Dissertations / Theses on the topic 'Medical care, Cost of Australia'
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McCreanor, Victoria Helen Rarity. "Identifying high-value care for coronary artery disease in Australia." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/130756/1/Victoria_McCreanor_Thesis.pdf.
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This project compared the cost-effectiveness of drug therapy, stents and surgery for Australian patients with heart disease, modelling their long-term treatment trajectories, costs and health outcomes. It showed that drug therapy is high-value and that the health system, and Australians, would benefit from targeted rather than routine use of stents. This research provides policy recommendations to reduce the use of low-value care and increase the use of high-value care for Australian patients with heart disease.
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Carter, Robert C. (Robert Charles) 1950. "The macro economic evaluation model (MEEM) : an approach to priority setting in the health sector." Monash University, Dept. of Management, 2001. http://arrow.monash.edu.au/hdl/1959.1/8672.
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Kelman, Christopher William, and christopher kelman@cmis csiro au. "Monitoring Health Care Using National Administrative Data Collections." The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020620.151547.
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With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation.
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Evaluation of health services has become increasingly important to provide indicators of the benefits, risks and cost-effectiveness of treatments. However, if administrative data are to be used for this purpose, several questions must first be addressed: Are the current data collections accessible? What outcome measures can be derived from these data? Can privacy issues be managed? Could the quality of the data be improved? Is the existing infrastructure adequate to supply data for evaluation purposes? Could the existing system provide a basis for the development of an integrated health information system?
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The aims of the project were:
· To examine the potential for using administrative data to generate outcome measures and surveillance indicators.
· To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework.
· To compare the Australian health-service data system with the current international state-of-the-art.
· To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity.
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The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. The potential to evaluate outcomes was investigated using all national health-service information currently available in electronic form. Record linkage techniques were used to combine and augment the existing data collections. Australias national health databases are to varying degrees, amenable to such linkage and cover doctor visits, pharmaceuticals, hospital admissions and deaths. The study focused on medical devices as an illustrative case but the results are applicable to the routine assessment of all medical and surgical interventions.
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For the Australian Medical Devices study, the records of 5,316 patients who had medical device implants in 1993-94 were selected from the archives of a major private health insurer. Five groups of medical implants were studied: heart valves, pacemakers, hips, vascular grafts and intra-optic lenses. Outcomes for these patients, including death, re-operation and health service utilisation, were compared and analysed.
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A comparison study was performed using data from the Manitoba Health database in Winnipeg, Canada. Manitoba provides a very similar demographic group to that found in Australia and is an example of a prototype integrated-health-information system. One of the principal advantages for research is that personally identified data about medical and hospital services are collected for all patients. Selection bias is eliminated because individual consent is not required for this type of research and all selected patients could be included in the study.
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The two studies revealed many barriers to the use of administrative data for health outcomes research. Service event data for the Australian cohort could be collected but only after long delays and hospital morbidity data were not available for the entire cohort. In contrast to the situation in Australia, the Manitoba data were both accessible and complete, but were lacking in detail in some areas.
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Analysis of the collected data demonstrated that without the addition of clinical data only general indications of trends could be deduced. However, with minimal supplementary clinical data, it was possible to examine differences in performance between brands of medical devices thus indicating one of the uses for this type of data collection.
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In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). The need for the establishment of a systemic quality management system for health care is discussed.
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The study shows that linked administrative data can provide information about health outcomes which is not readily available from other sources. If expanded and integrated, the system that is currently used to collect and manage administrative data, could provide the basis for a national health information system. This system would provide many benefits for health care. Benefits would include the monitoring, surveillance and cost-effectiveness analysis of new and existing treatments involving medical devices, drugs and surgical procedures. An integrated health information system could thus provide for both clinical and administrative needs, while in addition providing data for research.
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Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures.
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Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.
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D'Arrietta, Louisa, and n/a. "An investigation of the information needs and information-seeking behaviour of general practitioners in their delivery of patient care to the elderly on the Gold Coast." University of Canberra. Information, Language & Culture, 1994. http://erl.canberra.edu.au./public/adt-AUC20060426.164122.
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The study investigated the self-reported information needs and
information-seeking behaviour of 143 general practitioners in their delivery
of patient care to the elderly on the Gold Coast.
The study sought to obtain an information profile in order to begin
discussion on the need for possible infrastructures that may need to be
considered in any planning strategies concerned with access to and
provision of relevant, accurate and timely information to general
practitioners which affects their delivery of patient care to the growing
number of elderly patients.
A ten-page questionnaire utilising both structured and unstructured
questions was returned by 61.9 percent of the survey population.
Demographic characteristics indicated that respondents were representative
of general practitioners in Australia.
Respondents frequently needed information with 40 percent requiring it '1 -
4 times a week' and 78 percent 'once a month or more often'. Information
on medical fact was required most frequently, 29 percent, medical opinion
27 percent, and non-medical information 23 percent.
