure, which can effectively prevent or control chronic diseases. The oxygen level will affect the sleep of cardio, cardiovascular disease patients, it is easy due to lack of blood oxygen caused by insomnia, and even breathing difficulties and other problems, breathing adult values at 16-20 beats per minute at rest, If more than 20 beats or less than 16 beats, it means that the physical condition of abnormal need to find a doctor. Therefore, the paper constructed a simple physiological signal monitoring system, to measure blood pressure, blood oxygen, respiration and heart rate. By using the method of our system, we hope to help the seniors to be able to manage their own body condition so the young ones can focus on their career without having to worry about their seniors at home.

碩士
長庚大學
電機工程學研究所
96
Recently, the innovation in technology alters the way of healthcare for the elderly. Wearing a wireless and portable monitoring system can allow the elderly to move freely and safely. This study proposes a wireless system which integrates multiple sensors, two-lead ECG, three-axis accelerometer, two-axis Gyroscope, a Altimeter, to monitor physical conditions of the elderly. While falls or heart-rate irregulation were detected, an alarm would be sent to an healthcare system. Also, the system provides event-reminding function. Possible events for reminding include current weather, temperature and time for medicine taken.

碩士
國立交通大學
管理學院高階主管管理碩士學程
104
Taiwan Formosa Water Park explosion such "extreme disaster" this time was survive by the enthusiasm of medical staff, but health care system can not rely on enthusiasm. Since 1995, the implementation of National Health Insurance System, to 2011 the number of physicians grow to 68%, but the daily outpatient, emergency patients grow nearly 109%, day surgery patients grow about 114%, with 1.7 doctors per thousand people, and the medical costs accounted for Taiwan's GDP (gross domestic product) accounted for only 7%, well below the 10% of UK, 17% in the United States. In this paper, we use SWOT analysis, public questionnaires, medical questionnaire, review of the literatures and the experience of other countries to understand and more clearly the impact of the health care policy to critical care system. We summary three internal problems to Taiwan critical physicians, two foreign aggression problems to Taiwan medical hospital, twelve focus problems of Taiwan National Health Insurance System, a structural problem, and a fundamental problem. Taiwan National Health Insurance System 20 anniversary, hopes the politician of Taiwan can grasp this opportunity, begin to build a permanent, reasonable and equitable health care system.

碩士
國立高雄應用科技大學
電機工程系博碩士班
105
This research aims at the upcoming human rights issue of geriatric health care like reluctance of elders to stay in nursing home or senior living communities, etc. Conforming to the trend of instrument portablization, we designed the wearable home health care system to resolve the problem. It has the advantages of wearable devices, including real-time monitoring and portability. It can link to several kinds of biomedical elements, such as muscle sensors, heart rate monitors, and body temperature sensors, for people who need special health care. The system utilize single chip microcontroller of ATmega series to run the core program, which can analyze signals from gyroscope, biomedical elements, or other components. Through network interface to connect to wireless Wi-Fi module, users’ physiological information can be uploaded to database for further management. The hardware architecture refers to the user’s arm curvature and is manufactured through 3D printed injection molding. Through this design, the wearable home health care system can be applied for long-term physiological monitoring with minimal disturbance in daily hand work.

碩士
國立成功大學
電機工程學系專班
100
The problem exist in most elder’s care enterprise are concerning to the management and operation, such as “the shortage of manpower”, “cost and quality dilema”, and “effectiveness of management”. Since 2010 the Department of the Interior Taiwan plan to accredit and evaluate every elder’s care enterprise in Taiwan. This make many enterprise to seek for the help, information and data digitalize become the first choice of substitution. The clouding computer using in the elder’s care management was instantaneous make this problem to be alleviated. In this research, we try to find out a data centralize, system distributed, and customize system of clouding computation, for the elder’s care management system, trough the a ASP.NET technology. By putting the system and database into cloud computation, the user (elder’s care enterprise) only need PC with network connected equipped, once can gain the service from this professonar management system, to take care their enterprise, any aspect of operation, healthcare and social living. This project may overwhelm many information technology problems, such as setup, service contents, cost and method problem. By integrated this system, once will recommend an new service model to this enterprise, especially the communication among caregiver and family, to improve the care quality, professionally and reliability. This reliability will than convert to be a progressive social living, stability and realibility index. Keywords ：The cloud seniors health care *The Author **The Advisor