Dissertations / Theses on the topic 'Public hospitals Victoria Finance'

This research examines the impact, if any, of the introduction of casemix funding on public hospitals in Victoria. The results reported here show that in Victoria, during the period under observation, rural hospitals showed a significantly greater preponderance, relative to metropolitan hospitals, to either amalgamate or close down. Since 1 July 1993 public hospitals in Victoria have been compared for efficiency in the delivery of their services. The casemix funding arrangements were installed, among other reasons, to improve efficiency in the delivery of hospital services. Duckett, 1999, p 107 states that under casemix funding 'The hospital therefore becomes more clearly accountable for variation in the efficiency of the services it provides'. Also, 'Generally, case-mix funding is seen as being able to yield efficiency improvements more rapidly than negotiated funding'. Hospital comparisons provide State bodies with information on how to allocate funding between hospitals by means of annual capped budgets. Budgets are capped because funding is restricted to a given number of patients that can be treated in any given year. Thus, casemix funding relies heavily on cost comparisons between hospitals, and the way that hospital output is measured relies on the use of diagnosis related groups (DRGs).

This research examines the impact, if any, of the introduction of casemix funding on public hospitals in Victoria. The results reported here show that in Victoria, during the period under observation, rural hospitals showed a significantly greater preponderance, relative to metropolitan hospitals, to either amalgamate or close down. Since 1 July 1993 public hospitals in Victoria have been compared for efficiency in the delivery of their services. The casemix funding arrangements were installed, among other reasons, to improve efficiency in the delivery of hospital services. Duckett, 1999, p 107 states that under casemix funding 'The hospital therefore becomes more clearly accountable for variation in the efficiency of the services it provides'. Also, 'Generally, case-mix funding is seen as being able to yield efficiency improvements more rapidly than negotiated funding'. Hospital comparisons provide State bodies with information on how to allocate funding between hospitals by means of annual capped budgets. Budgets are capped because funding is restricted to a given number of patients that can be treated in any given year. Thus, casemix funding relies heavily on cost comparisons between hospitals, and the way that hospital output is measured relies on the use of diagnosis related groups (DRGs).

The aim of the research was to analyse the organisational dynamics surrounding a health care reform implementation process associated with the introduction of coordinated care, which is an Australian Government initiative to introduce structural changes to the funding and delivery of health-care in response to rising health care costs. A longitudinal case study of an implementation team was studied. This included the perceptions and experiences of individuals and institutions within hospitals, the general practice community and Divisions of General Practice. Furthermore, the case study explored organisational structures, decision-making processes and management systems of the Project and included an examination of the difficulties and conflicts that ensued. The broader context of health care reform was also considered. The study found that an effective change management strategy requires clarity around the definition of primary task in health care delivery, particularly when the task is complex and the environment uncertain. This requires a management and support structure able to accommodate the tensions that exists between providing care and managing cost, in a changing and complex system. The case study indicated that where tensions were not managed the functions of providing care and managing costs became disconnected, undermining the integrity of the task and impacting on the effective facilitation of the change process and hence, the capacity of stakeholders to embrace the model of co-ordinated care. Moreover, the micro dynamics of the project team seemed to parallel the macro dynamics of the broader system where economic and health care provision imperatives clash. Through its close analysis of change dynamics, the study provides suggestions for the improved engagement of stakeholders in health care change.

Thesis (MBA)--University of Stellenbosch, 2010.
The aim of this research report is to identify and quantify the cost drivers of three district hospitals in the Western Cape, namely Knysna Hospital, Oudtshoorn Hospital and Mossel Bay Hospital, and to simultaneously measure value-driven performance indicators. An environmental scan identified various driving forces that would significantly affect change in the healthcare industry such as the brain drain of health professionals, consumerism and cost containment and efficiency initiatives. The Department of Health’s understanding of the eighth Batho Pele principle of value for money is generally understood as providing quality health care within prescribed cost limits. An attempt is made to establish the effect of the quadruple burden of disease (the HIV/AIDS pandemic, persistent infectious diseases, injury arising from violence and road traffic collisions and emerging chronic conditions) on hospital expenditure in the Eden District. Research identified Mossel Bay as a high TB burden area known as a TB “hotspot” and it is a recognized immigration transit point en route to Cape Town. The population analyses revealed that Mossel Bay is the growth point of the Eden District, showing extraordinary growth of 25% between 2007 and 2009. Personnel costs: This study revealed that personnel costs are responsible for the overwhelming majority of the total expenditure of the district hospitals.Staff numbers, occupation specific dispensation (OSD) implementation and annual wage negotiations are the cost drivers of personnel costs. This study also found a clear correlation between an over-expenditure in personnel expenses and over-expenditure in the total expenditure of all three hospitals. Health care costs: Expenditure on blood products is considered a major cost driver of clinical expenses. Laboratory expenditure is clearly the largest cost driver for clinical expenses at all three hospitals. Together with laboratory expenses, medicine and medical supplies are the cost drivers for clinical expenses. Costs not related to health care: The three most significant administrative expenses are communication, stationery and printing as well as travel and subsistence allowances. The cost driver for subsistence and travel expenses is the number of vehicles followed by the preference of vehicle, which in turn determines the daily tariff and the kilometre tariff. This study revealed that Knysna Municipality has the cheapest electricity cost of the three towns. It is clear that cost and consumption of electricity and water are the two variables that affect municipal service expenditure the most. Equity: When the district hospital expenditure is combined with the primary health care expenditure in the three sub-districts, the figures show that Oudtshoorn is spending 3% more than its equitable share of the total budget at a higher cost of R978 per capita, in excess of R100 above the district average. Efficiency: The cost per patient day equivalent (PDE) per economic classification for all three hospitals is less than the average cost per PDE of the district hospitals in the Western Cape. The cost/PDE of Oudtshoorn Hospital is considerably higher than that of Knysna and Mossel Bay in all economic classifications, with the single exception of the agency cost of Mossel Bay Hospital. The cost of health care always reflects a combination of price, quantity and value, and it is impossible to consider individual cost drivers in isolation. Several cost-saving initiatives and managerial control measures are recommended.

