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AIMS Managed care is a market model of health care distribution, aspects of which are being incorporated into the Australian health care environment. Justifications for adopting managed care lie in purported claims to higher levels of efficiency and greater ‘consumer’ choice. The purpose of this research, then, is to determine the ethical implications of adapting this particular administrative model to Australia’s health care system. In general, it is intended to provide ethical guidance for health care administrators and policy-makers, health care practitioners, patients and the wider community. SCOPE Managed care emerges as a product of the contemporary, neo-liberal market with which it is inextricably linked. In order to understand the nature of this concept, then, this research necessarily includes a limited account of the nature of the market in which managed care is situated and disseminated. While a more detailed examination of the neo-liberal market is worthy of a thesis in itself, this project attends, less ambitiously, to two general concerns. Firstly, against a background of various histories of health care distribution, it assesses the market’s propensity for upholding the moral requirements of health care distributive decision-making. This aspect of the analysis is informed by a framework for health care morality the construction of which accompanies an inquiry into the moral nature of health care, including a deliberation about rights-claims to health care and the proper means of its distribution. Secondly, by way of offering a precautionary tale, it examines the organisational structures and regulations by which its expansionary ambitions are promoted and realised. CONCLUSIONS As a market solution to the problem of administering health care resources, the pursuit of cost-control, if not actual profit, becomes the primary objective of health care activity under managed care. Hence, the moral purposes of health care provision, as pursued within the therapeutic relationship and expressed through the social provision of health care, are displaced by the economic purposes of the ‘free’ market. Accordingly, the integrity of both health care practitioners and communities is corrupted. At the same time, it is demonstrated that the claims of managed care proponents to higher levels of efficiency are largely unfounded; indeed, under managed care, health care costs have continued to rise. At the same time, levels of access to health care have deteriorated. These adverse outcomes of managed care are borne, most particularly, by poorer members of communities. Further, contrary to the claims of its proponents, choice as to the availability and kinds of health care services is diminished. Moreover, the competitive market in which managed care is situated has given rise to a plethora of bankruptcies, mergers and alliances in the United States where the market is now characterised by oligopoly and monopoly providers. In this way, a viable market in health care is largely disproved. Nonetheless, when protected within a non-market context and subject to the requirements of justice, a limited number of managed care techniques can assist Australia’s efforts to conserve the resources of health care. However, any more robust adoption of this concept would be ethically indefensible.