The study found support for the proposition that computerised information
systems need to be enhanced and made widely known and available to
general practitioners to assist them in obtaining information that they need
in delivery of patient care to the elderly. There is a great need by these
general practitioners for non-medical information as well as medical
information. Therefore, the development of a database of non-medical
information containing information on local agencies and services is of high
priority.
Library information delivery services should also be de-institutionalised in
terms of lifting restrictions to services provided to enable general
practitioners greater access to information. Library services should aim to
provide remote access to information via telephone, fax and modem with
emphasis on value added services aimed at solving a particular specific
information need as well as straight-out bibliographic search services and
document delivery services.
Continuing medical education in the form of CME courses, conferences and
meetings should focus on specific information needs of general practitioners
in this area of patient care to the elderly. The need for information on
cardiology, orthopaedics, dermatology, physiotherapy, podiatry,
pharmaceutical benefits, home help, Meals-on-Wheels and nursing home
placement were areas of particular interest identified by respondents in this
study.
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O'Driscoll, Catherine T. "A study to determine the quality of life and experiences for liver and kidney transplant recipients and living kidney donors in Western Australia : the economic implications." University of Western Australia. School of Surgery, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0077.
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The use of quality-of-life as an outcome measure provides detailed information about the effectiveness of medical treatments than morbidity or mortality rates alone. The use of quality-of-life data in the clinical setting can inform patients regarding treatment options, treatment benefits and costs. In competing health care markets, outcome measurement is regarded as important as it is concerned with the impact of health care practice and affects health policy decisions. Doessel (1978) conducted the first Australian study on the cost-effectiveness analysis of renal replacement therapies. The study was based on Klarman, Francis & Rosenthal's (1968) the study, where the output was measured in terms of the number of life years gained from kidney transplantation, and a twenty-five percent weight was allocated in an attempt to capture quality-of-life from kidney transplantation. Doessel (1978) used two sources of data: Australian data (Disney 1974) and European data (Gurland et al. 1973; Shiel et al. 1974). The study measured life years gained, and agreed with the Klarman et al. (1974) findings that transplantation is the most effective way to increase life expectancy of persons with chronic renal disease (Butler & Doessel 1989). The outputs of the alternative treatments were not reported in monetary terms; the study focused on life years gained as the output measure. Hence the importance of this current study, which includes a cost-effectiveness analysis for cadaver liver, and living kidney transplantation for end-stage liver and kidney disease patients. Calls to respect patient autonomy and to produce patient-centered outcomes have recently brought the patients point of view back into the center of clinical medicine (Sullivan 2003). Survival rates indicate one measure of outcome however they do not reflect patients perceptions of health benefit or experiences. Noting that patients psychosocial effect on functioning is of more concern to them than their physical Thesis Preamble iii ability, that more accurate knowledge of patients conditions be measured prior to transplantation (Tarter et al. 1991). Recently researchers advocated investigating transplant patients' states of health to assess the social benefit of these expensive health care services from their perspective (Joralemon & Fujinaga 1997). The current study's mixed method, bridges the gaps in treatment outcome measurements, as the mixed method applied (Creswell 1994; Sim & Sharp 1998) prospectively measured quality-oflife, determined health utility, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The study reported the living donors experience of the donation process, described their needs; expressed using a new psychosocial model supporting future living kidney donor's during the donation process.
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Patterson, Jan. "Consumers and complaints systems in health care /." Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.
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Cheng, Qinglu. "Cost-effectiveness of guideline-based care for venous leg ulcers in Australia." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134462/1/Qinglu_Cheng_Thesis.pdf.
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This thesis investigated the cost-effectiveness of guideline-based care to manage patients with venous leg ulcers in the Australian setting. It showed that both the healthcare system and patients affected by venous leg ulcers would benefit from implementing and funding guideline-based care. This research provided important evidence to policy makers on the most efficient use of scarce health resources to manage venous leg ulcers. It is expected that these results will support changes to the reimbursement structure to increase access to guideline-based care for venous leg ulcers in Australia.
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Sinclair, Andrew James, and n/a. "The primary health care experiences of gay men in Australia." Swinburne University of Technology, 2006. http://adt.lib.swin.edu.au./public/adt-VSWT20060713.084655.
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The present research, consisting of two studies, was designed to examine the
primary health care experiences of gay men in Australia and assess doctors? attitudes and
training with regard to gay men and their health care. In the first study, 195 gay men were
surveyed regarding their health issues and their primary health care experiences. The
most important health concerns of gay men were stress and depression followed by
HIV/AIDS, body image disorder and other sexually transmissible infections. Including
those participants who were unsure, approximately one-half reported experiencing
homophobia and almost one?quarter reported experiencing discrimination in the
provision of health care. Despite this, respondents were generally satisfied with their
primary health care, although respondents felt that all GPs should receive additional
undergraduate medical education regarding gay men?s health. In the second study, 25
doctors (13 gay specialists and 12 non-gay specialists) were surveyed regarding their
knowledge of gay men?s health and their comfort working with gay men. Non-gay
specialist GPs were less comfortable treating gay men, reported poorer communication
and were more homophobic than their gay specialist counterparts. Further, doctors
perceived their medical education regarding gay men?s health has been inadequate.
