To see the other types of publications on this topic, follow the link: Health economics; Perinatal care.
Dissertations / Theses on the topic 'Health economics; Perinatal care'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Health economics; Perinatal care.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Mugford, Miranda. "How does the method of cost estimation affect the assessment of cost-effectiveness in health care?" Thesis, University of Oxford, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.318922.
Full text
2
Dulaney, Kristina, Diana Morelen, Matthew Tolliver, and Gayatri Jaishankar. "Integrating Perinatal Mental Health Screening into the Primary Care Setting." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8856.
Full text
3
Laubscher, Jessica. "Perceived barriers to perinatal mental health care utilization : a qualitative study." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79988.
Full textAbstract:
Thesis (MA)--Stellenbosch University, 2013.ENGLISH ABSTRACT: The topic of perinatal depression (i.e. depression during and after pregnancy) remains a subject of continued research interest, as a broad literature body reports that a large proportion of women suffering from this mental disorder do not receive appropriate treatment. This is worrisome, firstly, because mental health treatment is often readily available to the public and at no cost. Secondly, untreated perinatal depression not only holds dangerous consequences for the mother but also for the infant and the rest of the family. It is therefore important to identify those factors that act as barriers to mental health care utilization for perinatal depression. Although this is a persistent problem within the South African context, to date, little is known about the barriers to the utilization of available mental health services experienced among pregnant South African women. For this reason, the Perinatal Mental Health Project (PMHP) aims to provide mental health services at the same location where women receive obstetric services. However, despite their efforts, the number of women who decline available treatment is still of great concern. The present study offers a unique perspective on counselling for perinatal depression appointment-keeping barriers as it provides a holistic view of these barriers that exist not only within the women but also in their multi-levelled environments. Secondly, it addresses the problem of nonattendance to mental health care treatment offered by the PMHP and consequently also addresses the gap in South African research on the topic. The sample for this study was selected from PMHP files of those patients who failed to attend scheduled counselling appointments. The participants included in this study were selected by means of purposeful sampling to participate in face-to-face and telephonic semi-structured interviews. Participants were assured of confidentiality and anonymity. The semi-structured interviews were audio-recorded and transcribed after which transcriptions were entered into MS Word for textual analysis. Transcriptions were thematically analysed. The main themes that emerged from the present study included individual-related barriers, social-related barriers, institution-related barriers, community-related barriers and poverty-related barriers. The results of the present study reflect the motivations for depressive pregnant women to decline available and free mental health services provided by the PMHP, according to five main themes. These themes were then discussed according to Bronfenbrenner’s (1977; 1979) Ecological Systems Theory, which categorised the main themes identified according to the different systems operating within the patient’s environment, i.e. the individual-, micro-, meso-, exo-, and macrosystem. The individual system comprised the individual-related barriers, which included poor mental health, and ambivalent feelings toward the pregnancy. The microsystem comprised the social-related barriers, which included low social support and self-help strategies. Community-related barriers were considered within the mesosystem of the patient’s ecological environment, with stigma and pity as sub-barrier. The exosystem comprised the institution-related barriers, including referral protocol barriers, lack of information provided by the nurses, and nurses’ attitudes as experienced by participants. Lastly, poverty-related barriers were considered within the macrosystem, with financial life hardship, constant child-care demands, and transportation barriers as sub-barriers. The significance of this study lies in the original perspective offered on mental health care appointment-keeping behaviour within the South African context. Future research could, in addition to conducting interviews with hospital patients, include health care professionals and focus groups as this will allow for triangulation of the perspectives of all significant players. Also, having identified the problems and concerns with regards to attending counselling appointments, future research direction may be aimed at creating interventions designed to reduce the identified barriers to mental health care service use.
AFRIKAANSE OPSOMMING: Perinatale depressie (d.w.s. depressie voor en na swangerskap) bly ʼn onderwerp van voortdurende navorsings belang, aangesien ʼn breë navorsingsveld aandui dat ʼn groot proporsie van vroue wat aan hierdie geestesversteuring lei, nie die gepaste behandeling ontvang nie. Dit is kommerwekkend, eerstens, aangesien behandeling vir geestesgesondheid meestal openlik verkrygbaar is aan almal sonder enige koste. Tweedens, onbehandelde perinatale depressie hou nie slegs gevaarlike gevolge vir die moeder in nie, maar ook vir die baba en die res van die gesin. Dit is daarom belangrik om daardie faktore te identifiseer wat as hindernisse optree tot geestesgesondheid sorg diensgebruik vir perinatale depressie. Alhoewel dit ʼn voortdurende probleem binne die Suid-Afrikaanse konteks is, is daar tot op hede geen navorsing wat hindernisse tot gebruik van beskikbare geestesgesondheidsdienste bekend gemaak nie, veral wat ervaar word onder swanger Suid-Afrikaanse vroue nie. Vir hierdie rede, beoog die Perinatal Geestesgesondheid Projek (Perinatal Mental Health Project - PMHP) om geestesgesondheidsdienste te lewer by dieselfde plek waar vroue verloskundige dienste kan ontvang. Nietemin, ten spyte van hul pogings, is die getal vroue wat beskikbare behandeling van die hand wys steeds van groot kommer. Dié studie bied ʼn unieke perspektief op hindernisse tot berading vir perinatale depressie afspraak-ooreenkoms gedrag, aangesien dit ʼn algehele uitkyk bied op hindernisse wat nie slegs binne die vroue bestaan nie, maar ook in hul veelvlakkige omgewings bestaan. Tweedens, spreek dit die probleem van nie-bywoning van geestesgesondheidsbehandelingsdienste wat aangebied word deur die PMHP aan en gevolglik ook die gaping wat binne Suid-Afrikaanse navorsing rakende dié onderwerp bestaan. Die steekproef vir die studie was gekies van PMHP lêers van daardie pasiënte wat nie hul geskeduleerde terapie afsprake bygewoon het nie. Die deelnemers ingesluit in die studie is deur middel van doelgerigte-steekproefneming geselekteer om aan aangesig-tot-aangesig of telefoniese semi-gestruktureerde onderhoude deel te neem. Deelnemers is van hul vertroulikheid en anonimiteit van die proses verseker. Die semi-gestruktureerde onderhoude was oudio-opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in MS Word gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer. Die hooftemas wat na vore gekom het, sluit in individuele-verwante hindernisse, sosiale-verwante hindernisse, institusie-verwante hindernisse, gemeenskapsverwante hindernisse en armoede-verwante hindernisse. Resultate van dié studie reflekteer die motiverings van depressiewe swanger vroue om beskikbare en gratis geestesgesondheidsdienste wat verskaf is deur die PMHP van die hand te wys, volgens die vyf hooftemas. Hierdie temas is toe volgens Bronfenbrenner (1972) se Ekologiese Sisteemteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die individuele-, mikro-, meso-, ekso-, en makrosisteem. Die individuele sisteem het die individuele-verwante hindernisse ingesluit, wat swak geestesgesondheid, en teenstrydige gevoelens teenoor die swangerskap omvat het. Die mikrosisteem het die sosiale-verwante hindernisse ingesluit, wat swak sosiale ondersteuning, en self-help strategieë omvat het. Gemeenskapsverwante hindernisse is binne die mesosisteem van die pasiënt se ekologiese omgewing beskou, en het stigma en jammerte as sub-hindernisse ingesluit. Die eksosisteem het die institusie-verwante hindernisse ingesluit, wat verwysing protokol hindernisse, gebrek aan inligting verskaf deur die verpleegsters, en verpleegsters se houdings soos ervaar deur die deelnemers omvat het. Laastens is die armoede-verwante hindernisse binne die makrosisteem beskou, en het finansiële lewens swaarkry, konstante kindersorg eise, en vervoer-verwante struikelblokke as sub-hindernisse ingesluit het. Die belang van dié studie lê in die oorspronklike perspektief van geestesgesondheidsbehandeling dienste afspraak-ooreenkoms gedrag binne die Suid-Afrikaanse konteks, wat aangebied is. Toekomstige navorsing kan, bykomend tot die voer van onderhoude met hospitaal pasiënte, fokus daarop om gesondheidsorg kenners en fokus groepe in te sluit, aangesien dit die triangulasie van perspektiewe moontlik maak van al die belangrike rolspelers. Ook, aangesien die probleem en bekommernisse rakende bywoning van terapie afsprake reeds geïdentifiseer is, mag toekomstige navorsing in die rigting beweeg met die doel om intervensies te omskep wat beoog om die geïdentifiseerde hindernisse tot geestesgesondheidsorg diensgebruik te verminder.
