M.Com. (Business Management) / Please refer to full text to view abstract

M.A. (Public Management and Governance) / The study deals with the nature and problems of the proposed National Health Insurance system in South Africa in order to develop a management and governance model to promote universal healthcare in South Africa. The general aim of the study is, therefore, to analyse the concepts and policy initiatives related to the resolution on the National Health Insurance (NHI) scheme being passed at the ANC’s 52nd National Conference in Polokwane in 2009. Calls for a NHI together with relevant legislation and programmes, have consistently formed an integral part of Government’s national effort to build a united national health system in which the public health sector plays a dominant role as provider of first choice. The proposed NHI is a state-mandated and state-administered health insurance scheme that provides universal and comprehensive cover to all South Africans in spite of their financial status. In essence therefore, the vision of the NHI system is to be inclusive of the unemployed and the indigent who will also be afforded the opportunity to receive healthcare which is on par with everyone else’s and not based on what they can or cannot afford. This enquiry is premised on the variables that have influenced the development of South Africa’s healthcare system, the implementation challenges of the proposed NHI, according to the National Health Insurance Policy Paper of 2011, and the lessons that South Africa can derive from the implementation of the national health insurance schemes of Brazil and Ghana. The dissertation concludes that there are certain challenges in the current NHI debate in terms of the lack of technical details on the proposed NHI system, a lack of transparency in terms of the process, as well as problems related to the exclusion of the main stakeholders in the public and private health sector.

Class of 2011 Abstract / OBJECTIVES: To examine the effects of pharmacist-provided direct patient care with consideration to the patients’ socioeconomic status as determined by the patients’ health insurance. METHODS: A meta-analysis was conducted to evaluate the effects of pharmacist-provided direct patient care on different socioeconomic populations as determined by the patients’ health insurance by including results from several independent randomized control trials. A standardized and tested data extraction form was used to collect primary data on outcome category (therapeutic, safety, and humanistic), disease category (diabetes, hypertension, cardiovascular, dyslipidemia, asthma, and other), insurance status (Medicaid, Medicare, Veterans Affairs/ Department of Defense, private and uninsured), and outcome measures. The potential for bias data were analyzed by calculating a total potential for bias score and by construction a forest plot ordered by bias score. RESULTS: Twenty-two studies were included in the meta-analysis. The insurances most often reported were Medicaid (13.6%), Medicare (18.2%), the Veterans Affairs/ Department of Defense (VA/DoD) (41%), and private insurance (27.2%). All insurance groups benefited from pharmacist intervention (p<0.01). The Medicare patients benefited the least from the pharmacist interventions [standard mean difference (SMD) = 0.21], and the benefit of intervention was significantly less than the benefit for subjects having Medicaid, Private Insurance or VA/DoD coverage (p<0.02). CONCLUSION: While patients in all insurance type benefited from pharmacist intervention, Medicare patients seemed to benefit the least; further studies are needed to verify the findings and to explore why the benefit is less than for other groups.

Social health insurance is a form of health care financing that has gained increased attention in African countries in the past decade. Tanzania introduced social health insurance by the establishment of the National Health Insurance Fund (NHIF) in 1999 with, inter alia, the objective of improvement of the quality and availability of health services. The goal of this study was to determine the perceptions of services providers on the quality and accessibility of health services following the introduction of social health insurance. A qualitative approach was used to gain an insider's perspective from the service providers of how the services have changed following the introduction of the scheme. Individual interviews, observation and field notes were used to gather information on the quality and accessibility of health services under the policy of social health insurance. Data were analysed using Tesch's method of data analysis. The health workers generally perceived the fund as being beneficial to its members as it reduced the financial barriers to receiving health care. However, the objectives of the NHIF as a health financing mechanism were not adequately understood by the health workers. Although they perceived the quality of health services as having improved compared to previous years, they did not associate this improvement with the NHIF. The health workers also perceived accessibility of health services as having improved for insured patients but not for non-insured patients.