Six out of every ten children in South Africa are living in poverty. This situation is aggravated by the AlDS pandemic. The pandemic is also the cause of a generation of AlDS orphans and as a consequence a lot of pressure is put on society's resources. Although the fundamental rights of children are entrenched in the Constitution of the Republic of South Africa, 1996, the current legal and administrative framework is not being implemented effectively in order to realise these rights. The Constitutional Court has adjudicated upon several matters regarding the realisation of socio-economic rights, thereby confirming that socio-economic rights are indeed justiciable. This research is specifically concerned with the realisation of children's right to have access to health care as entrenched in sections 27 and 28(l)(c) of the Constitution. Read with section 7(2) of the Constitution, this right places negative as well as positive obligations on the state to respect, protect, promote and fulfil children's right to have access to health care. Children's right to health care are however dependent on the internal limitations contained in section 27(2) of the Constitution which states that the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of these rights. Having ratified the UN Convention on the Rights of the Child (CRC), the state is further bound to recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Parties to the CRC shall also strive to ensure that no child is deprived of his or her right of access to such health care services. Good health is dependent on more than a mere right to have access to health care. In order to ensure the highest attainable standard of health for all children, it is necessary that the available services are affordable and accessible on an equitable basis. Access to health care should be seen as part of a more comprehensive social protection package to ensure a minimum standard of living, consistent with the value of human dignity in our Constitution. In order to achieve this, the fragmented health care system which existed before 1994 and which was mainly a result of the previous dispensation of oppression and racial discrimination, had to be transformed in order to reach the ideal of improving the quality of life of all citizens as contained in the preamble of the Constitution. Ten years after the inception of the new constitutional dispensation, it can be said that the government is making progress with the transformation of the health system and making it accessible to all people, including children. After extensive research on the legislative and other measures that the government has implemented in order to realise children's right to access to health care, the following conclusions has been reached: State policies regarding health care are taking account of the needs of children as a vulnerable group of society and it can be said to be reasonable in the formulation thereof. Regarding the implementation of these policies, much remains to be done to ensure that the benefits thereof reach the children, especially more vulnerable groups such as street children and child-headed households - a common occurrence with the high prevalence of HIVIAIDS in South Africa. The enactment of the National Health Act 61 of 2003 is still awaited although it has already been signed. This legislation provides a national framework of norms and standards regarding the health care system and it is mainly based on the rights of patients. A new Children's Bill [B32 - 20031 has been introduced to parliament. The bill deals extensively with the rights of children as contained in the Constitution and also aims to give effect to governments' obligations in terms of the CRC. The enactment of the bill should be given priority, although measures should be implemented to ensure that health care services are also accessible to children who are not assisted by adults such as child-headed households. The allocation of public funds should be considered in order to provide better social assistance to families in dire need but mechanisms to ensure that children benefit from social grants must be implemented. Many of these grants are being abused by parents which means that although the grants are available, the money is not always spent to better the plight of the children. This is especially important in the light of the fact that the primary obligation to take care of children vests in the parents. The courts and especially the Constitutional Court, has taken their role in realising socio-economic rights seriously and very important guidelines has been formulated regarding the reasonableness of legislative and other measures in this regard. After the Khosa-case it should be said that although the courts are allowed to overstep the boundaries of separation of powers, they should not rewrite these boundaries by not taking appropriate account of the availability of financial resources. This also applies to the executive and legislature which should act more effectively to implement the court's decisions. The Human Rights Commission is playing an important role with regard to the realisation of socio-economic rights by monitoring and evaluating the implementation of government programmes and legislation. The Commission also provides valuable guidelines with regard to the realisation of socio-economic rights in the form of annual reports submitted to parliament. It is submitted that the Commission should however consider to define minimum core obligations of socio-economic rights since the Commission is better equipped to do this than the courts are. / Thesis (LL.M. (Public Law))--North-West University, Potchefstroom Campus, 2005.

Access to primary health care is an important determinant of health. Within current research there has been limited examination of neighbourhood level variations in access to care, despite knowledge that local contexts shape health. The objective of this research is to examine neighbourhood-level access to primary health care in the city of Mississauga, Ontario. Street address locations of primary care physicians were obtained from the College of Physicians and Surgeons of Ontario (CPSO) website and analyzed using geographic information systems (GIS). A 'Three Step Floating Catchment Area' (3SFCA) method was derived and used to measure multiple dimensions of access for the population as a whole, for specific linguistic groups and for recent immigrants. This research identifies significant neighbourhood-level variations in access to care for each dimension of access and population subgroup studied. The research findings contribute to a more nuanced understanding of neighbourhood-level variability in access to health care.

Access to primary health care is an important determinant of health. Within current research there has been limited examination of neighbourhood level variations in access to care, despite knowledge that local contexts shape health. The objective of this research is to examine neighbourhood-level access to primary health care in the city of Mississauga, Ontario. Street address locations of primary care physicians were obtained from the College of Physicians and Surgeons of Ontario (CPSO) website and analyzed using geographic information systems (GIS). A 'Three Step Floating Catchment Area' (3SFCA) method was derived and used to measure multiple dimensions of access for the population as a whole, for specific linguistic groups and for recent immigrants. This research identifies significant neighbourhood-level variations in access to care for each dimension of access and population subgroup studied. The research findings contribute to a more nuanced understanding of neighbourhood-level variability in access to health care.

