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1
Blanton, Sandra. "Justice in Health Care Access Measuring Attitudes of Health Care Professionals." TopSCHOLAR®, 2000. http://digitalcommons.wku.edu/theses/714.
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To measure attitudes toward justice in access to health care services in managed care plans in a convenience sample of medical professionals at Clark Memorial Hospital in Jeffersonville, Indiana. Methods. A sixteen item, self-administered instrument based on Morreim's four concepts of justice in health care access was administered to 147 health care professionals, representing physicians, allied health, and hospital administration. SPSS was used to analyze the results. Results. The attitudes of the respondents were negative toward managed care. They did not feel that managed care had been a positive development in the United States or that managed care had improved access to preventive care or improved primary care. On the survey instrument, respondents scored highest on the scale measuring fairness to individual patients. Conclusion. In a convenience sample of health care professionals at Clark Memorial Hospital in Jeffersonville, Indiana, equity in distributing access to health care among individual patient needs was found to more closely meet their expectations of justice in health care access. There were no differences found across occupational groups in their responses to the two scales. There were differences in attitudes toward managed care among occupational groups.
2
Wright, Trudy, and n/a. "Primary health care : the health care system and nurse education in Australia, 1985-1990." University of Canberra. Education, 1994. http://erl.canberra.edu.au./public/adt-AUC20061110.171759.
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Primary health care as a model for the provision of health services was
introduced by the World Health Organization In the mid 1970s. Initially
viewed as a means of health promotion and advancement of wellness in
developing countries., it was soon to be adopted by industrialised countries to
assist in relieving the demand on acute care services. This was to be achieved
through education of the community towards good health practices and the
preparation of nurses to practice in the community, outside of the acute care
environment Australian nurses were slow to respond to this philosophy of
health care and this study has sought to examine why this is so. It has been
found that there are a multitude of reasons for the lack of action In the decade
or more following the Declaration of Alma Ata and the major Issues have been
identified and elaborated.
Some of the major reports of the time that were associated with and had some
Influence on health care and nurse education have been examined to identify
recommendations and how much they support the ethos of primary health
care. These include the Sax committee report of 1978 and a submission by
the Department of Employment and Industrial Relations In 1987.
As part of the investigation, nursing curricula from around Australia in the
mid 1980s have been examined to determine the degree of the primary health
care content according to guidelines recommended by the World Health
Organization. It was found that generally at that time, there was a deficit In
the preparation of undergraduate students of nursing for practice In the area
of primary health care when the world, including industrialised nations, was
making moves towards this model of health care delivery.
Factors Influencing the slow response of nursing have been examined and
finally recommendations for further studies have been put forward.
3
Annear, Peter Leslie, and mikewood@deakin edu au. "Healthy markets - Heathly people? Reforming health care in Cambodia." Deakin University. School of Health Sciences, 2001. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20050825.134836.
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Health care reform has been described as a global epidemic. This thesis deals with nature and experience of health care reform in developing countries. Increasing privatisation, economic transition, and structural adjustment have provided the context for health system changes. Different approaches to reform have been developed by international organisations such as the World Bank, WHO and UNICEF. What has driven national health care reforms? Are such policies really appropriate to developing countries? Has a consensus now emerged in relation to international health policy? Has a new health care model appeared? The study of health care reform in Cambodia is a timely opportunity to investigate the implementation of health care reform under extreme conditions. These conditions include a legacy of genocide, long-term conflict, political isolation, and economic transition. This case study uses both qualitative and quantitative methods and multiple sources of data to analyse the reform program. The study reinforces the conclusion that, under conditions of extreme poverty, market based reforms are likely to have limited positive impact. Rather, understanding the cultural conditions that determine demand, delivering health care of a satisfactory quality, providing appropriate incentives for health practitioners, and supporting services with adequate public funding are the prerequisites for improved service delivery and utilisation. Cambodia's strategy of integrated district health service development and universal population coverage may provide an instructive example of reform. Emerging policy issues identified by this case study include the fundamental role of equity in service provision, the influence of the social determinants of health and illness and interest in the appropriate use of evidence in international health policy-making.
4
Baker, Timothy Alan. "Oregon Primary Care Physicians' Support for Health Care Reform." PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.
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This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI).
This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan.
Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive.
Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI).
While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program.
This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.
5
Kantola, H. (Hannele). "Management accounting change in public health care." Doctoral thesis, Oulun yliopisto, 2014. http://urn.fi/urn:isbn:9789526204680.
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Abstract The aim of this dissertation is to analyse the process of change in management accounting in public-sector health care. The change is examined through the implementation of a nationally homogeneous Diagnosis Related Grouping (DRG) system. The DRG system is used to classify health-care diagnoses into groups for service productisation and pricing. The system has been proposed as a solution for cost accounting and budgeting. The practical motivation of the dissertation is to analyse the embedding of change in organisations´ practises. The theoretical motivation of the dissertation is to extend the investigation of change by analysing the process of implementation of a nationally homogeneous system. The research data comprise 39 interviews conducted between 2006 and 2011 with hospital district representatives, the representatives of the company managing the DRG system, the DRG system supplier, and the representatives of the National Institute for Health and Welfare and the Association of Finnish Local and Regional Authorities. In addition to interviews, the data consists of participative observations, telephone inquiries, and newspaper articles. This dissertation consists of four essays that analyse the data through the lens of two theories: the Actor Network (ANT) and Institutional theory (NIS). The results indicate how the use of multiple theories (ANT ja NIS) as a methodology enriches and extends the insight into the change process in management accounting. For instance, the analysis of the homogeneous use of the DRG system, without investigating the