xi, 108 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Micro-level survey data are widely used in applied economic research. This dissertation, which consists of three empirical papers, demonstrates challenges in empirical research using micro-level survey data, as well as some methods to accommodate these problems. Chapter II examines the effect of China's recent public health insurance reform on health utilization and health status. Chinese policy makers have been eager to identify how this reform, characterized by a substantial increase in out-of-pocket costs, has affected health care demand and health status. However, due to self-selection of individuals into the publicly insured group, the impact of the reform remains an unresolved issue. I employ a Heckman selection model in the context of difference-in-difference regression to accommodate the selection problem, and provide the first solid empirical evidence that the recent public health insurance reforms in China adversely affected both health care access and health status for publicly insured individuals. Chapter III examines the construct validity of a stated preference (SP) survey concerning climate change policy. Due to the fact that the SP survey method remains a controversial tool for benefit-cost analysis, every part of the survey deserves thorough examination to ensure the quality of the data. Using a random utility approach, I establish that there is a great deal of logical consistency between people's professed attitudes toward different payment vehicles and their subsequent choices among policies which vary in the incidence of their costs. Chapter IV employs the same survey data used in Chapter III, but demonstrates the potential for order effects stemming from prior attitude-elicitation questions. In addition, it considers the potential impact of these order effects on Willingness to Pay (WTP) estimates for climate change mitigation. I find the orderings of prior elicitation questions may change people's opinions toward various attributes of the different policies, and thereby increase or decrease their WTP by a substantial amount. Thus, this chapter emphasizes the significance of order effects in prior elicitation questions, and supports a call for diligence in using randomly ordered prior elicitation questions in stated preference surveys, to minimize inadvertent effects from any single arbitrary ordering. / Adviser: Trudy Ann Cameron

The aim of my thesis was to examine people{\crq}s and professionals{\crq} opinions on introduction of the regulatory health fees. Within the scope of the two sub-targets, I tried to find out the amounts of the regulatory health fees acceptable for the citizens and something about the possibility to arrange a private health insurance. I briefly described the system of the public health insurance and I mentioned the system of the regulatory health fees and the annual protection limit in more detail in the theoretical part of the diploma thesis. In order to compile the thesis I used the method of questioning which I carried out by collecting data using a questionnaire and the method of the secondary analysis of data. Two statistics groups {--} general public and professionals from the South Bohemian Region - were defined for the research part. Based on the available literature, I established four hypotheses of which the first three were confirmed and the fourth one was disconfirmed by the research. The research revealed differences in opinions and perception of the regulatory health fees between the individuals and general public and professionals. The citizens{\crq} awareness {--} which still has its deficiencies as the questionnaire survey revealed {--} has definitely influence on the opinion on the regulatory health fees. The thesis could be used to increase the awareness of the system of the regulatory health fees and the annual protection limit, for lectures, eventually the respondents{\crq} replies and the research results could be taken into consideration when amending the existing Act No. 48/1997 Coll., on Public Health Insurance.

Public health insurance is an important part of the Czech health system. In the Czech Republic the model of national health insurance is administered using system of several insurance companies. The main target of these companies is to collect insurance rate from the payers and to cover health care provided to the insuree. The aim of this work is to map and assess professional and non - professional public knowledge of the system of the public health insurance. Three goals were set within the work. The first one was to find out the level of the professional public knowledge of the public health insurance. The second one was to find out the level of the non - professional public knowledge of the public health insurance. The third one was to compare both groups knowledge of the public health insurance. To realize the above mentioned aims three hypotheses were set. Hypothesis No.1: Most of the professional public is informed about the valid legal arrangement of the public health insurance. Hypothesis No. 2: Most of the non -professional public is informed about the valid legal arrangement of the public health insurance. Hypothesis No. 3: There is no difference between the professional and non - professional public knowledge of the valid legal arrangement of the public health insurance. To prove the set hypotheses the form of quantitative research was used. The technique of questionnaire was used for data collecting. For practical part the identical questionnaire for both professional and non - professional public was used. The research group of the questionnaire investigation was formed by respondents living and working in České Budějovice. The professional public within the research work was formed by people who work or worked in the health or social sphere. The final research group was formed by 200 respondents of professional and 200 respondents of non - professional public. The target of the thesis and partial aims were accomplished. The first two hypotheses were proved. The third one was not proved by the research work. It has been investigated what areas is professional and non - professional public most or less informed in. The results of the research work may be used for publication in the professional journals.

