Através do presente estudo analisou-se as decisões judiciais proferidas pelos Tribunais Superiores do Brasil - Supremo Tribunal Federal (STF) e Superior Tribunal de Justiça (STJ) - acerca dos conflitos entre usuários e operadoras de planos de saúde, a fim de verificar se nos julgamentos tem sido considerada a necessidade de preservação do direito à saúde. Na Parte I foram apresentados os pressupostos de compreensão do setor de planos de saúde, colocando-se à disposição informações sobre as denominações e classificações adotadas, histórico de formação e atual configuração. Ainda na primeira parte dissertou-se sobre o foco escolhido para a análise jurisprudencial: o direito à saúde. Evidenciou-se o processo histórico de reconhecimento dos direitos humanos e como o direito à saúde nele se inseriu, a natureza desse direito e sua consagração na legislação internacional e brasileira. Considerada a abordagem contratual que é dada aos planos de saúde, também se discorreu, ainda que brevemente, sobre o Código de Defesa do Consumidor (Lei nº 8.078/90) e a Lei de Planos de Saúde (Lei nº 9.656/98). A pesquisa jurisprudencial, apresentada nos capítulos da Parte II, abrangeu decisões sobre conflitos entre usuários e operadoras de planos de saúde disponíveis nos endereços eletrônicos dos Tribunais Superiores até 3 de junho de 2008 - data em que a Lei de Planos de Saúde completou 10 anos. Verificou-se que o STF não analisou o mérito dos recursos que lhe foram apresentados. A fundamentação adotada para tanto tem relevância na análise do impacto das decisões dos Tribunais Superiores na efetivação do direito à saúde em planos de saúde, mas prejudicou análises complementares. Assim sendo, no capítulo 5 as decisões do STJ e do STF foram analisadas no que diz respeito ao direito à saúde, e ao capítulo seguinte reservou-se a apresentação de aspectos complementares dos Recursos Especiais (STJ), como a natureza dos conflitos, a autoria das ações e os principais procedimentos, insumos e doenças negados aos usuários / Health insurance at Justice: is the right to health being effectived? studies how the Brazilian Superior Courts judge conflicts between health insurance companies and their users/clients. The objective of the study is to investigate whether and how the right to health takes part in the sentences. In the first part of the study the specific characteristics of the health insurance sector are introduced, including its development and its nowadays configuration and data. In the second part the judments of the Superior Courts (Superior Tribunal de Justiça and Supremo Tribunal federal) are presented and analysed.

O presente estudo tem como objetivo analisar a lucratividade dos clientes em uma operadora de saúde do segmento de baixo custo no Brasil. O mercado de saúde suplementar enfrenta inúmeros desafios para prosperar. Com a expansão nos últimos anos da classe média brasileira - a classe C - houve um aumento da demanda por serviços de planos de saúde privados de baixo ticket-médio. Foi realizada uma revisão da literatura, para embasar os princípios de modelos de negócios, a análise de lucratividade do cliente e a segmentação de clientes em uma operadora de saúde. O método utilizado foi um estudo de caso único, com pesquisa de dados de ordem qualitativa e quantitativa. Foram realizadas algumas entrevistas com os três principais executivos da operadora investigada, com o intuito de compreender o modelo de negócio construído e todos os seus diferenciais e inovações que garantiram seus resultados superiores à média do setor. Foram coletados dados contábeis, bases de receita e custo por beneficiário para análise quantitativa do resultado. Foi apresentado o modelo de negócio do estudo de caso investigado, bem como avaliada a lucratividade de clientes da operadora. Iniciou-se por uma análise quantitativa geral de variação contábil, com aprofundamento de análises na base de receita e custo de clientes, por sinistralidade, margem de contribuição absoluta e demais parâmetros, além da aplicação do conceito de CLV - Customer Lifetime Value. Ao analisar os resultados associados à avaliação da lucratividade, foram constatadas ações que pudessem ser tomadas para a melhora da mensuração do resultado final. O final das análises por cliente e por CLV se concentraram em grandes clientes corporativos, pois estes representam mais de 70% da carteira da operadora investigada. A conclusão apresentada foi a seguinte: para aumentar a margem de lucro absoluta bruta (R$) do negócio, ao subtrair as despesas assistenciais das receitas, deve-se segmentá-la por tipo de cliente e encontrar a margem de contribuição de cada. Na sequência, é necessário reajustar os clientes com margem de contribuição negativa, logo, obtém-se o maior resultado possível em termos de margem bruta total absoluta. Porém, mesmo para os clientes com margem de contribuição positiva, deve-se aprofundar sua análise de valor no tempo com o conceito do CLV. Verificou-se que clientes de margem positiva podem apresentar um CLV negativo para o mesmo período analisado. Esses clientes não devem ser desconsiderados, porque afetariam o resultado final, porém