Together, the results of the two current studies suggest that disclosure of sexuality is an
important issue for both gay men and doctors, and has the potential to impact on the
quality of health care that gay men receive. In order to improve the level of disclosure,
the pervasiveness of homophobia and discrimination in primary health care must be
reduced. Finally, the results indicate that medical education must be updated to reflect
current knowledge regarding the health issues of gay men. Failure to address these issues
will condemn gay men to continued health inequality.
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Ho, Chi-hang Bruce. "Health care financing options for Hong Kong." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25139526.
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Willis, Susan Beth. "Cost-benefit and cost-effectiveness of case management for a teen pregnancy and parenting program." CSUSB ScholarWorks, 1993. https://scholarworks.lib.csusb.edu/etd-project/630.
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Yip, Ying-ting, and 葉鎣婷. "A systematic review : cost-effectiveness of health informatics adoption for health care delivery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193814.
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BACKGROUND: Health Information Technology (HIT) enhances patient safety, which can also help to reduce health care costs. When it is used to replace the paper-based records, it will alter the workflow of front line workers and facilitate the management of care. The data captured can be shared in a seamless manner throughout the whole patient care journey. Since a significant upfront investment is required in the implementation and the use of the Electronic Health Record (EHR), it is still recognized as one of the major barriers. Despite these factors, governments and private health care provider organizations are all moving to implement a myriad of HITs. Therefore, meaningful use (MU) is an important criterion when assessing HIT utilization. This study focuses on the review and synthesis of evidence relating to the cost and effectiveness of health informatics adoption for health care delivery. Taking these findings into account may increase the likelihood of successful and cost-effective HIT implementation.
METHODS: Literature searches of BMJ, Science Direct, and PubMed as well as a manual search for grey literature via Google scholar were performed. The inclusion criteria were any studies, both quantitative and qualitative, that describe the cost-effectiveness of informatics via any type of HIT used during the provision of health care services. English publications from 2003 to 2013 with any type of study setting were included. Through this search, nine articles were chosen for the final analysis.
RESULTS: Among the nine selected studies, eight of them concluded that the adoption of HIT may-be-cost-effective to health care delivery. One study found the adoption of HIT not effective. The studies did not provide sufficient and concrete evidence to prove cost-effectiveness of HIT adoption.
DISCUSSION: There is insufficient evidence to support the cost-effectiveness of HIT adoption. The cost data from these studies are not available. Data quality, system design, and physician behavior are other concern for MU of health informatics. Health care organization and governments should engage with the end-users (e.g. medical & paramedical personnel and patients) during system design (or selection), adaptation and implementation.
CONCLUSION: Stakeholders should be aware of the tradeoffs throughout the implementation process. HIT scope, design, development, implementation, and performance monitoring should be well planned right from the start. In the foreseeable future, formal economics evaluation reports of Cost-Effectiveness Analysis (CEA) should be compulsory for stakeholders investing in Health Information Technologies.published_or_final_version
Public Health
Master
Master of Public Health
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Lindrooth, Richard C. "Selective contracting, cost sharing, and utilization management : a theoretical and empirical analysis of the market for health care /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/7463.
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Raikou, Maria. "Estimating medical care costs : an examination under conditions of censoring." Thesis, City University London, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269356.
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McGuiness, Clare Frances. "Client perceptions : a useful measure of coordination of health care." View thesis entry in Australian Digital Theses Program, 2001. http://thesis.anu.edu.au/public/adt-ANU20020124.141250/index.html.
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Chou, Ping-Hung. "Essays on Vietnamese hospital cost functions /." Thesis, Connect to this title online; UW restricted, 2004. http://hdl.handle.net/1773/7419.
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Fan, Yun-sun Susan. "Medical insurance : the solution to health care financing in Hong Kong? /." [Hong Kong : University of Hong Kong], 1992. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13236404.
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Liu, Lin. "Estimation of net present value of total health care costs." Diss., Connect to online resource - MSU authorized users, 2006.
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Thesis (Ph. D.)--Michigan State University. Dept. of Statistics and Probability, 2006.Title from PDF t.p. (viewed on June 19, 2009) Includes bibliographical references (p. 92-98). Also issued in print.
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Byrd, Linda W. Kavookjian Jan. "An examination of information technology and its perceived quality issues in single system hospitals in the United States." Auburn, Ala., 2009. http://hdl.handle.net/10415/1987.
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Koc, Cagatay. "Moral hazard and adverse selection in the economics of health care : three essays /." Digital version accessible at:, 2000. http://wwwlib.umi.com/cr/utexas/main.
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Robinson, Joshua J. Beil Richard O. "Rising health care costs and the two price market the impact of third-party payers /." Auburn, Ala, 2007. http://repo.lib.auburn.edu/2007%20Fall%20Theses/Robinson_Joshua_35.pdf.