practices of actors by making use of the ANT, the results could have been different in this respect. Especially, this dissertation indicates how important it is that actors’ actions are also examined in the processes of change in the implementation of public-sector management accounting systems. The idea for the DRG system was introduced to Finland almost twenty years ago. However, the results indicate that it has spread very slowly. According to earlier research, an institutional environment is considered to exercise pressure on organisations in order to make them adopt new practices that are homogeneous with other institutional practices. There is indirect pressure in decentralised health care in Finland, though its power for change is weak. This dissertation shows how the decentralisation of responsibilities in large-scale institutions, such as the health-care system in Finland, also slows down and decentralises reforms. As institutional power becomes weaker, the power of organisations to promote things seems to grow stronger, howeverTiivistelmä Tämän väitöskirjatyön tarkoituksena on analysoida johdon laskentatoimen muutosprosessia julkisen sektorin terveydenhoidossa. Muutosta tarkastellaan kansallisesti yhtenäisen diagnoosiperustaisen ryhmittelyjärjestelmän (Diagnosis Related Grouping, DRG) käyttöönottoprosessin kautta. DRG on järjestelmä, jossa luokitellaan terveydenhoidon diagnoosit ryhmiin palvelujen tuotteistusta ja hinnoittelua varten. Järjestelmää on esitetty ratkaisuna kustannuslaskentaan ja budjetointiin. Väitöskirjatyön käytännön motivaationa on analysoida muutoksen asettumista organisaatioiden käytäntöihin. Väitöskirjatyön teoreettisena motivaationa on laajentaa muutostutkimusta tarkastelemalla kansallisesti yhtenäisen järjestelmän käyttöönottoa. Tutkimuksen aineisto koostuu 39 haastattelusta, joita on kerätty vuosien 2006 ja 2011 välillä. Tutkimuksessa on haastateltu sairaanhoitopiirien henkilökuntaa, DRG-järjestelmän hallinnoiman yhtiön edustajia, järjestelmän toimittajaa, Terveyden ja hyvinvoinnin laitoksen sekä Kuntaliiton edustajia. Aineisto sisältää haastattelujen lisäksi osallistuvaa havainnointia, puhelinkyselyjä sekä lehtiartikkeleita. Tämä väitöskirjatyö koostuu neljästä esseestä, joissa analysoidaan aineistoa kahden eri teorian, toimijaverkostoteorian (ANT) ja institutionaalisen teorian (NIS), avulla. Tulokset tuovat esille, kuinka kahden teorian (ANT ja NIS) metodologinen käyttö rikastuttaa ja laajentaa näkemystä johdon laskentatoimen muutosprosessista. Esimerkiksi analysoitaessa DRG-järjestelmän yhtenäistä käyttöä tutkimatta toimijoiden toimintaa toimijaverkostoteoriaa hyödyntäen, tulokset voisivat tältä osin olla erilaiset. Erityisesti tämä väitöskirjatyö osoittaa, kuinka tärkeää julkisen sektorin johdon laskentajärjestelmien käyttöönoton muutosprosessia tutkittaessa on tutkia myös toimijoiden toimintaa. Idea DRG-järjestelmästä esitettiin Suomessa melkein kaksikymmentä vuotta sitten. Tulokset osoittavat kuitenkin, että sen leviäminen on ollut hyvin hidasta. Aikaisempien tutkimusten mukaan institutionaalisen ympäristön katsotaan painostavan organisaatioita, jotta ne ottaisivat käyttöön uusia menetelmiä, jotka ovat yhdenmukaiset muiden institutionaalisten käytänteiden kanssa. Suomen hajautetussa terveydenhoidossa esitetään epäsuoraa painetta, mutta sen voima muutokseen ei ole vahva. Väitöskirjatyö tuo esille miten suurien instituutioiden, kuten Suomen terveydenhoidon, vastuun hajautuessa myös reformit hidastuvat ja hajautuvat. Institutionaalisten voimien heikentyessä organisaatioiden voima ajaa asioita näyttää kuitenkin vahvistuvan
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Cornick, Ruth. "'You must tune your TB programme well...' : integrating TB, HIV and ARV care in Cape Town primary care setting." Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/9328.
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Includes bibliographical references (leaves 86-91).This study occurred in the context of three problems that have arisen within the South African HIV/AIDS crisis: the prevalent HIV and tubertulosis (TB) co-epidemic, the concern that antiretroviral (ARV) provision might compromise the existing TB control programme, and that the Western Cape's current limited vertical model of ARV roll-out will soon reach capacity. This study evaluated whether and how TB control changed following ARV introduction in a Cape Town primary care TB clinic and explored the process of integration of the TB and ARV services in the clinic.
7
Zhang, Yanzhen. "Health care systems in China /." This resource online, 1994. http://scholar.lib.vt.edu/theses/available/etd-07102009-040227/.
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Christiansen, Isaac Zvi. "Improving public health care an examination of the nature of Cuban government assistance to the Ghanaian public health care system /." [Ames, Iowa : Iowa State University], 2010. 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:1476285.
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Gallagher, Naomh. "Diabetes in Northern Ireland : using routine health care data to inform public health care policy." Thesis, Queen's University Belfast, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601482.
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Diabetes is a leading cause of morbidity and mortality around the world, and the prevalence is increasing dramatically. Rather surprisingly, there is no consensus regarding the burden of diabetes in Northern Ireland. This thesis outlines the creation and utilisation of a novel centrally collated population wide dataset of dispensed prescriptions known as the Enhanced Prescribing Data base (EPO). This was successfully used, together with linkage of other demographic and health-related data, to provide estimates of the prevalence, incidence and changing prevalence of diabetes in Northern Ireland over a three year period, and of the associated relative mortality risk for patients with diabetes. Through further linkage to unique and individual-level indicators of socioeconomic status, a comprehensive picture of the differential burden of diabetes across society was produced. Variation related to geography, demographics, socioeconomic variables, and over time was investigated. In addition, the thesis demonstrates how routine administrative data can be used to investigate the relationship between health policy and diabetes ca re. This was outlined in two studies; the first, using a time series analysis, showed how the introduction of financial incentives for GPs in the UK, , , through the Quality and Outcomes Framework (QOF) initiative changed the care of t he approximately 30% of patients with type 2 diabetes who are usually managed non• pharmacologically. The second study demonstrated how use of routine data can be used to undertake comparative analysis of patients with diabetes in Northern Ireland and the Republic of Ireland (two similar populations with distinct health systems) to the potentially mutual benefit of both jurisdictions. This thesis provides both a novel methodology to estimate diabetes in Northern Ireland, and a number of unique examples of how administrative datasets and record linkage can be successfully utilised to answer important and policy Relevant questions in diabetes and heather services research.
10
Zhang, Yanzhen. "Health care system in China." Thesis, Virginia Tech, 1994. http://hdl.handle.net/10919/43605.
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Stewart, Sharon Louise. "Primary care groups : implementing the public health agenda." Thesis, University of Liverpool, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.425660.
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Obermann, Konrad. "Public participation in the rationing of health care /." Diss., Aachen : Shaker, 2000. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=009236382&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Mafuwa, Edgar Ngonidzashe. "Experiences of Zimbabweans on the provision of health care at selected public health care centers in Cape Town, 1994-2009." University of the Western Cape, 2015. http://hdl.handle.net/11394/4856.