4
Singogo, Irene Miti. "Perinatal deaths in Lusaka, Zambia : mothers’ experiences and perceptions of care." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/6015.
Full text
5
Soto-Torres, Brenda. "Multiattribute evaluation of participation in perinatal care in rural Puerto Rico /." free to MU campus, to others for purchase, 1998. http://wwwlib.umi.com/cr/mo/fullcit?p9924928.
Full text
6
Byatt, Nancy. "Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID): A Master’s Thesis." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/731.
Full textAbstract:
Depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. This condition has deleterious effects on several birth outcomes, infant attachment, and children’s behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Obstetrics/Gynecology (Ob/Gyn) clinics need supports in place to adequately address depression in their patient populations. The primary goal of this thesis is to develop, refine, and pilot test a new low-cost and sustainable stepped care program for Ob/Gyn clinics that will improve perinatal women’s depression treatment rates and outcomes. We developed and beta tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of depression care, including training support and toolkits; and (3) proactive depression screening, assessment, and treatment in OB/Gyn clinics. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our formative and pilot work in real-world settings suggests RAPPID is feasible and has the potential to improve depression detection and treatment in Ob/Gyn settings. The next step will be to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care.
7
Byatt, Nancy. "Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID): A Master’s Thesis." eScholarship@UMMS, 2015. https://escholarship.umassmed.edu/gsbs_diss/731.
Full textAbstract:
Depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. This condition has deleterious effects on several birth outcomes, infant attachment, and children’s behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Obstetrics/Gynecology (Ob/Gyn) clinics need supports in place to adequately address depression in their patient populations. The primary goal of this thesis is to develop, refine, and pilot test a new low-cost and sustainable stepped care program for Ob/Gyn clinics that will improve perinatal women’s depression treatment rates and outcomes. We developed and beta tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of depression care, including training support and toolkits; and (3) proactive depression screening, assessment, and treatment in OB/Gyn clinics. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our formative and pilot work in real-world settings suggests RAPPID is feasible and has the potential to improve depression detection and treatment in Ob/Gyn settings. The next step will be to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care.
8
Jokhio, Abdul Hakeem. "A cluster randomised controlled trial of reorganising maternal health care services in Sindh, Pakistan." Thesis, University of Birmingham, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390759.
Full textAbstract:
A community-based randomised controlled trial was conducted in the district Larkana of Sindh province of Pakistan. The new model was based on reorganising the existing maternal health services. Three sub-districts were randomly assigned to the intervention group and four to the control group. The intervention consisted of integrating traditional birth attendants with the health care system, the use of safe delivery packs and the provision of antenatal care by doctors. Over one year 19,525 women were recruited and followed up. The proportion of referrals was higher in the intervention group (10.0 Vs 6.9 %; odds ratio 1.50 [95% Cl 1.26-1.74]). Significant differences were also found in some pregnancy complications including haemorrhage, obstructed labour and puerperal sepsis. Perinatal mortality in the intervention group was 83, compared to 118 per 1000 births for the control group, odds ratio 0.69 (95% Cl 0.53-0.85)(P
9
Katz, Sharilyn L. "Horizontal hostility and verbal violence between nurses in the perinatal arena of healthcare." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1523078.
Full textAbstract:
The goal of this study was to determine the frequency of horizontal violence in the Perinatal Service line and its affect on patient outcomes. A link to a 24-question survey instrument entitled "Horizontal Violence in Perinatal Nursing" was distributed to the Perinatal Discussion List with permission from its host. The sample included 63 nurses of which 61 completed the survey in its entirety. These results were collected from January 28, 2013 through February 11, 2013. The results indicated that Labor and Delivery does experience a higher frequency of horizontal violent behaviors than other perinatal units. It also showed that the Mother Baby unit demonstrates a higher frequency of recipient or victim behaviors. A relationship between horizontal violence and ineffective communication was shown as well as a relationship between horizontal violence and poor patient outcomes or near misses. These results show that horizontal violence is present on Perinatal units and are having a negative impact on our nurses and the patient care they give. Additional research is needed to study the work environments and all the factors that contribute to horizontal violence developing and becoming the accepted behaviors.
10
Chan, David C. (David Cchimin). "Essays on health care delivery and financing." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/81038.
Full textAbstract:
Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2013.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 167-172).
This thesis contains essays on health care delivery and financing. Chapter 1 studies the effect of organizational structure on physician behavior. I investigate this by studying emergency department (ED) physicians who work in two organizational systems that differ in the extent of physician autonomy to manage work: a "nurse-managed" system in which physicians are assigned patients by a triage nurse "manager," and a "self-managed" system in which physicians decide among themselves which patients to treat. I estimate that the self-managed system increases throughput productivity by 10-13%. Essentially all of this net effect can be accounted for by reducing a moral hazard I call "foot-dragging": Because of asymmetric information between physicians and the triage nurse, physicians delay discharging patients to appear busier and avoid getting new patients. Chapter 2 explores the development of physician practice styles during training. Although a large literature documents variation in medical spending across areas, relatively little is known about the sources of underlying provider-level variation. I study physicians in training ("housestaff") at a single institution and measure the dynamics of their spending practice styles. Practice-style variation at least doubles discontinuously as housestaff change informal roles at the end of the first year of training, from "interns" to "residents," suggesting that physician authority is important for the size of practice-style variation. Although practice styles are in general poorly explained by summary measures of training experiences, rotating to an affiliated community hospital decreases intern spending at the main hospital by more than half, reflecting an important and lasting effect of institutional norms. Chapter 3, joint with Jonathan Gruber, examines insurance enrollee choices in a "defined contribution exchange," in which low-income enrollees are responsible for paying for part of the price of insurance. Estimating the price-sensitivity of low-income enrollees for insurance represents a first step for understanding the implications of such a system that will soon become widespread under health care reform. Using data from Massachusetts Commonwealth Care, we find that low-income enrollees are highly sensitive to plan price differentials when initially choosing plans but then exhibit strong inertia once they are in a plan.
by David C. Chan.
