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1
Clark, Spencer R. "Health Care Reform's Effect on Private Medical Practices." Scholarship @ Claremont, 2011. http://scholarship.claremont.edu/cmc_theses/209.
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In March of 2010, the 44th President of the United States, Barack Obama, signed into law a health care reform bill that will change the medical and business approach to healthcare that has been witnessed for quite some time. The Patient Protection and Affordable Care Act, aims to eliminate several inefficiencies encountered in our current health care system, as well as extend coverage by providing affordable care for the roughly forty six million Americans currently uninsured. Many of the changes will be implemented over the next several years, but hospitals, businesses, physicians, and insurance companies are no doubt planning ahead for the effects these changes will have on their particular industry. Although there will be many facets of change affecting all of the previously mentioned occupancies, the goal of this paper is to investigate the effect healthcare reform will have on private medical practices in the United States. The following sections will cover ways in which medicine has been practiced in the pre-reform era, historical attempts made to pass health reform legislation, several of the issues our current system faces along with the reform changes implemented to fix them. Then I will investigate the effect these changes will have, if any, and conclude by relating everything back to independent medical practices.
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Kubacki, David. "News Reporting During the Healthcare Reform Debate." University of Toledo / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1333319763.
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Guimarães, Cristian Fabiano. "A variação do coletivo na saúde." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/130525.
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Este estudo problematiza a noção de coletivo na saúde, analisando os jogos e as disputas sobre essa expressão no campo das reformas sanitárias italiana e brasileira, visando compreender a singularidade da saúde coletiva. Tomando como ponto de partida o fato de que a saúde coletiva marca uma diferença no território da saúde, importa compreender a noção de “coletivo”, tomando-a como analisador, com a finalidade de acompanhar como ela se expressa na saúde e quais sentidos atualiza. Para fazer essa discussão, situamos nossa investigação em uma perspectiva genealógica, analisando a composição e a perda de sentidos dos territórios reformistas nos cenários italiano e brasileiro. Discutimos as imagens construídas para expressar o coletivo na saúde – a população, o grupo e a sociedade civil –, com o intuito de propor um modo diferente para pensar essa expressão, de caráter processual e intensivo, passando a entender o coletivo como potência. Não é a fixação dessa noção às formas que lhe são atribuídas que afirma a saúde coletiva, mas a força que caracteriza o coletivo como algo inespecífico, condição para a variação da potência. Acompanhando as experiências reformistas, ficou evidente que a imaginação e a composição de noções comuns são mecanismos disparadores da variação, ativando o desejo e as resistências. Analisar o coletivo na saúde coletiva de forma articulada com os movimentos reformistas italiano e brasileiro evidencia a singularidade dessa expressão no território da saúde. Considerar essa singularidade evita que, paradoxalmente, reproduza-se uma política que afirme os preceitos da medicina social ou da saúde pública no campo da saúde coletiva, abrindo a possibilidade para novas produções de sentido.This study discusses the notion of the collective in healthcare through the analysis of the games and disputes that take place over this expression in the field of Italian and Brazilian healthcare reforms, with the objective of understanding the uniqueness of collective healthcare. Taking as its starting point the fact that collective healthcare marks a difference in the health area, it is impotant to understand the notion of "collective", taking it as an analyzer, with the objective of monitoring how it is expressed in healthcare and which concepts it updates. To make this discussion, we situate our research in a genealogical perspective, analyzing the composition and the loss of sense in reformist territories in the Italian and Brazilian scenarios. We discuss the images constructed to express the collective in healthcare – the people, the group and the civil society – in order to propose a different way to think this expression, that is procedural and intensive in character, comming to understand the collective as power. It is not the establishment of that notion to the forms assigned to it that asserts the public healthcare, but the strength that characterizes the collective as something unspecific, condition for the change in power. Following the reformist experiments, it became clear that the imagination and the composition of common notions are trigger mechanisms for variation, enabling desire and resistance. By analyzing the collective in collective healthcare in coordination with the Italian and Brazilian reform movements, we stress the uniqueness of this expression in the healthcare area. To consider this uniqueness prevents, paradoxically, the reproduction of a policy that affirms the precepts of social medicine or public healthcare in the field of collective healthcare, opening the possibility for new productions of meaning.
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Richardson, Timothy R. "Military healthcare reform and legislative changes for FY01." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2000. http://handle.dtic.mil/100.2/ADA387369.
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Thesis (M.S. in Management) Naval Postgraduate School, December 2000."December 2000." Thesis advisor(s): Doyle, Richard B. ; Barrett, Frank J. Includes bibliographical references (p. 75-81). Also available online.
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Chan, Yee-ying Michelle, and 陳意映. "The formulation and implementation of healthcare reform in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31966469.
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Chan, Yee-ying Michelle. "The formulation and implementation of healthcare reform in Hong Kong." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B2329470x.
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Wang, Guang-Xu. "Network analysis of the universal healthcare financial reform in Taiwan." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/29827/.
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Taiwan adopted its National Health Insurance (NHI) scheme in 1995. Presently, the scheme covers virtually all of the island’s citizens. However, it is under the threat of a serious imbalance between expenditure and revenue. As spending has become unsustainable, everyone has realised the need for financial reform. However, the reform process itself is beset by political confrontations. There is a need to deepen the understanding of the relationships and dependencies among the policy actors. With a view to helping address this problem, this study empirically examines the multiple types of ties prevailing between the policy actors and the resulting power distribution while the DPP government was working earnestly towards reforming the NHI’s financial system in the period 2000-2008. Apart from official documents, data are drawn from a network survey coupled with semi-structural interviews of 62 policy actors including government officials and related unofficial policy participants. Measures such as the in-degree centrality index and core/periphery model, betweenness centrality, structural hole index (effective size), density index, E-I index and CONOOR procedure (Blockmodeling and multidimensional scaling - MDS) are used to identify the major participants and network structures in the NHI domain and assess their relative influence-powers on the basis of information transmission patterns, resource exchanges, action-set coalition relationships and reputational attributions. It is shown that, although the public sector and the medical associations were at the helm of the NHI reform, financial reform remained unfulfilled mainly because of poor communications among societal actors. We then performed a social network analysis and systematically mapped the prevailing political conflicts among diverse policy stakeholders. We confirm that SNA is an effective research tool for political feasibility evaluation; it can facilitate smoother policy adoption by enhancing better interactions within networks.
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Yan, Qing. "Inequity of Chinese healthcare system." Thesis, University of Macau, 2015. http://umaclib3.umac.mo/record=b3258539.
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Blackadar, Kerry Jean. "A content analysis of US newspaper coverage of Canada and the UK’s healthcare systems during America’s healthcare reform." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/27836.
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This study examines how Canadian Medicare and the United Kingdom’s National Health Service (NHS) were represented in US newspaper coverage between January 2008 and the first quarter of 2010, a period marked by changing healthcare policy in America and dramatic shifts in the journalism industry at large. Through a content analysis of print news from the New York Times, Wall Street Journal, and USA Today, this paper tracked and assessed reporting dimensions and coverage themes to illustrate the quantity and quality of coverage. The analysis was based on the seminal work of Pauline M. Vaillancourt Rosenau, who performed a content analysis of newspaper coverage of Canada’s healthcare system between 2000 and mid-June 2005 in the NYT and WSJ.
Findings from this thesis reveal that recent US newspaper coverage of Medicare, though narrow, is more accurate and balanced compared to coverage during Rosenau’s study timeframe. The NHS received far greater attention in US newspapers, indicating that outside factors, potentially including collaboration in the Iraq war, have spawned greater US media interest in the UK at large. On occasion, this study found coverage of the NHS to be critical, relying on anecdotal evidence to suggest systematic failure of aspects of healthcare in the UK. With respect to coverage themes, wait lines for treatment was a dominant issue in US newspaper reporting of both Canadian Medicare and the NHS. Medical tourism and problems associated with paying for universal healthcare also emerged in US representation of the NHS.
This paper concludes with a discussion of outside factors that may have influenced American newspaper coverage during the study period. Considering the current state of print journalism, this paper predicts that, in the years ahead, American print coverage of foreign healthcare will continue to decline. However, in conjunction with this, it is likely that increased online representation of foreign healthcare stories will occur, as new journalism platforms, such as blogs, continue to proliferate. Finally, as American reporters continue to gain greater access to online healthcare research databases, this study suggests that the quality of US coverage of Medicare and the NHS is likely to improve.
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Kooverjee, Mukesh Manilal. "A perspective on healthcare delivery systems with the emphasis on South African healthcare and the need for reform." Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/52687.
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Thesis (MBA)--Stellenbosch University, 2002.ENGLISH ABSTRACT: The need for efficient and equitable health provision remains a challenge for all countries and economies of the world. Defining health, healthcare and health provision are contentious issues, and public debate rages on as governments throughout the world attempt to quell public demands and expectations. Healthcare scenarios differ vastly from country to country, each attempting to accommodate its own needs, given the limitations placed on the systems in terms of human and financial resources. These differences are large as will be seen when countries with developed market economies are compared to those in the less fortunate Third World. The financing of healthcare systems is a complex and challenging task. Affordability of healthcare is an issue for all nations of the world. Most countries enjoy a mix of private and public funding to ensure that some degree of good health is attained by the nation as a whole. South Africa has a unique health system in that it has two distinct and separate health systems. This is not by chance. South Africa is a country that boasts enormous diversity but huge inequalities in terms of race, culture, class and income. Systems had therefore developed along very defined lines where the privileged have had access to expensive, modern and private healthcare while the poor and indigent have had to use a poorly structured public service. The purpose of this literature review is to research and to define those issues and concepts which require clearer perspective. It will also look at healthcare.