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Magister Artium - MAThere is a widely held assumption that immigrants have difficulties in accessing public health care services in South Africa. This assumption derives from the experiences of some immigrants in accessing public health care services at some public health care facilities which are all required by law and policy to provide such services. The main aim of the study was to investigate the experiences of Zimbabwean immigrants in accessing public health care services at some public clinics and hospitals in Cape Town. Foucault’s theory on power was used to unpack the experiences of Zimbabwean immigrants at these public health care centers. Zimbabwean immigrant participants were all purposively sampled for the study and medical personnel were randomly sampled. The Zimbabwean immigrants sampled had used public health care facilities in Cape Town. Semi-structured interviews were used to collect data from the Zimbabwean immigrants which were qualitatively analysed using content analysis. Questionnaires were also used to collect data from both the Zimbabwean immigrants and medical personnel and subsequently open-ended questions from the questionnaires were also analysed using content analysis and closed questions were analysed using the Micro-soft excel package of data assessment and statistically presented using pie, bar and line graphs. Themes that were recurring from the semi-structured interviews and responses from questionnaires suggested that immigrants in their experiences at public health care facilities encountered barriers that included communication problems, negative attitudes and xenophobia from medical staff, policy and practice problems and preferential treatment offered to citizens over non-citizens. Recommendations of what needs to be done to reduce barriers to health care for immigrants were made to all involved in the provision of health care. The study contributed to our understanding of barriers that immigrants encounter in accessing public health care in South Africa as well as the role of citizens in this process.
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Bowles, Paula. "Barriers to Lesbian Health Care." TopSCHOLAR®, 2003. http://digitalcommons.wku.edu/theses/581.
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The primary purpose of this research was to examine a sample of sixteen lesbian women regarding the barriers to lesbian health-care. From this information several interpretive findings regarding lesbian health-care are made. Data were gathered via indepth interviews with each individual lesbian. The data suggest that most lesbian women do not reveal their sexual orientation to their primary-care physician for fear of reprisal. Most of the women interviewed do feel they receive adequate health-care from their physician. The women who participated in this project did so confidentially and were assigned pseudonyms. They were asked questions on a variety of topics, which included demographics, physical health-care, mental health-care, general health, dental care, social and political issues, and homophobia. It was assumed that participants from smaller, more rural areas would face more barriers to health-care than participants from larger cities. The data gathered indicate that only three of the participants had, in fact, informed their primary-care physicians of their sexual orientation. Erving Goffman's stigma and social identity theory, feminist standpoint theory, lesbian feminist theory, and feminist theory provided the theoretical framework utilized in the analysis of barriers to lesbian health care. Combining these three theories allows a discussion of how stigma and homophobia combine to make lesbians invisible in the medical community. Health-care systems, like other major institutions, are structured to support traditional society.
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Lavoie, Josée G. (Josée Gabrielle). "Public health politics in Nunavik health care : shared concepts, divergent meanings." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=69633.
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In Nunavik, the question of self-determination in health care is becoming increasingly embedded in the community health discourse, which is used by both health planners and Inuit alike to negotiate diverging positions. While health planners envision northern health care as a subset of the Quebec system, Inuit perceive it as a vehicle to ends that transcend conventional health issues. This thesis will provide an overview of the development of Nunavik health services since the James Bay agreement, focusing on how the use of the community health discourse serves to promote, but also shapes and limits regional and community self-determination.
16
Akazili, James. "Equity in Health Care Financing in Ghana." Doctoral thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/9390.
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Includes bibliographical references.Financial risk protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". The study (the first of kind in Ghana) measured the relative progressivity of health care financing mechanisms, the catastrophic and impoverishment effect of direct health care payments, as well as evaluating the factors affecting enrolment in the national health insurance scheme (NHIS), which is the intended means for achieving equitable health financing and universal coverage in Ghana. To achieve the purpose of the study, secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other ministries and departments, and further complemented with primary household data collected in six districts. In addition 44 focus group discussions with different groups of people and communities were conducted. In-depth interviews were also conducted with six managers of District NHI schemes as well as the NHIS headquarters. The study found that generally Ghana's health care financing system is progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes which account for over 50% of health care funding. The national health insurance levy is mildly progressive as indicated by a Kakwani index of 0.045. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are associated with significant catastrophic and impoverishment effects on households. The results also indicate that high premiums, ineffective exemptions, fragmented funding pools and perceived poor quality of care affect the expansion of the NHIS. For Ghana to attain adequate financial protection and ultimately achieve universal coverage, it needs to extend cover to the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the NHI. Furthermore, the funding pool for health care needs to grow and this can be achieved by improving the efficiency of tax collection and increasing the budgetary allocation to the health sector.
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Hanna, Elizabeth Gayle (Liz), and lizhanna@netc net au. "Environmental health and primary health care: towards a new workforce model." La Trobe University. School of Public Health, 2005. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20061110.152550.
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Public health was once synonymous with environmental health. However, as living conditions improved the two fields diverged. Environmental factors are again re-emerging as hazards human health. Increasing global reliance on agricultural and veterinary chemicals (AgVets) over recent decades has is now a serious public health concern. Evidence of their toxicity has prompted international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals.
The study presented here attempts to explore the impact of these chemicals on two rural communities in Victoria, and ascertain the how the existing primary heath care system responds to AgVet exposure issues. Health determinants are complex, and inter-related, and the client �provider interface is not an entity acting in isolation from other frameworks. The provider-client service relationship has evolved against a background of legislation and provider training. Many external factors also impinge, such as the structure and focus of the health sector, and Australia�s systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address the issue of chemical exposure.
A CATI (Computer Assisted Telephone Interview) survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported AgVet exposure patterns and health data, and whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on the primary health care service experiences from local providers, and which services they preferred to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities. Information was sought on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys.
The study revealed rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist among rural populations. Many believe their own ill-health is linked to exposure, and express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure.
The lack of environmental health expertise among the existing primary health care workforce means that health conditions associated with exposure to AgVets are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority to develop a focus on human health, establish direct links, and biomonitoring programs to protect human heath. The U.S. has also developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required in Australia to connect the environment, chemical management and health portfolios, with respect to the emerging environmental issues of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.
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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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McCabe, Helen, and res cand@acu edu au. "The Ethical Implications of Incorporating Managed Care into the Australian Health Care Context." Australian Catholic University. School of Philosophy, 2004. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp48.29082005.
