Thèses sur le sujet « Health care reform – Czech Republic »

Prace charakterizuje tento systém, představuje jeho klady a zápory a srovnavá vybraná data se standardem zemí OECD s důrazem kladeným na srovnání s Českou republikou. V práci je zahrnuta část věnována popisu Chilské republiky

This thesis examines the political process of health care reform between 1989 and 1998 in the most advanced sizable political economy in Central and Eastern Europe (CEE) – the Czech Republic. Its aim is to explain the political process bringing about post-Communist health policy change and stimulate new debates on welfare state transformation in CEE. The thesis challenges the conventional view that post-Communist health care reform in CEE was designed and implemented to improve the health status of the people, as desired by the people themselves. I suggest that this is a dangerous over-rationalisation, and argue that post-Communist health care reform in the Czech Republic was the by-product of haphazard democratic political struggle between emerging elites for power and economic resources. The thesis employs the analytical narrative method to describe and analyse the actors, institutions, ideas and history behind the health policy change. The analysis is informed by welfare state theory, elite theory, interest group politics theory, the assumptions of methodological individualism and rational choice theory, and Schumpeter’s doctrine of democracy. Its focus is on the interests of health policy actors and how they interacted within an unhinged, but fast-consolidating, institutional framework. The results demonstrate that, while historical legacies and liberal ideas featured prominently in the rhetoric accompanying health policy change, in Realpolitik, these were merely the disposable, instrumental devices of opportunistic, self-interested elites. The resultant explanation of health policy change stresses the primacy of agency over structure and formulates four important mechanisms of health policy change: opportunism, tinkering, enterprise, and elitism. In conclusion, the relevance of major welfare state theories to the given case is assessed and implications for welfare state research in CEE are drawn.

The objective of this thesis is to examine the nature of health care system change in the Czech Republic and Hungary after the collapse of communism. In order to do so, the thesis focuses mainly on Europeanization and New Institutionalism as competing approaches in explaining domestic changes in Central and Eastern European Countries. While doing so, first this study tries to explore whether Europeanization is one of the main determinants in the transition process of the health care systems of the Czech Republic and Hungary and discusses the EU-level policies, laws and regulations related to the health care sector. Second, the study looks through the historical legacy and path dependency theories as branches of the New Institutionalist approaches to investigate the transition of the health care systems of case countries. The review of the related literature and empirical case studies exhibit that the transformation process of the health care systems of the Czech Republic and Hungary were possibly affected by many factors and it would be misleading to attribute all consequences to only one determinant. In this respect, the main argument is that the Europeanization effect is weak compared to the New Institutionalism approach in explaining the transition process of health care systems of Hungary and the Czech Republic
however, there are strong opportunities for EU institutions to shape the future contours v of health care systems and public health programs in Hungary and the Czech Republic.

This Master Thesis focuses on the structure of health related financial flows and patient satisfaction with privately owned hospitals in the Czech Republic. The main aim was to provide a general overview of health care system in the Czech Republic, to describe how the health care system is financed, and to find out if patients hospitalized in privately owned hospitals are more satisfied with the care provided in this type of hospitals. Having analyzed the major statistical reports from the WHO, EU, and the Institution of Health Information and Statistics of the Czech Republic, the theoretical part provided a comprehensive summary of health care, health financial flows, and pricing of health treatments. The practical part, on the other hand, shows distribution of health costs among differently aged people in the form of contribution/expenditure ratio. Finally, the results of the questionnaires conducted among patients in privately owned hospitals enabled to conclude that patients in the Czech Republic are still not fully aware of the difference between privately and publically owned hospitals.