devem ser destacados na gestão, para serem mais bem renegociados numa revisão de valores contratuais e aumento do seu ticket-médio. / This study aims to analyze the profitability of customers in a health maintenance organization (HMO) of low-cost segment in Brazil. The health insurance market faces numerous challenges to thrive. With the expansion in recent years of Brazilian middle class - the class \'C,\' there was an increase in demand for private health plans to low-average ticket services. A literature review was conducted to support the principles of business models, customer profitability analysis and customer segmentation in a health provider. The method used was a single case study, with qualitative and quantitative research data. Interviews were conducted with the top three executives in the investigated company, to understand the business as presented, as well as the analysis of HMO\'s customer profitability. It´s began as a general quantitative analysis of accounting variation, with deeper analysis on revenue and cost base per members, by MLB (Medical Loss Benefit), gross margin and other parameters, in addition to applying the concept of CLV - Customer Lifetime Value. When analyzing the results associated with the evaluation of profitability, actions were found that could be taken to improve the measurement of the final result. The end of the analysis by customer and by CLV was focused on large corporate clients, as they represent more than 70% of the investigated portfolio. The conclusion was presented: to increase model built and all its advantages and innovations that have ensured their results above the industry average. We collected accounting data, revenue and cost base by membership for quantitative analysis. The business model of the investigated case study the margin of gross profit absolute (R$) in the business, by subtracting the medical cost from revenues, it should be segmented by customer type and find the contribution margin of each one. Further, it should be reajusted all customers with a negative contribution margin, so it could be obtained the highest possible result in terms of absolute gross margin. But even customers with positive contribution margin, should be deepen in their analysis of value in time with the concept of CLV. It was found that positive margin accounts may have a negative CLV for the same reported period. Those customers should not be disconsidered, because affect the final result, but should be highlighted in the management review, to be better renegotiated as contract values and increased its ticket-average.

Orientador: Emerson Elias Merhy / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T21:46:18Z (GMT). No. of bitstreams: 1 Santos_FaustoPereirados_D.pdf: 1889545 bytes, checksum: 2bd15b1adba9c7c13177b6899d5238fd (MD5) Previous issue date: 2006 / Resumo: O trabalho analisa o processo de implantação da regulação pública no setor de saúde suplementar, entendendo a regulação como a capacidade de intervir nos processos de prestação de serviços, alterando ou orientando a sua execução. Tendo como marco a edição da Lei 9656/98, que regulamenta a saúde suplementar no país, discute as tensões anteriores e posteriores à lei, caracteriza o posicionamento dos atores envolvidos, os normativos editados pela Agência Nacional de Saúde Suplementar (ANS), classificando-os quanto às dimensões do processo regulatório: econômica, assistencial e da estrutura e operação do setor. Apresenta as principais mudanças provocadas pela regulação nestas dimensões e discute as lacunas identificadas no processo regulatório da saúde suplementar. As principais mudanças identificadas foram: a) A mobilidade da rede de serviços visando a sua redução, racionalizando-as e buscando a redução de custos; b) Redução do número de empresas que, anteriormente ao processo regulatório, apresentavam uma entrada constante de operadoras sem sustentabilidade, em função de dois movimentos: declínio das operadoras ativas e o aumento das operadoras canceladas; c) O número de beneficiários apresentou estabilidade nos planos médico-hospitalares, crescendo 3,7%, e grande expansão dos planos exclusivamente odontológicos (109,3%), nos últimos cinco anos. Dentre os médico-hospitalares, cresceram as Cooperativas Médicas (31 %), as Filantrópicas (6,7%) e Medicinas de Grupo (6,4%). As reduções ocorreram nas Seguradoras Especializadas em Saúde, cerca de 1,5 milhões de beneficiários (-25,1%) e no setor de Autogestões (-7,4%); d) A base da pirâmide dos beneficiários é sensivelmente mais estreita, enquanto o ápice é mais largo, proporcionalmente à pirâmide da população geral. O setor de saúde suplementar concentra mais idosos proporcionalmente e um número menor de jovens. Ocorreram mudanças na distribuição das faixas etárias da população de planos de saúde, reduzindo-se a população de jovens (menores de 19 anos), aumentando-se a população de inserção recente no mercado de trabalho (20 a 29 anos) e aquelas acima de 40 anos; e) Um decréscimo do número de beneficiários nas operadoras menores de 10 mil beneficiários. As demais operadoras aumentaram seus beneficiários, alterando