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1
Zemanová, Iva. « Health Care Reform in the USA ». Master's thesis, Vysoká škola ekonomická v Praze, 2011. http://www.nusl.cz/ntk/nusl-71683.
Texte intégralRésumé :
This thesis is concerned with US health care. It is focused especially on the health insurance market. It introduces basic characteristics of the US insurance system and discusses its main problems. The goal of this thesis is to determine whether voluntary private insurance is the main source of problems that the US health care system currently experiences. In order to do that, greatest deficiencies of US insurance policies, especially private ones, are identified based on the efficiency criterion. It is also briefly evaluated if identified deficiencies are going to be affected by the current health care reform.
2
Baker, Timothy Alan. « Oregon Primary Care Physicians' Support for Health Care Reform ». PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.
Texte intégralRésumé :
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.
3
Yilmaz, Volkan. « Health reform and new politics of health care in Turkey ». Thesis, University of Leeds, 2014. http://etheses.whiterose.ac.uk/7635/.
Texte intégralRésumé :
The health care system in Turkey has undergone a transformation process since the Health Transformation Programme (HTP) launched in 2003 and significantly increased marketization in health care provision. This study asks the following questions: What political dynamics enabled the introduction of health care reform in Turkey? What kind of political conflicts did the reform generate? How and to whose benefit have these conflicts been resolved? As a historically grounded, single country case study, this study draws on 33 in-depth interviews conducted with major political actors who were involved in the HTP. This study concludes that the reform under consideration was a product of two factors: the World Bank’s pro-market approach to health reforms that became internalised in the health care bureaucracy in Turkey after the mid-1980s, and the controlled populism of the Justice and Development Party (the AK Party). With the introduction of the HTP, the power distribution upon which Turkey’s health care system is based has been changing in three ways. First, the Turkish Medical Association (TTB) lost its leverage in health care policies. Excluded from the reform process, the only success of the TTB was using judicial activism to block the government’s attempts to introduce a full time work requirement for medical doctors. Second, the reform gave birth to the emergence of a new political actor in health care politics, namely private health care provider organisations. Private health care provider organisations, which avoided confrontational discourse in their relations with the government due to the financial dependency of the sector on the state, succeeded in altering the legal and administrative limits that the reform put on their opportunities for capital accumulation. Finally, the transformation of the AK Party from a catchall party to a cartel party that undermines the electoral competition in Turkey might put the representation of the citizens’ interests on health care policies at risk.
4
Donato, Francis A. « Reforming health care through managed care ». Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1995. http://www.kutztown.edu/library/services/remote_access.asp.
Texte intégralRésumé :
Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).
5
Mooney, Ellen. « Towards an end result comprehensive health care reform in Massachusetts and California / ». Diss., Connect to the thesis, 2007. http://hdl.handle.net/10066/1263.
Texte intégral
6
Belli, Paolo Carlo. « Incentives and the reform of health care systems ». Thesis, London School of Economics and Political Science (University of London), 2006. http://etheses.lse.ac.uk/1854/.
Texte intégralRésumé :
This thesis is a study of the reform of health systems from an international and an economic perspective. Its main unifying theme is to investigate the role played by incentives in the performance of health systems and their reform. In the first part, the thesis reconsiders the economic reasons that form the basis for public intervention in health markets, both in financing as well as in service provision. In fact, one of the key elements introduced with health reforms in the last few years has been greater competition in health insurance and provision, among private as well as public providers. It is thus interesting to start the analysis by revisiting the effects of competition in health markets on the basis of more recent contributions in microeconomic theory, our aim being to ascertain what would be the major deficiencies of unregulated markets, and to investigate into the impact of different public corrective measures. Chapter 2 looks at the effects of competition in the health insurance market and at the impact of different forms of public intervention to correct market failures. Chapter 3 presents a model of oligopolistic competition between two health providers, and it investigates the potential role of quality and/or price regulation as a means to extend coverage/improve quality beyond the point reached in correspondence to the market equilibrium. Then, the thesis focuses on the new resource allocation, contracting mechanisms and payment systems for providers (RAP reforms) implemented over the last few years, within the public sector, or intended to discipline the relationship with health care providers. Chapters 4 gives an introduction to the RAP reforms, their justification and main components. Chapter 5 focuses on payment systems and on efficiency issues, while Chapter 6 on the equity consequences of RAP reforms. Chapter 7 and 8 look at the health reforms implemented over the last decade in the former socialist countries. The evolution of health systems in those countries provides interesting lessons, illuminating the major weaknesses and limitations of the health reform model that has been prevailing and proposed world-wide over the last decade. Chapter 8 presents a qualitative study of the impact of the health reforms in Georgia, focusing specifically on the phenomenon of out-of-pocket payments, formal and informal, which currently are the prevalent source of funding for health in the region. A concluding chapter (Chapter 9) summarises some of the main findings of the thesis.
7
Gieri, William J. « Health care reform and the deficit, 1993-1996 ». Monterey, California. Naval Postgraduate School, 1997. http://hdl.handle.net/10945/8460.
Texte intégralRésumé :
Approved for public release; distribution is unlimitedHealth care reform in the 103rd and 104th Congresses has run the gambit from extremely ambitious to less than ambitious undertakings. Proposals have engendered partisan debates, because of the scope and complexity of the issues involved and their implications for the federal deficit. Estimating the budget consequences of health care reform has become critical because of the strong link between health care programs and the growth in the deficit. This thesis examines the major health care reform proposals considered by Congress during the period 1993-1996. These included the comprehensive bills considered in response to President Clinton's proposed overhaul in 1993-94, the cuts included in the Republican-led balanced budget plan in 1995 and the Kassebaum- Kennedy Bill, which became law in 1996. In each case, the thesis examined the deficit situation facing Congress at the time health care reform was engaged, plans to address the deficit, and the impact of each health care reform on the federal deficit. Data was obtained from congressional reports and periodicals, journals and Congressional Budget Office documentation. The major finding was that health care legislation which portends minimal impact on beneficiaries, providers and the deficit is much more likely to succeed, while legislation which has a much broader effect will not receive the same support
8
Atchison, Robert Bryan 1970. « U.S. health care reform and medical privacy rights ». Thesis, Massachusetts Institute of Technology, 1994. http://hdl.handle.net/1721.1/35424.
Texte intégralRésumé :
Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Civil and Environmental Engineering, 1994.Vita.
Includes bibliographical references (leaves 87-99).
by Robert Bryan Atchison.
M.S.
9
Nganda, Benjamin Musembi. « Structural reform of the Kenyan health care system ». Thesis, University of York, 1994. http://etheses.whiterose.ac.uk/14168/.
Texte intégral
10
Donato, Ron. « The economics of health care finance and reform : implications of market-based health reform in Australia / ». Title page, table of contents and abstract only, 1996. http://web4.library.adelaide.edu.au/theses/09ECM/09ecmd677.pdf.