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Hidalgo, Stevan. "Healthcare expenditure vs healthcare outcomes a comparison of 25 world health organization member countries /." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/SHidalgo2008.pdf.
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Yamada, M. "The effects of cost-saving efforts in the U.S. healthcare market." View abstract/electronic edition; access limited to Brown University users, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3318376.
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Coon, Scott D. "The MHS pharmacy benefit efficacy of civilian cost saving strategies." Thesis, Monterey, Calif. : Naval Postgraduate School, 2006. http://bosun.nps.edu/uhtbin/hyperion.exe/06Dec%5FCoon.pdf.
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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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Noble, Marilynn. "Integrating Health Care Systems to Maintain Quality Care and to Manage Cost." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6851.
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The rising cost of health care in the Philippines is a concern for the Department of Defense and TRICARE beneficiaries. The purpose of this quantitative cross-sectional research study was to determine the efficacy and acceptability of a different method to deliver health care to increase access to health care and decrease out-of-pocket costs while maintaining quality of care for TOP Standard beneficiaries who receive health care under the Philippine Demonstration. Secondary data was used to determine the acceptability of an alternative reimbursement methodology to decrease cost but maintain access to quality care. The Andersen's behavioral health care model and the Donabedian quality health care model were used to interpret the study results. A data set of 180 participants was evaluated using a cross-sectional quantitative methodology. Two Spearman correlations were used to examine the relationship between financial burden and satisfaction (r = .41, p < .001) and financial burden and confidence (r = .44, p < .001). Linear and binary regressions assessed the effects of age and gender on satisfaction with health care finder functionality when requesting a waiver (F (2,26) = 1.22, p = .313, R2 = .09). A computation of one-sample t-tests to determine the impact of a closed network, beneficiary out-of-pocket cost, and quality health care in Demonstration areas found the beneficiaries were satisfied with the demonstration. An analysis of the claims data pre and post demonstration showed a difference in the patients' out-of-pocket expenses and the acceptability and preference for a closed network. Social change was demonstrated by a decrease in the cost for TRICARE standard beneficiaries in the Philippines.
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Antioch, Kathryn M. "Improving cost effectiveness, distributional justice and allocative efficiency in hospital funding and service delivery in Australia and internationally." Monash University, Dept. of Epidemiology and Preventive Medicine, 2004. http://arrow.monash.edu.au/hdl/1959.1/5296.
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Puenpatom, Rajitkanok. "Effects of Thai healthcare policy on household demand, hospital efficiency and household earnings." Online access for everyone, 2006. http://www.dissertations.wsu.edu/Dissertations/Fall2006/r_puenpatom_121106.pdf.
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Walker, Annette Clare, of Western Sydney Nepean University, and Faculty of Nursing and Health Studies. "Nurse and patient work: comfort and the medical-surgical patient." THESIS_FNHS_XXX_Walker_ A.xml, 1996. http://handle.uws.edu.au:8081/1959.7/286.
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This grounded theory study investigates the experiences and perceptions of comfort and discomfort of hospital patients admitted for medical-surgical conditions, with a focus on the post-accute stage of hospitalisation. In-depth post-discharge interviews were conducted with seventeen English speaking adults who had been admitted to nine Australian hospitals. A substantive theory of finding comfort and of managing discomfort was generated. Processes of self-talk (anticipating, interpreting, accepting, making allowances and maintaining perspective) and self-care (self-help and seeking help, which involved accommodating to the level and type of help available through deferring, avoiding, persisting or desisting) were used to find comfort and to manage discomfort. The study has implications for nursign practice, management, research and education. Existing practice in the areas of assessment, communication, individualised care planning and the management of discomfort need to be strengthened if nursing care is to make a difference for this category of patient. The study revealed that integrated caring by nurses perceived by informants as 'experts', contributed most to the experience of finding comfort and managing discomfort in this group of informantsDoctor of Philosophy (PhD)
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LaVacca, Brian J. "The anticipated impact of the baby boomer generation on U.S. healthcare." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 2006. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 2006.Source: Masters Abstracts International, Volume: 45-06, page: 2948. Typescript. Abstract precedes thesis as 1 leaf (iii). Includes bibliographical references (leaves 150-153).
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Wollin, Judy A. "A comparative study of aspects of health care valued by residents with multiple sclerosis and staff at a residential setting." Thesis, Queensland University of Technology, 1993. https://eprints.qut.edu.au/36811/1/36811_Digitised%20Thesis.pdf.
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This research was undertaken in response to the implementation of a program of de-institutionalisation under the auspices of the Disability Services Act 1986, involving people with Multiple Sclerosis {MS) . The impact of de-institutionalisation on people with MS has not been researched before in Australia.
The aim of the research was to identify and compare aspects of health care valued by people with Multiple Sclerosis and staff at an assisted accommodation unit in suburban Australia.
