This diploma thesis analyse economy of chosen Czech health insurance companies and the impact of a factor of demographic structure. Main part of the thesis is an analysis of economy of health insurance companies. The thesis is divided into four parts. First chapter represents theoretical base for analysis as a whole and describe health system and subjects, which take place there. Second chapter is focused on selection criteria to choose insurance companies, which are subjects to investigation and their short introduction. In the third and the central part of the work are used theoretical knowledge got from health regulation or books, especially information took from annual reports and bases institutions as ÚZIS or ČSÚ. In the final part is made evaluation of information learned and their further use.

Analysis of current russian legislation regarding health insurance. Detailed overview of russian private health insurance market. Comparison with foreign health insurance systems.

This thesis on the topic "Insurance of pilots and cabin crew" deals with one of the professional groups of insured which in this case are pilots and cabin crew - the frontline staff on board of a commercial aircraft. It characterizes risks associated with these types of profession and possible ways of their elimination by insurance with a particular focus on health and travel insurance. The last chapter of this work also analyzes an offer of travel insurance suitable for pilots and cabin crew and it refers to exceptions from insurance claims related to the performance of these jobs.

The thesis is primarily oriented on economic aspects of health systems. It contains the analysis and description of health risks, health-insurance systems (models) and current status of Czech health system. Czech health system is described and scarified. Analysis of weak points, status of reforms and also a design of possible solutions are integral parts of this thesis. Both public and commercial approaches to health and insurance systems are involved, including current commercial insurance products which are available on Czech market.

The health care industry is undergoing significant change, particularly with the passage of the Patient Protection and Affordable Care Act in March of 2010. Using the Rokeach Value survey, the value priorities of the insured and uninsured respondents were assessed. The value priorities were also evaluated for the demographics of gender, ethnicity, education, income, and age group. The terminal value of health was culled out as a moderator variable relative to its influence in the decision to seek health care coverage. The most significant contribution of this study reveals an increased understanding of consumer value preferences and demographics and their influence on health care coverage choices. In turn, it advances personal value theory in a health care context and its implications to behavior and decision-making. The results establish the role of health as a significant moderator variable in the decision process. These findings reveal a multitude of insights, not only for the academic researcher, but for practitioners and policymakers alike who are commissioned to execute the new health care reform bill over the next several years. As health care reform is implemented over the next several years, a combination of legislative and market-based solutions will be necessary to curtail the rising number of the uninsured, and ensure there are parity, equity, and morality in the distribution of health care for all Americans.

Cette thèse étudie deux facteurs majeurs pour le bien-être individuel, la qualité de l'emploi et l'accès aux soins. Dans le premier chapitre, nous étudions l'effet de la perte d’emploi suite à une fermeture d’usine sur un large panel d’indicateurs mesurant la qualité de l'emploi retrouvé. Nous utilisons une stratégie d’appariement exact par tranche qui prend en compte les inobservables fixes dans le temps. Nos résultats principaux montrent une dégradation de la qualité de l’emploi suite au licenciement, dont la durée et l’ampleur dépendent de la dimension considérée. Le second chapitre étudie l'impact d'une assurance maladie publique plus généreuse sur la consommation de soins de santé. Nous utilisons la coexistence de deux systèmes d'assurance maladie en France, tous deux publics et obligatoires : le système national, et le régime local d'Alsace Moselle, donc les taux de remboursement sont plus élevés. Nous évaluons comment les personnes déménageant en Alsace Moselle modifient leur consommation de soins, en utilisant les personnes déménageant entre d’autres régions françaises comme groupe de contrôle. En étudiant plusieurs postes de santé, nous trouvons qu’au total, le régime d’Alsace Moselle n’engendre pas de hausse des dépenses. Le dernier chapitre s'intéresse à l'effet de l'achat groupé sur les prix des médicaments dans les hôpitaux français, en utilisant les créations de groupements entre 2009 et 2014. Nos données contiennent les prix d’achat des médicaments innovants dans les hôpitaux publics. Nos résultats montrent que l'achat groupé baisse les prix des médicaments en oligopole, mais n'a aucun impact sur les prix des médicaments qui n'ont pas de concurrents. / This thesis focuses on two major aspects of individual well-being : job quality and the availability of medical care. We first investigate the long-term effects of job displacement on several dimensions of job quality. We use a coarsened exact matching method that takes into account time-invariant unobservables. Our main findings point to a deterioration of job quality after displacement. The magnitude and duration of the observed negative impact depends on the dimension considered. The second chapter studies the impact of a more generous public health insurance. We use the coexistence of two compulsory public health insurance systems in France, the national system, and the Alsace Moselle local system, which offers higher reimbursement rates. We investigate how moving to Alsace Moselle affects healthcare consumption, taking individuals who move between other French regions as a control group. Overall, we show that the Alsace Moselle local system does not increase healthcare consumption. The third chapter estimates the impact of group purchasing on medicine prices in French hospitals. We take advantage of the creation of regional purchasing groups between 2009 and 2014. We use a unique database that provides information on the average annual prices paid by public hospitals for all innovative medicines. Using a fixed effects model controlling for medicine-specific bargaining abilities of hospitals and medicine-specific price trends, we find that group purchasing reduces prices of medicines in oligopoly markets, but has no impact on prices of medicines for which there exist no competitors.