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11
Song, Zirui. « Financial Incentives in Health Care Reform : Evaluating Payment Reform in Accountable Care Organizations and Competitive Bidding in Medicare ». Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10177.
Texte intégralRésumé :
Amidst mounting federal debt, slowing the growth of health care spending is one of the nation’s top domestic priorities. This dissertation evaluates three current policy ideas: (1) global payment within an accountable care contracting model, (2) physician fee cuts, and (3) expanding the role of competitive bidding in Medicare. Chapter one studies the effect of global payment and pay-for-performance on health care spending and quality in accountable care organizations. I evaluate the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), which was implemented in 2009 with seven provider organizations comprising 380,000 enrollees. Using claims and quality data in a quasi-experimental difference-in-differences design, I find that the AQC was associated with a 1.9 percent reduction in medical spending and modest improvements in quality of chronic care management and pediatric care in year one. Chapter two studies Medicare’s elimination of payments for consultations in the 2010 Medicare Physician Fee Schedule. This targeted fee cut (largely to specialists) was accompanied by a fee increase for office visits (billed more often by primary care physicians). Using claims data for 2.2 million Medicare beneficiaries, I test for discontinuities in spending, volume, and coding of outpatient physician encounters with an interrupted time series design. I find that spending on physician encounters increased 6 percent after the policy, largely due to a coding effect and higher office visit fees. Slightly more than half of the increase was accounted for by primary care physician visits, with the rest by specialist visits. Chapter three examines competitive bidding, which is at the center of several proposals to reform Medicare into a premium support program. In competitive bidding, private plans submit prices (bids) they are willing to accept to insure a Medicare beneficiary. In perfect competition, plans bid costs and thus bids are insensitive to the benchmark. Under imperfect competition, bids may move with the benchmark. I study the effect of benchmark changes on plan bids using Medicare Advantage data in a longitudinal market-level model. I find that a $1 increase in the benchmark leads to about a $0.50 increase in bids among Medicare managed care plans.
12
Davidson, Alan Reginald. « Health care reform in British Columbia : dynamics without change ? » Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0019/NQ48624.pdf.
Texte intégral
13
Goodwin, Simon Christopher. « Community care : the reform of the mental health services ? » Thesis, University of Sheffield, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387717.
Texte intégral
14
Greenberg, Garred Samuel. « Impact of Massachusetts Health Care Reform on Asthma Mortality ». Thesis, Boston College, 2013. http://hdl.handle.net/2345/3138.
Texte intégralRésumé :
Thesis advisor: Marvin KrausThesis advisor: Matt Rutledge
The state of Massachusetts implemented a health care reform in 2006 that induced a number of changes to its health care system. Studies regarding this reform bear a certain degree of predictive power on the national scale because the reform was used as a model for the Affordable Care Act, the highly controversial national health care reform law passed in 2010. Most of the research on health care reform focuses on the costs, not the quality, of health care. I utilized a difference-in-differences statistical design to isolate the impact of the Massachusetts reform on the state's asthma mortality rate, a health care quality indicator. Given certain assumptions, my empirical results indicate that the reform led to a 45.38% reduction in asthma mortality in Massachusetts. Due to the similarity between the Massachusetts and the national health care reform laws, I drew the conclusion that national asthma mortality rates will decrease after 2014 when certain key provisions of the national reform come into play
Thesis (BA) — Boston College, 2013
Submitted to: Boston College. College of Arts and Sciences
Discipline: Economics Honors Program
Discipline: Economics
15
Gomes, Diego Braz Pereira. « Essays on health care reform, wealth inequality, and demography ». reponame:Repositório Institucional do FGV, 2016. http://hdl.handle.net/10438/16498.
Texte intégralRésumé :
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This thesis contains three chapters. The first chapter uses a general equilibrium framework to simulate and compare the long run effects of the Patient Protection and Affordable Care Act (PPACA) and of health care costs reduction policies on macroeconomic variables, government budget, and welfare of individuals. We found that all policies were able to reduce uninsured population, with the PPACA being more effective than cost reductions. The PPACA increased public deficit mainly due to the Medicaid expansion, forcing tax hikes. On the other hand, cost reductions alleviated the fiscal burden of public insurance, reducing public deficit and taxes. Regarding welfare effects, the PPACA as a whole and cost reductions are welfare improving. High welfare gains would be achieved if the U.S. medical costs followed the same trend of OECD countries. Besides, feasible cost reductions are more welfare improving than most of the PPACA components, proving to be a good alternative. The second chapter documents that life cycle general equilibrium models with heterogeneous agents have a very hard time reproducing the American wealth distribution. A common assumption made in this literature is that all young adults enter the economy with no initial assets. In this chapter, we relax this assumption – not supported by the data – and evaluate the ability of an otherwise standard life cycle model to account for the U.S. wealth inequality. The new feature of the model is that agents enter the economy with assets drawn from an initial distribution of assets. We found that heterogeneity with respect to initial wealth is key for this class of models to replicate the data. According to our results, American inequality can be explained almost entirely by the fact that some individuals are lucky enough to be born into wealth, while others are born with few or no assets. The third chapter documents that a common assumption adopted in life cycle general equilibrium models is that the population is stable at steady state, that is, its relative age distribution becomes constant over time. An open question is whether the demographic assumptions commonly adopted in these models in fact imply that the population becomes stable. In this chapter we prove the existence of a stable population in a demographic environment where both the age-specific mortality rates and the population growth rate are constant over time, the setup commonly adopted in life cycle general equilibrium models. Hence, the stability of the population do not need to be taken as assumption in these models.