The research participants included the residents and staff of a residential centre for people with MS. Elements of quantitative and qualitative research methods were used. Data were collected using unstructured interviews and sequential questionnaires. These data were analysed using recurrent theme identification technique.
The research shows that the current program of deinstitutionalisation has resulted in changes affecting both residents and staff. The findings of the research were similar for both groups, who wish to see the Centre remain as much as possible as it is, with in-house services continued. Changes resulting in the abolition or reduction of services are not supported by either group.
While the overall objectives of the Disability Services Act 1986 are supported by residents and staff, the major conclusion of the study is that its implementation should more closely reflect the needs of people with MS already living in an assisted accommodation unit.
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Sims, Hazel Jane. "A case study of pressure group activity in Western Australia: Medical care of the dying bill (1995)." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1999. https://ro.ecu.edu.au/theses/1220.
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When the Australian Labor Party member for Kalgoorlie, Ian Taylor, presented his Private Member's Bill - the Medical Care of the Dying Bill (1995), he laid the foundation for this thesis. Mr Taylor introduced his Bill to the Western Australian Legislative Assembly on 28 March 1995. The Bill codified the terminally ill patient's right to refuse medical treatment, which clarified common law. This thesis attempts to overcome the dearth of literature in Western Australian lobbying concerning conscience-vote issues. It also identifies the key issues in understanding political lobbying, the form of pressure group activity that takes place and why certain groups respond in different ways. The pressure groups selected for this case study are examined, classified and evaluated resulting in a prescription for lobby group activity for similar conscience-vote issues. According to the Bill's sponsor, Ian Taylor, the legislation was needed to deal with the inconsistencies in common law of the medical treatment of terminally ill people. The Law Reform Commission in its 1991 Report on Medical Treatment for the dying, stated that there was a need to deal with the issue in Western Australia. Due to the advances in medical treatment practices in the past 50 years, doctors can prolong the life of patients for whom there is no cure. The major problem, however, is the Criminal Code: doctors and care providers can be at risk of prosecution and conviction if the patient's wishes are respected and medical treatment is withdrawn, leading to the patient's death. At present there is a general common law right to refuse medical treatment. According to Mr Taylor, the difficulty lies in the fact that in Western Australia, the common law is overridden by the Criminal Code. The Bill also highlighted the role of palliative care and the treatment of the dying. The opinion of most pressure groups was that the rights of terminally ill patients should be protected and enhanced. Of the groups selected for this case study, only the Coalition for the Defence of Human Life objected to the Bill. Other groups supported the principles of the Bill, while some hoped for voluntary euthanasia legislation and others gave tacit approval. Of all the groups the L. J. Goody Bioethics Centre distinguished itself as a key organisation which tended to monopolise political influence. Media exposure of the issue was high, particularly in The West Australian. The "right to die" issue was canvassed and often was reported with references to euthanasia. At the same time the Northern Territory legislation, the Rights of the Terminally Ill Bill (1995), was receiving much media attention. The issue of euthanasia was necessarily discussed in the context of national and international arenas. The political masters of thought on citizen participation and group theory were introduced early in the thesis. John Locke, Jean -Jacques Rousseau, James Madison, Alexis de Tocqueville, Thomas Paine and John Stuart Mill provided valuable insight into the nature of modern political thought on this interesting aspect of political activity. Contemporary political writers such as Trevor Matthews. Dean Jaensch and Graham Maddox were also consulted. The eight pressure groups selected for the study were the: • West Australian Voluntary Euthanasia Society Inc. • Coalition for the Defence of Human life • Australian Medical Association (WA Branch) • Australian Nursing Federation (WA Branch) • L. J. Goody Bioethics Centre • Silver Chain Nursing Association Inc. • Uniting Church of Australia • Anglican Church of Australia Information from the groups formed a significant part of this thesis. An attempt was made in the conclusion to ascertain the effectiveness of the various strategies utilised by the pressure groups and provide an insight into lobbying practices. Ultimately, though, the contentious Bill was not given a third reading. Nor was it debated in the Legislative Council. At one stage it was considered likely that the Bill would be recommitted to parliament. The monitoring of the Medical Care of the Dying Bill (1995) undertaken in this thesis, indicates that this would have been a lengthy and divisive process.
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何知行 and Chi-hang Bruce Ho. "Health care financing options for Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31966822.
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Fan, Yun-sun Susan, and 范瑩孫. "Medical insurance: the solution to health care financing in Hong Kong?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1992. http://hub.hku.hk/bib/B31964047.
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Fan, Lijun. "Effectiveness and cost analysis of a hospital in the nursing home program in Queensland, Australia." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/101165/1/Lijun_Fan_Thesis.pdf.
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This thesis evaluated the effectiveness and cost-saving potential of a health service delivery model in Queensland Australia, the Hospital in the Nursing Home program. The research adopted a before-after controlled study design, comparing the outcomes between an intervention hospital and a control hospital during the pre- and post-intervention periods. Findings from the research supported that the intervention was preferred over the current practice, which reduced the attendances to emergency departments (EDs) and inpatient hospitals from patients in residential aged care facilities, shortened their length of ED stay, and saved the overall costs.