Submitted by Priscilla Araujo (priscilla@ibict.br) on 2016-10-06T19:53:44Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Lizzie Karen do Carmo Neri_Mestrado_2016.pdf: 3855588 bytes, checksum: 9224c9538499fb6ec9a7d0869c819877 (MD5) / Made available in DSpace on 2016-10-06T19:53:44Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Lizzie Karen do Carmo Neri_Mestrado_2016.pdf: 3855588 bytes, checksum: 9224c9538499fb6ec9a7d0869c819877 (MD5) Previous issue date: 2016-05-18 / Submitted by Priscilla Araujo (priscilla@ibict.br) on 2016-10-06T19:53:46Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Lizzie Karen do Carmo Neri_Mestrado_2016.pdf: 3855588 bytes, checksum: 9224c9538499fb6ec9a7d0869c819877 (MD5) / Made available in DSpace on 2016-10-06T19:53:46Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Lizzie Karen do Carmo Neri_Mestrado_2016.pdf: 3855588 bytes, checksum: 9224c9538499fb6ec9a7d0869c819877 (MD5) Previous issue date: 2016-05-18 / A sociedade e os diversos tipos de organização precisam gerar, processar e aplicar a informação, de forma eficiente, baseada em conhecimentos, para obtenção apropriada de produtividade e de competitividade. Com o entendimento de que uma regulação eficiente do mercado de saúde suplementar exige informação e conhecimento profundo de sua dinâmica, a pesquisa, que teve como objetivo levantar e analisar as mudanças de planos de saúde realizadas pelos consumidores entre 2010 e 2014, com base nas informações enviadas pelas operadoras de planos de saúde à Agência Nacional de Saúde Suplementar (ANS), além de discutir como essa informação pode contribuir para a regulação da saúde suplementar, propõe a utilização dos sistemas de informação da ANS para o tratamento e análise de dados relacionados às mudanças de plano de saúde dos beneficiários entre as operadoras para colaborar para o conhecimento do mercado de planos privados de assistência à saúde e auxiliar no estabelecimento de prioridades e na formulação de diretrizes na área da saúde. A coleta dos dados foi realizada com auxílio de consultas SQL, nas bases de dados da ANS, com base nas especificações pré-determinadas, ou seja, a partir da prévia definição dos critérios, filtros e delimitações de campos, das tabelas e do intervalo de tempo para as extrações dos dados. Foi realizada a extração de dados das bases de dados de beneficiários de planos de saúde, de operadoras e de produtos, para análise e discussão dos dados relacionados às mudanças de planos de saúde no Brasil. Além disso, foram levantadas as estatísticas de acesso ao guia de planos da ANS e os resultados das buscas por termos selecionados, por haver relação com o tema mudança de plano de saúde na web com auxílio da ferramenta “google trends”. Esta pesquisa constatou a importância da grande base cadastral de beneficiários de planos de saúde, que pode ser analisada sob diversas óticas, para a compreensão do mercado da saúde privada, com a utilização de inúmeras variáveis e com focos diferentes. Como demonstraram os resultados, é possível a utilização dessa base para a compreensão da dinâmica das mudanças de plano de saúde e consequentemente para o aumento do conhecimento da saúde suplementar, o que traz importantes benefícios para o estabelecimento de diretrizes na área da saúde. / The society and the various types of organization need to generate, process and apply efficiently knowledge-based information appropriate for achieving productivity and competitiveness. With the understanding that effective regulation of the health insurance market requires information and thorough understanding of its dynamics, the research aimed to survey and analyze the health plan changes made by consumers between 2010 and 2014 based on the information sent by health insurance providers to the National Agency of Supplemental Health (ANS – Agência Nacional de Saúde Suplementar), and discuss how this information can contribute to the Regulation of Health Insurance, proposes the use of ANS information systems for the processing and analysis of data related to plan changes health of beneficiaries among operators to contribute to the knowledge of the private health plans market and assist in setting priorities and formulating guidelines in healthcare. Data collection was performed using SQL queries in the ANS database based on predetermined specifications, i.e. from the previous definition of the criteria, filters and boundaries of fields, tables and time interval for the extraction of data. It was held extraction of data in databases of health plans, providers and products for analysis and discussion of data related to health insurance changes in Brazil. In addition, they raised access statistics to guide the ANS plans and results of searches for selected terms to have relation with the theme health plan change on the web with the help of google trends tool. This survey found the importance of large cadastral base of beneficiaries of health plans, which can be analyzed in various, optical and understanding of the private healthcare market, and with the use of numerous variables and with different focuses. As shown by the results, using this basis for understanding the dynamics of health plan changes and consequently to the increase in supplementary health knowledge is possible, which has important benefits for the establishment of guidelines in health care.