I examined the factors that led to the rise and fall of psychiatric hospitals and its impact on two select groups of individuals: adults and older adults with severe mental illness. To explore the reasons behind these fluctuations, the State of Texas was used as a case study. Additionally, the fluctuations occurred for different reasons in public vs. for-profit investor-owned psychiatric hospitals. Using an investor-owned psychiatric hospital organization as a case study, I investigated the differences in factors that influenced the growth and/or demise in public vs. investor-owned psychiatric hospitals. Evolution and devolution of psychiatric hospitals was assessed during select time periods: 1700 to1930, 1940 to1970, 1980 to 2000, and 2000 to present. Time period selections were relevant to the important drivers of the span of time that influenced the psychiatric hospitals. Historical review and trend analysis was used to identify the total number of psychiatric hospitals and/or total number of psychiatric hospital beds and psychiatric hospitals by type. Analysis showed there was a cyclical pattern of evolution and devolution of psychiatric hospitals and each cycle altered the form, function, and role of the psychiatric hospital along with altering the location of care for adults and older adults with severe mental illness. The research results suggest a long-stay residential facility, specializing in evidence-based treatment for adults and older adults with severe mental illness, to counter the dire shortage of psychiatric hospital beds.

Thesis (MDF)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: The research on this topic was motivated by the concern about the state of disarray in the public hospitals infrastructure and that due to budget constrain across the globe, the governments can no longer afford to provide public health services alone without the assistance of the private sector. South African public healthcare system continues to function in a state of disarray. Public hospitals serve the vast majority of the South African population, but are underfunded and in most cases these hospitals have ailing infrastructure. The study will look at the mechanism to fund public hospitals. This study examines the role that the Industrial Development Corporation and the Development Bank of Southern Africa can play in addressing the gap that exists in funding public hospitals. It will attempt to answer the following questions of concern, how is public healthcare financed in South Africa, what are the major challenges in financing public hospitals, what is the current role played by the Industrial Development Corporation and the Development Bank of Southern Africa in funding the public hospitals and what are the other possible solutions to address these challenges. The findings indicate that, despite the government funding the public hospitals there is a shortfall of funds for hospitals to complete the project that they are engage in. Chris Hani Baragwanath Academic Hospital and other five cases of hospitals in KwaZulu Natal were looked at and confirmed that there is definitely a gap in funding public hospitals

While much has been written on the Australian film and television industry, little has been presented by actual producers, filmmakers and technicians of their time and experiences within that same industry. Similarly, with historical documentaries, it has been academics rather than filmmakers who have led the debate. This thesis addresses this shortcoming and bridges the gap between practitioner experience and intellectual discussion, synthesising the debate and providing an important contribution from a filmmaker-academic, in its own way unique and insightful. The thesis is presented in two voices. First, my voice, the voice of memoir and recollected experience of my screen adventures over 38 years within the Australian industry, mainly producing historical documentaries for the ABC and the SBS. This is represented in italics. The second half and the alternate chapters provide the industry framework in which I worked with particular emphasis on documentaries and how this evolved and developed over a 40-year period, from 1970 to 2010. Within these two voices are three layers against which this history is reviewed and presented. Forming the base of the pyramid is the broad Australian film industry made up of feature films, documentary, television drama, animation and other types and styles of production. Above this is the genre documentary within this broad industry, and making up the small top tip of the pyramid, the sub-genre of historical documentary. These form the vertical structure within which industry issues are discussed. Threading through it are the duel determinants of production: ‘the market’ and ‘funding’. Underpinning the industry is the involvement of government, both state and federal, forming the three dimensional matrix for the thesis. For over 100 years the Australian film industry has depended on government support through subsidy, funding mechanisms, development assistance, broadcast policy and legislative provisions. This thesis aims to weave together these industry layers, binding them with the determinants of the market and funding, and immersing them beneath layers of government legislation and policy to present a new view of the Australian film industry.