Ph.D.
11
Nguyen, Trang V. "Education and health care in developing countries." Thesis, Massachusetts Institute of Technology, 2008. http://hdl.handle.net/1721.1/45902.
Full textAbstract:
Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2008.Includes bibliographical references.
This thesis is a collection of three essays on education and health in developing countries. Chapter 1 shows that increasing perceived returns to education strengthens incentives for schooling when agents underestimate the actual returns. I conducted a field experiment in Madagascar to study alternative ways to provide additional information about the returns to education. I randomly assigned schools to the role model intervention, the statistics intervention, or a combination of both. I find that providing statistics reduced the large gap between perceived returns and the statistics provided. As a result, it improved average test scores and student attendance. For those whose initial perceived returns were below the statistics, test scores improved by 0.37 standard deviations. Seeing a role model of poor background has a larger impact on poor children's test scores than seeing someone of rich background. The key implication of my results is that households lack information, but are able to process new information and change their decisions in a sophisticated manner. Chapter 2, joint work with Gerard Lassibille, evaluates several interventions in Madagascar that sought to promote top-down and local monitoring of the school to improve education quality. Randomly selected school districts and sub districts received operational tools to facilitate their supervision tasks. Randomly selected schools in these treated districts were reinforced with teacher tools and parent-teacher meetings centered around a school report card. We find little impact of targeting district and sub-district administrators.
(cont.) Meanwhile, the intervention implemented at the school level improved some of the teachers' behaviors and student attendance. Student test scores also improved by 0.1 standard deviations after two years. These results suggest that beneficiary monitoring is more effective than mediated control in the hands of government bureaucrats in this context. Chapter 3 studies informal payments to doctors and nurses for inpatient health care in Vietnam. Exploiting within-hospital variation, I find that acute patients, despite having a presumably higher benefit of treatment, are 8 percentage points less likely to pay bribes, and pay less, than non-acute patients. One plausible interpretation is that doctors might face existing incentives against neglecting acute cases. I find that the differential payment by acute status is larger in central locations (expected to be well-monitored) and at facilities that receive more audit visits. Overall, these findings may be a sign of bureaucrats responding to incentives, even in a highly corruptible environment.
b y Trang V. Nguyen.
Ph.D.
12
Ling, Davina C. Y. (Davina Chiu-Yee) 1972. "Productivity and competition in health care markets." Thesis, Massachusetts Institute of Technology, 1999. http://hdl.handle.net/1721.1/9519.
Full textAbstract:
Thesis (Ph.D.)--Massachusetts Institute of Technology, Dept. of Economics, c1999.Includes bibliographical references (p. 171-178).
This thesis presents three empirical studies based on regulatory and institutional changes in the US hospital and pharmaceutical industries. Chapter 2 reports the results of an empirical study on changes in quality of health care after hospitals have undergone ownership conversions. Theoretical work on not-for-profit institutions has hypothesized that not-for-profit firms exist as a response to high contracting costs in markets with asymmetric information. If a firm knows more than its customers about the quality of the goods or services it sells, then the firm could cut costs by delivering lower-quality goods than it promises. Not-for-profit organizations serve as a solution to this problem by allowing managers to hold the firms in trust for their customers. Using readmission and mortality rates for heart and stroke patients as measures of quality of care, I find increases in mortality rate as well as readmission rate for heart attack patients after not-for-profit to for-profit conversions and after public to not-for-profit conversions. The deterioration in health care quality did not seem to be attributable to changes in the patient pool, but may be associated with changes in the number of procedures performed. The reduction in care for the uninsured after not-for-profit to for-profit hospital conversions may also point to the importance of legal enforcement and oversight as well as private contracts in ownership transfer. Chapter 3 considers altruistic behavior by not-for-profit, for-profit and public hospitals. Economic theories have hypothesized that not-for-profit organizations act in response to insufficient provision of social or collective consumption goods by private for-profit entities or by the government. I find support for not-for-profit hospitals behaving in an altruistic manner. Nevertheless, there is mixed evidence of both pure and impure altruism for not-for-profits. Similarly, public hospitals also exhibit behavior consistent with both pure and impure altruism. During the period of May 1995-June 1997, four former prescription-only drugs (Pepcid, Tagamet, Zantac and Axid) were introduced to the nonprescription market. Chapter 4 reports the impact of these introductions on thirteen similar incumbent products in the nonprescription drug market. I also analyze firms' use of advertising to compete and to increase demand for their products.
by Davina C.Y. Ling.
Ph.D.
13
Oostrom, Tamar. "Essays on innovation in health care markets." Thesis, Massachusetts Institute of Technology, 2020. https://hdl.handle.net/1721.1/127035.
Full textAbstract:
Thesis: Ph. D., Massachusetts Institute of Technology, Department of Economics, May, 2020Cataloged from the official PDF of thesis.
Includes bibliographical references (pages 191-203).
This thesis consists of three chapters on innovation in health care markets. The first chapter examines incentives in pharmaceutical innovation; the second explores selection in the response to recommendations in health care. The third chapter presents new evidence on determinants of recent drug overdose mortality. The first chapter examines the effect of financial incentives on reported drug efficacy in clinical trials. I leverage the insight that the exact same sets of drugs are often compared in different randomized control trials conducted by parties with different financial interests. I estimate that a drug appears 0.15 standard deviations more effective when the trial is sponsored by that drug's manufacturer, compared with the same drug in the same trial without the drug manufacturer's involvement. Publication bias explains a large share of this effect; observable characteristics of trial design and patient enrollment are less important.
I find the sponsorship effect decreases over time as pre-registration requirements were implemented. The second chapter, joint with Liran Einav, Amy Finkelstein, Abigail Ostriker, and Heidi Williams, presents evidence on the role of selection in considering whether and when to recommend screening for a particular disease. In the context of recommendations that breast cancer screening start at age 40, we show that responders to the age 40 recommendation are less likely to have cancer and have smaller tumors than do women who self-select into screening at earlier ages. Responders to the age 40 recommendation also have less cancer than women who never screen, suggesting that the benefits of recommending early screening are smaller than if responders were representative of all covered individuals.
The second chapter, joint with Liran Einav, Amy Finkelstein, Abigail Ostriker, and Heidi Williams, presents evidence on the role of selection in considering whether and when to recommend screening for a particular disease. In the context of recommendations that breast cancer screening start at age 40, we show that responders to the age 40 recommendation are less likely to have cancer and have smaller tumors than do women who self-select into screening at earlier ages. Responders to the age 40 recommendation also have less cancer than women who never screen, suggesting that the benefits of recommending early screening are smaller than if responders were representative of all covered individuals. The third chapter examines the role of declining community ties and social cohesion in the increase in drug overdose mortality in the past two decades. I assess the causal impact of declining religiosity on opioid deaths, instrumenting for religiosity with the Catholic sex-abuse scandal.
I find that the recent decrease in religious employment would result in approximately one-third of the total current opioid mortality rate. The effects are concentrated in areas with higher Catholic rates before the scandal and among young adults.
by Tamar Judith Oostrom.
Ph. D.
Ph.D. Massachusetts Institute of Technology, Department of Economics
14
Höfter, Ricardo Andres Henriquez. "Preferred providers, health insurance and primary health care in Chile." Thesis, Queen Mary, University of London, 2006. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1772.