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AIMS Managed care is a market model of health care distribution, aspects of which are being incorporated into the Australian health care environment. Justifications for adopting managed care lie in purported claims to higher levels of efficiency and greater ‘consumer’ choice. The purpose of this research, then, is to determine the ethical implications of adapting this particular administrative model to Australia’s health care system. In general, it is intended to provide ethical guidance for health care administrators and policy-makers, health care practitioners, patients and the wider community. SCOPE Managed care emerges as a product of the contemporary, neo-liberal market with which it is inextricably linked. In order to understand the nature of this concept, then, this research necessarily includes a limited account of the nature of the market in which managed care is situated and disseminated. While a more detailed examination of the neo-liberal market is worthy of a thesis in itself, this project attends, less ambitiously, to two general concerns. Firstly, against a background of various histories of health care distribution, it assesses the market’s propensity for upholding the moral requirements of health care distributive decision-making. This aspect of the analysis is informed by a framework for health care morality the construction of which accompanies an inquiry into the moral nature of health care, including a deliberation about rights-claims to health care and the proper means of its distribution. Secondly, by way of offering a precautionary tale, it examines the organisational structures and regulations by which its expansionary ambitions are promoted and realised. CONCLUSIONS As a market solution to the problem of administering health care resources, the pursuit of cost-control, if not actual profit, becomes the primary objective of health care activity under managed care. Hence, the moral purposes of health care provision, as pursued within the therapeutic relationship and expressed through the social provision of health care, are displaced by the economic purposes of the ‘free’ market. Accordingly, the integrity of both health care practitioners and communities is corrupted. At the same time, it is demonstrated that the claims of managed care proponents to higher levels of efficiency are largely unfounded; indeed, under managed care, health care costs have continued to rise. At the same time, levels of access to health care have deteriorated. These adverse outcomes of managed care are borne, most particularly, by poorer members of communities. Further, contrary to the claims of its proponents, choice as to the availability and kinds of health care services is diminished. Moreover, the competitive market in which managed care is situated has given rise to a plethora of bankruptcies, mergers and alliances in the United States where the market is now characterised by oligopoly and monopoly providers. In this way, a viable market in health care is largely disproved. Nonetheless, when protected within a non-market context and subject to the requirements of justice, a limited number of managed care techniques can assist Australia’s efforts to conserve the resources of health care. However, any more robust adoption of this concept would be ethically indefensible.
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James, Sharon Yvonne. "An exploratory descriptive study of Clinical stress and Burnout among Critical Care Health Care professionals." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1995. http://digitalcommons.auctr.edu/dissertations/3897.
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The purpose of this study was to examine the impact of clinical stress and burnout on health care professionals on critical care units.
Thirty individuals who were employed at a local public hospital participated in the study. Participants completed a 25 item questionnaire on clinical stress and a 20 item questionnaire on burnout. A bivariate analysis was computed using Pearson's(r) correlation. The study found that there is a significant relationship between clinical stress and burnout.
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Claassens, Mareli Misha. "Responsibility in health care." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4280.
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Hanna, Elizabeth Gayle. "Environmental health and primary health care : towards a new workforce model /." Access full text, 2005. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20061110.152550/index.html.
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Thesis (Ph.D.) -- La Trobe University, 2005.Research. "A Thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy [to the] School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria". Includes bibliographical references (leaves 255-293). Also available via the World Wide Web.
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Zwama, Gimenne. "Improving health care provider - health committee working relationships for responsive, people-centred health systems." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23422.
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As community-based governance structures in the service delivery of primary health care, health committees can promote the quality, accessibility and responsiveness of service delivery. More specifically, health committees provide a platform for community members to advocate for their health needs and meaningfully participate in decision-making, oversight and monitoring of service delivery. Hence, health committees provide a bottom-up strategy to realise the right to health and a people-centred health system. Previous research has found that Health Committees in the Cape Metropole of South Africa face similar challenges as their counterparts globally. In South Africa health committees' role and mandate often seem to be unclear and weak policy frameworks have resulted in wide variations in health committee functionality. Health care providers, particularly health facility managers, have been identified to play a key role in creating a supportive environment for health committees' genuine and effective participation. Particularly, health care providers' misunderstandings of health committees' roles and responsibilities as well as their lack of engagement with health committees can form barriers to health committee's functioning. A gap in understanding exists on the impact training of health care providers could have on health committees' meaningful participation. While many health committee members in the Cape Metropole of the Western Cape Province were already trained, health care providers had not been trained until May 2015. Present realist evaluation sought to describe and explore the immediate and short-term impact of this pilot training on health care providers' responsiveness towards health committees. Pre- and post-training questionnaires, direct observations and semi-structured interviews were employed as research methods. The training evaluation was enriched by participants' diverse professional positions and work environments as well as their various experiences and relationships with health committees. The study reveals that the training played a role in increasing health care providers' responsiveness towards health committees' roles and functions. Health care providers demonstrated understandings and intentions towards building effective working relationships with health committees. However, training is recommended to be followed up on and to be continuous to ensure intentions are translated into practice and to account for the dynamic nature of health facilities, health committees and the health system in which they reside. In this manner, health care providers can increasingly contribute to building sustainable relationships with health committees to promote meaningful and effective community participation, the strengthening of people-centred health systems and the progressive realisation of the right to health.
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Jofre-Bonet, Mireia. "Health care: interaction between public system and private sector." Doctoral thesis, Universitat Pompeu Fabra, 1998. http://hdl.handle.net/10803/7392.
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Esta tesis estudia la interacción entre el sistema público y el sector privado en la provisión de servicios de salud. Consta de una introducción y tres capítulos. El primero es teórico y utiliza un modelo de diferenciación vertical de producto donde el bien en cuestión es sanidad. Los consumidores difieren en su nivel de renta y la disposición a pagar de los menos ricos no cubre su coste marginal. La provisión mediante un oligopolio mixto con un agente público que maximiza el bienestar. El sector público proporciona servicios de menor calidad pero asequibles a toda la población y el privado cubre la demanda de calidad alta. El segundo capítulo es empírico, utiliza la Encuesta de Presupuestos Familiares 90-91 y analiza si incrementar el gasto público en sanidad provoca una expansión de los recursos globales dedicados a bienes de salud. El resultado es afirmativo. El incremento de gasto público en salud tiene un efecto sustitución pero no suficiente para contrarrestar la expansión del gasto.El tercer capítulo es empírico y estudia la calidad como anexo de unión entre proveedores público y privados. La base de datos utilizada es la Encuesta Nacional de Salud de 1993 y, complementariamente, la de presupuestos Familiares 90-91.
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Barbosa, Rafael Ribeiro. "Primary public health care and socioeconomic asymmetries in Portugal." Master's thesis, NSBE - UNL, 2012. http://hdl.handle.net/10362/9566.
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Phiri, Jane. "Socioeconomic inequalities in Zambia's public health care delivery system." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/9458.