AFRIKAANSE OPSOMMING: Die noodsaaklikheid vir effektiewe, billike en regverdige gesondheidsvoorsiening bly 'n uitdaging vir alle ekonomieë van die wêreld. Om gesondheid, gesondheidsorg- en gesondheidsvoorsiening te definieër, is 'n kontensieuse aangeleentheid en die openbare debat duur voort, soos regerings in die wêreld poog om te voldoen aan oorweldigende openbare eise en verwagtinge in hierdie verband. Gesondheidsorg-opsies verskil drasties van land tot land, wat elk poog om sy eie behoeftes te akkommodeer, gegewe die beperkings wat die sisteem belas in terme van menslike en finansiële hulpbronne. Hierdie verskille is beduidend, soos wat gesien kan word wanneer lande met ontwikkelde mark-ekonomieë vergelyk word met die lande in die minder bevoorregte derde-wêreld. Die finansiering van gesondheidsorg-sisteme is 'n komplekse en uitdagende taak. Die bekostigbaarheid van gesondheidsorg is 'n aangeleentheid wat al die lande van die wêreld raak. Die meeste lande van die wêreld het 'n gemengde gesondheidsorg-sisteem wat bestaan uit gedeeltelik privaat en gedeeltelik openbare fondse, sodat toegesien word dat 'n mate van goeie gesondheid bereik word deur die land as geheel. Suid-Afrika het 'n unieke gesondheidsorg-sisteem deurdat twee besondere en aparte gesondheidsisteme bestaan, wat beslis nie toevallig is nie. Suid-Afrika is 'n land wat spog met enorme verskeidenheid, maar beduidende ongelykhede in terme van ras, kultuur, klas en inkomste. Gesondheidsorg-sisteme het dus ontwikkel langs baie beslisde lyne waar die bevoorregtes toegang gehad het tot duur, moderne en privaat vesekerings-gebaseerde gesondheidsorg, terwyl die arm en armlastiges gebruik moes maak van 'n swakker gestruktureerde openbare diens. Die doel van hierde nagevorsde oorsig is om navorsing te doen om sisteme uit 'n globale perspektief te identifiseer en daardie beginsels toe te pas, wat voordelig kan wees in 'n plaaslike konteks. Daar word aanvaar dat die Suid-Afrikaanse gesondheidsorg-sisteem baie het om te leer van ervarings in beide die ontwikkelde en ontwikkelende lande. 'n Besondere begrip hiervoor, is die basis waarop 'n suksesvolle gesondheidsorg-sisteem in hierdie land gevestig kan word. Daar word gehoop dat deur die besondere perspektief te hê, sekere werkbare oplossings gevind en bereik kan word.
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Lindsay, Gail Margaret. "Nothing personal?, narrative reconstruction of Registered Nurses' experience in healthcare reform." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ63623.pdf.
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Noir, Charles Randall. "Information systems strategy and organizational reform in the Indian healthcare sector." Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611794.
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Miles, James Leon. "The Center for Total Health: Healthcare Reform in Cook County, Illinois." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1856.
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The Patient Protection and Affordable Care Act (PPACA) of 2010 requires hospital systems in the United States to shift the culture of patient care from a focus on sick-care to a focus on prevention and wellness care. Little is known about how hospital systems will make this culture shift while retaining quality patient care. The purpose of this case study of a pioneering hospital-based PPACA-compliant initiative was to answer the research question of how Wallace's revitalization movement theory (RMT) "a rapid culture change model"could serve as a transferable evaluation framework for PPACA prevention and wellness care compliance in hospital-based programs. Kingdon's policy streams theory provided a conceptual framework. Data analysis included iterative, thematic coding of interviews with 3 primary stakeholders responsible for developing the policy, planning, and program implementation strategies of the Center for Total Health (CTH). Nineteen extensive primary source documents were included in the analysis as well. Findings supported the utility of the RMT structure and definitions in the identification of culture change dynamics in CTH. Additionally, this structure served as a scaffolding for grouping individual and institutional rapid culture change dynamics into stages that could be evaluated in terms of PPACA compliance. These stages effectively identified a Kingdon policy window in which PPACA mandates could be expected to result in culture change in multiple streams of public policy development, not only in wellness and sickness prevention, but also in local, state, and national health cost-saving initiatives in food-as-medicine, community identity, public health support networks. It could also reduce chronic disease and the rising institutional care delivery costs.
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Lynch, Carmela Josephine. "The Effect of Healthcare Reform on the Sustainability of Nonprofit Hospitals." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2130.
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Healthcare spending in the United States has continued to rise with annual healthcare cost of $3.8 trillion in 2014. While costs and the population continue to rise, resources continue to dwindle. Consequently, Congress has imposed various price controls and healthcare reform measures over the past 20 years, including the recent Patient Protection and Affordable Care Act (PPACA), which aims to decrease spending while enhancing quality and safety of care delivery. As a result of the implementation of the PPACA, 34 million additional Americans may be eligible for healthcare in a system already needing additional resources, increased access to care, and strategies to offset increasing operational and fiscal challenges. The purpose of this descriptive study was to explore what strategies and changes 10 executive leaders of the nonprofit hospitals in Maryland used to address the operational and fiscal challenges of the PPACA. The conceptual framework for this study was built upon the general systems theory. The data were collected through semistructured interviews, cataloged and coded, analyzed using a modified van Kaam method, and reviewed by participants as part of member checking process. The findings revealed 3 emergent themes: investment in IT resources to support an EMR system, strategies to address healthcare workforce challenges, and strategies for sustainability for managed care outpatient services and patient safety and quality of care. The findings impact social change by presenting policies and processes that medical professionals can use to support local and national health care reform.
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Loriston, Izienne P. "Informing BPM practice in Emergency Units of South African hospitals for improved patient flow." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28442.
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Globally, higher healthcare demand strains existing systems, already overburdened by a lack of resources and funding while longer life expectancy and increased disease burden force higher patient loads. A majority of the South African population is medically uninsured and therefore depend on emergency care; consequently, the healthcare service demand easily exceeds available acute care to prevent life threat. When this happens, emergency centres suffer from overcrowding and long patient waiting times, which increases morbidity and mortality, associated patient risk. Moreover, critical resources such as staff and hospital beds are required for an even flow of patients through hospitals, but are distributed inefficiently. The South African healthcare system configuration therefore delays access to and compromises the delivery of equitable, unbiased life-saving healthcare in an environment moreover challenged by economic pressures. This calls for sustainable, cost-effective reform. Therefore, more efficient healthcare can save more lives by improving access to life-saving care. Research on current Healthcare Information Systems (HIS) shows an incoherent knowledge body with conceptual gaps in theories on healthcare, which disengages transformation potential. Comprehensive reform tactics thus require a priori concept discovery and diagnostics to make research practically useful. The systematic use of BPM theories allowed for the qualitative assessment of as-is process activity at patient touch-points at three hospitals – two public and one private – in the Western Cape of South Africa. Because a strategic Information Systems (IS) methodology, Business Process Management (BPM) poses business process activity improvement, this research draws from successful BPM activity as a means to improve patient flow processes in Emergency Centres (ECs). Success is evaluated by drawing from empirically supported enabler categories and prescriptive guidelines because BPM practice is not yet fully understood. The results show a clear correlation between the improvement areas at the three hospitals; improvements on aspects of actions and decisions taken during patient-flow process activity, therefore support a pragmatic approach to reform. The data confirms disparity between public and private healthcare. Healthcare appears to be a “doctor driven” service, which, based on qualitative decision-making, navigates patients along defined flows, enabled by supporting human capital and hospital assets. Optimal patient flow is a product of symbiotic working relationships and depends on efficient integration with wider hospital functions. Shorter waiting times and hospital stays reduce process burden. This leads to more efficient resource usage and regulated access to healthcare. However, integrated healthcare reform must consider the time demands and rigidity of clinical processes. The challenge lies in finding the space to invite parallel business agility to drive the reform of the stricken healthcare industry in South Africa.
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Tetteh, Dinah A. "U.S. Newspapers Coverage of The 2009/10 Healthcare Reform Debate: A Content Analysis." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etd/1256.
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The aim of this study was to examine the extent to which U.S. newspapers covered the chatter surrounding the 2009/10 healthcare reform debate at the expense of the substance. Also of importance was how the political leanings of newspapers influenced the coverage they gave the issue in terms of tone and page or story prominence. Newspaper endorsement data from Editor & Publisher magazine were used to determine the political leanings of U.S. newspapers based on the candidate they endorsed in the 2008 U.S. presidential election. Newspaper articles related to the topic were retrieved from the Lexis-Nexis database and analyzed. The results showed that overall the healthcare reform debate received substantial coverage in U.S. newspapers; but the major part of the coverage was dedicated to the arguments, protests, and thoughts of people concerning the issue (90.3%) rather than the substance of the issue (9.7%). Implications of the results for media practitioners, communication scholars, and researchers were discussed.