Full textAbstract:
Reforms in the early 1980s created Chile's mixed system of health care provision and finance. Since then Chileans have had to choose between a statesubsidised public health insurance system or the private health plans offered by several insurance companies. In the public system, users may be restricted to the public facility network, with no choice of doctor or medical centre, or they may opt for a free choice mode (preferred providers), which lets them choose both doctor and place of attention. Private insurance providers offer a wide variety of health plans, giving the customer a reasonable range of care options. Although this public-private mix has now been operating for more than 20 years, there has been no empirical study of the factors determining the choice of the preferred providers' mode by public beneficiaries. Likewise, few studies have looked at the determinants in the choice between public and private insurance, and the relationship between the latter choice and the use of health services. The first two empirical chapters of this thesis look at the determinants of these sources of choice, using different econometric tools: the choice of preferred providers is examined using a logit model; the analysis into the choice between public and private insurance uses a probit model; and the impact of holding private insurance as a factor in determining use of health services is estimated through a two-stage tobit model. A further significant aspect of the reforms of the '80s was the process of decentralisation for primary health care provision. Since then a substantial part of preventive health care and promotion occurs locally, and among these services children's health checks are an important policy objective. To encourage attendance parents are given free food supplements if they keep to the timetable for their child's check-ups. However these free food handouts partially account for attendance at the check-ups. Thus the final empirical chapter of the thesis uses a probabilistic model to look at the monetary and non-monetary factors that lead parents to request health checks for their children.
15
Ho, Chi-wan Nelson. "Factors affecting one's health care choice /." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B20897583.
Full text
16
Lu, Xiaomei. "Determinants of health care expenditure in Sweden." Thesis, Umeå universitet, Nationalekonomi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-161097.
Full textAbstract:
Sweden faces increasing pressures on health funding. Total expenditure on health care currently accounts for about 10.92% of GDP, which suggests an increase of about twofold over the last five decades. This paper examines the short-run and long-run relationship between income and health care expenditure in Sweden during the period 1980–2017. The study focused on the differences between short- and long-term elasticities. Consistent with the conventional findings, the income elasticity for health care is found to be greater than one, suggesting that health care is a luxury good in Sweden. Additionally, the age structure variable is found to have a significant positive impact on health care expenditure. Finally, the importance of another non-income variable, relative price, is also confirmed, an increase in relative price is associated with lower quantity of health care expenditure.
17
Hoe, Thomas P. "Essays on the economics of health care provision." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10048627/.
Full textAbstract:
Health care provision is a major sector of the economy in all developed economies. Productivity in these settings impacts levels of taxation and insurance costs, and for patients can often mean the difference between life and death. This thesis studies the economics of health care production in a hospital setting. I use uniquely rich administrative data from England over the period 2006 to 2013. I present three new findings. First, the number of patients admitted to hospital ('crowding') has an adverse impact on the quality of care delivered in hospitals. This features in Chapter 2, where I show that more crowding, despite its adverse effects, can benefit consumers because it allows for shorter waiting times for hospital appointments. Second, the number of days a patient spends in a hospital inpatient department has a material impact on the likelihood that a patient subsequently returns to hospital for further treatment ('readmission'). I quantify this relationship in Chapter 3 and argue that it partially explains the increases in readmissions that has accompanied the adoption of price regulation through prospective payment systems. Third, policies that constrain the amount of time patients can spend in a hospital emergency department can induce cost-effective reductions in patient mortality. This finding stems from Chapter 4, which is joint work with Jonathan Gruber and George Stoye, where we use an innovative application of 'bunching' techniques to study a landmark policy in emergency departments.
18
Masters, Grace A. "Bipolar Disorder in the Perinatal Period: Understanding Gaps in Care to Improve Access and Patient Outcomes." eScholarship@UMMS, 2021. https://escholarship.umassmed.edu/gsbs_diss/1127.
Full textAbstract:
Background:
Bipolar disorder (BD) is a significant cause of perinatal morbidity and mortality. Because BD is hard to detect and treat, these individuals often go without care. This dissertation was designed to: (1) identify the prevalence rates of BD and bipolar-spectrum mood episodes in perinatal individuals, (2) understand pertinent barriers to mental healthcare, and (3) elucidate how to bridge healthcare gaps.
Methods:
Data sources included: primary qualitative and quantitative data from obstetric clinicians, encounter data from Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a program aimed at helping clinicians to provide mental healthcare to perinatal patients. Analyses included: descriptive statistics, systematic review and meta-analysis, qualitative data analyses, longitudinal regression analyses, and group-based trajectory modeling.
Results:
The prevalence of BD in perinatal individuals was 2.6% (95% CI: 1.2 to 4.5%). Twenty to 54.9% were found to have a bipolar-spectrum mood episode. Barriers to mental healthcare for perinatal patients with BD included the paucity of psychiatric resources, difficulties in assessing BD, and stigma towards pharmacotherapy. Obstetric clinicians reported that MCPAP for Moms has helped them feel more comfortable in treating patients with BD. Longitudinal analyses of encounter data corroborated these findings - utilization of the program predicted increased clinician capacity to treat BD.
Conclusion:
Clinicians for perinatal individuals are being called upon and stepping up to care for complex illnesses like BD. Programs like MCPAP for Moms can help them feel more confident in this role, helping to bridge gaps in perinatal mental healthcare and ensuring that individuals with BD are able to receive appropriate care.
19
Saweka, Delfina Ângela. "Factors influencing malaria care seeking behaviour in two Ghanaian communities : formal versus informal malaria care." Master's thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/9456.
Full textAbstract:
Includes bibliographical references (leaves 101-110).The study primary objective was to investigate the determinants and extent of household’s reliance on the informal malaria care sector in two Ghanaians communities. The secondary objective wass to inform policy-makers and planners, especially from the public healthcare sector, on supply side issues that are likely to influence the current malaria care seeking patterns.
20
Fiedler, Matthew Aaron. "Essays on Provider Behavior in Health Care Markets." Thesis, Harvard University, 2013. http://dissertations.umi.com/gsas.harvard:11103.
Full text
21
Gross, Tal (Tal A. ). "Essays on health care consumption and household finance." Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/49705.
Full textAbstract:
Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2009.Includes bibliographical references (p. 107-111).
This thesis explores how health insurance affects the decisions that individuals make. The first chapter studies the effect of insurance on health care consumption. Nearly 10 percent of teenagers become ineligible for their families' health insurance coverage on their nineteenth birthdays. Due to the federal Emergency Medical Treatment and Active Labor Act, however, they do not lose access to free emergency room care. I develop a straightforward theoretical framework to understand the implications of insurance transitions at age nineteen. I then develop an empirical framework that exploits the discontinuity in health insurance at age nineteen. Using a unique database of 15 million hospital discharge records, I find that Emergency Room (ER) usage rises discontinuously at age nineteen, particularly for minorities and residents of low-income zip codes. As predicted by the theoretical framework, the jump in ER utilization at age nineteen is disproportionately driven by ailments that physicians classify as inappropriate for ER care. I also find suggestive evidence that health care expenditures outside of the ER decline. A large share of the increase in ER utilization at age nineteen takes the form of uncompensated care, the cost of which is born by third parties. These findings constitute some of the first evidence on how the incentives faced by the uninsured affect medical expenditure. The second chapter, written jointly with Matthew Notowidigdo, studies the contribution of medical costs in the decision to declare bankruptcy. Consumer bankruptcies increased eighty-seven percent in the 1990s.