Six out of every ten children in South Africa are living in poverty. This situation is aggravated by the AlDS pandemic. The pandemic is also the cause of a generation of AlDS orphans and as a consequence a lot of pressure is put on society's resources. Although the fundamental rights of children are entrenched in the Constitution of the Republic of South Africa, 1996, the current legal and administrative framework is not being implemented effectively in order to realise these rights. The Constitutional Court has adjudicated upon several matters regarding the realisation of socio-economic rights, thereby confirming that socio-economic rights are indeed justiciable. This research is specifically concerned with the realisation of children's right to have access to health care as entrenched in sections 27 and 28(l)(c) of the Constitution. Read with section 7(2) of the Constitution, this right places negative as well as positive obligations on the state to respect, protect, promote and fulfil children's right to have access to health care. Children's right to health care are however dependent on the internal limitations contained in section 27(2) of the Constitution which states that the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of these rights. Having ratified the UN Convention on the Rights of the Child (CRC), the state is further bound to recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Parties to the CRC shall also strive to ensure that no child is deprived of his or her right of access to such health care services. Good health is dependent on more than a mere right to have access to health care. In order to ensure the highest attainable standard of health for all children, it is necessary that the available services are affordable and accessible on an equitable basis. Access to health care should be seen as part of a more comprehensive social protection package to ensure a minimum standard of living, consistent with the value of human dignity in our Constitution. In order to achieve this, the fragmented health care system which existed before 1994 and which was mainly a result of the previous dispensation of oppression and racial discrimination, had to be transformed in order to reach the ideal of improving the quality of life of all citizens as contained in the preamble of the Constitution. Ten years after the inception of the new constitutional dispensation, it can be said that the government is making progress with the transformation of the health system and making it accessible to all people, including children. After extensive research on the legislative and other measures that the government has implemented in order to realise children's right to access to health care, the following conclusions has been reached: State policies regarding health care are taking account of the needs of children as a vulnerable group of society and it can be said to be reasonable in the formulation thereof. Regarding the implementation of these policies, much remains to be done to ensure that the benefits thereof reach the children, especially more vulnerable groups such as street children and child-headed households - a common occurrence with the high prevalence of HIVIAIDS in South Africa. The enactment of the National Health Act 61 of 2003 is still awaited although it has already been signed. This legislation provides a national framework of norms and standards regarding the health care system and it is mainly based on the rights of patients. A new Children's Bill [B32 - 20031 has been introduced to parliament. The bill deals extensively with the rights of children as contained in the Constitution and also aims to give effect to governments' obligations in terms of the CRC. The enactment of the bill should be given priority, although measures should be implemented to ensure that health care services are also accessible to children who are not assisted by adults such as child-headed households. The allocation of public funds should be considered in order to provide better social assistance to families in dire need but mechanisms to ensure that children benefit from social grants must be implemented. Many of these grants are being abused by parents which means that although the grants are available, the money is not always spent to better the plight of the children. This is especially important in the light of the fact that the primary obligation to take care of children vests in the parents. The courts and especially the Constitutional Court, has taken their role in realising socio-economic rights seriously and very important guidelines has been formulated regarding the reasonableness of legislative and other measures in this regard. After the Khosa-case it should be said that although the courts are allowed to overstep the boundaries of separation of powers, they should not rewrite these boundaries by not taking appropriate account of the availability of financial resources. This also applies to the executive and legislature which should act more effectively to implement the court's decisions. The Human Rights Commission is playing an important role with regard to the realisation of socio-economic rights by monitoring and evaluating the implementation of government programmes and legislation. The Commission also provides valuable guidelines with regard to the realisation of socio-economic rights in the form of annual reports submitted to parliament. It is submitted that the Commission should however consider to define minimum core obligations of socio-economic rights since the Commission is better equipped to do this than the courts are. / Thesis (LL.M. (Public Law))--North-West University, Potchefstroom Campus, 2005.

O trabalho buscou conhecer os motivos que levaram mulheres do município de Piraí, estado do Rio de Janeiro, agendadas para realizar o exame de mamografia, a não comparecer ao mesmo / The study sougth to know the reasons why women Piraí