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McKnight, Jacob. "Constructing reform in the Ethiopian healthcare system : unintended consequences for hospitals and patients." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:e844b6c5-2830-49ad-a411-2b3c0cb849ad.
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In the last decade, the reach of New Public Management (NPM) has stretched well beyond its Western origins as modernising African governments and their global health partners have sought to import new approaches. Public health systems in Africa are entirely different to those of the West however, and this sort of application introduces a number of contextually-specific questions that are not considered by the majority of the NPM literature. The few studies that do investigate NPM in Africa are evaluative in content, seeking to understand whether reforms work and to identify barriers to success. Invariably, whether they find in favour of public management reform or not, the same issues are highlighted: lack of capacity, weak institutions, and improper implementation. This thesis will build a theory of NPM reform that is particular to the African context. I develop this theoretical extension through an intensive ethnographic case study of one of the most important on-going public health reform efforts in Africa—the transformation of the entire Ethiopian hospital system to an NPM-style administrative regime. I develop a constructionist theory of African NPM through thick description of the hospitals under reform. I detail the various ways in which the reforms are indigenised as they meet up with local understandings, institutions, and market contexts, and the inevitable unintended consequences as managers seek to ‘make do’ in environments radically different to those of NPM’s origins. I then conduct a detailed consumer analysis to describe the strategies employed by patients seeking care. Patients from different class positions use very different strategies to get health services and I demonstrate that the reform has very different consequences for Ethiopians across classes. Many patients are not recognisable as the ‘customers’ described in the reform documents, and so the hospitals do not organise their reform efforts to serve them.
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Kabir, Shahnaz. "Reform strategies for management of vascular patients to reduce readmission and healthcare costs." Thesis, Utica College, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10250824.
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The capstone project reports the risk factors causing unplanned hospital readmission of vascular patients as well as the effects on healthcare cost. The methods for determining the risk factors include clinical indicators for risk prediction process, and the STAAR (State Action on Avoidable Rehospitalization) initiatives, which can be used as healthcare improvement projects to facilitate the cross-continuum team. The findings indicate a relationship between the patient’s engagement in the lower extremity vascular procedure, and effectiveness of follow-up after surgery in the reduction of hospital readmission and healthcare cost. Potential strategies to prevent the risk factors for readmission of vascular patients and to reduce the healthcare cost are discussed. Presenting unplanned readmission for vascular patients and reducing the cost associated with readmission is important for senior leaders and policy makers to improve health care outcome.
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Zhao, Hongwen, and zhaohongwen@nhei cn. "Governing the healthcare market: Regulatory challenges and options in the transitional China." La Trobe University. Public Health, 2005. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20080131.100619.
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During the transition from a planned economy to a decentralized, market socialist economy, the Chinese healthcare system has evolved from a centralized, egalitarian public system (1949-1979) to one which is largely self-governed and can be characterized as �public identity, private behavior� healthcare system (1980-1999). With blurring of the distinction between public and private governing systems, and a shift in norms towards profit orientation, major concern has arisen about the extent of high cost, high volume services being offered through excessive entrepreneurial practices.
This thesis is concerned with the regulatory strategies and options to reach 2010 health reform objectives of equity and efficiency under a mixed public/private market. While possible lessons can be drawn from established economies and transitional economies, China faces some unique challenges, given the diverse market structures and fragmented healthcare system across the country, and the underdeveloped framework for the rule of law. The thesis reviews policy documents from 1949 to 2004 and draws from interviews with senior health policy-makers and hospital directors in three different locations, in order to explore the role of the state in market regulation, the effectiveness of technical and social regulations, and how policy implementation and regulatory compliance occur.
The research has found that the dynamics of the healthcare system are shaped by the financing arrangements for healthcare and the absence of arms-length governance of hospitals by health departments. Without an effective state health financing tool, nor mature market institutions, China is not able to use neither performance-based regulation nor technology-based regulation. China has adopted a management-based regulatory strategy but the absence of effective governance structure hinders effective regulation.
If the reform objectives of improving healthcare quality while costs are to be attained, China will need to develop purchasing tools to alter the current perverse incentives for provider behavior. Government will also need to work with civil society organizations to develop tools for clinical governance, such as clinical audit for risk management and hospital accreditation programs. To do so requires establishing arms-length governance mechanisms between health departments and hospitals, and appropriate corporate governance structures within hospitals. Specifically, MOH needs to establish a technical policy think tank to investigate all the policy issues arising from the announcement of the 1997 health reform, including coordination with other line ministries and provincial authorities, and formulation and implementation of a policy research agenda, in order to attain a market-based governance system for health by 2010.
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Garcia, Tanisha. "Associations Between Leadership Style and Employee Resistance to Change in a Healthcare Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2536.
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. Abstract
Health reform is forcing healthcare administrators to make rapid changes. A tendency to resist change can present problems for these organizations, including the large, not-for-profit Catholic healthcare systems. In order to make positive contributions towards healthcare, it's important to recognize the nature of the organization's involvement to change. The transformational leadership style has been shown to be positively correlated with change however, the relationship among leadership styles, employees' behaviors, and motivation to change are still not well understood and require further study. Further, although Oreg's Resistance to Change (RTC) approach has been researched in direct patient care areas, RTC research in non-patient settings is lacking and necessary in delivering the full spectrum of patient care. This study focused on the relationship of transformational leadership to RTC and if the relationships leaders' have with subordinates' influence change. A customized survey that included the Multifactor Leadership Questionnaire, RTC, and Leader Member Exchange (LMX 7) was emailed to 500 random individuals of various ages and races from 3 non-patient areas. Thirty leaders and 133 raters responded. The regression analysis showed a strong correlation between transformational leadership and RTC. Additionally, each of the variables from the LMX 7 section of the survey showed associations indicating the relationship leaders develop with their subordinates and leader transformational scores were positive. This study may contribute to the awareness of RTC and utilizing transformational leadership style to move change in a positive direction for a healthcare setting.
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Henawi, Mohammed Khaled. "Healthcare financing reform in the Kingdom of Saudi Arabia : an assessment of willingness to pay." Thesis, Aston University, 2017. http://publications.aston.ac.uk/33345/.
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Lundberg, Maya. "Location choice of private primary healthcare providers in Sweden : After the Primary Care Choice Reform." Thesis, Umeå universitet, Nationalekonomi, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-174828.
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This study aims to analyse the location choices made by private primary healthcare providers as a result of the Primary Care Choice Reform. This will be done by analysing a unique dataset covering all new private primary healthcare providers during the time period of 2008 to 2018 in Sweden’s 290 municipalities. In order to examine the probability of a private primary healthcare provider locating in a given municipality, two logit regression models based on the year 2018 containing the number of private primary healthcare providers as the dependent variable, will be used for the empirical analysis. The results are presented as marginal effects and are calculated from the coefficients of the two logit regression models. In addition, there exist alternative measures to the dependent variable when analysing the location choice of private primary healthcare providers. For this reason, an alternative regression will be presented where the dependent variable is the share of healthcare providers in the municipality that is privately owned, to see if any new conclusions can be drawn. There is a broad range of possible determinants for where to locate. Those included in this study are the Care Need Index, political party, domestic net migration, distance, socio-economic variables and a variable measuring the population size. Furthermore, all private primary healthcare providers will be grouped according to which county council they belong to, since all county councils have different reimbursement systems. The findings imply that private primary healthcare providers are, on average, less likely to locate in municipalities defined as rural, compared to municipalities defined as urban. Socio-economic factors such as elderly people and income further influence the location decision, where people with less socio-economic status are at a disadvantage. For this reason, there are some questions about if the objectives of the Primary Care Choice Reform have been achieved and for whom.
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Makgatho, Adolf Tapelo. "Making sense of stakeholder responses to impending major policy reform in the private healthcare sector." Diss., University of Pretoria, 2015. http://hdl.handle.net/2263/52436.
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Implementing policy change is notoriously difficult, often marred by chronic delays or
outright failure to achieve its originally desired mandate. This challenge drew the
attention of many scholars who, over the years, published many studies attempting to
describe and analyse what the policy change process looks like and most notably,
strategies on how to better manage it. However, most of these studies tacitly
committed themselves to strategic issues of managing change from a policy-maker s
perspective, with very little consideration of what the change process actually looks and
feels like from the perspective of the change recipients. Yet, it goes without saying that
responses of these change recipients directly affect the outcomes of the change
process.
This study sought to address this gap in literature by exploring South Africa s prevailing
National Healthcare Insurance (NHI) policy reform. Using a qualitative design and
theoretical insights from political sciences, social sciences and organisational studies,
the study analysed how the relevant stakeholders in the private healthcare industry
were variously thinking about and responding to the proposed reforms.
The findings of the study emphasised the critical role of temporally sequenced
historical events in shaping an industry and influencing its change orientation. The
study also weighed in on scholarly debates that challenged general characterisation of
any recipients contradictory opinions as resistance to change . In this study, the
stakeholders seemingly antagonistic attitudes and responses to the NHI policy were
not necessarily a contestation against change in itself. Instead, the conflict was over
compatibility with the policy s implicit secondary goals. This contestation evoked
opinions and responses so strong that it overshadowed the stakeholders initial felt
need for change. From this perspective, this research argued for a distinction to be
drawn between diagnostic congruence and goal congruence. It further proposed that
paying diligent attention to formulating an accurate diagnosis of the problems to be
addressed through policy change could attenuate haggling and achieve far better
results than finding the best way to attain an agreed upon goal across all relevant
stakeholders.Mini-disseration (MBA)--University of Pretoria, 2015.
nk2016
Gordon Institute of Business Science (GIBS)
MBA
Unrestricted
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Jammoul, Nada Youssef. "Health system reform and organisational culture : an exploratory study in Abu Dhabi public healthcare sector." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/health-system-reform-and-organisational-culture-an-exploratory-study-in-abu-dhabi-public-healthcare-sector(a0e332d3-dc09-4839-be99-698d0c0f2690).html.