sua participação percentual. Aquelas de maior porte, acima de 200 mil, beneficiários aumentaram sua participação relativa; t) Cresceu a participação dos planos novos, sujeitos à legislação específica e ao controle da ANS. Em 2000 os planos novos representavam 37%; em 2003 chegaram a 50%; e a cerca de 60% em 2005; g) Um processo de coletivização da forma de adesão dos beneficiários aos planos de saúde; h) A principal mudança no formato de regulação assistencial foi a cobertura dos planos de saúde incluindo a obrigatoriedade do atendimento a todas as doenças do cm 10, e a edição de um rol mínimo de procedimentos. A assistência prestada pelas operadoras atende a todo o rol de cobertura definido. As lacunas do processo regulatório identificadas foram: aspectos concorrenciais e de transparência da operação no setor, a relação público e privado e a auto-suficiência do setor, o modelo de atenção à saúde, a existência de planos anteriores à regulamentação, a insuficiência de alguns Sistemas de Informações e os institutos públicos fora da regulamentação / Abstract: This work analyses the process of building the public regulation of the supplemental health care system. It assumes regulation as the capacity of the state to intervene in the offer of services, orienting its development or changing its pattems. The issuance of the 1998 Federal Law n° 9.656, regulating supplemental health care in Brazil is taken as a landmark. It debates the pre and post-Bill tensions, characterizing the positions ofthe actors involved. It also analyses the pieces of regulation issued by the Brazilian National Agency for Supplemental Health (ANS) classifying them according to different aspects of regulatory process: economic aspect; assistance; structure and operation of the sectof. 11 describes the main changes provoked by regulation and discusses the existing gaps in the regulatory process of supplemental health. The main changes pointed out were: a) the mobility in the net of services of health, aiming at its reduction and rationalization and seeking cost reduction; b) reduction in the number of companies due to decrease of active health company and increase in the number of health company cancelled. Prior to the regulatory process, there was a constant entrance in the system of operators without sustainability; c) in the last tive years, the number of beneticiaries has remained quite stable in the medical-hospital plans, expanding just 3.7%, while for the dental services it has grown remarkably (109.3%). Among the medical-hospital plans the medical cooperatives grew 31 %, the philanthropic sector grew 6.7% and medical companies grew 6.4%. Reduction was veritied among the insurance companies specialized in health, which have lost around 1.5 million beneticiaries (-25.1%), and among self management organizations (-7.4%); d) the basis ofthe pyramid ofbeneticiaries is clearly narrower comparing to the basis ofthe pyramid of the general population, while the top is larger. The supplemental health sector concentrates more elderly people and less young people comparing to the whole society. There has been changes in the range of age distribution for users of health plans: the group younger than 19 has reduced; there has been an increase in the number of young workers (from 20 to 29) and in the number of those above 40; e) there has been a decrease in the number of beneticiaries linked to operators with less than 10 thousand clients. The other operators increase their number and percentage of users. Those which work with above 200 thousand users increased their rei ative participation; f) the number of new plans submitted to specitic legislation and ANS control has grown. In the year 2000 they represented 37%, reaching 50% in 2003 and around 60% in 2005; g) the process of collective contracting of health plans has increased; h) the main change in the framework of regulation of assistance was the inclusion of mandatory assistance to ali illnesses listed in cm 10 and the edition of a minimum list of procedures. The assistance offered by the operators covers all the list defined. The gaps of regulatory process identified were: concorrencial and transparency aspects of the sector operation; public and private relationship and the self sufficiency of the sector; the health assistance model; the existence of plans prior to the regulation bill; the insufficiency of the information systems available; and the public institutions not reached by the regulation / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