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Includes bibliographical references.In this thesis, equality is considered as the absence of differences in utilization among individuals of different socioeconomic status while equity is taken to mean that individuals in equal need of health care should use the same amount of care, irrespective of their socioeconomic status. Using the above definitions, this thesis, examines equity/inequality in the utilization of public health care in Zambia. Concentration curves, concentration indices and horizontal equity indices were used for this purpose. This thesis focuses specifically on public health care that is subsidized by the Government. It is anticipated that the findings of this thesis will broaden the knowledge base on health care utilization inequities in Africa.
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Jung, Juergen. "Essays on reforming health care and public transfer programs." [Bloomington, Ind.] : Indiana University, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3324511.
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Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2008.Title from PDF t.p. (viewed on May 12, 2009). Source: Dissertation Abstracts International, Volume: 69-08, Section: A, page: 3240. Adviser: Gerhard Glomm.
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Mat, Taib Mohamad Zainuddi. "A systems enquiry within public health care in Malaysia." Thesis, Loughborough University, 2005. https://dspace.lboro.ac.uk/2134/7781.
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The overarching reason for studying the Malaysian Public Healthcare system is to investigate service delivery in all its forms. This research study will explore information management approaches applied to strategic, policy and operational requirementsf rom the level of the Ministry of Health, Malaysia (MoHM) through to the level of a State Hospital. In fact, six levels of recursion can be identified and at each level the interaction of information management systems (IMS) with information and communicationt echnologies( ICTs) are explored. The research is underpinned by its primary aim, this is to investigate the current IMS at the MoHM and suggest its advantages and limitations. To address the aim of the study requires the use of Beer's Viable Systems Model (VSM), here principally used in its diagnostic mode of enquiry. The strength of the VSM is its ability to model multi-recursive systems. Data and information that comprise the research inputs were gathered via questionnaire survey (441 responses, representing a response rate of approximately 71.13%), semi-structured interviews (with five top management officers of the public health system), document analysis, and personal observations. Findings reveal that the MoHM does not have the requisite variety to enable the successful realisation of an effective and efficient IMS. From the VSM diagnostic enquiry, issues raised concerning infrastructure, info-structure, and various aspects that relate to the human elements of the system. It is clear from the findings that the scope of the IMS, as well as its widespread adoption throughout MoHM and beyond, need to be addressed to allow further integration of information-based activities. An information architecture is urgently required to accommodate the technological change suggested. By combining these conclusions service delivery at MoHM will be greatly enhanced.
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Hartmann, Andre. "An assessment of telemedicine services within the Western Cape public health care system." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86225.
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Thesis (MEng)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Telemedicine is de ned as an electronic exchange of medical information and/or the delivery of clinical health care over a distance, by means of Information and Communication Technology (ICT). South Africa is faced with the problem of providing health care to a population in urban, as well as across vast rural areas. In addition to this, the South African health care system must deal with economical imbalances and a shortage of human resources to provide quality health care. Telemedicine services could provide a solution. Since the introduction of the rst national telemedicine services initiative in the late 1990s, a number of South African telemedicine services have been implemented in the public health care system. The majority of these telemedicine services have been prone to failure and many were prematurely terminated. The circumstances which in uence the failure or success of these services are not unknown. The lack of insight, and the high failure rate of telemedicine services implemented in the South Africa were the reasons for conducting this study. The purpose of the study is to assess telemedicine services implemented in the Western Cape public health care sector. The purpose is also to provide recommendations for improving the current and future telemedicine services in the Western Cape and other provinces. A telemedicine services assessment was conducted on a total of 26 telemedicine services identi ed at 6 health care facilities located in the Western Cape. The assessments were based on the TeleMedicine Services Maturity Model (TMSMM), which was developed speci cally for the purpose of assessing telemedicine services. The TMSMM capability statements were used as a yardstick to assess the maturity of each of the elements of telemedicine services in terms of the three service level groups (micro-,meso- and macro-level) and ve telemedicine domains (man, machine, material, method and money). The assessment process included: (i) the identi cation of telemedicine services at the selected health care facilities; (ii) the gathering of the relevant telemedicine service data by means of structured interviews; (iii) the transformation of the complex ow of information into Data Flow Diagrams (DFDs); (iv) the loading of telemedicine services data into a data warehouse; and (v) the analysis of data by means of On-Line Analytical Processing (OLAP), as well as box-and-whisker plots and statistical correlations. Based on the results of the TMSMM assessment, an electronic questionnaire was developed and administered amongst health care workers throughout the entire Western Cape. The questionnaire con rmed that the ndings from the TMSMM assessment are indeed representative of the entire Western Cape. The assessment of the telemedicine services provides information about the elements which a ect the success or failure of these services. This therefore addresses the initial research problem and ful ls the purpose of the study. These results were used as an input to the analysis of strengths, weaknesses, opportunities and threats (SWOT) of the delivery of telemedicine services in the Western Cape public health sector. For future references and studies, the SWOT analysis provides a point of departure for a strategic telemedicine services framework for a province like the Western Cape.
AFRIKAANSE OPSOMMING: Telegeneeskunde, per de nisie, behels die deel van mediese inligting en/of die lewering van kliniese gesondheidsdienste oor 'n afstand, deur middel van inligting en kommunikasie tegnologie (ICT). Telegeneeskunde dienste is moontlik een van die oplossings vir die lewering van gesondheidsdienste vir 'n bevolking wat versprei is oor 'n groot landelike gebied binne 'n publieke gesondheidsektor wat mense hulpbronne kort om kwaliteit gesondheidsorg te lewer. Die publieke gesondeheidstelsel van Suid Afrika het 'n drie-dubbele las van siektes, ekonomiese wanbalans and 'n tekort aan mediese praktisyns. Sedert die eerste nasionale inisiatief vir telegeneeskunde dienste in die laat 1990s bekend gestel is, is 'n paar telegeneeskunde dienste in die publieke gesondheidsektor van Suid Afrika geïmplementeer. Die meerderheid van hierdie dienste blyk onsuksesvol te wees. The faktore wat die implementeringsukses beïnvloed is nog nie goed nagevors nie. Die doel van hierdie studie is om telegeneeskunde dienste wat in die Wes- Kaap publieke gesondheidsektor geïmplementeer is te ondersoek. Die doel is verdermeer om aanbevelings te maak met die oog op die verbetering van bestaande en toekomstige dienste in die Wes-Kaap asook ander provinsies. Eerstens is 'n telegeneeskunde diens assessering uitgevoer op 'n totaal van 26 dienste 6 fasiliteite. Hierdie assesserings is gebasseer of the Telegeneeskunde Diens Volwassenheidsmodel (TMSMM), wat ontwikkel is spesi ek met die doel om telegeneeskunde dienste te assesseer. Dit word gedoen deur die dienste te meet in terme van drie vlakke (mikro-, meso- en macrovlak) en vyf domeine (man, masjien, materiaal, metode en geld). Die TMSMM vermoeë-stellings word as maatstaaf gebruik. Die assesseringsproses sluit in (i) die identi sering van telegeneeskunde dienste by die aangewese gesondheidsfasiliteite; (ii) die versameling van relevante telegeneeskunde data deur middel van gestruktureerde onderhoude; (iii) die transformasie van komplekse inligtings vloei na data vloeidiagramme (DFDs); (iv) die laai van telegeneeskundige dinste data in 'n databasis; and (v) die analyse van data deur middel van aanlyn analitiese verwerking (OLAP) sowel as boxen- snorbaard gra k en statistiese korrelasies. Gebasseer op die resultate van die TMSMM assesseringsproses, is 'n elektroniese vraelys ontwikkel en geadministreer onder gesondheidswerkers regoor die Wes-Kaap ten einde te bevestig of die gevolgtrekkings van die TMSMM assessering die hele provinsie verteenwoordig. Die assessering van die telegeneeskundige dienste verskaf inligting in terme van die faktore wat die sukses van telegeneeskundie dienste beïnvloed. Sodoende word die aanvanklike navorsingsprobleem aangespreek. Hierdie resultate is toe gebruik as inset vir die analise van die sterk punte, swak punte, geleenthede en bedreigings (SWOT) in die publieke gesondheidsektor van die Wes-Kaap in terme van telegeneeskundige dienste. Hierdie SWOT-analise kan in die toekoms gebruik word as vertrekpunt vir die ontwikkeling van strategiese raamwerk vir die implementering van telegeneeskundige dienste in 'n provinsie soos die Wes-Kaap.
