Thesis (MSc.(Med.)(Pharmacy))--University of Limpopo, 2010. / According to the World Health Organisation, there should be an essential medicines list in every functioning health care system in the world. The Department of Health of South Africa published its first Essential Drugs List for Primary Health Care in 1996 and for paediatric and hospital use in 1998. The South African Defence Force published its Military Medicine Code List (MMCL) in 2002. Since the implementation of the code list in the military service, no research study has been undertaken to determine adherence to the code list by prescribers or to determine indicators for possible non-adherence to the MMCL. The main aim of the study was to evaluate prescribing adherence to the MMCL list by doctors and nurses in the Primary Health Care military clinics in Gauteng. Further objectives were to establish indicators for non-adherence and provide suggestions to improve adherence, to determine to which drugs non-adherence was directed and to determine the average number of items prescribed per prescription. A cross-sectional, mainly quantitative, descriptive study was conducted at 14 military PHC dispensing points in Gauteng. Data were collected retrospectively from 838 prescriptions, of which 348 were written by doctors and 490 by nurses. A questionnaire was used to collect data prospectively from seven doctors and 34 nurses on their perceptions of the use of the MMCL. The prescriptions were analysed for adherence to the stipulations of the MMCL. Proportions of adherent prescriptions and items were compared between prescriber type (doctors and nurses), facility type (pharmacies and dispensaries) and facility location (Northern Region, close to 1 Military Hospital and Southern Region), using the Chi-square test. Non-adherent items were tabulated and grouped. Data from the questionnaires were analysed descriptively. Indicators for possible non-adherence and suggestions for improvement of adherence were listed and grouped. The average number of items per prescription was 3.4. Overall, 89.9% of prescriptions (n=838) and 96.4% of items (n=2832) were adherent to the MMCL. xii More prescriptions written by doctors (96,8%) were adherent, compared to nurses (84,9%; P<0.001). Only a few items were responsible for non-adherence. Nonadherent items specifically for nurses included corticoid nasal sprays, azithromycin, meloxicam and ispagula husks. Adherence of prescriptions dispensed in dispensaries (no pharmacist) (93.0%) was higher compared to pharmacies (87.0%; P<0.004). Prescriptions from facilities in the South of Gauteng (96.5%) were more adherent than those near 1 Military Hospital (North) (87.7%; P<0.001). Reasons for non-adherence included staff shortages, implementation and availability of the MMCL, absence of standard treatment guidelines (STGs) in the MMCL and delayed referrals to specialist departments. Suggestions for improvement of adherence to the MMCL included better implementation and distribution of the code list, addressing staff shortages, including Standard Treatment Guidelines (STGs) in the code list and improving the referral system from clinics to hospitals.

No description available.

No description available.

This master's thesis is focused on the comparison of different systems of payment for health care in the Czech Republic. Insurance companies play an essential part in financing health care and they are also responsible for setting the rules for health care providers, who in turn modify the systems of financing health care that had been set out. This is the reason why the issues concerning insurance companies are discussed in both parts of this thesis, firstly the theoretical side and secondly the practical one. The theoretical part of this thesis discusses the structure of the czech healthcare system as a whole and then the payment systems set up for individual providers of health care are analysed in the following chapters. The practical part shows examples of how the payment system for health care works, what problems it encounters, what exactly is the role of insurance companies and how to deal with presented problems. The aim of this thesis is to provide an overview of the types of payment systems for health care used in the Czech Republic and further focus on the specifics and details that are analysed along with their potential impact on the amount of the final payment.

This thesis deals with the most severe problems and the factors that affect the health care system in the Czech Republic. Lately there is an increase in financial expenses on health, mainly due to the aging of population. Another problem is the inefficiency of the use of these funds. The aim is to analyze these serious problems and factors affecting Czech health care system. The theoretical part characterizes the basic concepts related to health care systems, typology of these systems, health care system as an economic good and state interference in the system due to the specific characteristics of this market. In this part there is also the introduction of the historical development of the system. The practical part analyzes the most important issues and factors that affect the health care system of the Czech Republic, financing of the system and its comparison with systems in the Netherlands and the USA. Also, there are recommendations that could contribute to improving the situation.

Privatization of the public child welfare system has become increasingly popular since its introduction in the early 1990s. State governments that initiate the privatization of foster care services rationalize the changes with claims of effectiveness and/or increased efficiency of services for children and families. There has been no real focus on identifying what efficiency of the system means for children and their families, nor what aspects of effectiveness focuses on children in foster care. As a result, the unintended consequences of this total restructuring of foster care bureaucracy, through the privatization of the state foster care system – and its impact on the organization service delivery and the child – are as yet unknown. The primary aim of this study is investigate whether or not there are differences between state foster care systems and their levels of privatization, as well as the differences in states’ rates of efficiency and effectiveness with regard to a child’s trajectory of experience within the foster care system. Through the analysis of existing data on state-based child welfare service performance this project intends to increase the knowledge regarding the privatization of public child welfare systems and its effect on efficiency and effectiveness of service delivery.

Increasing attention has been paid to decentralized health care systems in order to evaluate health outcomes. In Brazil, state-run pharmaceutical assistance falls within the scope of a decentralized health care system, also known as SUS (Brazilian Unified Health System). The research intends to shed light on pharmaceutical policy implementation in Brazil through SUS, and argues that it can be used as a guide for institutional reform. This will be accomplished by reviewing the weaknesses and strengths of the SUS decentralized structure as revealed in the pharmaceutical policy responses to HIV/AIDS and tuberculosis. Under the assumption of pharmaceutical assistance improvement conditioned to re-centralization of some functions; it can be argued that a balanced approach to decentralization is more desirable to the pharmaceutical sector than the existing decentralized system. The aim of this study is to highlight the advantages of establishing a hybrid system for pharmaceutical assistance.

Increasing attention has been paid to decentralized health care systems in order to evaluate health outcomes. In Brazil, state-run pharmaceutical assistance falls within the scope of a decentralized health care system, also known as SUS (Brazilian Unified Health System). The research intends to shed light on pharmaceutical policy implementation in Brazil through SUS, and argues that it can be used as a guide for institutional reform. This will be accomplished by reviewing the weaknesses and strengths of the SUS decentralized structure as revealed in the pharmaceutical policy responses to HIV/AIDS and tuberculosis. Under the assumption of pharmaceutical assistance improvement conditioned to re-centralization of some functions; it can be argued that a balanced approach to decentralization is more desirable to the pharmaceutical sector than the existing decentralized system. The aim of this study is to highlight the advantages of establishing a hybrid system for pharmaceutical assistance.

Thesis (Ph.D.)--McMaster University, 2004. / Advisor: Charlene Miall. Includes bibliographical references (leaves 274-282)

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.