A assimetria de informação no sistema de saúde é um tema que ultrapassa o interesse apenas das empresas operadoras de seguro de saúde, de políticas públicas e de pesquisa acadêmica. O presente estudo analisa como os contratos de cosseguro influenciam os fenômenos do risco moral e da seleção adversa presentes nos planos de saúde e sua relação com a demanda de serviços médicos. Neste contexto, analisar a assimetria de informação no sistema de saúde se torna relevante por oferecer uma resposta consistente, que poderá embasar tanto as políticas públicas, quanto a forma de comercialização dos planos pelas empresas. Esse trabalho, a partir da Pesquisa Nacional por Amostra de Domicílios - PNAD 2003, procura observar a eficiência do contrato cosseguro como um mecanismo de mitigação de assimetria de informação, ou seja, excluídos os efeitos dos riscos associados ao indivíduo, se a diferença de contrato altera o comportamento dos agentes. Para atingir esse resultado foi proposto um método para testar a assimetria de informação utilizando o método de Monte Carlo. Os resultados sugerem que os contratos de cosseguros foram eficientes nos planos individuais, enquanto nos planos coletivos sua influência pode ser descartada. Por fim, o trabalho aponta que é mais eficiente, pelo bemestar social, a utilização de cosseguro para os contratos individuais, enquanto para os contratos coletivos são mais eficiente os contratos sem cosseguro. / Asymmetric information in the health care system is a topic of interest for medical insurance, policy makers and scholars. This research analyses how the contracts of coinsurance motivate the moral hazard and adverse selection phenomenon and consequences in medical services demand. In this context, the analysis of asymmetric information in the health care system provides support for the design of public policy and insurance plans. This research aims to estimate a structural model of health insurance and health care choices, using the 2003 National Household Sample Survey PNAD. It tested whether coinsurance contracts can work as efficient mechanisms to reduce risks related to asymmetric information. A methodological procedure using the Monte Carlo method was proposed to test for asymmetric information issues. The research suggests that coinsurance contracts were beneficial for individual plans, from a social welfare perspective. For the group plans, the benefit was not supported

Orientador: Pedro Luiz Barros Silva / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Economia / Made available in DSpace on 2018-08-21T00:39:58Z (GMT). No. of bitstreams: 1 Viana_JoaoFernandoMoura_D.pdf: 3718637 bytes, checksum: ad94097ee1a7f8323428fbfbaf43b8c1 (MD5) Previous issue date: 2012 / Resumo: Regimes de proteção social de países que vêm apresentando dinâmica de acelerado envelhecimento populacional, possuem sistemas de assistência à saúde público e privado duplicados e competidores entre si e se utilizam do mesmo complexo público-privado médico industrial, necessitam reestruturar o papel do Estado, das Famílias e das Empresas no financiamento do seu sistema de saúde. Mostra-se necessário adotar políticas severas de controle de gastos, aumentar o rigor nos processos de incorporação tecnológica, regular a comercialização de produtos e serviços médicos de alto valor e introduzir mecanismos eficientes de portabilidade dos planos de saúde, visando criar competição, em especial no momento dos reajustes de preços. No Brasil, não se pode mais caracterizar como "supletiva" a atividade dos planos de saúde, o que aponta para a necessidade de revisão da regulação entre o público e o privado no sistema de saúde, uma vez que a concepção original do marco regulatório partia de um sistema supletivo mas que na verdade é duplicado, em termos de suas coberturas, em relação ao sistema público. Do ponto de vista do financiamento, além de aumentar o volume do gasto público através da estruturação de política fiscal adequada ao seu financiamento nos moldes constitucionais, a sociedade deve discutir a ampliação das deduções tributárias dos gastos com saúde para setores empresariais intensivos de mão de obra e para pessoas físicas idosas, facilitando o acesso destes segmentos aos cuidados médicos. Não visa esta medida atender à expansão do mercado de planos de saúde e sim à manutenção da capacidade de pagamento dos atuais beneficiários de planos privados. A não adoção deste conjunto de medidas poderá redundar no esgotamento e colapso da capacidade de financiamento da política de saúde como um todo, um dos pilares dos regimes de proteção social do mundo moderno / Abstract: Social protection schemes in countries showing a rapid ageing population dynamic, and that have public and private health care systems which are duplicate and compete against each other and utilize the same public-private medical industrial complex, need to restructure the role of the State, the Family and the Companies in the funding of its health care system. There is a need to adopt strict policies to control spending, increase the rigor in the processes of incorporating technology, regulate the commercialization of high value medical products and services and introduce efficient mechanisms for health insurance portability, seeking to create competition, especially when it comes to price adjustments. In Brazil it is no longer possible to characterize the activity of health plans as "supplemental", which points to the need to revise the regulation between public and private sectors in health care system, since the original conception of the regulatory framework was based on a supplemental system but is in fact a duplicate in terms of its coverage in relation to the public system. From a financing point of view, in