This thesis deals with the health system in the Czech Republic, with a focus on the management of health insurance companies in revenue from premiums collected and expenditure on the health care insurance policy holders. The first part deals with the health system in general to get a general idea of the health system. It deals with various types of health systems, participants in health insurance and various types of health care. The second part is devoted to legal legislation, the history of the health system in the Czech Republic, different types of reimbursement of health care and health insurance status in the health system. The last part of thesis deals with analysis of health insurance, which is based on a comparison of the various health insurance companies in terms of insured persons, income from insurance premiums and expenses and health care.

This thesis deals with the enforcement of claims coming from public health insurance by VZP ČR. The work is divided into theoretical and practical part. The theoretical part describes the reasons for the claims on public health insurance, their findings through the administrative procedure and the legal possibilities of enforcement. It also contains a description of the bankruptcy and criminal proceedings. In the practical part is an analysis of enforcement of claims by VZP ČR from 2012 to 2015. The work also includes the definition of the organizational structure of the VZP ČR. In the final part of the thesis we identified shortcomings in the current working with claims by the VZP ČR.

This thesis provides a description of reflux disease, especially its nature, diagnosis and treatment, followed by the analysis of the costs of this disease and the procedure for the patient as an example.

Due to recent advances in medical technology, the number of children with special healthcare needs (CSHCN) is steadily growing in the United States. CSHCN comprise more than 40% of overall healthcare costs nationwide, even though this group is only comprised of 16% of the U.S. child population. There are significant differences between private and public health plans in terms of cost, adequacy, and parent satisfaction. As an added benefit, some public and private health insurance plans offer nursing care coordination (or nursing case management) services. The purpose of this study was to understand the experiences of parents of CSHCN enrolled in public and private insurance with or without a nurse care coordinator assigned. A phenomenological approach was used. One-to-one semi-structured interviews were conducted with 16 participants. Colaizzi’s (1978) eight steps of data analysis was the selected methodological interpretation. Five themes emerged from this study: Struggle with Self-Preservation, Abandonment and Isolation, Self-Reliance and Advocate, Interdependence, and Lifeline. These study findings highlighted the major differences with parents navigating their child’s health insurance. These differences were dependent on the type of insurance and sources of support available. The experience of parents with a nurse care coordinator differed from parents without a nurse. Parents of CSHCN enrolled in public insurance with a nurse care coordinator considered the nurse to be a primary source of support. These nurses were instrumental in solving problems with the public health plan. On the contrary, parents with CSHCN enrolled in private insurance without a nurse care coordinator carried this additional burden. There were also noticeable differences in parents’ satisfaction with the adequacy and cost of their child’s health insurance. Parents of CSHCN enrolled in private insurance voiced dissatisfaction with higher costs associated with their child’s plan. Meanwhile, parents of CSHCN enrolled in Medicaid expressed that out-of-pocket expenses were covered. Results from this study can be used to make policy changes by insurance companies. Incorporating nursing care coordination not only results in healthcare savings for the health plan but improved health outcomes for its members as well. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

Health care represents an increasing proportion of global consumption. We discuss ways to model health care utilization on an individual basis. We present a probabilistic, generative model of utilization. Leveraging previously observed utilization levels, we learn a latent structure that can be used to accurately understand risk and make predictions. We evaluate the effectiveness of the model using data from a large population.

Recent developments in public debate, health policy, and research on nontraditional families have brought gay-parent families, especially gay fathers, into the cultural and political spotlight. Existing research and literature on LGBT families and gay fatherhood have emphasized relationship dynamics within the families but there are gaps in the literature regarding the health and well-being of these families, specifically as it relates to health insurance. Using symbolic interactionism, life course theory, and grounded theory methodology, I conducted a qualitative pilot study to investigate gay fathers\' health insurance experiences. I collected responses from 10 White, gay fathers across the United States and asked questions about access to health insurance, the process of providing insurance for their families, access and use of community resources, and unique factors of their health insurance story. This research adds to the same-sex parent knowledge based by (a) gaining an understanding of the family decisions gay fathers make around health insurance, (b) identifying obstacles and subsequent solutions to health insurance problems, (c) discussing issues of disclosure and outness in gay father families, and (d) uncovering continued gender associations with the division of labor. This study has more broad implications for theoretical concepts like intersectionality and agency, but also provides insights into policy inequalities that continue in the United States. / Master of Science