(cont.) By the end of the decade, more than one percent of American households were declaring bankruptcy in any given year. Anecdotal evidence and several observational studies suggest that out-of-pocket medical costs are pivotal in a large fraction of consumer bankruptcy declarations. In this paper, we use variation in Medicaid eligibility to assess the contribution of medical costs to household bankruptcy risk. Using cross-state variation in Medicaid expansions from 1992 through 2002, we find that a 10 percentage point increase in Medicaid eligibility reduces the personal bankruptcy rate by 8.7 percent, with no evidence that business bankruptcies are similarly affected. We interpret our findings with a model in which health insurance substitutes for other forms of financial protection. We conclude with a calibration exercise that suggests that out-of-pocket medical costs are pivotal in roughly 26 percent of personal bankruptcies among low-income households. The third chapter studies how transitions in insurance status may affect the consumption of health care. Transitions from one insurance program to another-or from insured status to uninsured status-are common. How these transitions affect individuals depends, in part, on whether consumers anticipate the loss of insurance. Potentially, if consumers are sufficiently forward-looking, they may "stock up" on health care before losing coverage.
(cont.) This paper studies the transition in insurance status as teenagers move from their family's coverage to uninsured status or other insurance plans. I find no evidence that teenagers stock up on medical care before coverage ends, but rather a general decrease in health care consumption in the last month of coverage.
by Tal Gross.
Ph.D.
22
Molitor, David Paul. "Physician behavior and technology diffusion in health care." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/77795.
Full textAbstract:
Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2012.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 127-132).
Chapter 1 examines geographic variations in physician practice styles by exploring the role of physician-specific factors such as preferences and learned behavior versus environment-level factors such as hospital capacity. I exploit cardiologist migration across geographic regions and find that physicians who start off in the same region and subsequently move to dissimilar regions practice similarly before the move but very differently after the move. Based on this change in behavior, baseline estimates imply that the role of the environment on physician behavior is twice as important as physician-specific factors. Specifically, a one percentage point change in practice environment results in an immediate 2/3 percentage point change in physician behavior, with no further changes over time. Chapter 2 (co-authored with Leila Agha) explores the diffusion of new cancer drugs by testing the influence of physician investigators who lead clinical trials. The basic idea is to exploit variation across drugs in the location of clinical trials to test whether geographic proximity to a principal investigator influences the speed of technology adoption. Using original data on clinical trial study authors and sites for 21 new cancer drugs along with Medicare claims data from 1998-2008, we estimate that patients are 30% more likely to receive treatment with a new drug if they seek care in the hospital referral region where the drug's principal investigator practices. This effect, which is estimated in the first two years following initial FDA approval, fades over time until there is no apparent difference in utilization after four years. Chapter 3 (co-authored with Leila Agha) explores the prescribing of new cancer drugs for off-label (non-FDA approved) indications, yielding three key results. First, over 20% of new cancer drug use within the Medicare population over 1998-2008 was applied to off-label cancers. Second, geographic proximity to the principal investigator of a drug's pivotal clinical trial-a factor which appears to significantly boost on-label usage-has no discernible impact on off-label prescribing. Third, we find that prescribing increases following FDA approval expansions, suggesting that approval status influences patient treatment and thus may provide a useful policy instrument for directing medical technology adoption.
by David Paul Molitor.
Ph.D.
23
Shiu-Thornton, Sharyne. "Culturally competent perinatal health care for Chinese and Mien refugees : ethnographic narratives from Seattle's International District Health Clinic /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/6468.
Full text
24
Pehlivan, Canan. "Design and flow control of stochastic health care networks without waiting rooms : A perinatal application." Phd thesis, Ecole Nationale Supérieure des Mines de Saint-Etienne, 2014. http://tel.archives-ouvertes.fr/tel-00994291.
Full textAbstract:
In this thesis, by being motivated from the challenges in perinatal networks, we address design, evaluation and flow control of a stochastic healthcare network where there exist multiple levels of hospitals and different types of patients. Patients are supposed urgent; thus they can be rejected and overflow to another facility in the same network if no service capacity is available at their arrival. Rejection of patients due to the lack of service capacity is the common phenomenon in overflow networks. We approach the problem from both strategic and operational perspectives. In strategic part, we address a location & capacity planning problem for adjusting the network to better meet demographic changes. In operational part, we study the optimal patient admission control policies to increase flexibility in allocation of resources and improve the control of patient flow in the network. Finally, in order to evaluate the performance of the network, we develop new approximation methodologies that estimate the rejection probabilities in each hospital for each arriving patient group, thus the overflow probabilities among hospitals. Furthermore, an agent-based discrete-event simulation model is constructed to adequately represent our main applicationarea: Nord Hauts-de-Seine Perinatal Network. The simulation model is used to evaluate the performance of the complex network and more importantly evaluate the strength of the optimal results of our analytical models. The developed methodologies in this thesis are combined in a decision support tool, foreseen under the project "COVER", which aims to assist health system managers to effectively plan strategic and operational decisions of a healthcare network and evaluate the performance of their decisions.
25
Mutopo, Yvonne. "Rethinking health care financing models: the case of Zimbabwe's health sector." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27236.
Full textAbstract:
The purpose of the current study was to assess how RBF performed in terms of efficiency, effectiveness, equity and governance in the Zimbabwean context. It outlines the evolution of health systems thinking and health funding models over time to show the history and changing landscape of health care financing and their actors. General consensus is there is need to focus on results of health care investments against a background of prodigious amounts of foreign aid with marginal or no improvements in heath care delivery for decades of development assistance in developing countries. Health systems in developing countries are beset with burgeoning domestic and foreign debts as well as diminishing fiscal space that has more often put the primary health delivery system in developing nations in "comatose". The research made use of both qualitative and quantitative dimensions. Findings indicate that the pre-RBF era was characterised by poor primary health outcomes, unsound governance and a lack of confidence in the public health delivery system. However, since RBF implementation, access to health care by marginalised groups has increased, with incentives and community participation liberalising health systems to greater efficiency as shown by slight increases in post-natal care visits in rural health care centres. A trade-off between achieving efficiency and equity was found especially when scaling up health programmes under the RBF initiative. Through embracing RBF, the primary health delivery system is poised for future development attributed to community buy-in and people-centric empowerment approaches.
26
Haque, Rezwan. "Organizational Innovation in Health Care." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17463146.
Full textAbstract:
This dissertation investigates whether differences in organizational innovation amongst health care providers can explain the huge variation in costs and outcomes. I specifically consider two facets of organizational innovation: the deployment of information technology and the relationships between hospitals and physicians.
In the first chapter, I investigate IT adoption in a service setting by considering the impact of electronic medical records (EMRs) on the length of stay and clinical outcomes of patients in US hospitals. To uncover the distinct impacts of EMRs on operational efficiency and care coordination, I present evidence of heterogeneous effects by patient complexity. I find that EMRs have the largest impact for relatively less complex patients. Admission to a hospital with an EMR is associated with a 2\% reduction in length of stay and a 9\% reduction in thirty-day mortality for such patients. In contrast, there is no statistically significant benefit for more complex patients. However, I present three additional results for complex cases. First, patients returning to the same hospital benefit relative to those who previously went to a different hospital, which could be due to easier access to past electronic records. Second, computerized order entry is associated with higher billed charges. Finally, hospitals that have a high share of publicly insured patients, and hence a bigger incentive to curb resource use, achieve a greater reduction in length of stay for complex patients after EMR adoption.