addition to increasing the volume of public spending through the structuring of fiscal policy appropriate to its constitutional funding form, society should discuss the expansion of tax deductions with health expenses for labour intensive business sectors and elderly individuals, facilitating their access to health care. This measure does not seek to meet the needs of the expansion of the health plans market, but rather the need to preserve the ability to pay of current private plans beneficiaries. Failure to adopt this set of measures may result in the exhaustion and collapse of the financing capacity of health policy as a whole, one of the pillars of social protection schemes in the modern world / Doutorado / Economia Social e do Trabalho / Doutor em Desenvolvimento Economico

八零年代起，我國政府即對生技新藥產業寄予厚望，為促使生技醫藥產業成為明星產業，行政院也自1982年起，將生物技術列為國內八大重點科技產業之一，並投入相當大的金額補助產業之發展；至今已歷經35年，卻仍僅極少由台灣本土研發之新藥成功上市。 本研究主要採用文獻探討以及個案訪談作為主要的研究方法，先藉由文獻探討建立起論文整體之架構，之後再透過兩間國內本土新藥研發公司的訪談加以實證。本研究探討衛生福利部中央健康保險署現行之藥價政策對於國內本土研發新藥上市策略之影響，以及《全民健康保險藥物給付項目及支付標準》第17-1條實施後，是否有助於國內本土研發新藥上市的問題，進行深入分析與探討。而可得到以下初步之研究結論： 一、我國政府的鼓勵措施對於台灣的新藥發展之影響 我國政府多以科技專案補助臨床試驗的形式協助國產新藥公司研發新藥。 二、比較在台灣及其他國家研發新藥的鼓勵措施 我國與日本政府皆有提供新藥不同形式之新藥相關加成給付；本研究未發現韓國政府有針對新藥提供相關加成給付措施。 三、台灣健保藥價制度與台灣研發的新藥藥價 1.對新藥開發類型之國產新藥公司而言，期望政府在設定參考藥品之藥價時，可以選擇使用參考藥品之初始藥價作為reference price。 2.對新藥開發類型之國產新藥公司而言，期望在選擇參考藥品時，可以鼓勵創新藥理作用之新藥、跳脫侷限治療相同疾病用藥之思維。 3. 對新藥開發類型之國產新藥公司而言，全民健康保險藥物給付項目及支付標準第17-1條規範參考類似藥品之十國藥價不合理，因為若以台灣為第一上市國，則尚未在其他國家取得藥價，此法規自相矛盾。 四、我國藥品政策與台灣研發新藥上市策略 對新藥開發類型之國產新藥公司而言，健保給付國產新藥之藥價無法符合國產新藥公司期望之藥價，國產新藥公司改採取由病患自費購買藥品的方式銷售。 / Since the 1980s, our government has placed great hopes toward the industry of biotech and new drugs in order to take such industry to a booming stage. The Executive Yuan has also listed biotechnology as one of the eight key technological industries in the country since 1982. Furthermore, large amounts of subsidies have aided the development of this industry. This industry has been in development for 35 years, however, very few new drugs developed by domestic pharmaceutical companies have been launched successfully in Taiwan. This study mainly used literature review and case interview as the main research methods. Firstly, the structural development of the thesis was built on reviewing past literature. Then, the empirical study was conducted through interviews with two domestic new drug research and development pharmaceutical companies. This study examined the impact of the current drug pricing policy of the National Health Insurance Administration on the domestic market for research and development of new drugs. Moreover, the effectiveness of implementation of Article 17-1 of the "National Health Insurance Drug Payment Program and Payment Standards" was investigated in relations to the development of domestic new drugs in the country. In-depth analysis was employed to explore and discuss our research. The following preliminary conclusions were obtained: First, the influence of the government's encouragement measures on the development of Taiwan's new drugs was examined. Results revealed that the government have mainly been funding domestic new drug companies to research and develop new drugs through subsidized clinical trials of technological projects. Second, the encouragement measures for developing new drugs in Taiwan and other countries were compared. Results showed that both Taiwan and the Japanese government have been providing new forms of new-drug-related premiums for new drugs. However, in this study, we did not find the Korean government providing relevant premiums measures for new drugs. Third, we explored the drug price system of Taiwan's national health insurance and the prices of new drugs that were developed domestically. We found that 1) for domestic pharmaceutical companies that specializes in developing new drugs, they anticipate the government to use the initial drug prices of the reference drugs as reference prices when setting the prices of reference drugs; 2) for domestic pharmaceutical companies that specializes in developing new drugs, they anticipate the government to encourage innovations of new drugs leading to new pharmacological effects and overcoming the idea of limiting treatment to the same illness or conditions when they are selecting reference drugs; 3) for domestic pharmaceutical companies that specializes in developing new drugs, under Article 17-1 of the "National Health Insurance Drug Payment Program and Payment Standards", the statement that drug prices should be referenced from ten countries is unresonalbe because prices cannot be obtained from other countries if Taiwan is the first country to launch the new drug. Thus, the regulation is contradictory in itself. Fourth, we examined Taiwan’s pharmaceutical policy and the marketing strategy of new drugs developed domestically. Findings showed that for domestic drug companies that specializes in developing new drugs, when the drug payment provided by the national health insurance does not meet the drug prices set by the new drug companies, these companies employ a strategy that the patient pay for the drugs instead of the national insurance system.