Esta tese contém três capítulos. O primeiro capítulo usa um modelo de equilíbrio geral para simular e comparar os efeitos de longo prazo do Patient Protection and Affordable Care Act (PPACA) e de reduções de custos de saúde sobre variáveis macroeconômicas, orçamento do governo e bem-estar dos indivíduos. Nós encontramos que todas as políticas foram capazes de reduzir a população sem seguro, com o PPACA sendo mais eficaz do que reduções de custos. O PPACA aumentou o déficit público, principalmente devido à expansão do Medicaid, forçando aumento de impostos. Por outro lado, as reduções de custos aliviaram os encargos fiscais com seguro público, reduzindo o déficit público e impostos. Com relação aos efeitos de bem-estar, o PPACA como um todo e as reduções de custos melhoram o bem-estar dos indivíduos. Elevados ganhos de bem-estar seriam alcançados se os custos médicos norte-americanos seguissem a mesma tendência dos países da OCDE. Além disso, reduções de custos melhoram mais o bem-estar do que a maioria dos componentes do PPACA, provando ser uma boa alternativa. O segundo capítulo documenta que modelos de equilíbrio geral com ciclo de vida e agentes heterogêneos possuem muita dificuldade em reproduzir a distribuição de riqueza Americana. Uma hipótese comum feita nesta literatura é que todos os jovens adultos entram na economia sem ativos iniciais. Neste capítulo, nós relaxamos essa hipótese – não suportada pelos dados – e avaliamos a capacidade de um modelo de ciclo de vida padrão em explicar a desigualdade de riqueza dos EUA. A nova característica do modelo é que os agentes entram na economia com ativos sorteados de uma distribuição inicial de ativos. Nós encontramos que a heterogeneidade em relação à riqueza inicial é chave para esta classe de modelos replicar os dados. De acordo com nossos resultados, a desigualdade Americana pode ser explicada quase que inteiramente pelo fato de que alguns indivíduos têm sorte de nascer com riqueza, enquanto outros nascem com pouco ou nenhum ativo. O terceiro capítulo documenta que uma hipótese comum adotada em modelos de equilíbrio geral com ciclo de vida é de que a população é estável no estado estacionário, ou seja, sua distribuição relativa de idades se torna constante ao longo do tempo. Uma questão em aberto é se as hipóteses demográficas comumente adotadas nesses modelos de fato implicam que a população se torna estável. Neste capítulo nós provamos a existência de uma população estável em um ambiente demográfico onde tanto as taxas de mortalidade por idade e a taxa de crescimento da população são constantes ao longo do tempo, a configuração comumente adotada em modelos de equilíbrio geral com ciclo de vida. Portanto, a estabilidade da população não precisa ser tomada como hipótese nestes modelos.
16
Sorensen, Ros Public Health & Community Medicine Faculty of Medicine UNSW. « The dilemma of health reform : managing the limits of policymaking, managerialism and professionalism in health care reform ». Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2002. http://handle.unsw.edu.au/1959.4/33194.
Texte intégralRésumé :
Hospitals worldwide are under pressure to perform and models abound to remedy poor performance. Reform, however, is contested, uneven and slow. One reason is that few models address a core issue in reform: the management of clinical work. A further reason is that stakeholder groups, specifically policymakers, managers and clinicians, limit opportunities for collaborative problem solving as they seek to impose their own frame of reference in the struggle for control. I hypothesise that performance will be relatively better in hospitals that have in place strategies of agreement to set the objectives of reform, such as participative problem identification, problem solving and decision making, together with a method to manage clinical work. This hypothesis was tested in twelve public hospitals in three Australian states between 1999 and 2001 using both quantitative and qualitative research methods. Government and hospital policy documents were assessed and semi-structured interviews were conducted to gauge the attitudes and practices of managers and clinicians regarding health care reform. The results of the research show that hospitals with inclusive strategies for change, principally strategies of agreement, joint education and skills development, team-based incentives to direct and reward effort and a method of clinical work management, performed better than those without. Findings indicate that policy was developed and communicated as a rational top-down process that tended to exclude diverse views. Although the effect of different jurisdictional policy processes on hospital performance was not clear, they had considerable impact on the environment of reform. Cost containment and patient safety dominated as policy objectives. These alone did not engage clinician interest or address service quality. The connection between the quality of care and its cost did not appear to be understood. Organisational structures and processes necessary to support reform, that is communication forums for objective setting and performance review, integrated clinical and corporate accountability systems and organisational capacity building were not in place in the majority of hospitals studied. An organisational model of clinical work management was developed to improve cost-effectiveness by balancing clinical autonomy and clinical accountability based on the research results.
17
Ferguson, Lorraine J. « Health care reform and structural interests : Casemix as a tool for reform in the Australian health industry ». Thesis, Queensland University of Technology, 2000. https://eprints.qut.edu.au/36766/1/36766_Digitised%20Thesis.pdf.
Texte intégralRésumé :
This thesis uses a policy research framework to examine the development, implementation and evaluation of the casemix-based health care reform policies that were embedded within the 1988 and 1993 Medicare Agreements between the Commonwealth Department of Health and states and territories of Australia. Alford's (1975) conceptual framework of structural interests is used to examine the power of strategically placed interests in health care, and the barriers and challenges those interests pose to reform of the hospital system in particular. Alford (1975:14) argued that health systems must be understood in terms of the continuing struggle between the dominant structural interests (mainly doctors) and the challenging structural interests (government bureaucrats, health administrators, health planners and academic researchers) who try to reform the health system. Casemix-based hospital management information and funding systems provide tools for understanding hospital activity and costs and in doing so, provide incentives for improving efficiency and reforming clinical practice.
The aims of the study were to gain a better understanding of the processes used in developing the reform policies; to explain in an analytical way, who influenced what was decided in relation to policy development and implementation; to examine the impact of the implementation of casemix-based funding policies in two Australian states from the points of view of the structural interests in health care; and to summarise the implications for future health care reform policy development m Australia. The data collection methods used for this study include depth interviews with fifteen casemix 'elites', a focused synthesis of important documents related to casemix policy, and secondary analysis of hospital activity data to evaluate the impact of casemix-based funding in the States of Victoria and South Australia.
The findings clearly demonstrate that the inclusion of the casemix-based reform policies into the 1988 Medicare Agreements was a deliberate approach by the challenging structural interests to signal a new era of reform and accountability for the Australian public hospital system. The use of the Casemix Development Program as a policy instrument was seen by the stakeholders to have a positive impact in terms getting commitment to policy direction and for developing expertise in casemix-based systems, but it was criticised for a lack of research priorities and the subsequent waste of funds.
Casemix-based funding systems were seen by the stakeholders to have both positive and negative aspects. Both the challenging and dominant structural interests agreed that there was an improvement in management information and financial systems, giving them better information for budget allocation and resource management. This resulted in improved hospital access and efficiency, as measured by patient throughput, length of stay and average cost per casemix-adjusted separation. The dominant structural interests found that with better information and more accountability for resource use there was an improved focus on team work and patient management. Despite these improvements, there was a belief among the dominant structural interests that quality of care had deteriorated under casemix-based funding.
Negative aspects of casemix-based funding systems were seen to include a focus on technical efficiency at the expense of allocative efficiency and an emphasis on acute hospital services and throughput without consideration of the resources required for other services; particularly community services which had to deal with early discharges. Stakeholders also felt that there was increased pressure on bedside clinical staff with the increases in patient throughput and acuity, and that these pressures threatened the ability of so called teaching hospitals to adequately train health professionals and to conduct research.
While the casemix-based reform policies resulted in a coalition of the challenging and dominant structural interests to improve health care delivery in Australia, there is no evidence to suggest that there has been any real change in the social, economic and political structures which reinforce medical dominance in health care in Australia.
Recommendations for future policy research and policy learning are made with a view to improving the nature of health care reform policy and its impact on the health of the Australian population.
18
Leung, Wai-Ching. « Equity of access to health care : case studies in primary care and coronary artery surgery ». Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249587.