In the second chapter, co-authored with Robert Huckman, I investigate the role of process specialists in guiding customers through such complex service transactions by considering the management of patients admitted to U.S hospitals. Traditionally, a patient's primary care physician has been in charge of his or her hospital admission. Over the past decade, however, there has been a steady rise in the use of hospitalists - physicians who spend all their professional time at the hospital - in managing inpatient care. Using data from the American Hospital Association and the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample (NIS) database, we find that hospitals with hospitalist programs achieve reductions in the risk-adjusted length of stay of inpatients over the time period 2003 to 2010. The effect is strongest for complex patients who have a higher number of comorbidities. Our findings support the view that process specialists such as hospitalists are particularly beneficial for complex transactions that entail a greater degree of coordination.
In the final chapter, I document the positive relationship between consolidation in the health care industry and technology adoption. I propose several mechanisms that could explain the association between the adoption of electronic medical records and greater hospital-physician integration. I show that the positive correlation between technology adoption and hospital consolidation has been increasing over time. I show that hospitals located in concentrated markets are more likely to adopt electronic medical records and to use hospitalists. Moreover, for a limited set of hospitals, the quality of management is positively associated with the adoption of electronic medical records and the use of hospitalists.Business Economics
27
Liu, Fei. "Three essays on health insurance and health care consumption." [Bloomington, Ind.] : Indiana University, 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3243799.
Full textAbstract:
Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2007.Title from PDF t.p. (viewed Nov. 18, 2008). Source: Dissertation Abstracts International, Volume: 67-12, Section: A, page: 4627. Adviser: Pravin K. Trivedi.
28
Jung, Juergen. "Essays on reforming health care and public transfer programs." [Bloomington, Ind.] : Indiana University, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3324511.
Full textAbstract:
Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2008.Title from PDF t.p. (viewed on May 12, 2009). Source: Dissertation Abstracts International, Volume: 69-08, Section: A, page: 3240. Adviser: Gerhard Glomm.
29
Ataguba, John E. "Distributional impact of health care finance in South Africa." Doctoral thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/10030.
Full textAbstract:
Includes bibliographical references.In South Africa, health care is financed through different mechanisms - allocations from general taxes, private health insurance contributions and direct out-of-pocket payments. These mechanisms impact differently on different households. While there are empirical evidence in developed countries, the distributional impact of such payments and methodological challenges in such assessments in the context of Africa are scarce. Borrowing from the tax literature, the thesis aims to assess the relative impact of health care financing on households' welfare and standards of living. Methodological issues around the assessment of income redistributive impact of health care payments in the context of South Africa are also explored.
30
Phiri, Jane. "Socioeconomic inequalities in Zambia's public health care delivery system." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/9458.
Full textAbstract:
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.
31
Mulenga, Arnold. "Income redistributive effect of health care financing in Zambia." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/13786.
Full textAbstract:
Equity in health care financing and progress towards universal health coverage (UHC) have increasingly received recognition and growing attention for their potential to improve health outcomes globally. However, most low income countries and in particular those in sub-Saharan Africa which have borne the greater share of global disease burden have had relatively lesser success in their endeavours to improve their health care financing systems. It is only a few that have made considerable progress towards universal health coverage. Zambia, a developing country struggling with income inequalities and poor progress to achieving universal health coverage, is no exception. The current discussion on countries moving toward universal health coverage, however, requires an understanding of the impact of the prevailing health care financing mechanisms on income distribution. Investigation of an overall income redistributive effect of health care financing thus requires assessing health care financing in relation to the principles of contributing to financing health care according to ability to pay. Zambia is currently considering major health systems reforms toward a universal health system. Health care financing system in Zambia is however faced with numerous challenges that must be addressed prior to meeting this goal. To promote the goal of achieving universal health coverage, there is a need to measure the extent of the redistributive effect of the current health care financing mechanisms. This allows identifying which health care financing mechanisms provide financial protection and promote universal health coverage in the country. With this growing focus on the goal of universal health coverage (UHC), health care financing mechanisms should not only relate to who pays and who receives the benefit, but also to their effects on income distribution. This is because financing of health care may have redistributive effects and equity consequences. This income redistribution may be intended or unintended. Even in the latter case, policy makers may be interested in the degree to which it occurs. This is because it has consequences for the distribution of goods and services other than health care and, ultimately, for welfare. This study investigates the extent to which the current health care financing in Zambia redistributes income, particularly whether or not it reduces income inequality. The study seeks to evaluate an overall pattern of income redistributive effect of the current health care financing mechanisms. It specifically assesses the income redistributive effect of two broad health care financing mechanisms; general tax and out of pocket (OOP) payments. Using a standard procedure for analyzing income redistribution of health care financing in Zambia, the study decomposes the income redistributive effect of each of the two broad health care financing mechanisms into the vertical, horizontal and reranking components.
32
Schwartz, Aaron Lawrence. "Measuring Health Care Quality and Value: Theory and Empirics." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17463148.
Full textAbstract:
Imperfect information is a pervasive feature of health care markets. Therefore, measuring the quality and value of health care services may inform efforts to improve health care delivery. This dissertation explores several applications of performance measurement in health care: describing national practice patterns, evaluating the effects of payment reforms, and contributing to policies that reward providers for measured performance.
Chapter one describes the use of low-value services in fee-for-service Medicare. Drawing from evidence-based lists of services that provide minimal clinical benefit, I develop 26 claims-based measures of low-value services. Applying these measures to Medicare claims, I demonstrate that 42% of beneficiaries received at least one of these services in a year, which constituted 2.7 % of overall annual spending. When more specific and less sensitive versions of the measures were used, I detected low-value service use for 25% of beneficiaries, constituting 0.6% of overall spending. In adjusted analyses, spending on low-value services was substantial even in regions at the 5th percentile of the regional distribution of low-value spending. Adjusted regional use was positively correlated among five of six categories of low-value services. These findings are consistent with the view that wasteful practices are pervasive in the US health care system. The results also suggest that the performance of claims-based measures in supporting policies to reduce overuse may depend heavily on how the measures are defined.
Chapter two examines the role of provider organizations in influencing the delivery of low-value services. In Part I of this chapter, I assess whether provider organizations exhibit distinct profiles of low-value service use in fee-for-service Medicare. In one sample of 3,137 large provider organizations and another sample of 250 provider organizations that entered the Medicare Pioneer Accountable Care Organization (ACO) Program or the Medicare Shared Savings Program, I demonstrate that provider organizations’ use of low-value services exhibits considerable variation, substantial persistence over time, and modest consistency across service types. In Part II of this chapter, I evaluate the effects of the Pioneer ACO Program on the use of low-value services. In a difference-in-differences analysis, I compare the use of low-value services between beneficiaries attributed to Pioneer ACOs and beneficiaries attributed to other providers, before (2009-2011) vs. after (2012) Pioneer ACO contracts began. During its first year, the Pioneer ACO program was associated with modest reductions in low-value services, with greater reductions for organizations that had provided more low-value services. The findings in this chapter suggest that provider organizations can influence the use of low-value services by affiliated physicians, and that organization-level incentives can reduce low-value practices.