Interactive version of the thesis is filed with the printed copy in the UNISA archives
The study investigated and described public hospitals in terms of management processes with reference to financial planning, organizing, leading and control in order to identify deficiencies in the financial management of public hospitals. The aim was to identify gaps in the management of financial processes and to provide guidelines and strategies to improve these. The purpose of the research was addressed within a quantitative approach applying exploratory and descriptive designs. A self-administered questionnaire was used to collect the data that fit the objectives of the research. The study population compassed all 27 public hospitals as study units in a specific geographic area, namely Mpumalanga Province with the following inclusion criteria: active patient capacity of 100 beds and more, which employ personnel such as (1) medical, (2) paramedical and (3) administrative and a working application of the BAS as financial accounting system since its interception in the year 2000. Nine public hospitals were randomly selected as the sample hospitals. Within the nine hospitals, four groups of staff were selected by means of stratified random sampling, namely management, health professionals, and financial and administrative staff. The number of staff selected within each hospital differed, from 15 to 50, amounting to a sample size of three hundred (n=300). A response rate of 66.66% v (n=182) was achieved. The sample consisted of 4 (2.27%) chief executive officers, 3 (1.70%) financial managers, 84 (47.72%) unit managers and 91 (50.00%) subordinates. The response rate of 66.66% in this study was an indication of the unavailability of the health care professionals (which include management, health professionals and financial and administrative staff) within the nine public hospitals. The major inferences drawn from this study are that the different health care professions have a poor perception of the scope of financial management in terms of financial needs, utilization of resources, the scope and function of leading and delegation, and applying appropriate financial control methods.
Health Studies
D. Litt. et Phil. (Health Services Management)

Thesis (MBA.) -- University of Limpopo, 2007
The Department of Health and Social Development in Limpopo endeavors to efficiently and effectively manage revenue collection. The study analyzed the revenue collection for the Capricorn district hospitals from 2001 to 2006 by identifying problems and possible solutions related to revenue collection. A quantitative analysis of data has been obtained from in- depth structured interviews and revenue records. An analytic retrospective study design was used. All revenue records from 2001/2002 to 2006/2007, financial managers, revenue clerks, and clients /patients who came to request credit from each hospital constituted the population of the study. The findings were that in 2001/2002 none of the hospitals were able to attain the revenue targets. In 2005/2006 revenue targets were increased by almost double the amount however all hospitals were able to attain the revenue targets as prescribed. It implies that the hospitals were able to collect more revenue than in the previous financial year. It has been noted that the appointment of CEOs has brought a tremendous change in revenue collection. It has been identified that revenue is the life blood for a country or institution. The institutions need commitment of all stakeholders to collect revenue.

High quality of working life is vital for maintaining an adequate workforce, and given the current global nursing workforce shortage, the quality of nurses’ working lives is of particular importance. The literature suggests that ensuring working conditions are attractive enough to retain nurses in the workforce is the most cost-effective and sustainable strategy for addressing the nursing shortage. Drawing upon the Theory of Work Adjustment as a theoretical framework, this cross-sectional, mixed-method study sought to explore the opinions about quality of working life held by nurses working in public hospitals in Victoria. Differences in opinion about key aspects of working life between nurses who planned to continue a career in nursing and those who planned to make a career change were also sought. Data were collected using a Likert-style survey and semi-structured interviews and were analysed by means of the SPSS computer program and qualitative content analysis.

This project provides various points of view to determine whether the private sector can build-own-operate-transfer pubhc infrastructure projects more efficiently than the public sector and will use as an example the building of the City Link Project. The project will argue the advantages of it being managed by the private or public sector. Some consideration will be given to the argument that the Victorian State Government simply does not have the capital or the expertise to complete a public infrastructure project the size of the City Link.