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Wirrmann, Erica. "Talking about 'public health' : an exploration of the public health roles of primary care practitioners in England." Thesis, Oxford Brookes University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424590.
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The British Government, since 1997, have placed a strong emphasis on public health and the reduction of health inequalities. Alongside this, they have progressed a major reform of the NHS which aims to 'shift the balance of power' to the frontline. Primary care is an increasingly important aspect of the Government's new agenda, which aims to improve health for everyone, and for the worst off in particular. This thesis identifies general practice, and the core practitioners that work within it, as key potential contributors to a public health agenda. But 'public health' is a conceptually contested terrain, and as a concept, can be understood and interpreted in a myriad of ways. The impact of this lack of shared understanding is explored both for policy making and implementation, and for the development of public health practice in primary care. This research brings together public health and primary care literatures in order to illuminate the historical and organisational contexts within which current developments are taking place. It critically analyses the public health discourse of New Labour policy documents in order to explore the ways in which 'public health' is understood and talked about within recent government policy, and the government's expectations of primary care practitioners, in terms of their public health roles. Finally, the research draws on case study material from one (pre-2002) health authority area in England to examine practitioners' understandings of public health, and their perceptions of their public health roles. Using Wenger's (1998a) social theory of learning as a framework, it looks at the organisational and wider contexts in which practitioners work, and explores how varied and unclear understandings of public health, both in policy and practice, might be affecting practitioners' engagement with public health. The study highlights the dangers of vagueness surrounding the term public health, and finds a tendency both in policy and practice to regard it as a set of activities, rather than as an approach to work. Its malleability means that it can be interpreted both in a politically acceptable way, and in a way that fits within existing practice. Thus, as a concept, it loses its radical edge and is no longer something that challenges or guides policy and practice. The research finds that the ways in which practitioners interpret public health can contribute to their non-engagement in the public health agenda. This is not helped by conflicts within policy which threaten the development of stronger public health roles within general practices. The thesis concludes by recommending the development of shared understandings of public health, particularly as a valuedriven approach to work, rather than as a set of activities.
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Harries, Jane. "Abortion services in South Africa : challenges and barriers to safe abortion care : health care providers' perspectives." Doctoral thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10623.
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Includes bibliographical references (leaves 199-213).Unsafe abortion is a preventable phenomenon and continues to be a major public health problem in many countries especially in the developing world. Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion, and a shortage of trained and willing abortion providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.
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Parisian, Esther Elizabeth. "Health Care Reform and Rural Hospitals: Opportunities and Challenges under the Affordable Care Act." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1313596532.
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Temmers, Lynette. "Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services." University of Western Cape, 2019. http://hdl.handle.net/11394/7655.
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Master of Public Health - MPHCommunity health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC
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Wang, Xiaochuan (Sherry). "Three essays on population health and public health policy." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/29270.
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Empowered patient or empowered physician. An analysis of the importance of the gatekeeper in the health delivery system. This paper examines the important role of the gatekeeper in the health delivery system. A simple theoretical model is developed which compares the resource allocation when physicians act as gatekeepers with the decisions taken when patients are empowered. It is shown that even when there is no asymmetry of information---and so patients and doctors are equally able to identify the appropriate therapy---that the institutional arrangement matters. Patients demand more time with physicians when they are empowered whereas physicians want to spend more time developing their expertise when they are empowered. The reaction of physicians and patients to changes in policy instruments also differs across institutional arrangements. The analysis also draws attention to the design of the compensation scheme for physicians, and investigates the benefits of using a non-linear scheme.
Wealth, health, and the pursuit of happiness. This paper provides a theoretical framework to illustrate the relationship between income, utility maximization, and healthy choices. The analysis indicates that the choices of individuals who maximize utility are not the same as those arising were the individual to maximize wellness. In fact, rational individuals will over-eat and under-exercise relative to health maximizing levels. Yet as individuals get wealthier, they have better health. The paper also compares different strategies for health promotion. Income redistribution may lead to a net increase in population health and in social welfare. By contrast, policies that specifically target lifestyle choices may succeed in persuading citizens to choose a health-maximizing lifestyle, but result in a net welfare loss to society.
An empirical investigation of household income and income polices on obesity in Canada. Using the master files of the Canadian Community Health Survey (CCHS), this paper examines the effect of income on obesity and individuals' body-mass index. An instrumental variable technique is employed to derive consistent estimates of this effect and to take account of the possible endogeneity between income and body weight. It is found that higher income will lead to lower body weight for women, while its effect on the body-weight outcome of men is unclear. This chapter uses the estimates of the relationship between income and body weight to simulate the impact of government income policies---like social assistance and child support---on obesity. It is shown that incomes policies may not only decrease income inequality but may also contribute to a lower incidence of obesity amongst the poorer population thus decreasing overall health care costs.
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Röhrs, Stefanie. "Nurses decision-making in termination of pregnancy services at health care facilities in the Western Cape." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/9427.