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Haghshenas, Abbas Public Health & Community Medicine Faculty of Medicine UNSW. "Negotiating norms, navigating care: the practice of culturally competent care in cardiac rehabilitation." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/32280.
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BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.
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McNamara, Laurence James. "Just health care for aged Australians : a Roman Catholic perspective /." Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phm1682.pdf.
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MURPHY, CATHRYN LOUISE School of Health Services Management UNSW. "INFECTION CONTROL IN THE AUSTRALIAN HEALTH CARE SETTING." Awarded by:University of New South Wales. School of Health Services Management, 1999. http://handle.unsw.edu.au/1959.4/17600.
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1,708 members of the Australian Infection Control Association were surveyed to describe the practices of Australian infection control practitioners. The study details the methods infection control practitioners use to co-ordinate and measure nosocomial infections as clinical outcomes of Australian infection surveillance and control programs. Administrators' and clinicians' perceptions of the elements and infrastructure of infection surveillance and control programs and the role of the infection control were measured in 316 hospitals in New South Wales, Australia. A literature review found that the development of Australian infection surveillance and control programs is behind that of U.S.A and the United Kingdom. The survey of the infection control practitioners identified that their role and duties varied between facilities as did the time allocated to infection control tasks. The survey of infection control practitioners demonstrated variation in their levels of skill, education and experience. Infection control practitioners' use and application of evidence and associated skills was examined and found to be limited in relation to clinical decision making and policy development. The survey also examined the methods infection control practitioners use to undertake surveillance of nosocomial infections. The methods reported indicated non-standard approaches to surveillance activity. A survey of administrators and clinicians in NSW hospitals was undertaken to identify variation in administrator and clinician perceptions and to describe their level of support for recommended essential infrastructure and criteria for infection surveillance and control programs and the role of the infection control practitioner in accordance with Scheckler's model. The survey indicated divergent views regarding the role of the infection control practitioner and the essential elements of infection surveillance and control programs. The study identified that education of infection control practitioners is necessary to facilitate standard approaches to co-ordinating infection surveillance and control activity. The development of Australian infection surveillance and control programs require a strategic alliance between stakeholders. to define essential elements of infection surveillance and control programs. In addition, the role of the infection control practitioner must be defined before key stakeholders can agree on the minimum skills, qualifications and experience required by an infection control practitioner.
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Hooker, Roderick Stanton. "Cost-Benefit Analysis of Physician Assistants." PDXScholar, 1999. https://pdxscholar.library.pdx.edu/open_access_etds/4029.
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This study examined if physician assistants (PAs) are cost-beneficial to employers. In an era of cost accountability, questions arise about whether a visit to a PA for an episode of care differs from a visit to a physician, and if PAs erode their cost-effectiveness by the manner in which they manage patients.
Four common acute medical conditions seen by PAs and physicians within a large health maintenance organization were identified to study. An episode approach was undertaken to identify all laboratory, imaging, medication and provider costs for these diagnoses. Over 12,700 medical office visits were analyzed and assigned to each type of provider and medical department. Patient variables included age, gender, and health status. A multivariate analysis identified significant cost differences in each cohort of patients.
In every condition managed by PAs, the total cost of the visit was less than that of a physician in the same department. This was significant for episodes of shoulder tendinitis, otitis media, and urinary tract infections. In no instance were PAs statistically different from physicians in use of laboratory and imaging costs. In each instance the total cost of the episode was less when treated by a PA. Sometimes PAs ordered fewer laboratory tests than physicians. There were no differences in the rate of return visits for a diagnosis between physicians and PAs. Patient differences were held constant for age, gender, and health status.
This study affirms that PAs are not only cost-effective from a labor standpoint but are also cost-beneficial to those who employ them. In most cases, they order resources for diagnosis and treatment in a manner similar to physicians for an episode of care, but the cost of an episode of an illness is more economical overall when the P A delivers the care. This study validates the federal policy of support for primary care P A education and suggests that PA employment should be expanded in many sectors of the health care system. These findings and the results of this cost-benefit model are evidence of its validity in predicting health care costs.
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Raisch, Dennis William 1952. "ANALYSIS OF ANTIBIOTIC THERAPY IN SELECTED DIAGNOSIS RELATED GROUPS (CLINICAL PHARMACY, PATIENT CARE, LENGTH OF STAY, TREATMENT, CHARGES)." Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/276371.
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Lanoye, Autumn. "The Impact of a Primary Care Psychology Training Program on Medical Utilization in a Community Sample." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3508.