Objective: The objectives of the study were to determine General Practitioners' attitudes to National Health Insurance (NHI) and to capitation as a mechanism of reimbursement. The study also aimed to explore determinants of these attitudes. Design: The methodology utilised a cross-sectional survey using telephone interviews and four focus group discussions. Setting: The study area was the Cape Peninsula area in the Western Cape Province of South Africa. Participants: 174 general practitioners (GPs) were randomly sampled from a total population of 874 GPs in the Cape Peninsula area. Main outcome measures: The main outcome measures were GPs' acceptance of NHI and of capitation as a method of reimbursement. Main results: Sixty three percent of GPs (63,3%) approved of NHI. More than 81 % approved of NHI if GPs were to maintain their independent status, for example their own premises and working hours. Eighty two percent (82,3%) said NHI would be a more equitable system of health care than the system that existed at that time, 88% approved of the fact that NHI would make care by GPs more accessible and 73% said they had the capacity to treat more patients. However, 61,3% of GPs disapproved of capitation as a form of reimbursement. The most common conditions cited by GPs for support of NHI were retention of professional autonomy, fee for service reimbursement and adequate levels of reimbursement. Conclusions: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, approval of NHI is to some extent conditional to details of the NHI system, such as payment mechanisms, workload, income and effects on professional autonomy. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI in South Africa requires serious consideration by policy makers. While this research demonstrates broad ideological and conceptual support for some form of NHI or SHI, further research is required to provide more detailed quantitative information on the trade-offs that GPs would be prepared to make for them to support the introduction of a new socially based insurance system. A national survey of medical practitioners is recommended.

Philosophiae Doctor - PhD / This study is a philosophical analysis of the National Health Insurance (NHI) policy and legislation, including the related NHI Fund, with a view to assessing its prospects in realising Universal Health Coverage (UHC). The NHI system is about ensuring universal access to quality healthcare for all. The rationale is to provide free healthcare for all at the point of care/service. This legislation has the potential to transform, on the one hand, the relationship between the public and private healthcare sectors and, on the other, the nature of public funding for healthcare. Part of the challenge with the NHI system is that it seeks to provide healthcare for all, but by seeking to integrate the private sector it runs the risk of commercializing healthcare. The study is philosophical in that it holds that ideas have consequences (and conversely actions have presuppositions with certain meanings). In part, it aims to show that an implementing mechanism of the NHI system as presently envisaged has socio-political and economic implications with fundamental contradictions within it; for it seeks to incorporate the private healthcare sector in offering free public healthcare services. This introduces a tension for private healthcare services operate with a neoliberal outlook and methodology which is at odds with a public approach that is based on a socialist outlook. The analysis may make explicit conceptual and ideological tensions that will have practical consequences for healthcare. Much of the commentary on the NHI system have focused on the practical consequences for healthcare; my intervention is to explore and critically assess the various philosophical assumptions that lie behind these practical concerns. Some of these practical consequences are related to the possibility that healthcare is likely to become commercialized and the public healthcare sector will remain in a crisis. This study argues for the provision of access to high quality healthcare facilities for all members of the South African population. Healthcare must be provided free at the point of care through UHC legislation or by the setting up of the NHI Fund as financing mechanism. The study provides reason for the decommercialization of healthcare services completely – that is for eliminating private healthcare from contracting with the NHI Fund. Essentially, it argues for the claim that healthcare should not be traded in the market system as a commodity and that the NHI system in its current incarnation seeks to do precisely that. I further argue that in theory and in practice the neoliberal and socialist assumptions underlying the NHI system in its present formulation do not fit together. On the contrary, rather than a two-tiered system incorporating the private and public healthcare sectors, the dissertation argues for a different way of conceptualizing the NHI system that privileges the latter.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13363号 / 論医博第2205号 / 新制||医||1045(附属図書館) / (主査)教授 妹尾 浩, 教授 今中 雄一, 教授 川上 浩司 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Numerous studies have shown that consumers react imperfectly to changes in health insurance coverage. To justify consumer valuation in health insurance decision-making, I use Medical Expenditure Panel Survey (MEPS) data and conduct three studies to examine consumer’s private information in health insurance decision-making under a conceptual framework of consumer perception, which potentially is informative about Affordable Care Act (ACA) Health Insurance Marketplace consumer behavior. In the first study, I examine the joint role of individual preferences and health risk in two types of insurance decision-making: the probability of being insured and the probability of employment-based insurance if insured. Using logistic regression, I find that the healthier and wealthier consumers tend to have more positive attitudes towards health insurance and thus are more likely to be insured. The effects of health risk measures vary largely in insurance decisions conditional on different preference measures and preference levels. In the second study, I investigate insurance coverage bundle choices with multi-dimensional private information in an artificially created market setting. I adapt the approach developed by Lokshin and Ravallion (2005) and conduct logistic regression modeling to estimate the reduced forms for coverage bundle choice and consumer attitude respectively. Predicted linear indices for consumer attitude and coverage bundle choices are calculated separately, then their correlation coefficients are compared. In this study I find that consumer attitude plays a dominating role in health insurance decision-making, suggesting that risk preferences may internalize health risks and influence insurance purchasing decisions. To further explore consumer perceptions within an individual’s personal system of decision rules, in the third study, I construct coverage bundle choices in an order from the least complete to the most complete, and examine the effect of consumer perceived plan quality to coverage bundle choice decisions. I use the generalized ordered logit method and a Bayesian learning process for the analysis. I find that coverage bundle choice decisions are value-based, for which perceived plan quality plays a significant and persistent role. The study results also have important policy implications to enhancing consumer engagement and optimizing health insurance management to provide high quality care to health insurance beneficiaries.