Background: Since 1965, there have not been any major revisions of the healthcare laws in the United States, until the recent implementation of the Affordable Care Act (ACA). However, ACA is not well understood and is often controversial. The purpose of this study is to: (1) evaluate the relationship between the employers’ and the employees’ perceptions regarding the ACA mandates for small businesses, (2) evaluate the relationship between the self-reported and the tested knowledge of individuals regarding the ACA mandates for small businesses, and (3) determine if socio-demographic factors influence individual’s perception of the law. Based on the gathered information, we aim to develop a socio-ecological model of ACA acceptance to address the barriers and facilitators to implementing the new law and recommend changes to address any deficits. Method: An online questionnaire was distributed anonymously to employees and employers of small businesses. The data gathered included information on the participants' knowledge and perceptions on the law and their socio-demographic information. Kendall correlation test, generalized linear regression models and bootstrapping resampling method were employed to detect differences in the perceptions & knowledge of employees and employers, to evaluate the association between self-reported and tested knowledge, and to generate a SEM model of ACA perception and acceptance. Results: Based on the analysis, we found that job status significantly affects the individual perception of the law (p = 0.004). The study showed a statistically significant negative association between the self-reported knowledge and the actual-tested knowledge of individuals (r= -0.4174, p-value of 0.01159). We found that interpersonal level had the highest impact on perception (coefficient of 5.67, p-value0.05). Conclusion: Individual perception is a key factor in adoption of new policies. A socio-ecological model of ACA acceptance can be a powerful tool in addressing the barriers and facilitators to the successful implementation of the new law and to modify the policies to address any deficits in the law.

Since numerous legislative changes in sickness insurance in the Czech and Slovak republics are currently occurring, it is worth to analyze their impact on society. Because of the interconnected evolution of sickness and health insurance, it is essential to look at these changes from a broader perspective. Also health insurance regulation constitutes one of the most debated over legal areas due to its enormous implications on the lives of every single one of us. Certain aspects of health insurance reform in the Slovak republic did not go exactly according to the plan and its results are therefore increasingly met with outrage. The aim of the work is to analyze the most interesting aspects of sickness and health insurance reforms in the Czech and Slovak republics and further identify its positives and weaknesses. Furthermore two alternative concepts of sickness and health insurance regulation are described. The social welfare system in the United Kingdom is briefly introduced and the legal framework of the National Health Service is presented as an alternative to the local concepts of Health insurance. Secondly, after successfully implementing large scale reforms in Health insurance regulation, the Netherlands serve as bright example of a market and patient oriented healthcare system with excellent...