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The health system in Abu Dhabi has undergone a series of far reaching reforms during the past six years, yet in spite of the structural transformations, public confidence in the performance of this vital sector is still skeptical at best and employee engagement is still low. The thesis was underpinned by the aim to reveal the challenges in public health system reform outside the context of western administration. This thesis is an attempt to analyse the intricate, multidimensional concept of organisational culture within the complex structure of public healthcare sector in a fast growing economy like Abu Dhabi. Managing organisational culture is increasingly viewed as an essential part of health system reform. Organisational culture in health care organisations has gained increased consideration as an important factor that affects health systems reform and influences the quality of health care. The research project aims to explore the context of health system reform in Abu Dhabi and to understand the organisational culture of the different constituents of its public healthcare sector. Using a multi-method investigation combining both qualitative and quantitative approaches using the Competing Values Framework as conceptual framework, this research aims to provide a critical assessment of organisational culture in healthcare sector in Abu Dhabi. Semi-structured interviews were conducted in the regulator, operator, and three public hospitals prior to the use of a survey instrument based on the Organisational Culture Assessment Instrument (OCAI). The data analysis revealed that the prevailing cultural model of the Abu Dhabi public sector organisations was concurrently governed by hierarchy and market cultures while the presence of clan and adhocracy models was relatively limited. Interesting variations in assessment of clan culture were found between UAE nationals and other nationality clusters. The findings also revealed a desired cultural shift manifested by a higher emphasis on clan and adhocracy cultures and a lower emphasis on hierarchy and market culture. Those results confirm the presence of two opposing or competing cultural dimensions clan/adhocracy vs. hierarchy/market. This research makes a considerable contribution to the sparse empirical studies in health system reforms and organisational culture in the Arab Gulf states, and proposes important explanations and possible solutions to the salient challenges facing the health system in Abu Dhabi.
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Hon, Wai-ping Tiki. "An analysis of policy options to tackle the problem of expanding expenditure in public healthcare in Hong Kong." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21036640.
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Chen, Yan, and 陈龑. "Health care financing in China : what lessons China can learn from other countries on healthcare reform?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193770.
Full textAbstract:
Background
China never stops taking effort to reform its health care system. Health care financing, which is one of the essential control knobs to health care system, has significant influences on the sustainability of the health system, the quality of services it delivers, the health status of the population as well as the success of the whole health care reform process.
Objectives
This article aims to summarize the evolution of China’s health care financing system, its current situation and challenges, discuss what lessons China can learn from the successful experiences or unsuccessful pitfalls of others countries on its health care financing reform.
Methods
Articles were searched through PubMed and CNKI. Further relevant articles were identified by searching the citations listed in retrieved articles manually. 96 articles were reviewed. Statistics about China’s health care system were mainly from government white paper, SHA technical paper, Chinese government websites and WHO website. The information about the performance of health care systems in other countries was mainly from OECD database and WHO website.
Results
In China, insufficient government expenditure and high out-of-pocket payments; social health insurance providing limited risk protection, with low-level risk pooling; escalation of costs; inefficient financing resources allocation in providers; disparities among regions and provinces all lead to the inequity and inefficiency of the health care financing system and create heavy financial burden on patients. Based on experiences from other countries, the total health expenditure in China could take an even larger proportion of GDP in the future; it is reasonable to increase general government expenditure to further reduce the household out-of-pocket payment and provide financial protection and ensure equity; expanding services coverage and proportion of the costs covered, gradually merging the risk-pool units and different schemes can make social health insurance a more powerful tool to make sure people’s access to basic health care; a new payment mechanism and stricter supervision on supply side can effectively contain the escalation of the costs; government should inject more funding to front-line institutions and the function of primary care in China can be stimulated by a good primary health care delivery system, in which the role of primary care provider is clearly defined as the gatekeeper of the health care system, with a proper referral mechanism; more responsibility should be taken by central government to allocate financing resources based on the fiscal capability of local governments; Chinese government should foresee the demand of aging population and take actions before it is too late.
Conclusion
It is consensus that China’s health care reform is heading at the right direction. However, there are a lot of problems in China health care financing system remaining to be solved. Health care financing system varies greatly in each country and there is no perfect health care financing system in the world. Thus no single country can be one hundred percent copied by China. But general principles and one or some most successful and advanced portions of other countries’ health care financing systems can still be used as references by China after further assessment. Unsuccessful oversea experiences are also precious lessons for preventing Chinese government from making same mistakes. A good health care financing system should be designed on the basis of a systematic review of all domestic financing policy and previous international experiences.published_or_final_version
Public Health
Master
Master of Public Health
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Kabajulizi, Judith. "Macroeconomic implications of healthcare financing reforms : a computable general equilibrium analysis of Uganda." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2016. http://researchonline.lshtm.ac.uk/2545198/.
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There are a lot of health sector reforms across the spectrum of high to low income countries. There are underlying pressures for reform regarding the role and responsibility of different actors in relation to healthcare financing, production, consumption and regulation. The health sector itself is usually a very significant economic sector in its own right, and thus changes to it have direct impacts on the economy and indirectly through their effect on health, yet there is little consideration of these wider macro effects. The wider macro-economic effects refer to the general equilibrium outcomes of the economy’s transmission mechanisms through wages,rents, factor demand and supply, foreign exchange rates and sectoral shares in output, which in turn affect changes at the macro level (including GDP, private and public consumption, investment, imports and exports, and poverty levels). There is an ever increasing attention to the question of how to increase financial resources for healthcare, particularly by governments. This thesis sets out to evaluate the economy wide impacts of healthcare financing reform policies, taking Uganda as a case study. Using a recursive dynamic computable general equilibrium (CGE) model, calibrated from a health-focused Social Accounting Matrix (SAM), the impact of healthcare financing reform policies is assessed. Three sources of fiscal space for health – prioritisation of the health sector, earmarked taxes for health, and aid for health – are analysed. Results showed that increasing resources to the health sector from any of the three sources of fiscal space for health coupled with the envisaged improvements in the population health status leads to higher GDP growth rates and reduces poverty. The tax for health policy showed the highest GDP growth rates while the aid for health policy achieved the highest reduction in poverty. Therefore, government should increase resources to the health sector in order to achieve the aspirations of the Uganda Vision 2040.
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Chen, Dongjin. "Legacies and Incentives:Explaining Variation in Local Healthcare Expenditure Variation in Post-Mao China." Kent State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=kent1343052167.
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Arjoon, Cindy. "A Comparative Study: How Educational and Healthcare Preparedness Affected Marketization of the Chinese and Indian Economies." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4432.
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In this archival study, I explore reasons why India's economic takeoff into marketization in 1991 failed to meet the same success as China in 1979 when it made the same transition. I analyze the impact of education and healthcare on development and how investments in both sectors can yield significant returns privately and socially. The research in this paper seeks to answer the following question: Why was the Indian economy unable to meet the same success as China when developing a global, open market economy?
In order to answer this question, I begin by proving a solid relationship between education, healthcare, and development. Then, I set out to undercover education and healthcare reforms enacted by China that helped contribute to the overall success of the new economy. After, I look at the holes in the education and healthcare sectors of India that contributed to the weak transition into the new economy, as well as new mandates that seek to repair these issues so that the economy can grow and prosper at a more favorable pace.
The results of this study reflect that India was unable to meet the success of China when transitioning to a global market economy because poor social preparedness prevented the Indian people from reaching their full potential. With poor education and a major lack of healthcare, the population could not contribute to the growth of the new economy because they either did not understand how to stimulate it, or were simply too sick.
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Fisher, Ronald L. "What Cost Hospital Quality: Performance Uncertainty Under Market Reform." VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/705.