Texte intégralRésumé :
Equity of access to health care was the founding aim of the NHS and a recent White Paper on NHS reforms re-emphasised its importance. This thesis consists of two contrasting studies on equity of access using individual patients as units of analysis. The main objective of the first study was to examine the equity of access to primary care services including GP consultation, out-of-hour services and referral to specialist services. The study involved secondary analysis of patient questionnaire data from a national survey. The objectives of the second study were to examine the equity of access to coronary artery surgery in one health district among those who underwent coronary angiography, and to examine whether the waiting time for coronary artery surgery was correlated with clinical need. It involved retrospective collection of data from medical records using the New Zealand Priority scores as an indicator of need. The first study showed that the following patient groups subjectively experienced disadvantages in several aspects of primary care services:- younger people, those with poor subjective physical and mental health, females, non-whites, residents in Inner London and those in paid work or full-time education. The possible reasons for these findings were discussed. It was recommended that the delivery of primary care services should take into account these results and that further research should be conducted into the extent and nature of differential patient expectation amongst different patient groups. The second study did not show any significant inequity of access to coronary artery surgery according to sex, age, smoking status and socio-economic status. However, there was little correlation between clinical need and waiting time for coronary artery surgery. These results informed subsequent development of cardiology and cardiac surgery services in the health district. The methodologies used in these two studies were compared and contrasted.
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Le, Fevre Anne M. « Health care policy and reform a comparative study of policy making and the health care systems in five OECD countries ». Thesis, Curtin University, 1997. http://hdl.handle.net/20.500.11937/1765.
Texte intégralRésumé :
Many of the assumptions underlying health care issues appear to be taken for granted by policy makers, when if fact they ought to be examined for their relevance to today's problems. This research attempts to do so, by analysing the non-economic issues and factors involved in the financing and provision of health care. It will be argued that policy makers commonly have a unidirectional economic perspective in both policy making and in health care system reform directives, a situation which leaves issues such as the health status of the population and of equity in resource allocation to political rhetoric, while in practice, policies deal with the issue of cost reduction. Of major importance is the moral dimension in policies dealing with health and welfare, which is clearly either forgotten or is afforded too little consideration in policy making. This is particularly relevant to the issue of rationing of health care in publicly provided health care systems. While always quietly practised by clinicians in the past, rationing is now required to be overt because demand for health care has outstripped available resources.The substance of the argument comes from the analysis of a very large literature on the broader issues affecting health care policy, such as concepts of social justice, ethics of resource allocation and the physician-patient relationship, all of winch ought to underpin policies for the mechanisms of funding and provision of health care systems.A conceptual diagram of a health care system is offered to provide a framework for the discussion of how the issues are interrelated at micro, meso and macro levels in policymaking. Examples of reforms to health care systems are taken from five OECD countries which share a common social, political and economic heritage: Australia, United Kingdom, New Zealand, Canada and the United States of America.The conclusions from this research show that theoretical incoherence pervades this most complex of policy areas, allowing the economic imperative to take precedence over the substantive health care issues.
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Dunkley-Hickin, Catherine. « Effects of primary care reform in Quebec on access to primary health care services ». Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123121.
Texte intégralRésumé :
Primary health care reform has become an area of priority in health policy with a strong importance placed on interdisciplinary teams of health care professionals. Quebec's model, the groupes de médicine de famille (GMFs), were introduced late in 2002 emphasizing team-centered approaches to service delivery and aiming to improve access to primary health care, especially to improve after-hours access and to increase the number of Quebecers with a family doctor.A decade after their implementation, I investigated the impact of GMFs on various measures of access to primary health care and perceived remaining barriers. I emphasize potential access – i.e. measures that capture whether an individual has the ability to access needed health care including having a regular medical doctor.I used data from seven waves of the Canadian Community Health Survey to capture reported access to primary care and barriers to access. GMFs emerged at different rates in different health regions across Quebec allowing the construction of a GMF 'participation' measure using the share of primary care physicians practicing in GMFs in each health region and year. I employed a modified difference-in-difference analysis design that uses multivariate regression analysis to control for time trends in the outcomes, time-invariant differences between regions and individual-level covariates in an attempt to estimate the causal impact of GMF implementation on access to primary health care.I verified that pre-policy differences in terms of population and socioeconomic characteristics between regions with ultimately high vs. low rates of GMF participation are reasonable and remain fixed over time, making comparisons of these regions appropriate. Results suggest that rates of reported access have increased over time in most Quebec health regions. However, these measures of access vary across regions and some always report lower rates of access. Controlling for time trends, fixed differences between regions, and individual characteristics, reported access does not change significantly as GMF participation increases. Improved access to primary health care was one of the principal objectives of Quebec's primary care reform a decade ago. My findings suggest that increased GMF participation has not improved several important measures of access, and that additional policy measures may be necessary to increase potential access to primary health care.La réforme des soins de santé de première ligne occupe une place prioritaire parmi les réformes de santé, notamment avec une grande importance accordée à des équipes interdisciplinaires de professionnels de santé. Le modèle choisi par Québec, les groupes de médecine de famille (GMFs), a été mis en place à la fin de 2002. Ce modèle met l'emphase sur des équipes interprofessionnelles et vise à augmenter le nombre de Québécois avec un médecin de famille, ainsi qu'à offrir une plus grande accessibilité des services de la première ligne, notamment hors les heures normales de travail. Une décennie après leur implantation, j'ai étudié l'impact des GMFs sur diverses mesures d'accès aux soins de santé de première ligne. Je mets l'emphase sur l'accès potentiel – c'est-à-dire les mesures permettant de déterminer si un individu a la possibilité d'accéder aux soins de santé nécessaires, y compris d'avoir un médecin régulier.J'ai utilisé des données de sept cycles de l'Étude sur la santé dans les collectivités canadiennes pour capturer l'accès déclaré aux soins de première ligne et obstacles à cet accès. Il existe une variation régionale dans l'implantation des GMFs à travers les différentes régions sociosanitaires du Québec, ce qui me permet de construire une mesure de participation aux GMFs constituée de la proportion des médecins de première ligne pratiquant en GMF par région sociosanitaire et par année. J'ai employé une analyse qui consiste de modèles de différence-dans-les-différences modifiées qui utilise une analyse de régression multivariée pour contrôler les tendances temporelles, les différences constantes entre les régions, et les covariables au niveau individuel, le but étant d'estimer l'effet causal de la mise en œuvre des GMFs sur l'accès aux soins de santé de première ligne.J'ai vérifié que les différences de caractéristiques populationnelles et socio-économiques dans la période pré-politique entre les régions ayant un taux élevé par rapport à celles ayant un faible taux de participation aux GMFs sont raisonnables et fixes au cours des années de mon étude, rendant ainsi toute comparaison de ces régions appropriées. Les résultats suggèrent que les taux d'accès déclarés ont augmenté au fil du temps dans la plupart des régions sociosanitaires du Québec. Toutefois, ces mesures d'accès varient selon les régions et certains signalent toujours des taux inférieurs d'accès. Contrôlant pour les tendances temporelles, les différences fixes entre les régions, et les caractéristiques individuelles, l'accès déclaré ne change pas de manière significative avec l'augmentation de la participation aux GMFs.Un meilleur accès aux soins de santé de première ligne constituait l'un des principaux objectifs explicites de la réforme des soins de santé de première ligne de 2002. Mes résultats suggèrent que l'augmentation de la participation aux GMFs n'a pas amélioré plusieurs mesures importantes d'accès. En conséquence, des politiques supplémentaires pourraient être nécessaires pour accroître l'accès potentiel aux soins de santé de première ligne.