Healthcare is a complex arena of multi-skilled interaction. In recent years, it has grown extensively out of the simple act of treating the sick by a noble healer to taking measures of preventing illness not only of the clients but also of the community. It is no more a deal between two persons: the sick and the healer (like a doctor). Community healthcare is regulated by several agencies including legislative agencies (like government, international health organisations), professional bodies, industrial regulators, consumer advocates and commercial entities (such as insurance companies and pharmaceuticals). Healthcare service providers or professionals are not the sole regulators rather their actions need to balance the legal obligations to the client (such as client satisfaction), to staff (such as workplace safety) and to business (to maintain competitive advantage in the industry). Current healthcare service provision is challenged by many factors including diversification of the task, diversity of workforce characteristics due to globalisation and increased service demand by knowledgeable customers searching proactive healthcare and not just curative care. To overcome these challenges along with maintaining quality service, organisations need skilled staff. This, however, is threatened by occupational hazards like occupational violence against staff (OVAS) which is well documented globally and across Australia. The impact of OVAS is not limited only to disruption of service but also to the quality of service and shortage of human resources in some cases. Regulatory agencies like the Department of Health, Comcare, Safe Work Australia and Worksafe Victoria (VAGO, 2013) are providing guidelines on OVAS management. Most healthcare providers are considering some actions, but not with any universal consensus. According to the hierarchy of control in Work Health and Safety Management System (WHSMS) a hazard could best be controlled by eliminating it, but if not then training of staff is an option. Training will always be needed whether or not other measures of hazard and risk control are implemented. This encourages research to develop effective training in terms of trainers’ perspective (in delivery), learners’ perspective (of appreciating the sessions) and management’ perspective (of the outcome of hazard control). Literature shows that the workforce training in hospitals to control OVAS lacks consistency and uniformity across Australian hospitals. ‘Management of Violence and Aggression International Training’ (MSVT) is one training programme run by the BN123 Health, Victoria, since 1990. With that background the main aim of this qualitative case study research project was to “identify the effectiveness of the existing training programme (MSVT) in prevention of occupational violence against staff (OVAS) “. Occupational violence is a part of work health and safety issue. So, the research intended to enquire: ‘Is the existing MSVT in prevention of OVAS achieving its purpose, particularly in the current WHSMS setting of the hospital?’ The literature review assisted in identifying the causes of OVAS, types, prevalence and the factors associated with it. It also helped to analyse the published incidents. Among different training evaluation methods, the Kirkpatrick’s model was found most suitable to evaluate MSVT. Analysis attempted to correlate the outcome of the training against existing objectives. Limited access to information meant that I could not perform in-depth analyses, but the findings of this study are expected to guide future research on the effectiveness of MSVT at BN123 Health with more integration to the WHSMS and other safety programmes This research used a qualitative case study with Actor-Network Theory (ANT) to fulfil the goal. The limited access to health facilities both due to obstacle in sensitive data collection and accessing busy participants of different sections of the hospital in a limited time frame. This study explored actors related to OVAS and suggested adoption of an innovative approach to improve workplace safety through the formation of new networks. It did this by looking through the lens of Actor-Network Theory (ANT). The present vision of the government in digitalising the health sector in Australia is a prime opportunity to re-align the network in the WHSMS of the hospital for better impact of training on the OVAS situation. Limited guidance from top management was an issue. MSVT was under the control of the Psychiatric Department at its inception but was then moved under Human Resources (HR), which seems to have reduced its importance and resource management ability. Hospitals are dominated by clinical priorities rather than HR issues. Being a part of the general training programme administered by HR has limited the ability of MSVT as it struggled to receive funding to recruit enough full-time trainers to undertake research on OVAS incidents, promote the programme across the whole organisation, publish materials to create awareness to all staff and develop resources to help retain the knowledge of the participants in the post-training period. Limited flow of information on OVAS was another issue. Even though BN123 Health invests in innovation like RSKSOFT, for reporting it did not purchase all the modules of that programme to improve the flow of information to the trainers of MSVT. BN123 Health demonstrated a proactive attitude in managing OVAS by procuring and trademarking MSVT but is lacking continuity of efforts in it, maybe due to its commitment to clinical aspects of the service. This could be verified by further research. The research identified scope for innovation. Firstly, the training programme could be strengthened by incorporating recent updates on organisational objectives and legislative changes and standardisation with industry practices. It could also be strengthened by incorporation of an improved audio-visual component, distance learning facilities for beginners and refreshers, updating resources including books and journals, inter-organisation exchange programmes and inclusion of regular research results in booklets and handouts. Targeted delivery would also assist, with constant vigilance on incidents and inclusion of vulnerable groups in training. Another worthwhile innovation would be to change the focus from staff only programmes to involve customer or client interest. This could include arranging training for clients and carers as they are a party in the conflict. Management training would be useful to prepare resources for the population of the catchment area, bringing together all healthcare providers (including GPs) who refer clients to the hospital. Updating real-time information collection, storage and analysis by professionals as well as information access to trainers would also be a worthwhile innovation. With the availability of mobile technology, BN123 Health has scope to improve its ability to get real-time information from the incident spot and to develop better management to control events. This could also provide arrangements for easy data entry by general staff.