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Healthcare is an organizational field that has undergone profound change in the last few decades, an era characterized by market reform. Healthcare production has revealed both economic and quality problems in past eras, and reporting on these problems can be seen to have contributed to pressures for social reform. Yet, the move toward more market-oriented governance structures and design solutions also reflects a wider isomorphic institutional tendency for organizing social order.The conceptual frame work of this study takes a pessimistic stance on whether the market reform has achieved the intended goals with respect to advancing organizational quality performance. The framework draws on institutional theory and complementary collective action notions in organization theory concerned with boundedly rational decision-making to reason that healthcare evidences certain contextual characteristics that are not a good fit with the market enterprise model of organizing organizations. Specifically, hazards to the efficient market thesis were considered to include uncertain outcomes, a high degree of technical and coordination complexity, and the need to account for intertemporal process transformations of significant duration.A longitudinal design was used to test efficient market thesis propositions. Inpatient administrative data was used to develop two latent hospital quality performance variables, a Mortality quality indicator and an Errors quality indicator. The two latent variables were derived from three selected AHRQ patient safety indicators and an inpatient mortality rate. The measurement model was validated as evidencing significant systematic between-hospital variation. Audited survey data, along with inpatient discharge data was used to develop hospital economic performance variables and process control variables.A set of predictive supply-and-demand models were used to test: 1) whether there is evidence of any trend in quality performance, and how market competition relates to observations of improvement; 2) whether quality cost more; and, 3) whether preferences for better quality outcomes related to hospital economic performance. A hierarchical linear model growth-curve design was employed to assess the predicted relationships and to account for unmeasured organizational dependent relations determinant of hospital quality performance. The unaccounted for systematic between-hospital variance was taken to estimate an "unspecified" hospital-specific institutional effect, independent of material-resource factors. The measurement model results for each of the quality indicators selected evidenced construct validity for patient-level risk-adjustment. Each quality indicator demonstrated a significant systematic between-group variance component in all of the four years studied. The two latent hospital quality performance variables also demonstrated systematic between-hospital variance in growth trajectories in the linear growth-curve model.The predictive models evidenced no significant growth rate trend for either of the quality indicators, indicating the competitive bar on quality performance was unaffected during this period of market reform. Neither was there any evidence that pricing mechanism were able to price the utility of better outcomes, as higher quality did not cost more. Neither was there evidence that consumer preferences for better quality related to better hospital economic performance, as measured by hospital operating margins.
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Kornreich, Yoel. "Unorthodox approaches to participation in authoritarian regimes : the making of China's recent healthcare reforms." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/38163.
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In recent years, non-democratic regimes have introduced a host of participatory forums. This paper asks why, given the absence of binding constitutional or institutional designs, authoritarian governments introduce, at their own initiative, participatory forums? To respond to this question, the paper suggests three theoretical possibilities: fragmented authoritarianism, enhancing legitimacy and information-gathering. Looking at the drafting of China’s recent healthcare reforms--where the government enacted various forums of participation--the paper tests these theories. Its findings indicate that these theories are not mutually exclusive, as each could explain the causes for the introduction particular participatory forums. This paper argues that this analytical framework could extend beyond the scope of China’s healthcare reform, and be applied to other episodes of policymaking both in China, and other non-democratic regimes.
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Ahmad, Farooq. "Healthcare reforms in the state teaching hospitals of Peshawar, Pakistan : a multi-stakeholder perspective." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/422208/.
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This study examines the local government reforms embodied in the Medical Teaching Institution (MTI) Act of 2015 in Khyber Pakhtunkhwa province (KP), Pakistan. The aim of the Act was to improve employee performance in the province’s public teaching hospitals, and this research explores the reforms from the perspectives of key stakeholders, especially with regard to the introduction of performance-related pay. This research fills gaps in the current body of knowledge on performance-related pay in developing countries and makes a significant addition to the few existing studies on this topic. It addresses the contradictory theoretical stance between the discourses of New Public Management and Public Service Motivation on performance-related pay in the public sector. The theoretical concepts are derived by integrating New Public Management, Institutional Theory, Public Service Motivation Theory and Cross-cultural Theory. The study uses a mico-meso-macro framework of analysis to investigate the actions and reactions of those affected by the reforms in three of the public teaching hospitals. The underlying philosophy is one of critical realism. Following the case study approach, a multiple case study involving three public teaching hospitals was designed. The data were collected in three phases from participants at the Khyber Teaching Hospital (KTH), Lady Reading Hospital (LRH) and Hayatabad Medical Complex (HMC), Peshawar, KP, Pakistan. The respondents were doctors, ward managers, members of the boards of governance and the provincial health minister. The semi-structured interviews, as the main data collection tool, were corroborated by participant observation, field notes, memo writing and MTI reforms documents. The MTI reforms were a political initiative by the newly elected government in KP province to address problems of performance, poor service structure and the corrupt appraisal system. Changes included decentralisation, autonomy, a new system of accountability and the introduction of performance-related pay in the case hospitals. Poor communication, conflict of interest, lack of consultation with local actors, poor planning and dismissive behaviour by the higher leadership were the main reasons for doctors’ resistance to the reforms. The research findings show that performance-related pay was acceptable to the study participants due to institutional and social realities in KP, Pakistan and that it did not undermine their public service motivation due to high professional standards and strong religious belief. The research makes a number of contributions. First, it provides rich empirical material on employees’ reactions to public-sector healthcare reform and offers valuable insight into how policy from a secular individualist culture can successfully integrate with a religious collectivist culture. Second, it addresses the contradictory stances of New Public Management and Public Service Motivation on performance-related pay in the public sector by taking an inter-disciplinary approach. Third, this research adds to the body of empirical research on public healthcare reform in a developing country, and fourth, it yields findings which, we hope, will inform and influence the academic community as well as public-sector policy-makers.
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Hon, Wai-ping Tiki, and 韓慧萍. "An analysis of policy options to tackle the problem of expanding expenditure in public healthcare in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31965842.
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New, Elizabeth. "RACISM, RESISTANCE, RESILIENCE: CHRONICALLY ILL AFRICAN AMERICAN WOMEN’S EXPERIENCES NAVIGATING A CHANGING HEALTHCARE SYSTEM." UKnowledge, 2018. https://uknowledge.uky.edu/anthro_etds/28.
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This medical anthropology dissertation is an intersectional study of the illness experiences of African-American women living with the chronic autoimmune syndrome systemic lupus erythematosus (SLE), commonly known as lupus. Research was conducted in Memphis, Tennessee from 2013 to 2015, with the aim of examining the healthcare resources available to working poor and working class women using public sector healthcare programs to meet their primary care needs. This project focuses on resources available through Tennessee’s privatized public sector healthcare system, TennCare, during the first phases of the Patient Protection and Affordable Care Act (ACA). A critical medical anthropological analysis is used to examine chronically ill women’s survival strategies regarding their daily health and well-being. The objectives of this research were to: 1) understand what factors contribute to poor women’s ability to access healthcare resources, 2) explore how shared illness experiences act as a form of community building, and 3) document how communities of color use illness narratives as a way to address institutionalized racism in the United States. The research areas included: the limits of biomedical objectivity; diagnostic timeline in relation to self-reported medical history; effects of the relationship between socio-economic circumstance and access to consistent healthcare resources, including primary and acute care, as well as access to pharmaceutical interventions; and the role of non-medical support networks, including personal support networks, illness specific support groups, and faith based organizations. Qualitative methods were used to collect data. Methods included: participant observation in support groups, personal homes, and faith based organizations, semi-structured group interviews, and open-ended individual interviews. Fifty-one women living with clinically diagnosed lupus or undiagnosed lupus-like symptoms participated in individual interviews. Additionally twenty-one healthcare workers, including social workers, Medicaid caseworkers, and clinic support staff were interviewed in order to contextualize current state and local health programs and proposed changes to federal and state healthcare policy.
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Wang, Mengyuan. "The way of chinese medical reform : new trends in the era of the “internet+” and big data." Master's thesis, Instituto Superior de Economia e Gestão, 2019. http://hdl.handle.net/10400.5/18585.
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Mestrado em Desenvolvimento e Cooperação InternacionalA China é um país com uma população imensa, com recursos médicos insuficientes e distribuição desigual. Portanto, existem muitos problemas no serviço de saúde. Devido ao desenvolvimento atrasado do sistema médico, a qualidade dos recursos médicos é baixa, o custo é alto e a eficiência dos serviços médicos é baixa. Um dos principais fatores explicativos dessa situação é a falta de apoio do governo e seguro médico imperfeito. Para resolver esse problema, o governo começou a reformar o sistema de segurança médica. Desde a reforma do seguro médico de 1988, após várias mudanças, o sistema de seguro médico da China amadureceu gradualmente. A tese descreve brevemente a estrutura básica, o conteúdo e o caminho da mudança nos cuidados de saúde. E as deficiências do atual sistema de seguro médico. A análise introduz o papel da "Internet+" e da "big data" na reforma do sistema de seguro médico e avalia as potencialidades da sua introdução e operacionalização para a gestão e governança do sistema de saúde.
China is a population republic country has insufficient medical resources and uneven distribution. Therefore, there are many medical problems. Due to the backward development of the medical system, the quality of medical resources is poor, the efficiency of medical services is low, and the cost is high, which brings many difficulties for the Chinese people to seek medical treatment. However, one of the main factors of these problems is the lack of government support and imperfect medical insurance. To solve this problem, the government began to reform the medical security system. Since the 1988 medical insurance reform, after several changes, China's medical insurance system has gradually matured. The thesis will briefly describe the basic framework, content and path of change in health care. And the shortcomings of the current medical insurance system. According to the characteristics of the times, talk about the impact of "Internet +" and "Big Data" on the current Chinese industry, including people's lives. Therefore, the analysis introduces the positive role of big data Internet for the reform of medical insurance system, and provides convenience for the management and governance of medical insurance system. Analyze whether "Internet +" and "Big Data" can lead to new trends in the reform of the health care system.
info:eu-repo/semantics/publishedVersion
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Yamada, Go. "Input-output analysis on the economic impact of medical care in Japan." 京都大学 (Kyoto University), 2016. http://hdl.handle.net/2433/215218.
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Schimmel, Noam. "Presidential rhetoric justifying healthcare reform : continuity, change & the contested American moral order and social imaginary from Truman to Obama." Thesis, London School of Economics and Political Science (University of London), 2013. http://etheses.lse.ac.uk/779/.