Chapter three analyzes the economic properties of performance measures used in both health care and education policy. Because observable outcomes constitute a noisy signal of performance in these settings, shrinkage estimators are often used to improve measurement accuracy. I demonstrate that these improvements in accuracy come at the cost of reducing a measure’s responsiveness to agent behavior, thereby diluting incentives for performance improvement. In a model of consumers sorting between agents, I show that welfare depends on two components: (1) accuracy of performance signals, which promotes efficient consumer sorting, and (2) incentives for performance improvement, which promote efficient agent effort. Using Monte Carlo simulation, I evaluate the accuracy and incentive properties of various techniques for estimating hospital performance in heart attack mortality. Shrinkage estimators entail substantial incentive distortions, particularly for smaller hospitals, which experience an approximate 50-70% “tax” on improvement. Several estimation techniques, including the methods currently used by Medicare, are dominated on the basis of both accuracy and incentive criteria. I discuss various policy alternatives to shrinkage estimation, such as increasing the timespan of measuring performance.Health Policy
33
Rebelo, Luís Francisco de Gouveia Durão Pina. "The Economics of Health and Health Care: Assessing health determinants and impacts on an aging population." Tese, Faculdade de Economia da Universidade do Porto, 2010. http://hdl.handle.net/10216/62305.
Full text
34
Rebelo, Luís Francisco de Gouveia Durão Pina. "The Economics of Health and Health Care: Assessing health determinants and impacts on an aging population." Doctoral thesis, Faculdade de Economia da Universidade do Porto, 2010. http://hdl.handle.net/10216/62305.
Full text
35
Govender, Moganambal. "The financing of health care and health sciences education and training in South Africa." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/9549.
Full textAbstract:
Includes bibliography.The aim of this study was to critically analyse the funding and expenditure patterns of institutions training health personnel. This included an investigation of the distribution of income from the various sources by geographic areas (i.e. by province), between historically white and black training institutions and between those institutions that are attached to academic hospital complexes and those which are not. The study also attempted, where possible, to determine the unit costs of training different cadres if health personnel. The methodology included a review of the literature on health personnel education and training, a questionnaire survey of nursing colleges and PDoHs in South Africa, and analysis of the Department of Education's South African Post-secondary Education (SAPSE) data base, which records and monitors the funding, staffing and student data of universities and technikons in South Africa.
36
Stricker, Anna M. "The Affordable Care Act: Year One." Scholarship @ Claremont, 2015. http://scholarship.claremont.edu/scripps_theses/677.
Full textAbstract:
The Affordable Care Act (ACA) was designed to reduce the number of citizens who do not have health insurance, and reduce the prices of health insurance premiums. Using multiple regression analysis, the effects of the components of the ACA, along with baseline characteristics of the states, are examined in relation to ACA premium prices and the rate of uninsured. We find that premium prices are higher in states with more uninsured, and states with more obesity have more uninsured. This is most likely related to pre-ACA practice of excluding people with pre-existing conditions from health insurance coverage, yet still caring for those uninsured individuals in emergency departments and hospitals, while passing on the costs of their care to those with insurance. When examining the specific components of the ACA, we find that premium prices are lower in states that implemented state run Internet exchanges, and that less people are uninsured in states that implemented state sponsored Internet exchanges. The other elements of the ACA, namely the number of available insurance plans, and the number of ACO’s, had no effect on either the premium prices or the number of uninsured. Given the possible influence of the political opposition to the ACA on the general population’s cooperation with the ACA, the political dominance of the states was also examined, but found to have no effect on either premium price or the number of uninsured. In conclusion, we find that states with higher rates of uninsured have higher premium rates, and states with higher rates of obesity have more uninsured. After one year of the ACA, we can measure the effect of Internet exchanges on reducing premium prices and the expansion of Medicaid on reducing the uninsured.
37
Wamukuo, Joseph Thairu. "Demand for ante-natal care in Nairobi's slum areas." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/9699.
Full textAbstract:
Bibliography: leaves 71-74.This paper studies the factors influencing the demand for ante-natal care in two of Nairobi's slum areas, namely, Kibera and Mathare. Antenatal care is important as its absence I underprovision means higher incidences of both maternal and infant mortalities. On the other hand proper ante-natal care means improved well-being of both mother and child. These two groups constitute over 70% of Kenya's population. For any economic and social development programmes to succeed, there is need to give mother and child special attention. The factors influencing the demand for ante-natal care could be grouped into three major categories; socio-economic (age, marital status, income etc.), facility (quality of care) as well as policy (user-fee) variables. The data for the analysis was obtained by means of a household survey conducted in Kibera and Mathare. A two stage sampling procedure was used for the data collection. This involved first, listing of all clusters from which a random selection of clusters to be studied was done and secondly, the households were drawn by a random sample within each of the selected clusters.
38
Farnworth, Michael G. "Three essays in health economics /." Thesis, *McMaster only, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape3/PQDD_0033/NQ66265.pdf.
Full text
39
Hurdelbrink, Jonathan R. "Essays in the economics of long-term care utilization." Thesis, University of New Hampshire, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10161840.
Full textAbstract:
This research examines three factors – macroeconomic conditions, the Deficit Reduction Act of 2005, and inter-vivos transfers – that influence both the availability of long-term care services and the use of these services. The first essay explores how changes in the macroeconomy, specifically the 2007-2009 “Great Recession,” affect the utilization of paid and unpaid long-term care services. It is theoretically unclear how long-term care use should be affected by such downturns, as an individual’s health status, wealth, insurance coverage and access to care are all likely to change during a significant downturn such as the “Great Recession.” Using data from the 1998-2012 waves of the Health and Retirement Study, a survey that follows Americans over the age of 50 as they begin to transition into retirement, we estimate the effects of changes in the unemployment rate at both the national and county levels on long-term care use. We find consistent evidence that overall care use declines significantly during downturns, with additional results suggesting that these results may be driven by reductions in individual wealth and improvements in individual health status. The second essay examines how the implementation of the Deficit Reduction Act of 2005, a policy that imposed stricter regulations about how individuals could “spend down” their assets to become Medicaid eligible, impacts both asset transfers and long-term care use among the elderly. Using data from the 1998-2010 waves of the Health and Retirement Study, I estimate the effects of this policy using a difference-in-difference framework. Overall, individuals seem to substitute from making inter-vivos transfers to holding assets in trusts in response to the enactment of the Deficit Reduction Act. With regard to care use, individuals seem to substitute from in-home long-term care to more visits to both doctors and adult day care facilities following the DRA, an effect primarily driven by the wealthiest and youngest individuals. The third essay investigates the relationship between parent-to-child inter-vivos asset transfers and future informal care provision by that child. Using data from the 1998 – 2010 waves of the Health and Retirement Study, I am able to use the timing of the transfers and the care use to describe this relationship. The results suggest that the receipt of an inter-vivos transfer during the previous two years is strongly positively correlated with that child’s likelihood of providing care during the previous month. In addition, I confirm a previous finding in the literature that child’s gender, relationship to the parent and geographical proximity to the parent all significantly influence the child’s decision to provide care.