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Coyle, Natalie. « Primary Health Care Reform : Who joins a Family Medicine Group ? » Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=106399.
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Reorganization of primary health care is being actively pursued and new models of primary health care delivery are being developed in the U.S. and in several Canadian provinces. In Quebec, Family Medicine Groups (FMGs) were created in 2002 in order to provide enhanced access and better coordination of care through a team based approach to primary care. Previous research on new models of primary health care has often failed to evaluate their effects within a causal inference framework, and little attention has been paid to the type of physicians and patients that voluntarily join them. Understanding who is attracted to new models is not only important to adjust for selection bias, but it may affect future reforms by helping to elucidate what would happen if FMGs were implemented on a population level. This thesis attempts to understand the voluntary selection of patients and physicians into Family Medicine Groups in Quebec, Canada. A longitudinal administrative dataset of vulnerable patients (elderly or chronically ill) from the Régie de l'assurance maladie du Québec (RAMQ) has been divided between FMG and non-FMG users, and includes information on demographic characteristics, chronic illnesses and ambulatory and tertiary health service use before the advent of FMGs. Physicians of these patients are characterized by their FMG status, demographics, and practice and patient characteristics before FMGs are in place. Multivariate regression is used to identify key predictors of joining a FMG among both patients and physicians. Lastly, comparable physician and patient populations are created using propensity scores in order to set up the evaluation of health outcomes, utilization of services and costs in the years after joining a FMG. The distribution of propensity scores and their ability to balance key covariates after different matching and weighting techniques was investigated. Results of the analysis reveal that geographic location, socio-economic status, visits in an ambulatory setting, emergency room visits, hospitalizations and having a usual provider of care are all factors which affect the probability of a patient joining a FMG. Specifically, residents of remote regions, low socio-economic status and those who use emergency rooms and hospitals more often are more likely to be enrolled, whereas patients that use ambulatory services and have a usual provider of care are less likely to be enrolled. Similarly, it is shown that factors that affect a physician's likelihood of joining a FMG include time since graduation, geographic region and revenue from traditional fee-for-service vs. other sources. Younger physicians and those who practice in a local community centre (CLSC) and short term/acute inpatient hospital care (CHSCD) are more likely to participate. Propensity scores were able to balance the pre-treatment differences, and this finding is robust across different mechanisms of adjusting for the propensity score. Overall, it was shown that participation in a FMG is not a random process and any further research on the effect of FMGs, or any other type of primary health care reform, should consider this. Accounting for the type of patients that join different models, by using propensity score analysis for example, will be critical to forming evidence based policy recommendations. Particular consideration for geographic location, patients' morbidity, socio-economic status, health service use, as well as physicians' age and experience working in other settings is needed.La réorganisation des soins de santé primaires est un objectif qui suscite un intérêt considérable au moment où de nouveaux modèles de prestation de soins de santé primaires sont mis en place aux États-Unis et dans plusieurs provinces canadiennes. Au Québec, les Groupes de médecine de famille (GMF) sont créés en 2002 afin de fournir un accès aux soins élargi et une meilleure coordination grâce à une approche des soins de santé primaires favorisant le travail en équipe. Les études antérieures sur les nouveaux modèles de soins de santé primaires n'incluaient généralement pas d'évaluation de leurs effets sous l'angle de l'inférence causale et peu d'attention a été accordée au type de médecins et de patients qui y participaient volontairement. Cerner le profil des personnes qui sont attirées par ces modèles est important, pas seulement pour ajuster les biais de sélection, mais cela peut aussi affecter les réformes à venir en permettant d'établir ce qui se passerait si les GMF étaient mis en place au niveau de la population entière. Cette thèse cherche à comprendre le principe de la sélection volontaire des patients et des médecins dans les Groupes de médecine de famille au Québec. Un ensemble de données administratives longitudinales sur des patients vulnérables (personnes âgées ou malades chroniques), émanant de la Régie de l'assurance maladie du Québec (RAMQ) a été divisé entre les inscrits dans les GMF et les non-inscrits. Les données comportent des informations sur les caractéristiques démographiques, les maladies chroniques ainsi que sur l'utilisation de services de santé ambulatoires et tertiaires avant la mise en place des GMF. Les médecins de ces patients sont caractérisés par leur statut de GMF, leurs données démographiques ainsi que par les spécificités de leur cabinet et de leurs patients avant la mise en place des GMF. Une régression multidimensionnelle est utilisée afin de définir les prédicteurs clés à l'inscription aux GMF à la fois pour les patients et pour les médecins. Enfin, des populations comparables de médecins et de patients sont créées en utilisant des scores de propension afin de mettre au point l'évaluation des résultats pour la santé, de l'utilisation des services et des coûts dans les années suivant l'inscription à un GMF. La distribution des scores de propension et leur capacité à équilibrer les covariables à la suite de différentes techniques de regroupement et pondération, a été examinée. Les résultats de l'analyse révèlent que la situation géographique, le statut socio-économique, les visites dans un service ambulatoire, les visites dans les salles d'urgence, les hospitalisations et le fait d'avoir un prestataire de soins habituel sont tous des facteurs qui affectent la probabilité d'inscription à un GMF. Il est aussi démontré que les facteurs qui affectent la probabilité qu'un médecin soit membre d'un GMF incluent le nombre d'années écoulées depuis l'obtention du diplôme, la situation géographique et le revenu des traditionnelles rémunérations à l'acte par rapport à celui d'autres sources. Les scores de propension ont permis d'équilibrer les différences avant traitement, ce résultat est robuste par rapport à différents mécanismes d'ajustement du score de propension. Dans l'ensemble, il est démontré que la participation à un GMF ne relève pas du hasard, ce que toute recherche additionnelle sur l'effet des GMF ou toute autre réforme des soins de santé primaires, devrait prendre en considération. La comptabilisation du type de patients qui s'inscrit dans les différents modèles, par exemple en utilisant les scores de propension, sera critique dans l'élaboration de recommandations basées sur des faits établis. La prise en compte particulière de la situation géographique, de la morbidité des patients, du statut socioéconomique, de l'utilisation des services de santé ainsi que de l'âge des médecins et de leur expérience de travail dans divers environnements apparaît nécessaire.
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Agartan, Tuba Inci. « Turkish health system in transition historical background and reform experience / ». Diss., Online access via UMI:, 2008.