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Mental illness and psychological distress is associated with higher rates of medical service usage and treatment of these issues results in more appropriate medical utilization rates. Little research has been conducted in an integrated care clinic, wherein health psychologists or behavioral health specialists work together with physicians to provide patient care. The current study examines the effects of brief behavioral and mental health interventions on patient medical utilization in this setting with care delivered by medical residents and doctoral psychology trainees. Access to the health system’s electronic billing records allowed for objective measures of annual healthcare utilization in terms of inpatient, outpatient, and emergency department use. A quasi-control group was constructed using propensity score matching in order to compare patients who had received a primary care psychology intervention to those who had not. Rates of inpatient utilization decreased significantly among treated patients overall as well as among treated patients identified as frequent attenders; there was no change in inpatient utilization among patients in the control group overall nor among frequent attenders in the control group, indicating that there is likely an effect of behavioral and mental health treatment on rates of inpatient visits. Rates of emergency department use and specialty outpatient visits were comparable between treated and control group patients, suggesting the lack of a treatment effect in these areas. Strengths, limitations, possible mechanisms, and implications for future research are discussed.
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Dutto, Shannon Marina. "The economic determinants of the rising costs of health care in the United States." Thesis, Georgia Institute of Technology, 1996. http://hdl.handle.net/1853/30544.
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Sinclair, Andrew. "The primary health care experiences of gay men in Australia." Connect to this title online, 2006. http://adt.lib.swin.edu.au/public/adt-VSWT20060713.084655/.
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Collins, Sherry. "MEDICAL DIAGNOSTIC GROUPING AND NURSING INTENSITY CASE MIX AS PREDICTORS OF AGGREGATE RESOURCE CONSUMPTION IN HOSPITALIZED PATIENTS (ACUITY, PROSPECTIVE PAY, DRG'S)." Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/275347.
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Queen, Courtney M. "Uninsured Adult Working-Age Population in Tarrant County: Access, Cost of Care, and Health--Hispanic Immigrants." Thesis, University of North Texas, 2004. https://digital.library.unt.edu/ark:/67531/metadc4578/.
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This study uses secondary survey data collected from a sample population of clients from JPS Health Network in Tarrant County, Texas from July-August, 2000. Respondents for this study represents a group of working-age Hispanic immigrant adults, N=379. Andersen's "Behavioral Model for Vulnerable Populations" is used to as the theoretical framework. Bivariate crosstabulation revealed significant relationships for dependent variables: problems getting needed healthcare, doctor visits, emergency room visits, overnight in the hospital, and obtaining prescription medication. Findings confirm that lack of coverage, competing needs, and difficulties in the health care system are significant in access health care. Subsequent implications and policy recommendations suggests the inevitability of short and long term health consequences unless changes are made to policies and programs.
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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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Botha, Pieter. "The profile and cost of end-of-life care in South Africa - the medical schemes' experience." Master's thesis, University of Cape Town, 2020. http://hdl.handle.net/11427/32460.
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South African medical schemes spend billions of Rands each year on medical care costs for their beneficiaries near their end of life. Hospi-centric benefit design, fee-for-service reimbursement arrangements and fragmented, silo-based delivery of care result in high, often unnecessary spending near the end of life. Factors including an ageing population, increasing incidence rates of cancer and other non-communicable diseases, and high levels of multi-morbidity among beneficiaries near their end of life further drive end-of-life care costs. Low levels of hospice or palliative care utilisation, a high proportion of deaths in-hospital and chemotherapy use in the last weeks of life point to potentially poor-quality care near the end of life. The usual care pathway for serious illness near the end of life acts like a funnel into private hospitals. This often entails resource intensive care that includes aggressive care interventions right up until death. The result is potentially sub-optimal care and poor healthcare outcomes for many scheme beneficiaries and their surviving relatives. Understanding the complex nature of the end of life, the different care pathways, the available insurance benefits, the interactions between key stakeholders and the multitude of factors that drive end-of-life care costs are vital to setting end-of-life care reform in motion. In order to increase value at the end of life, i.e. to increase quality and/or to reduce costs, benefit design reform, alternative reimbursement strategies, effective communication and multi-stakeholder buy-in is key.
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Laganiere, Simon Erik. "Uncompensated Care provided by Physicians at an Academic Medical Center during 2007-2008 using an Opportunity Cost Model." Yale University, 2010. http://ymtdl.med.yale.edu/theses/available/etd-04222010-160438/.
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This project was aimed at defining, quantifying and analyzing the value of uncompensated care provided by physicians as part of the Yale Medical Group for the 2008 fiscal year. Using an opportunity cost model, uncompensated care was calculated for each department as a total of bad debt and free care and then compared to existing estimates of such care. Another aim of this study was to conduct an interdepartmental comparison of the value of such care as a percentage of departmental earnings. To undertake this study, a literature search was performed to determine previous estimates and models of uncompensated care by physicians. Primary financial data (including charges, payments and write-offs for Bad Debt and Free Care) from the Yale Medical Group for fiscal year 2008 was then collected, fed into the opportunity cost model and compared to published estimates. The results of this study showed that, as a whole, physicians at the Yale Medical Group provided $6,510,373.65 of Uncompensated Care (or 2.75% of Total Payments) with a departmental range of 0.57%-15.29% of Total payments. These results show that Faculty physicians at Yale provided a larger amount of Uncompensated care than the published estimates obtained from random sampling of almost 4000 physicians. The results also reveal large differences in levels of uncompensated care between departments at Yale.