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Includes bibliographical references.Using the theory of "street-level bureaucrats" , this thesis examines the implementation of the South African Choice on Termination of Pregnancy Act by exploring nurses' decision-making in termination of pregnancy services. As front-line providers, nurses play a critical role in the implementation of termination of pregnancy services. Nurses may be required to assist in informing, preparing or counselling women who request a termination of pregnancy and, if appropriately trained, nurses can perform terminations of pregnancy. Research suggests, however, that 15 years after the promulgation of the law, nurses continue to be reluctant to participate in termination of pregnancy services thereby undermining the successful implementation of the Choice on Termination of Pregnancy Act.
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Marti-Morales, Madeline. "Care coordination, family-centered care and functional ability in children with special health care needs in the United States." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/870.
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Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children's functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, and FA in CSHCN. The design of this study was a secondary analysis of data from the 2005--2006 National Survey of CSHCN. The study was guided by an adapted socioecological multilevel conceptual framework. Statistical methods included univariate, bivariate, and multiple logistic regression analysis. Results indicated that CC was associated with FA in CSHCN. CSHCN that did not receive CC had a 53% increased risk (OR =1.53, 95%CI 1.21--1.94, p < 0.001) for a limitation in FA compared to CSHCN that received CC, controlling for age, gender, number of conditions, household poverty level, parental educational level, and health insurance. FCC was not associated with a limitation in FA in CSHCN ( p = 0.61). Findings from this study were consistent with the socioecological multilevel framework and the literature on care coordination. This study contributed to positive social change by providing information that can be used by public health officials, health care providers and policy makers in developing policies to assure that care coordination is provided to CSHCN and their families in order to improve their health outcomes and functionality.
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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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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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McGuiness, Clare Frances, and clare mcguiness@calvary-act com au. "Client perceptions : a useful measure of coordination of health care." The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020124.141250.
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Despite the many interventions and trials aimed at improving coordination of health care, there is currently no accepted measurement of coordination. My professional interests and an opportunity provided by the Care Plus (Coordinated Care) Trial in the ACT led me to consider client perceptions as a potentially appropriate measure. My research question is can coordination of health care be usefully measured through client perceptions?
¶
I addressed this question by developing and testing an instrument to measure perceptions of coordination called the Client Perceptions of Coordination Questionnaire (CPCQ). In the thesis I describe the processes of developing the instrument, testing it through use in several studies and considering how useful such an instrument may be for health services research. In addition to the Coordinated Care Trial, I conducted two validation studies - in a chronic pain population and a general practice sample.
¶
In Part 1 of the results I demonstrate good face, content and discriminant validity, and reliability of the instrument. Psychometric analysis of the CPCQ did not support scaling, and identified areas were the instrument could be improved. Nevertheless the underlying construct of client perception of coordination as a measure is entirely new, and it is therefore worthwhile to explore its associations with other health outcome data. In Part 2 I use a single item from the CPCQ, how often did you feel the care you received was well-coordinated? to explore this construct. I explore the influences upon on client perceptions of coordination, and examine its associations with service utilisation and health outcome data.
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The construct of perceived coordination, and the capacity of the CPCQ to measure it accurately show considerable promise as measures of health care. Consistent trends were found that suggested coordination was a complex construct, and that a stronger theoretical base was needed to interpret this complexity. Theory is the first of the phases of instrument development, and so I revisit these in order to summarise the strengths and weaknesses of the current CPCQ. Overall, the perceptions of coordination have surprisingly plausible associations with other health data, the effort to improve the instrument should be worthwhile for a wide range of health service evaluation and research.
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Miller, Robin. "Managing change in health and social care." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6672/.
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This PhD by Publication has investigated contemporary management of change practice in health and social care. Through eight case studies it explores change within different sectors, roles and organisations within national, regional and local systems. More successful change programmes are better able to understand their contexts, to design change theories that will work within these contexts, to fully implement the activities planned on the basis of these theories, and to have the resources and autonomy to complete the programme to its conclusion. Despite the relative success of some programmes, there are common opportunities for change management practice to be improved. These include -the meaningful engagement of service users throughout the process; setting of intermediary and final outcomes that provide opportunity for formative and summative evaluation, and in the use of relevant data to enable reflective change practice. It would also appear that despite the considerable body of knowledge regarding management of change this rarely explicitly influences change programmes and therefore stronger collaboration between academia and practice is still required. A pragmatic approach in which different academic fields collaborate to directly respond to the problems faced in practice would be beneficial.
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Adanri, Olubunmi A. "Maternal Health Literacy, Antenatal Care, and Pregnancy Outcomes in Lagos, Nigeria." Thesis, Walden University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10282020.
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Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew’s health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (p < .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.
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Clinton, Chelsea, and Chelsea Clinton. "Choosing Health Insurance: Public, Private or None?" Thesis, University of Oregon, 2012. http://hdl.handle.net/1794/12390.
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I estimate two models of consumer health insurance choices where individual attributes and e.g., income, age, gender, cost, etc. affect qualification for specific programs e.g., Medicaid and Medicare, but also affect the choices individuals make. From these results, I assess how these attributes affect health insurance choices using the 2008 Medical Expenditure Panel Survey. I then use these results to predict how individual health insurance choices change with the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. My predictions estimate that more 50 percent of those who become eligible for Medicaid under ACA will switch to Medicaid or choose to have both Private and Medicaid insurance.
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Lee, Yuna Swatlian Hiratsuka. "Fostering creativity to improve health care quality." Thesis, Yale University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10633255.
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Eliciting and evaluating new ideas to improve the quality of health care are important processes for health care organizations. Creativity, which refers to the generation of novel and useful ideas, is required for innovation and is valued by many organizations. Health care staff (e.g., primary care providers, nurses and medical assistants) can be an important source of creative ideas. In my dissertation, I conducted a longitudinal, mixed methods study of 220 improvement ideas generated over 18 months by improvement team members from 12 federally qualified community health centers. I also analyzed the experiences of 2,201 patients cared for by these individuals. I used data from patient surveys, quality improvement team meeting transcripts, staff surveys and wearable sociometric sensors.