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The original contribution to knowledge of my thesis is a comparative historical analysis of the rhetoric used by four Democratic presidents to expand access to and affordability of healthcare. Specifically, the thesis situates Democratic presidential healthcare reform rhetoric in relation to opposing conservative Republican ideologies of limited government and prioritization of negative liberty and their increasing prominence in the post-Reagan era. It examines how the American moral order and social imaginary has evolved and how Democratic presidential healthcare reform rhetoric was both informed by and responded to it. I employ Aristotle’s tripartite categories of ethos, pathos and logos to undertake rhetorical analysis. I illuminate how each president sought to persuade audiences, what rhetorical strategies they used and how they justified their healthcare reform efforts. I pay particular attention to the compromises entailed by the usage of specific strategies and their rhetorical effects. The thesis illustrates how Presidents Harry Truman and Lyndon Baines Johnson contextualized healthcare reform within their broader efforts to secure positive liberty and social and economic rights in the Fair Deal and Great Society, respectively. This is in contrast to Presidents Bill Clinton and Barack Obama who did not advance a comprehensive vision of government guaranteed positive liberty and citizen welfare. Rather, they made arguments for healthcare reform based on pragmatism and economic efficiency and appropriated tropes of conservative rhetoric such as efficiency to critique market failure. They showed deference to the conservative principle of maximizing the role of the private sector in healthcare provision. There is a marked contrast between Truman and Johnson’s explicit expressions of care for economically disadvantaged and working class Americans and Clinton and Obama’s rhetorical elision of these populations, and their focus on the ‘middle class.’ Despite these substantive differences a major continuity in the rhetoric is an enduring appeal to communitarian solidarity.
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Liang, Zhanming, and N/A. "Characteristics, Competencies and Challenges: A Quantitative and Qualitative Study of the Senior Health Executive Workforce in New South Wales, 1990-1999." Griffith University. School of Public Health, 2007. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20070914.091446.
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Healthcare reforms and restructuring have been a global phenomenon since the early 1980s. The major structural reforms in the healthcare system in New South Wales (NSW) including the introduction and implementation of the area health management model (1986), the senior executive service (1989) and performance agreements (1990), heralded a new era in management responsibility and accountability. It is believed that the reforms, the process of the reforms, and the instability brought about by the reforms may have not only resulted in the change of senior healthcare management practices, but also in the change of competencies required for senior healthcare managers in meeting the challenges in the new era. However, limited studies have been conducted which examined how health reforms affected its senior health executive workforce and the above changes. Moreover, no study on senior healthcare managers has focused specifically on NSW after the major reforms were implemented. The purpose of this research was to examine how reforms in the NSW Health public sector affected its senior health executive workforce between 1990 and 1999 in terms of their roles and responsibilities, the competencies required, and the challenges they faced. This study, from a broad perspective, aimed to provide an overview of the NSW reforms, the forces behind the reforms and the effects the reforms may have had on senior health managers as predicted by the national and international literature. This study also explored the changes to the senior health executive workforce in the public sector during the period of rapid change in the 1990s and has provided indications of the managerial educational needs for future senior healthcare managers. Both quantitative and qualitative data have been collected by this study using triangulated methods including scientific document review and analyses, a postal questionnaire survey, and in-depth telephone interviews. The findings from the two quantitative methods informed and guided the development of the open-ended questions and overall focus of the telephone interviews. This study found differences in the characteristics and employment-related aspects between this study and previous studies in the 1980s and 1990s, and identified four major tasks, twelve key roles and seven core competencies required by senior health executives in the NSW Health public sector between 1990 and 1999. The study concludes that the demographic characteristics and the roles and responsibilities of the NSW Health senior executive workforce since the reforms of the 1980s have changed. This study also identified seven major obstacles and difficulties experienced by senior health executives and suggested that during the introduction and implementation of major healthcare reforms in NSW since 1986, barriers created by the system prevented the achievement of its full potential benefits. Although this study did not focus on detailed strategies on how to minimise the negative impact of the health reforms on the senior health executives or maximise the chance of success in introducing new changes to the system, some suggestions are proposed. Most significantly, the study has developed a clear analytical framework for understanding the pyramidal relationships between tasks, roles and competencies and has developed and piloted a new competency assessment approach for assessing the core competencies required by senior health managers. These significant findings indicate the need for a replication of the study on an Australia-wide scale in order to extend the generalisability of the results and test the reliability and validity of the new competency assessment approach at various management levels in a range of healthcare sectors. This is the first study acknowledging the impact of the introduction of the area health management model, the senior executive service and performance agreements in the NSW public health system through an original insight into the personal experiences of the senior health executives of the reforms and examination of the major tasks that senior health executives performed and relevant essential competencies required to perform these tasks. The possible solutions identified in this study can guide the development of strategies in providing better support to senior healthcare managers when large-scale organisational changes are proposed in the future.
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Loomis, Jennifer Cullen. "Activist Doctors: Explaining Physician Activism in the Oregon Movement for Single-Payer Healthcare." PDXScholar, 2015. https://pdxscholar.library.pdx.edu/open_access_etds/2214.
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Changes in American healthcare over the last half century have created social and economic crises, presenting challenges for doctors and patients. The recently-implemented Patient Protection and Affordable Care Act is an incremental reform that does little to change the complex multi-payer financing characterizing American healthcare. There have been growing demands for more equitable financing arrangements, notably, a single-payer healthcare system in which medical care is financed through a single, non-profit payer and in which medical care is treated as a public good and medically-necessary care is available to everyone.
Nationally-representative surveys have demonstrated widespread physician support for single-payer legislation. Yet, very little scholarship has examined physician activism and virtually no studies have examined physician activism for single-payer healthcare. It is important to examine physician activism for single-payer because their participation is considered fundamental to achieving the goals of the movement. If the movement is successful in implementing single-payer financing , more efficient use of healthcare resources will ensure that all residents have access to needed medical care without being saddled by financial burdens from their care.
Oregon is one of several US states with a growing grassroots movement to enact single-payer healthcare at the state level. This study seeks to examine the determinants of collective action for physicians in the Oregon movement for single-payer healthcare by answering two research questions. First, what accounts for differences in activism among physicians who support single-payer healthcare system? And second, for those physicians who are active, what activities do they do and what shapes those choices of activities? Data includes 21 semi-structured interviews with physicians around the state of Oregon supplemented with participant observation data. The interview data was analyzed using techniques from grounded theory and thematic analysis.
I find that among collective action theories, collective identity theory best accounts for whether or not a physician engages in single-payer activism. A strength of collective identity theory is that it brings to light the importance of subjective interpretations of structural conditions by movement actors. The findings suggest that differences in interpretation shape the influence of motivators for and barriers to an individual's decision to engage in activism.
Physicians that become active are primed to engage in single-payer activism because of their moral value sets and frustrating work experiences. They seek out groups of like-minded physicians who then are part of the process of socially-constructing a collective identity. This collective identity is emotionally-laden, is a reaction to state policies, serves to distinguish insiders from outsiders, and facilitates activism. Activist physicians engaging in the process of collective identity come to believe that altering financing is the only way to solve healthcare system issues. The activists view the political and cultural barriers to single-payer as surmountable by their activism.
In contrast, non-activists interpret structural conditions like American politics and American culture as immutable barriers that will prevent the attainment of single-payer at the national or state level. In addition, non-activists lack the collective identity activists share because their beliefs contradict key beliefs of activists. The combination of the lack of collective identity and the perception of immutable barriers results in their non-participation.
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Melo, Daniela Tranches de. "A influência dos movimentos sociais na normatização e efetivação das políticas públicas : a experiência do Movimento Sanitário e do Sistema Único de Saúde." Universidade do Estado do Rio de Janeiro, 2013. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7033.
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Conselho Nacional de Desenvolvimento Científico e TecnológicoO trabalho parte da hipótese de que os movimentos sociais potencializam sua capacidade de pautar agendas e normatizar suas demandas quando conseguem convergir para uma agenda única. Busca-se exemplificar essa tese por meio de uma análise do Movimento Sanitário e a subsequente Reforma Sanitária. A partir da atuação deste movimento foi possível incluir uma nova forma de entender a saúde na Constituição de 1988 e sua regulamentação via Lei Orgânica da Saúde LOS , responsável pela criação do Sistema Único de Saúde SUS. O objetivo norteador do trabalho é a compreensão do motivo pelo qual algumas políticas públicas de saúde foram implementadas com sucesso enquanto outras permaneceram no papel. Argumenta-se que o fato de muitas das premissas instituídas na Lei Orgânica ainda não terem sido efetivadas tem relação, entre outros fatores, com a crescente fragmentação e institucionalização dos movimentos pela saúde, ocorrida ao longo da década de 1990. Hoje o que se observa é uma grande heterogeneidade dos atores ligados ao setor, com os novos movimentos sociais pela saúde apresentando-se de forma cada vez mais difusa. No ano em que o Sistema Único completa 25 anos, é necessário repensar suas estratégias, falhas e sucessos. Destarte, o trabalho leva à reflexão de que ao se buscar a efetivação do SUS legal é premente que doravante se retomem os princípios fundantes da Reforma Sanitária.