Work and unemployment, care, and related social security policies have been flashpoints for gendered discourses and practices across many nation states. In the Czech Republic, this has been the case during Czechoslovak state socialism and in the emergence of market-based democracy since 1989. These systems have differently contested the figure of the working and caring woman, and the state’s role in providing support and resources to its citizens, but have both done so in gendered ‘productivist’ terms. The everyday experiences of those citizens living through these macro-level changes has not often featured in analyses of ‘transition’ and the (neoliberal) capitalism which has followed – their navigation of these gendered systems, and the ways in which this may be post-socialist, is further underexplored. Drawing on 22 interviews, alongside questionnaires and several months of observation with 10 previously unemployed single mothers participating in an NGO’s employability project, this thesis addresses this gap in the literature. Using a ‘needscapes’ analytical framework, I demonstrate that micro-level perspectives can usefully inform the design of policies and provision with which my participants were interacting. Many of my participants were experiencing financial, emotional and physical crises due to the Czech state’s disengagement with their needs, an inaccessible and low paying labour market which prioritised ‘independent’ male workers, and care services which excluded less well-resourced individuals. The group of single mothers and a small number of disabled people who numbered among my participants had particularly acute experiences of these issues. My participants’ experiences of labour market, social security and care provision issues associated with neoliberalism were often post-socialist. This included their navigation of a precarious and low paid labour market, which they critiqued using images of Communist scarcity, and in which discourses about the inappropriate figure of the Communist working woman contributed to disciplinary gender enactments and budget-saving policies which sought to channel mothers out of the labour market. My analysis suggests that (sometimes contradictory) neoliberal discourses and practices in the Czech Republic are complexly intertwined with and co-produced through post-socialism, and often function in tandem with neo-conservative discourses about gender. Many of my participants did not seek to live in the ways suggested by socially and politically prevalent discourses, that promote as the ideal citizen an (implicitly male) self-supporting, employed individual. My participants instead presented themselves as inter-subjectively connected to others, with their accounts of working, being unemployed, claiming social security, caring or receiving support experienced through their relationships with others and the needs of those around them. In their caring interactions, the value of dependent relationships and the involvement of both men and women in their caring kin networks highlight alternative gender enactments as characterising their navigations of post-socialist neoliberalism. Their perspectives dispute dominant political narratives about transition, which cast this as a process occurring at an individual – rather than collective – level, and resulting in a ‘self-supporting’ capitalist individual. Here, their experiences of ‘neoliberal’ change in the Czech Republic is complexly and inter-subjectively post-socialist, sometimes articulated through gendered enactments.

This thesis explores the roles that medicine, human rights discourse, and the arts play in the project to improve the lives of patients suffering from severe forms of mental illness in the context of the post-socialist transformation of the Czech Republic. It is a study of the ways in which social solidarity and social exclusion intersect in the spaces of mental illness in a particular historical setting, and how the responsibility for care is negotiated between families, communities, the medical profession, and the state. The first part of the thesis focuses on the proposed reform of care for patients with severe mental illness that was put forward in the two decades after 1989. I examine the origins and aims of the attempted institutional change – the ‘humanization of psychiatry’ – in the context of the influential Charter 77 movement which demanded respect for the rights of those who are unable to claim them for themselves. I also trace how the re-establishment of a civil society that owed much to the concept of ‘apolitical politics’ and the process of the reintegration of Czech Republic into the European community impacted the attempted reforms. More than twenty years after the revolution, Czech Psychiatry still does not comply with international standards of care and, as I show, despite the explicit disclaimer with the totalitarian past and great hopes for change, there is in fact a clear continuation of many of the practices, ideas, interactions, as well as forms of governance of the preceding decades. These historical legacies, in combination with other factors, such as ideological disagreements within the psychiatric profession, a lack of political interest in this area, and a strong focus on other economic priorities have all contributed to the failure to improve mental health care. The second part of the thesis offers a complementary perspective on these processes – a view from ‘inside’ of the institutions that provide psychiatric care. The origins of institutional care in Central Europe date back to late nineteenth century, when large hospitals were built within parks as self-sufficient complexes surrounded by walls, outside of large cities. My research took place in two contrasting institutions: one a highly specialised clinical and research center for treatment of acute conditions, and the other a hospital for treatment of chronic conditions originally devoted to those with ‘incurable’ conditions. I show how the notion of ‘curability’ is a crucial factor in both the experience of the patients and the social responses to their conditions. In this part I also explore some epistemological issues in psychiatry, including knowledge, practices, and ideology, in the context of a strong scientific materialism where – unlike in many parts of the world – the tradition of psychoanalysis has been absent. Specifically, I examine the role of neurobiological paradigm in various interpretations of psychotic experience, its affect on patient’s self-understanding, and its role in the externalization of agency and responsibility. Finally I address the phenomenon of using ‘unclaimed bodies’ of psychiatric patients for anatomical teaching and research, and interpret this practice through notions of liminality, impurity, and sacrifice. I conclude the thesis by examining the ethical dimension of psychiatric care in the light of the writings by Emmanuel Lévinas.

The thesis aims to critically compare liberal and mandatory health systems, and based on detected advantages and disadvantages of each, propose certain solutions and recommendations to optimize the health care system. During this task it also puts into context historical, legal and ethical backgrounds which strongly influence the system set up. Optimal adjustment of the health care system is an issue that worries most of the world's countries and this thesis, with it's unbiased evaluation, proposes suggestions on potential better functionality and effectiveness of health care. The theoretical part of the thesis deals with the major economical terms connected to health care and the typology of healthcare systems. In the following practical part, the US and the Czech healthcare systems are analyzed as the representatives of the liberal and the traditional mandatory health care systems by the international comparison method and the result shows positive experiences from the systems, applicable especially for the Czech Republic.

