The complexity of issues in health care in the United States--specifically insurance coverage, access, affordability, quality of care, and financing--requires effective new models for governing, in which governmental and non-governmental organizations seek to solve problems collaboratively rather than independently. This research explores collaborative governance as a model to form new partnerships among for-profit, nonprofit, and public organizations in an effort to create community-based, locally governed health care entities in Oregon through coordinated care organizations (CCOs). A key question is whether collaboration, through CCOs, brings together government and non-governmental organizations to solve "intractable problems" by establishing new public-private partnerships in Medicaid. The research focuses on the formation of CCOs, including the influence of local, political, institutional, and historical contexts, planning processes, and governance structures. The hypothesis is that conditions, norms, governance structures and processes, and the presence or absence of a combination of these factors, facilitate or impede participation and decision-making, and over time, successful system integration by these new complex organizations. This study developed insights into similarities and differences among CCO governance structures by investigating three CCOs. Findings from the case study suggest that the following key factors influence the collaborative governance process among government and non-governmental organizations within CCOs: prior history of conflict or cooperation; open, transparent, and inclusive processes for stakeholders; face-to-face dialogue, trust building, and shared understanding; and high-functioning governing boards. Results also indicate that maintaining stakeholder participation can be challenging due to time and cost, power imbalances and competing interests among stakeholders, and mistrust and lack of facilitative leadership. The results suggest that collaborative governance is a strategic approach for the allocation of limited resources across public, private, and nonprofit organizations to deliver services to Oregon's Medicaid population. The significance of this study is that it identified starting conditions that facilitate and hinder the ability of CCOs to effectively solve problems through governance mechanisms. Oregon's CCOs offer an example of multiple layers of governing institutions--federal, state, and county--using formal authority to influence a specified set of outcomes, the Triple Aim, in a specific policy domain: provision of health care services for underserved Oregonians. Results of the study can help inform a larger, more fundamental question in public administration about contemporary governance: whether government through collaborative governance can create the "conditions for rule and collective action" through public-private partnerships to achieve policy goals (Stoker, 1998). Further research is needed to better understand whether local community-based organizations such as CCOs offer a sustainable model to address policy issues in other arenas by which there is "more government action and less government involvement" (Agranoff & McGuire, 2003). This study contributes to the theory of collaborative governance and may inform future policy decisions about CCOs in Oregon and, more broadly, ongoing national health care reform efforts.

Expenditures on health are currently an important and growing item of public as well as private budgets in the developed world. This diploma thesis analyzes two different approaches to the function of health insurance on the example of the Czech Republic and the United States of America. The theoretical part will generally characterize access to health care through different theories; there will be also introduced the system of health insurance and the agents on health care market. The specifics of the health care market will be also explained. The analytical part of the work will focus on health insurance systems in the Czech Republic and the United States and their development, with accent on major reforms of recent years. With mutual comparison of the two systems, thesis will examine the shortcomings of public health insurance and private health insurance, including the effectiveness of their removal. Afterwards, the analysis of selected indicators of health care will be provided. The aim of the work is an analysis of the different systems of health insurance in the Czech Republic and the United States with relationship to the recent reforms and evaluation of their mutual effectiveness.

M.Com. (Business Management) / The purpose of the present study was to investigate the perceptions of medical practitioners towards managed health care and its implications for patient care. The study population was the medical practitioners in the northern suburbs of Johannesburg. A questionnaire was distributed to 224 medical practitioners in the northern suburbs of Johannesburg. The total number of the respondents was 81 with 53% being general practitioners and 47% being specialists. The findings of the study indicated that the majority of respondents perceived managed healthcare to have a negative impact on doctor-patient relationship, the ability to carry out their ethical obligations towards the patients, and that the limitations implemented by managed health care have a negative impact on the quality of care. The respondents also perceived managed healthcare to be consistent in reducing unnecessary procedures and reducing the expenditure. Recommendations made to remedy the situation include introducing a topic of managed health care as part of undergraduate studies to empower practitioners before they start a private practice. It would be advisable to include medical practitioners to help reform the strategies that will enable medical practitioners to carry out their ethical obligations towards the patients and to deliver quality care to the patients. The study concluded that medical practitioners hold negative perceptions towards managed health care and perceive managed health care to impact the quality of care negatively.

M.Comm. / Health care in South Africa has been well described in terms of structure. However, to what extent would it be possible to describe the health care sector in South Africa in terms of that used to describe an industry? What conclusions could be drawn at the end of the study if this was or was not possible? Strong emphasis in industry analysis is placed on the nature of the competitive forces and on levels of profitability. Can the South African health care sector also be described in those terms? The following objectives can be identified in this study: To complete a literature review on the structure of health care in South Africa in terms of facilities, geographic location, services offered, manpower, financing, remuneration, population served and legislation. To complete a literature review on models and methods that can be used to analyse industries. To determine to what extent it is possible to apply Porter's model (and others) of industry analysis to the South African health care industry. To identify key success factors for the industry. To draw conclusions from the study and make some recommendations.

Simposio: Hacia un cambio del Sistema de Salud Peruano: experiencias y perspectivas. / After several months of arduous deliberations, the National Agreement, a policy coordination forum highest level in Peru, approved a document entitled “The objectives of health care reform.” In this article it review the work done and the product reached by consensus, which includes as priorities, among others, strengthening of SIS like public insurance, implementation of a policy of multi-year investment, strengthening the protection of health rights outlined, strengthening the primary health care and improving access to safe and effective medicines. The effect is an agreement that gives significance to a process that has the character of state policy and defines the framework within which they must develop health policies in the following years.

Primary health care (PHC) is an effective way to "optimize and reorganize the health care service system" and solve the "difficulty in obtaining expensive medical services". In the process of China's promotion of health care reform, PHC has been placed at the core part. In this paper, by tracing the history of the development of China's PHC, and evaluating, analyzing and comparing the current similar policies in the field of PHC in China and Britain, a certain understanding of the effects of China's current PHC policies has been presented. In the end, some suggestions inspired by UK experiences been proposed for the future development of PHC in China. Keywords Primary health care; China; health care reform; UK primary health care

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Appalachia is characterized as being a place of health inequalities, including substandard health care access. Health disparities in access to health care persist in the region, and many Tennessee residents are unable to afford premiums, if they can afford insurance at all. Uninsured individuals rely on community based free clinics, which serve as health care safety nets and allowing people to obtain limited health care. This ethnographic investigation, involving semi-structured interviews and participant-observation of the Blackberry Spruce Free Clinic, provides insight into the continued need of health care safety net resources. This research provides a patient’s perspective on the barriers to care for the uninsured, the difficulties in managing chronic illnesses and other medical needs when relying on charity care, and the problems of clinic management in its role as a temporary solution for the uninsured population.

Shortly after his inauguration in 2009, President Barack Obama set to work on health care reform. Little more than a year later the President signed the Patient Protection and Affordable Care Act, which achieved a goal of so many previous administrations, into law. In order to encourage the passage of health care reform, Obama promoted a health care crisis in America. This study examines the President's rhetoric surrounding the health care crisis in order to explore the characteristics of a potential sub-genre of presidential discourse—domestic promoted crisis. Textual analysis of the President's remarks on health care revealed five strategies used in order to promote this crisis to the American people and encourage legislation to resolve it. In addition to characteristics, the concept of promotion of crises is discussed. / Master of Arts