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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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Bhatia, Vandna Coleman William D. « Political discourse and policy change : Health reform in Canada and Germany / ». *McMaster only, 2004.
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25
Jackson, Kevin Lee. « Health Care Reform and the Transition from Volume to Quality Payment Models : A Primary Care Focus ». ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/445.
Texte intégralRésumé :
The 2010 Patient Protection and Affordable Care Act (PPACA) resulted in providers and health care organizations conforming to new payment models that connect reimbursement to patient outcomes. Primary care providers (PCPs) are tasked to provide new quality provisions as chronic disease management is a key focus to improve outcomes. The purpose of this study was to understand the transition to new payment models and determine whether care is improved. The conceptual framework is grounded in health care access models geared towards the improvement of quality outcomes including the chronic care model (CCM). The research questions were designed to understand providers' perspectives on new metrics to improve quality and the implications on practice workflows and patient outcomes. This phenomenological study consisted of interviews with 9 PCPs directly impacted by health care reform and the implementation of new quality metrics designed to improve patient outcomes. The study analyzed PCPs' perspectives on health care reform and the transition to new quality focused payment models and determined if quality is improved. Collection of data was designed to understand PCPs' challenges in alignment of their medical practices to newly defined provisions of quality expectations. Respondents reported concern with new payment models focused on quality outcomes and reported overall patient care had not improved as a result of alignment of quality initiatives to payment. The implications of positive social change will be an improved understanding of new models of payment intended to maximize reimbursement and address potential challenges with the implementation of quality metrics in order to effectively improve patient outcomes.
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Le, Fevre Anne M. « Health care policy and reform a comparative study of policy making and the health care systems in five OECD countries ». Curtin University of Technology, School of Marketing, 1997. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=11246.
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Many of the assumptions underlying health care issues appear to be taken for granted by policy makers, when if fact they ought to be examined for their relevance to today's problems. This research attempts to do so, by analysing the non-economic issues and factors involved in the financing and provision of health care. It will be argued that policy makers commonly have a unidirectional economic perspective in both policy making and in health care system reform directives, a situation which leaves issues such as the health status of the population and of equity in resource allocation to political rhetoric, while in practice, policies deal with the issue of cost reduction. Of major importance is the moral dimension in policies dealing with health and welfare, which is clearly either forgotten or is afforded too little consideration in policy making. This is particularly relevant to the issue of rationing of health care in publicly provided health care systems. While always quietly practised by clinicians in the past, rationing is now required to be overt because demand for health care has outstripped available resources.The substance of the argument comes from the analysis of a very large literature on the broader issues affecting health care policy, such as concepts of social justice, ethics of resource allocation and the physician-patient relationship, all of winch ought to underpin policies for the mechanisms of funding and provision of health care systems.A conceptual diagram of a health care system is offered to provide a framework for the discussion of how the issues are interrelated at micro, meso and macro levels in policymaking. Examples of reforms to health care systems are taken from five OECD countries which share a common social, political and economic heritage: Australia, United Kingdom, New Zealand, Canada and the United States of America.The conclusions ++from this research show that theoretical incoherence pervades this most complex of policy areas, allowing the economic imperative to take precedence over the substantive health care issues.
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Ware, Patricia. « Independent domiciliary services and the reform of community care ». Thesis, University of Sheffield, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.265999.
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Baker, Norma G. L. « Health care restructuring in acute care settings : implications for registered nurses' attitudes / ». St. John's, NF : [s.n.], 2002.
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Tam, Sin-yee. « Ups and downs on the policy agenda the case of health care system reform in Hong Kong after 1997 / ». Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41012860.
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Flood, Colleen M. « Comparing models of health care reform, internal markets and managed competition ». Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0003/NQ33923.pdf.
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Maddow, Rachel. « HIV/AIDS and health care reform in British and American prisons ». Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369619.
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Hadjimaleki, Sohayla K. « Replacing health insurance with health assurance establishing the right to health care and the need for reform in the United States / ». [Denver, Colo.] : Regis University, 2009. http://165.236.235.140/lib/SHadjimaleki2009.pdf.
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Hon, Wai-ping Tiki. « An analysis of policy options to tackle the problem of expanding expenditure in public healthcare in Hong Kong ». Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21036640.
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West-Oram, Peter George Negus. « Global health care injustice : an analysis of the demands of the basic right to health care ». Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/5559/.
Texte intégralRésumé :
Henry Shue’s model of basic rights and their correlative duties provides an excellent framework for analysing the requirements of global distributive justice, and for theorising about the minimum acceptable standards of human entitlement and wellbeing. Shue bases his model on the claim that certain ‘basic’ rights are of universal instrumental value, and are necessary for the enjoyment of any other rights, and of any ‘decent life’. Shue’s model provides a comprehensive argument about the importance of certain fundamental goods for all human lives, though he does not consider health or health care in any significant detail. Adopting Shue’s model, I argue that access to health care is of sufficient importance to the enjoyment of any other rights that it qualifies as what Shue describes as a ‘basic’ right. I also argue that the basic right to health care is compatible with the basic rights model, and is required by it in order to for it to achieve its goal of enabling right holders to enjoy any decent life. In making this claim I also explore the requirements of the basic right to health care in terms of Shue’s triumvirate of duties and with reference to several key examples.
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Morgan, Natalie D. G. « The impact of health care reforms on community health nurses' attitudes / ». St. John's, NF : [s.n.], 2002.
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Annear, Peter Leslie, et 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.
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Robertson, Mary Eileen. « Virtual learning for health care managers ». Thesis, Curtin University, 2006. http://hdl.handle.net/20.500.11937/1122.