The thesis charts the development and importance of medical tourism. The goal is to analyze the market of medical services for foreign clients in selected destinations especially in the Czech Republic and Germany. The thesis explains the basic terms related to health oriented tourism, consists of the information on target medical tourism destinations around the world, analyze the position of the Czech Republic and Germany in the market of health services for foreign clients. The practical part finishes with information on the operation of the particular agency that deals with incoming health tourism in the Czech Republic.

Health care systems in many countries around the world have been subject to major reform initiatives since 1980s and 1990s. The main rationale for reform was an increasing need to control costs in health care as the countries struggled to adapt to the global economic conjuncture and deal with their financial problems. The movement to reform health care arose in that context and spread amongst health care experts and policy makers. The aim of this study is to understand how reforms were initiated and what forces drove them. This topic is addressed through the case studies of change in health care policies in Turkey and the Czech Republic, both of which having experienced the influence of global economic trends, yet are defined by fundamentally different economic, political and social conditions. The findings of the study support that health policy ideas were diffused to the two countries via international policy networks; domestic contexts facilitated the diffusion. Interest groups were important actors in both countries, but the role played by various groups differed in the two countries. Finally, the countries appear to have tendency to converge to a certain degree with regard to their health financing system. Key words: Health care reform, policy diffusion, globalization, Czech Republic, Turkey.

Defence date: 24 November 2014
Examining Board: Professor Sven Steinmo, EUI (Supervisor); Professor László Bruszt, EUI; Professor Ana Marta Guillén Rodríguez, University of Oviedo; Professor Ellen Immergut, Humboldt University Berlin.
What determines the pace of policy innovation and change? Why, in other words, do policy makers in some countries innovate faster than in others? This thesis challenges conventional explanations, according to which policy change occurs in response to class conflict, partisan preferences, power of professional groups, or institutional and policy legacies. The thesis instead argues that different paths of policy change can be best explained by the different learning processes by which policy makers develop ideas for new policies in reaction to old policies. The thesis draws upon both ideational and institutional streams of literature on policy change, and develops its argument that policy change, understood as a learning process, is a result of interactions between three different, yet interdependent factors – ideas, interests and institutions. The thesis explores this argument by investigating in detail two radical cases of policy innovation – the introduction of market-oriented elements in Czech and Polish healthcare policy during the first two post-communist decades. The selection of the two cases is based on the methodological rationale of the 'most similar system design', given that the healthcare systems of the two countries were both state-dominated under communism, while in the post-communist period the governments of the two countries introduced market-oriented reforms that followed rather divergent policy paths. While Czech reforms were relatively consistent and comprehensive, those in Poland were fragmented, delayed and beset with reversals. The thesis looks at these two cases of healthcare reforms from a long-term historical perspective, covering the inter-war, the communist and, most thoroughly, the post-communist period. It draws upon the official documents, secondary literature and more than 40 interviews with policy making elites, and compares the two policy paths using small-N research design, causal analysis and process tracing techniques. The main finding of the thesis is that the market-oriented ideas that occurred in healthcare policy circles during the 1970s and 1980s were crucial drivers of the post-communist reforms in the two countries. However, the capacity of these ideas to serve as a basis of policy change was dependent on two factors – on the existence of political actors who were willing to promote these ideas, and on the interaction of institutional veto points with the electoral and partisan dynamic. The findings of this thesis contribute to the better integration of the literatures on the role of ideational and institutional factors in policy change, and to the research on the causes and consequences of marketization in healthcare and, more broadly, in social policy.

The risk adjustment model currently used does not adequately compensate insurers for predictable differences in individuals' health care expenditures in the Czech Republic. It then leads to financial inequality in the redistribution of funds to the insurance companies and causes their financial problems. This study introduces a PCG model as another method for risk adjustment and determines to what extent the predictive performance of the model can be improved when applied to Czech data. We analyze 10% of population sample in the Czech Republic in years 2011 and 2012. Our results confirm the appropriateness of the PCG model for the Czech environment. When the PCG variables are added to the demographic model, R2 value of the prediction model increases from 2.03% to 13.87%.