Doctor of Philosophy / Department of Economics / William F. Blankenau / This dissertation consists of three essays on how health and education affect the labor market outcomes of workers. Health and education issues have been key determinants of labor demand and supply. In light of increasing incidence of health problems and the rapid growth of post-baccalaureate certificates in the US, this dissertation seeks to answer questions about labor market outcomes of workers with poor health history and with post-baccalaureate certificates. The first essay which I co-authored with Dr. William Blankenau and Dr. Benjamin Schwab uses a résumé-based correspondence test to compare the employment consequences of an illness-related employment gap to those of an unexplained employment gap. The results of the experiment show that while the callback rate of applicants with an illness-related employment gap is lower than that of the newly unemployed, applicants with illness-related employment gaps are 2.3 percentage points more likely to receive a callback than identical applicants who provide no explanation for the gap. Our research provides evidence that employers use information on employment gaps as additional signals about workers' unobserved productivity. Co-authored with Dr. Amanda Gaulke and Dr. Hugh Cassidy, the second essay tests how employers perceive the value of post-baccalaureate certificates using the same methodology in the first essay. We randomly assign a post-baccalaureate certificate credential to fictitious résumés and apply to real vacancy postings for managerial, administrative and accounting assistant positions on a large online job board. We find that post-baccalaureate certificates are 2.4 percentage points less likely to receive a callback than those without this credential. However, this result is driven by San Francisco, and there is no effect in Los Angeles or New York. By occupation, we also find that there is only significant negative effect in administrative assistant jobs, and there is none in managerial or accounting assistant jobs. A typographical error made in the résumés of certificate holders regarding the expected year of completion of the certificate may also contribute to negative effects of a certificate. Using NLSY79 data, the third essay tests whether the source of health insurance creates incentives for newly-diagnosed workers to remain sufficiently employed to maintain access to health insurance coverage. I compare labor supply responses to new diagnoses of workers dependent on their own employment for health insurance with the responses of workers who are dependent on their spouse's employer for health insurance coverage. I find that workers who depend on their own job for health insurance are 1.5-5.5 percentage points more likely to remain employed and for those employed, are 1.3-5.4 percentage points less likely to reduce their labor hours and are 2.1-6.1 percentage points more likely to remain full-time workers.

Master of Public Health - MPH / The World Health Organisation estimates that more than 50% of medicines are inappropriately used globally. The situation is worst in developing countries such as Nigeria, where irrational prescribing practices account for wastage of resources, catastrophic medicines costs and poor access to health services. In 2005, the Social Health Insurance Programme was launched as a financially sustainable model to achieve cost effective and affordable health care services including medicines. This study investigated prescribing practices and availability of medicines in the Social Health Insurance Programme in accredited public sector secondary hospitals in the Federal Capital Territory, Nigeria.Methodology:The study is a descriptive, cross-sectional and retrospective survey of prescriptions of insured outpatients in the Federal Capital Territory, Nigeria. Four hospitals were selected by stratification of thirteen (13) public secondary hospitals in the territory into urban/peri-urban areas, followed by random selection of two hospitals from each stratum.A total of seven hundred and twenty (720) retrospective prescription encounters of insured outpatients were systematically selected from encounters between July 2009 and June 2010 at the selected facilities. Data on prescribing practices and the extent to which prescribed medicines were provided were assessed with the use of modified WHO/INRUD indicators. Descriptive statistics were generated with Epi-info (version 3.4.3) and SPSS (version 17.0)Results: Out of the seven hundred and twenty (720) prescriptions that were assessed analgesics/NSAID, antibiotics, antimalarials and haematinics/vitamins collectively accounted for 67.4% of the medicines prescribed.A comparison of the results with WHO/Derived reference values showed that average number of medicines prescribed per prescription (3.5 ±1, p<0.001) and the rate of antibiotic prescribing (53.7%, p=0.009) were higher than the WHO recommended ranges of (1.6-1.8) and (20.0- 25.4%) respectively.The use of generic names in prescribing (50.9%, p<0.0009) and medicines prescribed from the Essential Medicine List (74.2%, p=0.05) were considerably lower than the standard (100%) However, the rate of injection prescribing (12.49%, p=0.4) was within the recommended range (10.1–17.0%).The study also found that 85.1%, (p=0.001) of prescribed medicines were dispensed, while 93.4% (p=0.256) of essential medicines were dispensed which was lower than the recommended standard (100%). Overall, only 58%,(p<0.0001) of patients had all prescribed medicines completely dispensed and this was significantly lower than the desired standard (100%.) in social health insurance programmes.Conclusions:The findings of this study show trends toward irrational prescribing practices as characterized by poly-pharmacy, overuse of antibiotics, sub-optimal generic prescribing, as well as poor adherence to the use of NHIS-Essential Medicine List. There was sub-optimal provision of prescribed medicines. These are potential threats to the scheme‟s goal of universal access to health care in the year 2015. Pragmatic multi-component interventions are recommended to promote rational prescribing and improve equity in access to essential medicines.