40
Welle, Derek John. "Health care in the United States: How the determinants of health insurance status differ across regions." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29229.
Full textAbstract:
Using a nationally representative sample of individuals across all fifty United States from the 2016 American Community Survey (ACS), this research explores differences in the incidence and predictors of health insurance status across region (i.e. West, Midwest, South, and Northeast) for individuals age 18 and older. The data suggests that: 1) Individuals from the Northeast are the most likely to have some form of health insurance, while individuals from the South are the least likely; 2) The factors which influence health insurance status are relatively similar across all regions, though they often differ substantially in magnitude; 3) In some cases region can play a significant role in determining the type of insurance an individual has (i.e. Public versus Private). Policy makers will find these results useful to target specific factors within regions that may prove to increase the number of insured individuals. Furthermore, researchers may choose to use this paper as a current reference and starting point for further in-depth analysis on targeted factors within specific regions.
41
Ho, Chi-wan Nelson, and 何志雲. "Factors affecting one's health care choice." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31220873.
Full text
42
Basu, Rashmita. "Healthy lifestyle, disease prevention and health care utilization." Pullman, Wash. : Washington State University, 2009. http://www.dissertations.wsu.edu/Dissertations/Fall2009/r_basu_112309.pdf.
Full text
43
Castro, Beatriz. "Access control regulation in the health care sector." Thesis, Stockholms universitet, Juridiska institutionen, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-156879.
Full textAbstract:
This thesis is about access control in the health care sector. Access control is a function in It-systems that allows authorized users to access data they have right to access, prevents unauthorized users from accessing data and prevents authorized users from disclosing data unlawfully. One of the pillars of access control is that a user only is authorized to access data that he or she needs to perform a task. This describes the principle of least privilege and its objective is to ensure data's confidentiality and integrity. In the health care sector where an increasing number of public and private actors are processing sensitive data the application of this principle is essential to protect patients' privacy and confidence in the system. The lawmaker has incorporated the principle of least privilege in legal bodies such as the General Data Protection Regulation, Patient Data Act and the regulation of registers that allow processing of health data. This thesis examines how the lawmaker has incorporated the principle of least privilege to protect health data. Therefore, it examines access control regulation, in particular, requirements on management of access rights and log audits. The lawmaker has applied this principle through requirements on the system that should be incorporated by default and through requirements on management of access rights. The conclusion is that given that the tendency in health care, like in other sectors, is toward automation and more focus on self-care, the requirements should be directed more to systems than medical staff.
44
Zanola, Roberto. "Issues in the economics of health care and the arts." Thesis, University of York, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270029.
Full text
45
Robone, Silvana Maria <1976>. "Essays in Applied Health Economics: Evidence on Health and Health Care in Italy and UK." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2008. http://amsdottorato.unibo.it/1194/.
Full textAbstract:
This thesis is the result of my experience as a PhD student taking part in the Joint Doctoral Programme at the University of York and the University of Bologna. In my
thesis I deal with topics that are of particular interest in Italy and in Great Britain.
Chapter 2 focuses on the empirical test of the existence of the relationship between technological profiles and market structure claimed by Sutton’s theory (1991, 1998) in
the specific economic framework of hospital care services provided by the Italian National Health Service (NHS). In order to test the empirical predictions by Sutton, we
identify the relevant markets for hospital care services in Italy in terms of both product and geographic dimensions. In particular, the Elzinga and Hogarty (1978) approach has
been applied to data on patients’ flows across Italian Provinces in order to derive the geographic dimension of each market. Our results provide evidence in favour of the
empirical predictions of Sutton.
Chapter 3 deals with the patient mobility in the Italian NHS. To analyse the determinants of patient mobility across Local Health Authorities, we estimate gravity equations in multiplicative form using a Poisson pseudo maximum likelihood method, as proposed by Santos-Silva and Tenreyro (2006). In particular, we focus on the scale effect
played by the size of the pool of enrolees. In most of the cases our results are consistent with the predictions of the gravity model.
Chapter 4 considers the effects of contractual and working conditions on selfassessed health and psychological well-being (derived from the General Health Questionnaire) using the British Household Panel Survey (BHPS). We consider two
branches of the literature. One suggests that “atypical” contractual conditions have a significant impact on health while the other suggests that health is damaged by adverse
working conditions. The main objective of our paper is to combine the two branches of the literature to assess the distinct effects of contractual and working conditions on health.
The results suggest that both sets of conditions have some influence on health and psychological well-being of employees.
46
Wang, Thomas Dean. "Essays on Public Outcomes Reporting and Technology Adoption in Health Care." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10179.
Full textAbstract:
This dissertation consists of three essays on hospital-based healthcare delivery. The first essay examines the effect of public reporting of hospital-level surgical mortality rates on patient outcomes in the context of California’s coronary artery bypass graft (CABG) report cards and the Acute Coronary Syndrome (ACS) population from 2004-2007. Compared to control states, I find that observed mortality rates in California improved by 12-19% after the introduction of report cards with the effect relating to quality improvement in all areas of patient care, including initial care of acute patients, surgery characteristics, and postoperative care. The second essay examines the diffusion of robotic surgery technology and its effect on patient treatment patterns. The diffusion of this technology has coincided with a rapid period of growth in surgical treatment of prostate cancer, and this has raised questions of whether technology adoption is driving overtreatment. I find that technology adoption accounts for 37-73% of increased age-adjusted surgery rates, and this is substitution away from radiation therapy. However, robotic surgery adoption explains only 12-24% of the increased total surgical volume. I show that, instead, two population trends account for most of the growth in surgery volume. The third essay examines the relationship between robotic surgery adoption and the market structure of the surgical treatment of prostate cancer. I show strong correlation between hospital robot adoption and increases in market share. Higher diffusion of robotic surgery is associated with exit of small volume providers from this procedure market and growth in the number and size of high volume providers, whose collective market share nearly doubled from 2003 to 2009. This market consolidating effect accelerated the availability of the new treatment to patients and has implications for how strategic competition may drive technology diffusion.Economics
47
Kim, John. "Industries in rapid change : essays on health care, banking and software." Thesis, Massachusetts Institute of Technology, 1998. http://hdl.handle.net/1721.1/9829.
Full text
48
Mahunga, P. "Determinants of home based care services provision for the people living with HIV/AIDS: A case study of Hope ('Tumaini') Home Based Care Programme in Tanzania." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/10689.
Full textAbstract:
Includes abstract.Includes bibliographical references.
The higher increase in the number of HIV/AIDS patients in the country has necessitated the expansion of Home Based Care (HBC) programmes and has called for the need to strengthen the HBC services in Tanzania. Since scaling up of HBC services is fundamental and the resources dedicated into HBC programs are supposed to be utilized efficiently, the factors hindering the provision of HBC services should be known and resolved. A cross sectional study was applied in studying the factors that influence the provision of HBC services and a quantitative method of data collection and analysis was used. A sample of 8 civil society organisations out of 23 carrying out HBC activities under 'Hope' HBC program were selected, representing organizations from rural and peri urban areas.
49
Lidgren, Mathias. "Health economics of breast cancer /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-202-6/.
Full text
50
Kiracho, Elizabeth Ekirapa. "Equity in the allocation of primary health care resources in Uganda." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/8915.
Full text