1 Abstract The aim of diploma thesis is searching for solution of long-term sustainability for health care financing in Czech Republic with respect to future demographic development of Czech population and with respect to development of other factors influencing income and expenditure of health care system. After introduction there is the second chapter that describes evolution and current state of Czech health care system. The third chapter deals with historical progress of income and expenses on health care in Czech Republic and adds an international comparison. The chapter four identifies main motives for future change of Czech health system financing. The chapter five shows inspiring examples how health care financing works in Netherlands, Switzerland and Germany. The sixth chapter describes basic aspects, advantages and disadvantages of introducing nominal premium to Czech health insurance system. In chapter seven there is a summary of process of introducing nominal premium and results of model of future income from reformed health insurance for year of nominal premium introduction - 2015. The basic outcome of model is fact that nominal premium introduced in amount of 725 CZK per month per person can bring additional finance to health care system in amount of 31 505 bil. CZK in despite of replacing...

The thesis analyses factors influencing medical tourism within the Czech Re- public where districts ("okresy") and regions ("kraje") are considered as the units where the patient can travel to receive health care. The dataset was pro- vided by the Czech general health insurance (VZP). The research covers the period 2011-2014 and reveals the differences between "medical tourism" for hospitalizations and for medical treatments and between travelling into other districts ("okresy") and travelling into other regions ("kraje") for medical ser- vice in the analyzed regions of the Czech Republic. The results statistically approved how particular diagnoses, their seriousness, age, gender, availability of health care and other factors influence travelling for health care in the Czech Republic. JEL Classification A12, C22, C55, I11, I12, I19 Keywords medical tourism, the Czech Republic, health care Author's e-mail eva7.nemeckova@seznam.cz Supervisor's e-mail jana.votapkova@fsv.cuni.cz

Charles University in Prague, Faculty of Pharmacy in Hradci Králové Department of Social and Clinical Pharmacy Student: Klára Pousková Supervisor: PharmDr. Jan Kostřiba, Ph.D. Title of thesis: Opinions and Attitudes of Patients to Differences in Health Care Systems in the Czech Republic and Germany Key words: health care systems, extra care, questionnaire survey, Czech Republic, Germany Introduction: Czech Republic and Germany are two neighboring countries, located in central Europe, but there are number of differences between them. This thesis focuses on the differences in their health systems. Official statistics provide an objective view on the situation in both healthcare systems. Nevertheless those statistics don't include patient's opinions. A questionnaire survey was therefore created to include their point of view. Objectives: The aim of this thesis was to compare selected characteristics of the Czech and German health care systems, to recognize the major differences between them and to identify their greatest advantages and disadvantages. Methods: The survey was realized in selected towns in the Czech Republic and in Germany. All pharmacies in these towns were asked to take part. Patients were interviewed with adherence to the created questionnaire. The interview was conducted by the...

Accessibility of health care in the Czech Republic according to the geodemographic characteristics of the population Abstract Public healthcare is a subject that affects us all. The health and medical status of the population is a key measure of how advanced a country is. That is why healthcare issues attract so much debate. A number of factors affect the health of a nation. On one hand there are factors such as how individuals look after their health. Dietary habits, sufficient physical exercise and preventive care are all factors that the individual has control over. On the other hand, however, there are determinants affecting whether healthcare take-up is adequate. The cost of providing healthcare and medical equipment together with healthcare accessibility - the topic of this thesis - are factors affecting the population's health. It is the duty of all public healthcare stakeholders to limit the impact of these determiners. One of the main barriers to healthcare take-up is accessibility. On 1 January 2013 government decree no. 307/2012 Coll. came into effect quantifying healthcare accessibility for the first time. This law stipulates the local and travel time accessibility that ensures accessibility depending on type of healthcare on the basis of an upper travel time limit or waiting period....

The diploma thesis deals with the field of the care after quadriplegics in the Czech Republic and the United Kingdom. The aim of the diploma thesis is to describe positive and negative aspects of the care provided to quadriplegics both in Great Britain and the Czech Republic from the point of view of the care users, and subsequently to propose possibilities of improvement of the care in the Czech Republic. The theoretical part explains quadriplegia and outline social and health systems for quadriplegics in the Czech Republic as well as in the United Kingdom. This part includes the description of compensatory aids available for clients, conditions of health and social insurance, rehabilitation care options and financial support in both countries. In the research part, based on data interpretation of the data collected by qualitative research technique (interviews that were implemented with quadriplegics living the Czech Republic and United Kingdom), I analyze the situation of the clients of both social and health systems. These interviews revealed several areas of positive and negative evaluation of the existing situation and highlight possibilities of potential future improvement of the care in the Czech Republic.

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.