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Loiseau, Pierre. "La maîtrise des dépenses de santé confrontée à la responsabilité médicale aux États-Unis et en France /." Aix-en-Provence : Presses Univ. d'Aix-Marseille, PUAM, 2005. http://www.gbv.de/dms/spk/sbb/recht/toc/514098546.pdf.
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Rudzki, Stephan J. "The cost of injury to the Australian army." Phd thesis, 2009. http://hdl.handle.net/1885/110379.
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This thesis is the first study to have determined a comprehensive estimate of the
cost of injury to the Australian Army. The approach used was that of a cost of illness
study, which summarised the economic burden of injury and provides information for
stakeholders, allowing them to make informed decisions on the allocation of scarce
healthcare resources. Cost of illness (COI) studies serve a different purpose to that of
health economic evaluations which are focused on evaluating the cost of an
intervention rather than estimating the cost of a particular disease. A "top down"
approach to analysis was adopted utilising high level organisational databases to obtain
cost data. This thesis adopted the primary perspective of government, but also
considered costs from a societal and individual perspective.
Estimating the economic burden of injury in a defined population is dependant
on the availability of data of sufficient quality and scope, which is often lacking. This
was the case in this thesis where available datasets contained data of poor quality or
insufficient detail to provide accurate injury cost data. A number of assumptions were
required in order to develop estimates of the contribution of injury to different sources
of cost. There is a clear requirement for Defence to improve it injury surveillance and
introduce an electronic health record to facilitate this. Efforts must also be made to link
clinical data with cost data to better inform decision makers about the relative benefits
achieved from the considerable cost resulting from injury.
The cost of injury has three components; direct costs; indirect costs; and
intangible costs. Direct costs considered in this analysis included external medical and
compensation costs, as well as compensation liabilities calculated by the Australian
Government Actuary. Indirect costs included productivity losses, with invalid pensions
also included because they constitute a significant cost to Government not usually
included in (COI) studies. An additional analysis of the net present value of lost wages
was conducted on those soldiers who were invalided from the Army. A novel approach,
termed the Capital Investment Model, was used to estimate the loss of training
investment as a result of premature separation from the Army due to injury. Intangible
costs were not included in this study because of the difficulty in placing a monetary
value on these aspects of injury.
Direct injury costs in 1996 were estimated to be between $40.75 and $42.36M
with outstanding compensation liabilities of $270M. Indirect costs were estimated to be
$10.74M with invalid pension liabilities of $63.82M. Capital losses due to premature
separation from the Army due to injury were estimated to be $10.1 OM. The total cost of
injury to the Australian Army (in 1996 dollars) was estimated to be between $61.59M
and $63.20M, with estimated pension and compensation liabilities of $333.82M. Injury
causes a significant financial impost.
This is also the first study to compare the cost and outcomes of a range of spinal
surgical procedures reflective of general orthopaedic community practice. It adopted a
"bottom up" approach to analysis, where detailed data was obtained from individual
records and a patient survey. This allowed for outcome and cost analysis by subgroup.
A number of findings were consistent with the literature, in particular the dissociation
between pain score and functional capacity. Increasing complexity of surgical
intervention increased costs with no improvement in clinical outcome and alarming levels of radiological exposure was found. Radiation exposure could not be compared
to other studies as they did not report the distribution of radiological investigations. The
decision to undergo surgery appears to be based on the baseline level of pain and the
fear of it worsening rather than specific clinical indications. The use of effective nonoperative
methods of reducing pain offers the prospect of significantly reducing the
patient demand for surgery and its attendant cost.
The greatest injury-related cost savings from a societal perspective are obtained
from interventions that promote early return to work and minimize lost productivity.
Preventing an injury prevents the associated cost, so efforts in the area of injury
prevention are critical in reducing the burden of injury. The significant reduction in
injury observed from the Defence Injury Prevention Program highlights the benefit of
effective primary prevention programs. Equally, once an injury occurs, secondary
prevention efforts seek to achieve maximum restoration of function with minimal
morbidity and cost. The results of the spinal surgery study have shown that
improvement in primary outcome measures are not effect by the cost of the chosen
intervention and efforts to achieve pain relief through non-operative means,in order to
prevent surgical intervention, should be a high priority for research, not just in Army
but in the broader community.
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Kelman, Christopher William. "Monitoring Health Care Using National Administrative Data Collections." Phd thesis, 2000. http://hdl.handle.net/1885/47457.
Full textAbstract:
With the inevitable adoption of information technology into all areas of human pursuit,
the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation.
¶ ... ¶
The aims of the project were: · To examine the potential for using administrative data to generate outcome measures and surveillance indicators. · To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework. · To compare the Australian health-service data system with the current international state-of-the-art. · To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity. ¶ The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. ... ¶ In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). ...¶ ... Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures. ¶ Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.