The study departs from the hypothesis that social movements improve their ability to bring specific themes to the forefront and to introduce new regulations when they converge around a single agenda. It illustrates this thesis through an analysis of the Sanitary Movement and the subsequent Health Reform. Their actions allowed for a new way of understanding health in the 1988 Constitution and its regulation via Health Law - LOS - , responsible for the creation of the Unified Health System - SUS. The guiding purpose of this thesis is to explain why some public policies related to healthcare were successfully implemented while others were not. In other words, the study examines the factors behind the non-effectiveness of the premises established by the LOS, indicating that this occurred in part due to the increasing fragmentation and institutionalization of the healthcare movement throughout the 1990s. Today one can observe an expressive heterogeneity in the healthcare movement with new actors presenting themselves in an ever more diffuse way. In the year that SUS turns 25, we need to rethink its strategies, successes and failures. This thesis leads to the final reflection that in order for SUS to actually work it is pressing that all actors involved in the healthcare movements return to and reclaim the Sanitary Reform founding principles.
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Winter, LeAnn. "Policy or politics: a content analysis of how the network nightly news covered the 2009-2010 health care issue." Thesis, Kansas State University, 2011. http://hdl.handle.net/2097/8842.
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Master of ArtsDepartment of Communication Studies
William Schenck-Hamlin
Many critics and scholars (e.g. Lippman, 1927, Putnam, 2000, Entman, 1989, McChesney, 2004, Funigiello, 2005), have argued that news media coverage of major political affairs and policy often fails to provided citizens with the information they need to engage in these issues in a thoughtful manner. The style of news utilized by networks as well as choices in framing have been found to have a significant impact on what is covered and how audiences perceive coverage (Bennett, 2005, Patterson, 2000, Prior, 2003, Zaller, 2003, Cappella & Jamieson, 1997, Ibrahim, 2010, ‘T Riet et al., 2009, Bizer & Petty, 2005, Ben-Porath & Shaker, 2010, Domke & Shah, 1995, and Esposito, 1996). According to the PEW Foundation (2010) a large portion of the 2009-2010 healthcare coverage focused on politics and not how the healthcare system functions (policy). This paper explores the coverage of the 2009-2010 heath care issue by the Network Nightly News through the use of a content analysis. For the purpose of this study, the proposed method of Budge et al. (2001) political party platform categories were used to code the content of the broadcast. These 46 codes contained issues that dealt with the policy of health care and the politics surrounding healthcare, as well as positive vs. negative framing. 30 broadcasts were randomly chosen, one day for each month, from the three nightly news networks during the ten months of highest coverage. Each broadcast was divided into “quasi-sentences”, where each sentence was broken down into individual actions. Results illustrate the frequency between policy and political content, and positive and negative content surrounding the 2009-2010 health care issue. KEYWORDS: Framing, Policy, Politics, Health Care Reform, Network Nightly News, Content Analysis, Quasi-Sentence
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Hamel, Michael Graham. "RESISTANCE TO MANDATED HEALTHCARE CHANGE: USING PSYCHOLOGICAL REACTANCE TO PREDICT RESPONSES TO THE PATIENT PROTECTION AND AFFORDABLE CARE ACT INSURANCE COVERAGE REQUIREMENT." OpenSIUC, 2015. https://opensiuc.lib.siu.edu/dissertations/1139.
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The Affordable Care Act (ACA), passed on March 23rd, 2010, contains widesweeping legislation aimed at reforming the current U.S. healthcare system. The ACA has been lauded by its proponents and deeply criticized by its opponents. The current paper included two experimental studies designed to test if the individual insurance mandate requirement is a specific source of the psychological and behavioral resistance displayed toward the ACA. In study 1 the individual insurance mandate requirement did not produce greater negative attitudes towards the ACA or the current Presidential administration and it did not predict attitudes towards the longevity of the ACA. Democrats were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA and Democrats also reported a lower likelihood of the ACA being repealed in comparison to Independents, Republicans or Libertarians. In study 2, the non-significant individual insurance mandate findings from study 1, were replicated in study 2. However, Democrats again were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA in comparison to Independents, Republicans and those with no political affiliation. Democrats also indicated that they were less likely to vote for a political candidate who supports the repeal of the ACA in comparison to Independents, Republicans and those with no political affiliation. Implications and future research directions are discussed.
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Saffore, Lateef Yusef PhD. "What Factors Influence Medicare Reimbursement Payments for Healthcare Providers that Admit Diabetic Patients?" University of Akron / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=akron1303145384.
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Gaetan, Eleanor Kennelly. "Curative politics and institutional legacies : the impact of foreign assistance on child welfare and healthcare reform in Romania, 1990-2004 : a cautionary tale /." College Park, Md. : University of Maryland, 2005. http://hdl.handle.net/1903/3219.
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Thesis (Ph. D.) -- University of Maryland, College Park, 2005.Thesis research directed by: Government and Politics. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.
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Guimar?es, Shyrley Bispo. "A atua??o do psic?logo no contexto das refer?ncias ambulatoriais em sa?de mental de Aracaju - SE." Universidade Federal do Rio Grande do Norte, 2011. http://repositorio.ufrn.br:8080/jspui/handle/123456789/17475.
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Previous issue date: 2011-04-08Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico
Psychologists‟ insertion in mental healthcare ambulatory clinics occurred during the decade of 1980, in the context of the claims disseminated by sanitary and psychiatric reforms, of the formation of minimum mental healthcare teams and of the retraction of the private clinic. Historically, this migration had been accompanied by the importation of practices traditionally applied at the clinics. Furthermore, the lack of clear guidelines from the Health Ministery occasioned the opening of ambulatory clinics with diversified structures at each city. The objective of this dissertation was to study the practices of psychologists at mental healthcare ambulatory references at Aracaju-SE. Were interviewed psychologists of these services and managers of the municipal health secretary using a semi-structured interview guideline, in addition to the analysis of management reports. It was observed that the mental healthcare references had experienced substantial changes referred to its structures and operation, leading to a present framework of expansion and readjustment. It was realized that there is an effort by the psychologists to maintain individual and group assistance, using adjustments in the frequency of the sessions and in the focus of the activities. Besides the progresses, the relation with the psychiatrist still works basically through the medical record, blocking advances on joint discussions of the cases. Some advances toward the amplified clinic are notable, like the overcoming of the isolated usage of psychiatric diagnostic and the replacement of the line‟ criterion by the urgency one. Sheltering had become an interesting strategy on flux ordination, however the mismatch between offer and demand seems to be a matter which extrapolates the psychologists‟ sphere at the references. For this reason the narrow of the relation with family healthcare centers seems to be the major challenge to be faced by psychologists at mental healthcare ambulatory references
A inser??o do psic?logo nos ambulat?rios de sa?de mental ocorreu na d?cada de 1980, no contexto das reivindica??es propagadas pela reforma sanit?ria e psiqui?trica, da forma??o de equipes m?nimas de sa?de mental e da retra??o da cl?nica privada. Historicamente, essa migra??o foi acompanhada da importa??o de pr?ticas tradicionalmente aplicadas no consult?rio. Ademais, a falta de diretrizes claras por parte do Minist?rio da Sa?de ocasionou a abertura de ambulat?rios com estruturas diversificadas em cada munic?pio. O objetivo desta disserta??o foi estudar a atua??o do psic?logo nas Refer?ncias Ambulatoriais em Sa?de Mental de Aracaju-SE. Foram entrevistados psic?logos desses servi?os e gestores da secretaria municipal de sa?de a partir de roteiro semiestruturado, al?m da an?lise de relat?rios de gest?o. Observou-se que as Refer?ncias em Sa?de Mental sofreram transforma??es substanciais quanto ? sua estrutura e funcionamento, levando a um quadro atual de expans?o e de readequa??o. Percebeu-se um esfor?o por parte dos psic?logos em manter os atendimentos individuais e de grupo, a partir de ajustes na frequ?ncia nas sess?es e no foco das atividades. N?o obstante os progressos, a rela??o com o psiquiatra ainda se processa basicamente pelo prontu?rio, impedindo de avan?ar na discuss?o conjunta dos casos. S?o not?veis alguns avan?os em dire??o ? cl?nica ampliada, como a supera??o do uso do diagn?stico psiqui?trico de forma isolada e da substitui??o do crit?rio fila pelo de urg?ncia. O acolhimento tornou-se uma estrat?gia interessante de ordena??o do fluxo, por?m o descompasso entre oferta e demanda parece ser uma quest?o que extrapola o ?mbito dos psic?logos das refer?ncias. Por essa raz?o, o estreitamento da rela??o com as unidades de sa?de da fam?lia parece ser o maior desafio a ser enfrentado pelos psic?logos das Refer?ncias Ambulatoriais em Sa?de Mental
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Protazio, Mairla Machado. "Errâncias de usuários de saúde mental : quando o cuidado se tece nas itinerâncias." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/140867.