Texte intégralRésumé :
The health industry in Canada, as well as in other industrial countries, has been in the process of reform for many years. While such reform has been attributed to fiscal necessity due to increased health costs, the underlying causes are far more complex. Demographic changes, new technologies, expanded health care procedures and medications, increased demand and the globalization of health services have all contributed to the change and complexity of the industry. Health reform varies from country to country. In Canada, with a publicly funded health industry, the main reform method has been regionalization. This decentralized reform method arranges health services under a regional corporate management structure. The primary objective of this study was to assess the effects of health reform on the educational development of health-care managers in British Columbia, a western province of Canada. The study had a two-fold approach; to ascertain how health reform had changed the skill needs of health-care managers, and whether e-learning could benefit health management education. The key research questions that guided the study were: How might recent changes in the health industry have affected the learning needs and priorities of health-care managers? What factors might hinder attempts to meet any learning needs and priorities of health-care managers? and What benefits might e-learning provide in overcoming hindrances to effective health management education?A combination of quantitative (survey closed questions) and qualitative (survey open-ended questions, interviews and stakeholder feedback) methods was employed in this study. Overall, this study is described as productive social theory research, in that it addressed a recognized change in learning needs for health-care managers following a period of health reform, a socially significant phenomenon in the health industry. Relying on such tools as a survey, interviews, and stakeholder discussions, data was collected from over five hundred health-care managers. The data collected in this study provided valuable insight into the paradigm shift occurring in the educational needs of these managers. The study found that health reform had expanded the management responsibilities of healthcare managers and increased the complexity of service delivery. Restructuring of the health industry decreased the number of managers, support systems, and career opportunities for managers and increased the manager’s workload, communication problems and the need for new knowledge and skills. In addressing the learning needs of health-care managers, the study found there were limitations in health management educational opportunities available to health-care managers. The findings also show that current health management education was focused on senior managers leaving the majority of industry leaders with limited learning opportunities to upgrade their knowledge and skills at a time of great organizational change.In addition, a classroom format dominated the learning delivery options for many managers. A list of fourteen management skills was used in the survey instrument to ascertain what new skills were needed by health-care managers following thirteen years of health reform. The findings show that of the fourteen skills, twenty-nine percent of health-care managers had no training and fifty-seven percent received their training through in-service, workshops and seminars. Irrespective of gender, age, working location and education the data showed that healthcare managers were mainly receiving training in change and complexity and people skills with less training occurring in planning and finances. Using the same fourteen skills, health-care managers priorized their immediate learning needs, listing the top three, as: evidence-based management, change and complexity and financial analysis. While evidence-based management and financial analysis could be attributed to the introduction of a corporate management structure in the health industry, change and complexity was an anomaly as managers were already receiving training in this skill. Health industry stakeholders believed this anomaly was due to continued uncertainties with ongoing health reform and/or a need for increased social interaction during a time of organizational change. In addressing the many learning needs of health-care managers a new health management education strategy was proposed for the province which included the need for an e-learning strategy.The e-learning approach being proposed in this study is an integration of skill training and knowledge sharing directly blended into the workflow of the managers, using a variety of learning technologies. To support this idea, the study found that the majority of health-care managers were not only familiar with e-learning, they also felt they had the computer and Internet skills for more learning delivered in this manner. While a strong need for face-to-face learning still remained, a blended e-learning strategy was proposed for skill training, one that would accommodate the learning needs of managers in rural and remote areas of the province. Knowledge sharing technologies were also proposed to improve the flow of information and learning in small units to both newcomers and experts in the industry. Since this would be a new strategy for the province, attention to quality and costs were identified as essential in the planning. The study found that after years of health reform a new health management educational strategy was needed for the health industry of British Columbia, one that would incorporate a number of learning technologies. Such a change in educational direction is needed if the health industry wishes to provide their leaders with a responsive learning environment to adapt to ongoing organizational change.
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Xie, Mengyu. « Reform of health care system in urban China a case study in Shanghai / ». Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31365255.
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Newton, Benjamin Robert. « Facing scarce health resources in the future : from reform to rationing ». Thesis, Boston University, 1998. https://hdl.handle.net/2144/27732.
Texte intégralRésumé :
Boston University. University Professors Program Senior theses.PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
2031-01-02
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Jackson, Michael Scott. « Mulling over Massachusetts health insurance mandates and entrepreneurs / ». Fairfax, VA : George Mason University, 2008. http://hdl.handle.net/1920/3056.
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Thesis (Ph.D.)--George Mason University, 2008.Vita: p. 208. Thesis director: Roger Stough. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Public Policy. Title from PDF t.p. (viewed July 3, 2008). Includes bibliographical references (p. 196-207). Also issued in print.
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Anguish, Penny Marie Irene. « The real business of health care reform, community participation or local production ? » Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ37391.pdf.
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Pyne, Donna G. « Nurses' perceptions of the impact of health care reform and job satisfaction ». Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0007/MQ42430.pdf.
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Lesch, Matthew Simon. « The politics of loss imposition : health care reform in Ontario and Alberta ». Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/13386.
Texte intégralRésumé :
Why are some provincial governments more successful at imposing loss than others? This thesis deals with interprovincial differences in loss imposition strategies by examining health care reform in the 1990s. To explain this variance, this thesis argues that loss imposition capacity is affected by the strength of opponents and how skilful a government is in neutralizing opponents. To test this hypothesis, it analyzes the health care reform experiences of the Ontario Progressive Conservative and the Alberta Progressive Conservative governments. It emphasises how the two provincial governments used different political strategies to deter opposition to its health care reform policies. Further, it describes why the opposition each government faced was so inherently different. A comparison of the two cases reveals that the Alberta government was much more successful at imposing loss. The empirical findings presented here have several implications for future study of provincial public policy and ‘the politics of loss imposition’.
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Chang, Nai-Wen, et Nai-Wen Chang. « A Comparison of Health Care Reform in Taiwan, China, and United States ». Digital Archive @ GSU, 2013. http://digitalarchive.gsu.edu/iph_theses/289.
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Health care reform is important in order to modify health care systems so that they operate more efficiently. There are various studies that compare the reforms of different countries to understand how these countries adjust their systems. This capstone introduces the health care system in Taiwan, China, and the United States, discusses the challenges they meet, and offers a comparison of recent reforms.
The health care systems are introduced through three sections: collection of funds, pooling of funds and purchasing of services, and providing of services and exemptions. All three countries face the financing burden of health expenditure. To offer universal coverage and comprehensive benefit to its citizens, these three countries makes changes to qualifications for those insured, services provided to beneficiaries and payment systems for physicians, and contributions to pooling of funds.
These reforms address barriers in reaching universal coverage in the three dimensions which are indicated in a WHO issued paper, that explains how to remove financial risks and barriers to access, promote efficiency and eliminate waste, and raisie sufficient resources for health (WHO, 2010). Despite the research, reforming the health care system to offer the accessibility of affordable services to individuals and to maintain sustainability of the health care financing will continually to be an issue.
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Lister, John R. W. « The impact of global pressures on the reform of health care systems ». Thesis, Coventry University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.412299.
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Wesley, Gordon Brian. « Multiple Regression Analysis of Factors Concerning Cardiovascular Profitability Under Health Care Reform ». ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1468.
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Cardiovascular (CV) patients receive one-third of the care and account for $444 billion of the health care costs in the United States. The cardiovascular service line (CVSL) in hospitals contributes to the profitability influenced by elements of resource dependence theory (RDT). The purpose of this study was to understand whether the regression model of hospital characteristics and outcomes would predict profitability in a CVSL through the cost-to-charge ratio (CCR). The use of a general linear model and multiple regression analysis to examine the 2012 National Inpatient Sample from the Healthcare Cost and Utilization Project allowed estimates from a weighted sample of discharges from all hospitals in participating states. Transformation to dichotomous, independent variables preceded analysis of CV-conditions by discharges. An analysis of variance included in the validated model of grouped strata predicted a level of profitability through the CCR, (4, 509) = 129.83, p < .001, R2 = .505. Mortality was not a significant predictor in the regression model. The 3 characteristic variables with an inverse relationship to the CCR, which resulted in favorable profitability for CVSL, included large, academic, and private for-profit institutions. Prior research aligns well to the study, which emphasized the importance of RDT. Leaders in health care organizations may choose to employ decision making that is dependent upon big data and reference to internal resources to achieve reform expectations. Predictive modeling may aid in the strategic direction of health care organizations. Social implications of this study include hospitals striving to enhance the value proposition by centering care activities around the person over rationing finite resources by condition.