This dissertation deals with the Czech and the German public health insurance system. The main aim is to analyze the public health insurance system in the Czech Republic and Germany and their comparison according to selected criterias. The dissertation is divided into four parts. In the first chapter there are briefly described various methods of financing health care. The content of the second chapter is the analysis of the German public health insurance system. This chapter also presents the basic characteristics of the German private health insurance. In the third chapter we can find the analysis of the Czech public health insurance system. An integral part of the second and the third chapter is the analysis of the income of the public health insurance system in 2005 - 2010. In chapter four there is a comparison of the two systems of public health insurance. Then individual parts are selected from the systems (the insured, the assessment basis, the insurance rate and income of the public health insurance) and they are compared according to selected quantitative and qualitative criterias.

The purpose of this study was to describe factors that influence the enrolment of dairy farmers to a Community Health Insurance scheme for better access to healthcare. Quantitative, descriptive, contextual, cross-sectional research was conducted and the Health Insurance for the Poor framework was used to describe these factors. Data collection was done using a structured interview guide. The sample consisted of 135 farmers who supplied milk to a dairy cooperation in western Kenya. Among the sample were respondents (n=17) who were enrolled to the Tanykina Community Healthcare Plan (TCHP). The findings revealed that lack of information and unfamiliarity with TCHP, lack of affordability and the distance from the TCHP centres might prevent farmers from registering for the Tanykina Community Healthcare Plan. Improved marketing strategies and establishing more health centres which are more accessible are among the recommendation made to increase the membership to the TCHP / Health Studies / M.A. (Public Health)

Cette thèse est consacrée aux systèmes d'assurance maladie mixtes où la couverture publique obligatoire peut être améliorée par une complémentaire santé. Les questions abordées portent sur l'effet inflationniste de la complémentaire sur le prix des soins et sur l'impact de la tarification à l'âge sur les solidarités entre malades et bien portants et entre catégories de revenu. Les analyses empiriques sont réalisées sur données françaises. Cette base de données originale regroupe les consommations de soins de 99,878 affiliés à la MGEN sur la période 2010-2012. Le chapitre 1 estime l'effet causal d'une meilleure couverture sur la consommation de dépassements d'honoraires et démontre l'effet inflationniste de la complémentaire sur le prix des soins. Le chapitre 2 considère l’hétérogénéité de l'impact d'une meilleure couverture sur les dépassements et sa corrélation avec la demande d'assurance. De fait, l’effet inflationniste de la complémentaire est accentué par des effets de sélection. Le chapitre 3 montre que la tarification à l'âge permet de maximiser les transferts entre malades et bien portants au détriment de la solidarité entre hauts et bas revenus. / This thesis deals with two questions relative to efficiency and fairness in mixed health insurance systems with partial mandatory coverage and voluntary supplementary health insurance (SHI): (i) the inflationary effect of SHI on medical prices; (ii) the fairness of SHI premiums. We set the analysis in the French context and perform empirical analyses on original individual-level data, collected from the administrative claims of a French insurer (MGEN). The sample is made of 99,878 individuals observed from 2010 to 2012. In Chapter 1, we estimate the causal impact of a generous SHI on patients' decisions to consult physicians who balance bill their patients. We find evidence that better coverage contributes to the rise in medical prices. In Chapter 2, we specify individual heterogeneity in moral hazard and consider its possible correlation with coverage choices. We find evidence of selection on moral hazard: individuals who are more likely to ask for coverage exhibit stronger moral hazard. In Chapter 3, results show that when SHI is voluntary, age-based premiums maximize transfers between low and high healthcare users but do not guarantee vertical equity.