Part one of this research draws on organizational theory to develop hypotheses and tests empirically the impact of creative idea implementation on patient care experiences, the relationship between idea creativity and implementation, and moderators of this relationship. Results suggest that the implementation of creative ideas is positively associated with better patient care experiences, but such ideas are less likely to be implemented. Three staff-level characteristics - more collaborative relationships, longer organizational tenure, and higher network centrality (a more central position in the organization's social network) – increase the likelihood that staff's creative ideas will be implemented. Part two of this research assesses the health care staff characteristics associated with idea creativity. The results show that staff with a peripheral perspective on care delivery (behavioral health provider and medical assistant), and staff with lower satisfaction and who have a shorter organizational tenure, are significant correlates of idea creativity. Part three of this dissertation focuses on the tactics that quality improvement leaders use to foster idea creativity, evolution, and implementation in their groups. The results suggest that the leader tactic of brainstorming is associated with groups having more creative, rapidly implemented, low-engagement ideas, which might be an effective tactic for leaders seeking disruptive change. The tactic of group reflection on process is associated with slower implemented, high-engagement ideas, which might help leaders elicit well-considered and deliberated solutions. I develop a conceptual framework for understanding creativity in health care organizations based on these findings, which may help scholars and health care professionals improve their understanding of health care innovation and how better to facilitate the expression and implementation of creative ideas.
This dissertation contributes to health services and organizational research by elucidating how creativity in health care organizations is fostered and facilitated, and how it affects outcomes. Understanding how creative ideas may improve the organization and delivery of quality care could facilitate efforts to discover and evaluate new ideas regarding the quality of health care delivery.
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Capp, Stan, and kimg@deakin edu au. "The Geelong Community's Priorities and Expectations of Public Health Care." Deakin University. School of Health Sciences, 2001. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20040505.114253.
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Abstract
This thesis set out to achieve the following objectives:
(1) To identify the priorities and expectations that the Geelong community has of its public health care system.
(2) To determine if there is a common view on the attributes of a just health system.
(3) To consider a method of utilising the data in the determination of health care priority setting in Barwon Health.
(4) To determine a model of community participation which enables ongoing input into the decision making processes of Barwon Health.
The methodology involved a combination of qualitative and quantitative research. The qualitative work involved the use of focus groups that were conducted with 64 members of the Geelong community. The issues raised informed the development of the interview schedule that was the basis of the quantitative study, which surveyed a representative sample of 400 members of the Geelong community. Prior to reporting on this work, the areas of distributive justice, scarcity and community participation in health care were considered. The research found that timely access to public hospitals, emergency care and aged care services were the major priorities; for many people, the cost was less relevant than a quality service. Shorter waiting times and increased staffing levels were strongly supported. Increased taxes were nominated as the best means of financing the health system they sought. Community based services were less relevant than hospital services but health education was supported. An egalitarian approach to resource distribution was favoured although the community was prepared to discriminate in favour of younger people and against older people. There was strong support for the community to be involved in decision making in the public health care system through surveys or focus groups but very little support was given to priorities being determined by politicians, administrators and to a lesser extent, medical professionals.
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Crelinsten, Linda. "Public participation in health care decision-making : the Canadian experience." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ47780.pdf.
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Reeves, Rachel. "Fair treatment : public conceptions of distributive justice in health care." Thesis, University of Oxford, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365351.
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Rogers, Gary. "Feeling queer can a primary health care approach mitigate health inequity experienced by homosexually active South Australian men? /." Connect to this title online, 2005. http://thesis.library.adelaide.edu.au/public/adt-SUA20060726.161708/.
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Magner, MaryBeth. "The Effects of Managed Care on the Quality of Dental Hygiene Care." TopSCHOLAR®, 1998. http://digitalcommons.wku.edu/theses/344.
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Managed care has become a prominent mechanism for insuring dental care. Empirical research suggests that managed dental plans provide lower quality care to patients. However, few studies have specifically addressed the effects of managed care on the quality of dental hygiene care. Thus, in this study the researcher examines whether dental hygienists deliver a lower level of treatment to managed care patients than to those who are not subject to managed care. Questionnaire data were gathered from 193 members of the American Dental Hygienists' Association residing in the Chicago area. The primary independent variable, managed care, was measured with an item that asked the respondents to indicate the percentage of patients they treat that are insured by a managed dental plan. The questionnaire also contained items that measured the frequency in which the respondents perform 23 tasks that are indicators of quality of dental hygiene care. Principal components factor analysis of these 23 items yielded the study's two dependent variables: periodontal procedures and appointment time. Regression analysis of the data revealed a significant negative relationship between managed care and appointment time. This relationship may be attributable to an economic incentive on the part of dentist-employers who control the amount of time scheduled for dental hygienists' patients. Dentist-employers may reduce the time available for managed care patients in order to allow longer appointments for more profitable fee-for-service patients. The study results did not support the notion that managed care affects the extent to which dental hygienists perform periodontal procedures. These mixed results suggest that future research should examine the relationships between managed care and other aspects of quality of dental hygiene care not addressed in the current study.
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Van, Driel Adrian Edgar. "An exploratory study into the benefits of the new health care system in South Africa, with specific reference to health care providers in the Western Cape." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.
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Fordham, Maria. "Being and becoming a specialist public health nurse : net weaving in homeless health care." Thesis, University of Bedfordshire, 2012. http://hdl.handle.net/10547/304613.
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In this study, systematic reflection in professional practice is seen as a dynamic process towards socio-political action, negating a navel-gazing critique. Positioned within nursing, the pioneering narrative inquiry approach will be highly valuable in medicine, education and other health fields. When I embarked on this study, research to guide me in homeless health care was limited and there is, even yet, insufficient evidence to demonstrate the effectiveness of advanced nursing practice in England particularly with homeless people. Through its reflexive narrative nature that research gap is addressed in a profound journey that illuminates my transformation over a three year period of being and becoming a Specialist Public Health Nurse (homelessness). The methodology draws dynamically on an eclectic, philosophical framework which includes reflective practice/guidance, narrative inquiry, hermeneutics, aesthetics, critical social science theory, storytelling, performance-ethnography and ancient wisdom. The Six Dialogical Movements (Johns, 2009) provides coherence to the twenty-one practice experiences that adequately marked my transformation towards my practice vision. I used the Being Available Template (Johns, 2009) as a reflexive framework which became the metaphoric net of my practice, showing where and how homeless people fall through the net of care, and my role in weaving a stronger net. I also drew on the work of Belenky et al's (1986) voice perspectives to show empowerment in my specialist role. Within the narrative, each story illuminates complexity and brings new knowledge about homeless health care. The study tangibly links childhood trauma to adult homelessness; it illuminates suffering in homelessness, showing where and how mainstream health professionals contribute to suffering when they do not grasp their role within the net, perpetuating homelessness. Appreciating precarious engagement in four quadrants: health services, homeless services, the homeless person and my SPHN role, is a concept that illuminates the precariousness of the net. The study concludes with a SPHN Homeless Health Care Model. Towards an ensuing social action through dialogue, I use the term 'audiencing' rather than transferability of findings. Hearing stories from 'street to boardroom' - making the invisible visible - has been profound in health services as evidenced in the narrative.