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Kabir, Shahnaz. « Reform strategies for management of vascular patients to reduce readmission and healthcare costs ». Thesis, Utica College, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10250824.
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The capstone project reports the risk factors causing unplanned hospital readmission of vascular patients as well as the effects on healthcare cost. The methods for determining the risk factors include clinical indicators for risk prediction process, and the STAAR (State Action on Avoidable Rehospitalization) initiatives, which can be used as healthcare improvement projects to facilitate the cross-continuum team. The findings indicate a relationship between the patient’s engagement in the lower extremity vascular procedure, and effectiveness of follow-up after surgery in the reduction of hospital readmission and healthcare cost. Potential strategies to prevent the risk factors for readmission of vascular patients and to reduce the healthcare cost are discussed. Presenting unplanned readmission for vascular patients and reducing the cost associated with readmission is important for senior leaders and policy makers to improve health care outcome.
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Song, Zirui. « Payment Reform in Massachusetts : Health Care Spending and Quality in Accountable Care Organizations Four Years into Global Payment ». Thesis, Harvard University, 2014. http://etds.lib.harvard.edu/hms/admin/view/44.
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Background: The United States health care system faces two fundamental challenges: a high growth rate of health care spending and deficiencies in quality of care. The growth rate of health care spending is the dominant driver of our nation’s long-term federal debt, while the inconsistent quality of care hinders the ability of the health care system to maximize value for patients. To address both of these challenges, public and private payers are increasingly changing the way they pay providers—moving away from fee-for-service towards global payment contracts for groups of providers coming together as accountable care organizations. This thesis evaluates the change in health care spending and in quality of care associated with moving to global payment for accountable care organizations in Massachusetts in the first 4 years. This thesis studies the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), a global payment contract that provider organizations in Massachusetts began to enter in 2009. The AQC pays provider organizations a risk-adjusted global budget for the entire continuum of care for a defined population of enrollees insured by Blue Cross Blue Shield of Massachusetts. It also awards substantial pay-for-performance incentives for organizations meeting performance thresholds on quality measures. This work assesses its effect on spending and quality through the first 4 years of the contract. Methods: Enrollee-level claims data from 2006-2012 were used with a difference-in-differences design to evaluate the changes in spending and quality associated with the Alternative Quality Contract over the first 4 years. The study population consisted of enrollees in Blue Cross Blue Shield of Massachusetts plans (intervention group) and enrollees in commercial employer-sponsored plans across 5 comparison states (control group). Unadjusted and adjusted results are reported for each comparison between intervention and control. Changes in spending for all 4 AQC cohorts relative to control were evaluated. In adjusted analyses of spending, I used a multivariate linear model at the enrollee-quarter level, controlling for age, sex, risk score, indicators for intervention, quarters of the study period, the post-intervention period, and the appropriate interactions. For analyses of quality, an analogous model at the enrollee-year level was used. Process and outcome quality were evaluated. Results: Seven provider organizations joined the AQC in 2009, with a total of 490,167 individuals who were enrolled for at least 1 calendar year in the study period. The control group had 966,813 unique individuals enrolled for at least 1 year during the study period. Average age, sex, and risk scores before and after the AQC were similar between the two groups. In the 2009 cohort, claims spending grew on average $62.21 per enrollee per quarter less than control over 4 years (p<0.001), a 6.8% savings. Analogously, the 2010, 2011, and 2012 cohorts had average savings of 8.8% (p<0.001), 9.1% (p<0.001), and 5.8% (p=0.04), respectively, by the end of 2012. Savings on claims were concentrated in the outpatient facility setting, specifically procedures, imaging, and tests (8.7%, 10.9%, and 9.7%, respectively, p<0.001). Organizations with and without risk-contracting experience saw similar average savings of 6.3% and 7.7%, respectively, over 4 years (p<0.001). About 40% of savings were explained by lower volume. Pre-intervention trends were not statistically different between intervention and control (-$4.57, p=0.86), suggesting savings were not driven by inherently different trajectories of spending. No differences in coding intensity were found. In sensitivity analyses, estimates were robust to alterations in the model, variables, and sample. Notably, claims savings were exceeded by incentive payments to providers (shared savings and quality bonuses) in 2009-2011, but exceeded incentives payments in 2012, generating net savings. Improvements in quality among intervention cohorts generally exceeded New England and national comparisons. Quality performance on chronic care measures increased from 79.6% pre-intervention to 84.5% post-intervention in the 2009 cohort, compared to 79.8% to 80.8% for the HEDIS national average, a 3.9 percentage-point relative increase over the 4 years. Analogously, preventive care and pediatric care measures increased 2.7 and 2.4 percentage points relative to control, respectively. On outcome measures, achievement of hemoglobin A1c, LDL cholesterol, and blood pressure control grew by 2.1 percentage points per year in the 2009 cohort after the AQC, while HEDIS averages remained largely unchanged (Figure). Conclusion: After 4 years, physician organizations in the AQC had lower spending growth relative to control and generally outperformed national averages on quality measures. Shared savings coupled with quality bonuses can exceed savings on claims in initial years, but over time, savings on claims may outgrow incentive payments. Incentive payments themselves may serve meaningful purposes, as quality measures may protect against stinting and shared savings may help ease providers into risk contracts. Changes in utilization suggest that this payment model can help modify underlying care patterns, a likely prerequisite for sustainable reform. The AQC experience may be useful to policymakers, insurers, and providers embarking on payment reform. Combining global budgets with pay-for- performance may encourage organizations to embark on the delivery system reforms necessary to slow spending and improve quality.
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Kuhn, Diane Marie. « Health Care Reform in Mexico and Brazil : The Politics of Institutions, Spending, and Performance ». Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10659.
Texte intégralRésumé :
Health care reform in Latin America has been a continuous process over recent decades, and several countries have implemented programs of universal care. This dissertation looks at the implementation of universal care programs in Brazil and Mexico, and highlights the politics of implementing these reforms. In the first paper, I evaluate the implementation of infrastructural reforms as part of Seguro Popular in Mexico. I conclude that the reforms were partially successful, but that success varied considerably by region. In the second paper, I show that spending on health care in Brazil is strongly related to political partisanship, and that the reform process has not significantly changed this relationship. In the third paper, I suggest that individual characteristics, and not political variables, best explain variations in the quality of care patients receive in Brazil. As a whole, these papers serve to highlight the understudied role of politics in the implementation of health care reform.Government
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Watson, M. « The division of labour in child health care : Poland and England and Wales compared ». Thesis, University of Warwick, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.373279.
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