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Esta dissertação destina-se a problematizar a produção de cuidado no sistema único de saúde brasileiro, investigando como as itinerâncias de usuários de saúde mental e suas errâncias nos seus territórios de vida podem constituir uma rede de cuidados, a fim de identificar quais saberes produtores de saúde são legitimados nessas trajetórias. Lançando mão de modos de fazer uma clínica itinerante, descortina-se uma perspectiva de cuidado territorializado, relacionada aos percursos que os usuários traçam e às suas errâncias, ao modo de estar e ocupar este território, aos afetos e encontros que nele e com ele se estabelecem. A cartografia foi utilizada como método neste estudo que se caracteriza como uma pesquisa-intervenção: contrariando tradicionais percursos investigativos em que as metas são pré-definidas, na cartografia é o próprio processo da pesquisa que vai delineando seus rumos e desdobramentos no campo. O estudo se concentrou na interface Saúde Mental – Atenção Básica, incluindo-se em uma pesquisa maior que investigou as práticas e ações de cuidado em saúde mental na atenção básica na região Macrometropolitana do Rio Grande Sul. Além deste cenário de práticas exercidas nos seis municípios incluídos na região da pesquisa maior, compuseram o campo desta pesquisa de mestrado outras cenas relacionadas ao cuidado que se tece em rede no SUS, registradas em diários de campo realizados entre 2011 e 2014, período em que a pesquisadora atuou como Agente Redutora de Danos em outro município do nordeste do país. As narrativas colocam em análise um modo de cuidar que a desinstitucionalização inaugura: um cuidado territorializado que promove autonomia E protagonismo e busca uma “grande saúde”, no sentido trágico do termo, definido a partir da filosofia de Nietzsche. Com isto, problematiza-se certa produção de cuidado em rede que esteja para além de uma rede de cuidado instituída e provoca-se o olhar para aquilo que está, muitas vezes, invisível no cotidiano dos serviços de saúde. Entre os resultados desta pesquisa, identificou-se que a articulação mais estreita a ser costurada entre a saúde mental e a atenção básica pôde-se apresentar como uma potente alternativa para favorecer um cuidado em rede que envolva todos os atores da saúde de um território. Dessa forma, pode-se romper com uma lógica de cuidado centrada na doença para um cuidado que amplie a vida e desnaturalize os modos de subjetivação regulamentados, característicos da biopolítica. A aposta indicada ao final desta pesquisa é de que, ao trazer para as equipes da atenção básica um debate antes restrito ao campo da Reforma Psiquiátrica, experimentam-se novas perspectivas de cuidar das singularidades, amplia-se a concepção de clínica e inventam-se novas saúdes.This master's dissertation is dedicated to problematize care production in the brazilian unified healthcare system (SUS), investigating how mental health user's roaming and wandering through life's territories can constitute a caring network in order to identify which health producing knowledges are legitimated in these trajectories. Resorting to ways of making a roaming clinic unveils a perspective of territorialized care related to the routes that the users set and their wanderings, to the way of being in and occupying this territory, to the affections and encounters that are stablished in it and with it. Cartography was used as a method in this study that is characterized as an intervencional research: counteracting tradicional investigative routes in which the goals are pre-stablished, in cartography, it's the research process itself that outlines it courses and field unfoldings. The study focused at the Mental Health/Basic Care interface, being part of a broader research that investigated about the mental health practices and actions of care in basic care at the macrometropolitan region of Rio Grande do Sul. Besides this scenario of exerted practices at the six municipalties included in the broader research region, part of this research field is composed of other scenes related to the care that are woven in a network in SUS, registered in field diaries between 2011 and 2014, period in which the researcher worked as a harm-reduction agent in another municipalty of the country's northeastern region. The narratives put in analysis a way of taking care that started with the disinstitutionalization: a territorialized care that promotes autonomy, protagonization and seeks for a “great health”, in the tragic sense of the word defined by Nietzsche's philosophy. With that, is problematized a certain networked care production that is beyond an established care network and arouses the viewing to that which is, most of the time, invisible in healthcare services everyday’s life. Among the outcomes of this research it was identified that the narrower articulation between mental health and basic care to be done was able to present itself as a powerful alternative to favor a networked care that implicates all health actors of a territory. This way, it is possible to break with an illness-centered way of conceiving care, in the direction of a care conception that magnifies life and denaturalizes the regulated modes of subjectivation typical of biopolitics. The bet that this research indicates at its ending is that, by bringing a debate to the basic care work groups, formerly restricted to the field of Psychiatric Reform, new perspectives on how to take care of singularities are experimented, the conception of clinic is enlarged and new health modes are invented.
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Philip, Ajith John. "An assessment of equity in geographical allocation of resources relative to need, in public primary healthcare services in the Northern Cape in South Africa." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.
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Bazyler, Caleb, and Kevin Breuel. "Comparing the Cost Effectiveness of a Celiac Disease Panel to a Testing Cascade." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/3774.
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Recent reductions in healthcare funding in the United States has pressured clinical laboratories to provide the same quality of diagnostic testing with fewer resources. Testing cascades have been developed to assist in the diagnosis of various illnesses, which use fewer tests and subsequently reduce costs. However, the cost effectiveness of a celiac disease (CD) testing cascade compared to a panel is currently unknown. Therefore, the purpose of this study was to determine if a CD testing cascade was equivalent to a panel in identifying patients deemed likely for CD, and to compare their cost effectiveness in a sample of symptomatic patients from Northeast Tennessee. A retrospective analysis using a CD testing cascade was performed on 933 outpatient samples referred to our laboratory from 2012 to 2017 with a request for a celiac disease serology panel. The seroprevalence of CD for the panel and the cascade were the same in this population (1.82%, 95% binomial confidence interval: 1.06% to 2.90%). The total cost of the CD cascade was 268% less than the cost of the panel resulting in a savings of $44,705, which translates to a savings of $47.92/patient. Based on these findings, we recommend utilization of the cascade to identify patients with likely CD. In the future, creative use of novel testing strategies can have significant contributions to healthcare reform and afford patients more cost-effective clinical diagnostic testing.
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Sabey, Courtney. "Implementation of Mental Health Reform and Policy in Post-Conflict Countries: The Case of Post-Genocide Rwanda." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39940.
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Mental health has been receiving increasing amounts of attention in recent years. Despite this, there are still many barriers to receiving mental health care in all parts of the world. Post-conflict countries have the dual challenge of increased mental health problems among their populations and trying to respond to these problems with low resources as their economies are often destroyed by the effects of war. This research studies the implementation of Rwanda’s post-genocide mental health policy to assess the challenges and best practises of implementing mental health reform in a low-resource, post-conflict country. The thesis found that the implementation of Rwanda’s mental health policy has relied on policies of rapid decentralization and integration to increase accessibility to mental health care. Decentralization has ensured that mental health services are available at every level and relies on a referral system. Mental health care is integrated into the general healthcare system by training generalists in hospitals and health centres to respond to mental health issues, therefore making these services available at nearly all health institutions. These policies were viewed positively by stakeholders, but there were still many gaps and challenges in the implementation of Rwanda’s mental health policy. One of the major challenges was stigma acting as a barrier to accessing services while one of the largest gaps was that the implementation relies too much on institutionalized, individualized, and Westernized care, which participants pointed out is not always suitable in the Rwandan context. Recommendations included an increase in sensitization campaigns, shifting towards community-based mental health care, expanding personnel and services, as well as increasing funding. The analysis, relying on complexity theory, found that many of the gaps are missed by the government because of a lack of collaboration with local organizations and service providers working in the domain.
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Tegnér, Marcus. "Den hybrida yrkesrollen : En studie om verksamhetschefer inom svensk sjukvård." Thesis, Linnéuniversitetet, Ekonomihögskolan, ELNU, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-20619.
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De senaste decennierna har sjukvården förändrats. Förändringsarbetet är inspirerat av New Public Management genom införandet av reformer. Teorier och organisatoriska modeller som fungerat bra inom det privata näringslivet har applicerats på organisationer inom den offentliga sektorn, vilket medfört en ökad admininistrativ arbetsbörda. Verksamhetsreformen gjorde det möjligt för andra yrkesgrupper än läkare att ta plats inom högre ledande positioner inom offentlig svensk sjukvård. Förändringarna inom sjukvården har krockat med den medicinska professionen. Läkare som har ett ledningsansvar hamnar i en korsning med ökade krav avseende politik, ekonomi och styrning jämfört med tidigare. Denna studie fokuserade på verksamhetschefer som är läkare, vilket ledde till studiens forskningsfråga: Hur förhåller sig verksamhetschefer till sitt arbete inom offentlig sjukvård? Syftet med studien är att öka förståelsen av hur läkare i en ledande position upplever och relaterar till sin egen arbetssituation inom den svenska sjukvården. Det är en hermeneutisk studie som har en abduktiv forskningsansats. Semi-strukturerade intervjuer har gjorts via telefon med totalt åtta intervjupersoner. Intervjupersonerna har två gemensamma faktorer – de är läkare och verksamhetschefer. Ökade krav på styrning, mätning och admininstration har gjort att verksamhetscheferna upplever att sjukvården blivit mer produktionsbaserad. Fokus på ekonomi har ibland tenderat till att bygga över medicinska prioriteringar. Verksamhetschefens ansvar borde minska och fler stödfunktioner borde implementeras för att underlätta det administrativa arbetet. Alla verksamhetschefer har valt att fortsätta med kliniskt arbete vid sidan av sina övriga uppgifter. Flera personer delegerade även en del administrativa arbetsuppgifter. Möten och personalrelaterade frågor uppfattades vara tidskrävande arbetsuppgifter. Medicinsk kompetens i form av att vara läkare ansågs vara nödvändig för att förstå verksamheten, något som politiker och centrala ledningsfunktioner saknar. Mer makt och inflytande borde förslagsvis flyttas över från politiker till den operativa nivån.