Die Ausgaben für das Gesundheitssystem sind in den vergangenen Jahren kontinuierlich und stärker als das Bruttoinlandsprodukt gestiegen. Auch für die Arzneimittelkosten als relevante ökonomische Komponente im Kontext der gesamten Gesundheitskosten war für den Betrachtungszeitraum der Jahre 2008 - 2013 ein nahezu stetiges Wachstum zu verzeichnen. Zwischenzeitliche regulatorische Maßnahmen konnten zwar eine kurzzeitige Dämpfung dieses Wachstums im Jahr 2011 erreichen, in den nachfolgenden Jahren zeigte sich jedoch wieder ein steigender Kostentrend. Eine differenzierte Analyse der Arzneimittelkostenentwicklung ergibt verschiedene Einflussfaktoren. Hier sind soziodemographische Merkmale der betrachteten Kollektive, ökonomische und technologische Parameter im Umgang mit Arzneimitteln sowie die politisch-rechtliche Regulierung in den jeweiligen Kostenträgersystemen PKV und GKV zu nennen. Nicht zuletzt spielt die individuelle Situation der Patienten als Kombination aus Faktoren wie Gesundheitszustand, Risikofaktoren, Lebensstil und Therapieadhärenz eine zentrale Rolle in der effektiven und effizienten Anwendung von Arzneimitteln. Die im Rahmen dieser Dissertation detailliert analysierten Krankheitsbilder Hypertonie, Diabetes mellitus und Fettstoffwechselstörungen sind jeweils durch eine hohe Prävalenz gekennzeichnet und treten im Kontext des Metabolischen Syndroms oft kombiniert auf. Durch direkt entstehende Behandlungskosten und indirekt verursachte Kosten aus Folgeerkrankungen haben die ausgewählten Krankheitsbilder ein besonderes gesundheitsökonomisches Gewicht und nehmen einen bedeutenden Stellenwert im Rahmen der aktuellen gesundheitspolitischen Diskussion ein. Das Ziel dieser Dissertation ist es, aufzuzeigen, wie sich die Arzneimittelkosten im Kontext des Metabolischen Syndroms in jeweils einem Versichertenkollektiv der GKV und PKV entwickelt haben. Hierzu wurde jeweils eine Datenbasis pro Kollektiv nach den Kostenparametern Arzneimittelkosten, Verordnungsmengen, Werte pro Verordnung sowie den soziodemographischen Parametern Versichertenanzahl, Altersgruppen, Geschlecht und Postleitzahlenbereiche (nur für PKV-Kollektiv) ausgewertet. Der Untersuchungszeitraum ergibt sich aus einer vergleichbar auszuwertenden Datenbasis für beide Kollektive für die Jahre 2008 - 2013. Das Ergebnis der Kostenanalyse sind Wachstumsraten für alle genannten Kostenparameter zu den jeweiligen Subsegmenten der Kollektive. Zusammenfassend lässt sich feststellen, dass die Entwicklung der Arzneimittelkosten und ihrer Komponenten (Mengen und Werte) in allen untersuchten therapeutischen Hauptgruppen für beide Kollektive während des Betrachtungszeitraums 2008 - 2013 zwar teilweise unterschiedliche Verläufe zeigt, in der Gesamtbetrachtung aber sehr ähnliche Werte liefert. Bei den Lipidsenkern ist die Deckungsgleichheit der Wachstumswerte am größten. Auffällig ist dabei, dass die Werte pro Verordnung im PKV-Kollektiv gleiche oder sogar geringere Wachstumsraten aufweisen als im GKV-Kollektiv. Obwohl der Übergang zu generisch verfügbaren Arzneimitteln in der GKV in der Regel viel schneller stattfindet und es im Betrachtungszeitraum eine große Dynamik auf dem Generikamarkt gab, resultierte daraus kein Unterschied zwischen den Kollektiven in dieser Betrachtung. Ein zentrales Ergebnis der durchgeführten Altersgruppenanalyse ist, dass nicht ausschließlich für die höheren Altersgruppen diskussionswürdige Entwicklungen zu verzeichnen sind, sondern auch die jüngste detailliert ausgewertete Gruppe der 40- bis 49-Jährigen auffällige Steigerungsraten bei einzelnen Untersuchungsparametern aufweist. Dieses Alterssegment hat zwar in der aktuellen ökonomischen Betrachtung möglicherweise ein noch geringes Gewicht innerhalb der Gesamtpopulation, durch die beobachteten Steigerungsraten besteht jedoch Anlass zu frühzeitigen Interventionen. Hier offenbaren sich Ansatzpunkte für einen veränderten Fokus bei der Konzeption zielgruppenbezogener Interventionsmaßnahmen. Auch wenn die Kostenentwicklung in den untersuchten therapeutischen Hauptgruppen im Betrachtungszeitraum relativ moderat verläuft, zeigt u. a. der überdurchschnittliche Anstieg der Verordnungsmengen die gesundheitsökonomische Relevanz der detaillierten Analyse von Arzneimittelausgaben. Diese Ausgaben stellen einen wichtigen Faktor im Kontext der gesamten Gesundheitskosten dar. Weitere Forschungsansätze, die Kosteneinflüsse durch Begleit- oder Folgeerkrankungen sowie Sekundärschäden der betrachteten Krankheitsbilder untersuchen, können einen zusätzlichen Beitrag zur langfristigen Finanzierbarkeit des Gesundheitssystems leisten.:1 Einleitung 1.1 Gesundheitsausgaben in Deutschland 1.2 Leistungsarten der Gesundheitsausgaben 1.3 Arzneimittelkosten 1.4 Das Metabolische Syndrom 1.5 Forschungsstand 2 Fragestellung 3 Daten und Methodik 3.1 Datenschutz und Datensensibilität 3.2 Datenquellen 3.3 Datenauswertung und –analyse 3.4 Limitationen 4 Ergebnisse 4.1 Charakterisierung und Entwicklung der betrachteten Kollektive 4.2 Entwicklung der Gesundheitskosten 4.3 Entwicklung der Arzneimittelkosten 4.4 Entwicklung der Verordnungsmengen und -werte 4.5 Gesamtkostenentwicklung nach Mengen- und Werteffekten 4.6 Entwicklungen in den umsatzstärksten therapeutischen Hauptgruppen 4.7 Entwicklungen für Antihypertensiva, Antidiabetika und Lipidsenker 5 Diskussion 5.1 Limitationen 5.2 Gesamtentwicklung der Gesundheits- und Arzneimittelkosten 5.3 Antihypertensiva 5.4 Antidiabetika 5.5 Lipidsenker 5.6 Übergreifende Handlungsoptionen 6 Ausblick 7 Zusammenfassung 8 Summary 9 Literaturverzeichnis 10 Abkürzungsverzeichnis 11 Tabellenverzeichnis 12 Abbildungsverzeichnis 13 Erklärungen zur Eröffnung des Promotionsverfahrens 14 Erklärung zur Einhaltung rechtlicher Vorschriften,

According to the World Health Organisation (WHO) the goal of universal health coverage is to ensure that all people obtain the necessary health services without being financial limped because of the payable fees. This requires: - A strong, efficient, well-run health system; - A system for financing health services; - Access to essential medicines and technologies; and - A sufficient capacity of well-trained, motivated health workers. In an effort to compliment the abovementioned, the South African government proposed the National Health Insurance System (NHIS) to address the health inequality and to improve access to quality healthcare for its citizens. The National Department of Health (NDOH) has already consulted with several stakeholders since the launch of the NHI Green Paper in August 2011. Already 11 National Health Insurance (NHI) pilot sites have been established in the nine South African provinces to assess the feasibility, acceptability, effectiveness and affordability to engage the private healthcare sector. This study aimed to evaluate the feasibility of the NHI in South Africa as well as the way in which it could be implemented to be more acceptable to all stakeholders involved. A qualitative research approach was followed due to the nature of the study. Furthermore, an exploratory methodology was applied in order to generate hypotheses. The research design for this study included a literature review, participatory data collection, semi-structured interviews and data analysis. The study found that there is a need for NHI in South Africa. However, medical practitioners (also referred to as general practitioners or GPs further in the study) feel uncertain about the implementation progress which is unclear to them. Also evident is the, fear for loss of income should the NHI be implemented and thus the remuneration package remained a main concern for all. / MBA, North-West University, Potchefstroom Campus, 2015

According to the World Health Organisation (WHO) the goal of universal health coverage is to ensure that all people obtain the necessary health services without being financial limped because of the payable fees. This requires: - A strong, efficient, well-run health system; - A system for financing health services; - Access to essential medicines and technologies; and - A sufficient capacity of well-trained, motivated health workers. In an effort to compliment the abovementioned, the South African government proposed the National Health Insurance System (NHIS) to address the health inequality and to improve access to quality healthcare for its citizens. The National Department of Health (NDOH) has already consulted with several stakeholders since the launch of the NHI Green Paper in August 2011. Already 11 National Health Insurance (NHI) pilot sites have been established in the nine South African provinces to assess the feasibility, acceptability, effectiveness and affordability to engage the private healthcare sector. This study aimed to evaluate the feasibility of the NHI in South Africa as well as the way in which it could be implemented to be more acceptable to all stakeholders involved. A qualitative research approach was followed due to the nature of the study. Furthermore, an exploratory methodology was applied in order to generate hypotheses. The research design for this study included a literature review, participatory data collection, semi-structured interviews and data analysis. The study found that there is a need for NHI in South Africa. However, medical practitioners (also referred to as general practitioners or GPs further in the study) feel uncertain about the implementation progress which is unclear to them. Also evident is the, fear for loss of income should the NHI be implemented and thus the remuneration package remained a main concern for all. / MBA, North-West University, Potchefstroom Campus, 2015