There is extensive research on the prevalence of college student engagement in risky sexual behaviors and its potentiating factors in college/university settings. However, there remains limited data and study on the use of campus health centers, as well as the patterns of how students seek sexual health care, its relationship to student gender identity, and student engagement in sexual risk behaviors. Despite literature surrounding student health centers and how students seek out medical care, the minimal data in the field regarding campus health center use, if and how students specifically seek out sexual health services, and how this collectively might vary across students with different gender identities, clearly indicate a need for further research on the experiences of students on college campuses in this regard. This dissertation is a secondary data analysis of the American College Health Association-National College Health Assessment III. This study’s specific aims were to: 1) describe key characteristics of students utilizing student health centers 2) describe if and how frequently college students are regularly seeking sexual health services; and 3) evaluate the relationship between a student’s gender identity and engagement in risky sexual behaviors. Drawing on a nationally representative sample of undergraduate students, analyses illustrated that students utilizing health services were primarily heterosexual female undergraduate students, with differing rates of utilization health services and sexual health services depending on race/ethnicity, year in school, and primary source of health insurance.The results confirmed that there are barriers to college student utilization of sexual health services, specifically for students who are non-heterosexual and transgender. Fewer students are seeking out their student health center and are seeking out care from services from other medical locations or may not be seeking out care at all. These findings highlight the need to ensure that student health centers on college campuses are inclusive of all students, regardless of gender identity. Given the important role that campus health center services play in promoting positive health outcomes and reducing sexual risk among its students, universities should consider efforts to increase student health center utilization, as it is a primary source of college student healthcare.

The work deals with the registration of incoming patients to the physician. In the theoretical section summarizes the current technical solutions used in practice to record the waiting clients to provide various services. One chapter is devoted to describing the identifiers occurring in the population. The result is to design a custom solution based on reading data from health care cards.

The impending NHI will cause a disruptive change in the health care industry in South Africa. For that reason the affected firms need to prepare themselves. Furthermore the current stakeholders in the private health care sector are feeling disenfranchised in terms of how the NHI will turn out.The aim of this study was to understand the response of existing firms whose existence is threatened due to impending disruptive change.The research method that was used was qualitative and exploratory in design. It involved one on one semi structured interviews with 13 respondents from a total of 7 firms who were selected to participate in the study, from the following business groups: pharmaceutical firms, private hospitals, and medical distributors.The findings revealed that the majority of firms would respond by strengthening their relations with the government who is the key stakeholder in the NHI. Secondly, they would build capacity in terms of resources and capabilities in line with the NHI. Lastly, they would innovate their value offering in the current market or new markets. / Dissertation (MBA)--University of Pretoria, 2012. / Gordon Institute of Business Science (GIBS) / unrestricted

El acceso a un sistema de salud digno constituye uno de los derechos fundamentales de toda persona, en el Perú se han realizado grandes esfuerzos para mejorar la calidad de los sistemas de salud, es un desafío al bicentenario el brindar un aseguramiento de salud de calidad que pueda alcanzar a todos los peruanos. Este objetivo enfrenta grandes desafíos ya que existen deficiencias en los procesos de las instituciones que brindan servicios de salud, siendo la Aseguradora Pública de Salud uno de los principales actores en el aseguramiento de la salud en el Perú. Nuestra investigación se ha centrado en el proceso de Evaluación Automática (EA), que tiene como objetivo evaluar la validez de las atenciones brindadas por las Instituciones Prestadoras de Servicios de Salud (IPRESS) afiliadas a la Aseguradora Pública de Salud. Durante los años 2017 y 2018 se detectó que el 3.82% y 1.85% del total de atenciones presentaban irregularidades. Estudios hechos a nivel mundial muestran que el nivel de irregularidades en entidades similares se encuentra entre el 3% y el 10% por lo que existe la posibilidad de elevar la capacidad de detección de irregularidades en la citada aseguradora. A través de nuestra investigación hemos identificado que mediante el uso de modelos predictivos construidos mediante la analítica de datos en el proceso de Evaluación Automática (EA), específicamente en la etapa llamada Supervisión Médica Electrónica (SME), se puede incrementar el nivel de detección de irregularidades, para ello es necesario aplicar la metodología CRISP-DM y el software WEKA. / Access to a decent health system is one of the fundamental rights of every person, in Peru great efforts have been made to improve the quality of health systems, it is a challenge for the bicentennial to provide quality health assurance that can reach all Peruvians. This objective faces great challenges since there are deficiencies in the processes of the institutions that provide health services, with the Public Health Insurer being one of the main actors in health insurance in Peru. Our research has focused on the Automatic Evaluation (EA) process, which aims to assess the validity of the health care provided by the Health Services Provider Institutions (IPRESS) affiliated with the Public Health Insurer. During the years 2017 and 2018 it was detected that 3.82% and 1.85% of the total health care presented irregularities. Studies done worldwide show that the level of irregularities in similar entities is between 3% and 10%, so there is the possibility of increasing the ability to detect irregularities in the aforementioned insurer. Through our research we have identified that by using predictive models constructed through data analytics in the Automatic Evaluation (EA) process, specifically at the stage called Electronic Medical Supervision (SME), it is posible to increase the level of irregularity detection, for this it is necessary to apply the CRISP-DM methodology and the WEKA software. / Trabajo de investigación

Regulation of prices and reimbursement of medicinal products Abstract Medicinal products are essentially part of every human life. It is therefore desirable to ensure that they are offered on the market at a fair and affordable price, precisely through price and reimbursement regulation. The aim of this diploma thesis is to analyse how the regulation of prices and reimbursements applies to human medicinal products in the provision of outpatient health care, the price and reimbursement of which is decided by the State Institute for Drug Control in administrative proceedings. In order to achieve this goal, the thesis is divided into four parts. The first part defines the basic concepts needed understand the meaning and purpose of the system of price and reimbursement regulation, such as a medicinal product, price or reimbursement. Furthermore, this part is devoted to the types of administrative acts occurring in the field of price and reimbursement regulation and introduces the Ministry of Health and the State Institute for Drug Control as the most important administrative authorities operating in this field. The second part analyses the legislation effective until 31st December 2007. The forms of administrative activity then performed by the Ministry of Health and the Ministry of Finance are analysed in more...

Little is known about the impact of drug abuse/dependence on health insurance coverage, especially by race groups and income levels. In this study, we examine the disparities in health insurance predictors and investigate the impact of drug use (alcohol abuse/dependence, nicotine dependence, and illicit drug abuse/dependence) on lack of insurance across different race and income groups. To perform the analysis, we used insurance data (8057 uninsured and 28,590 insured individual adults) from the National Surveys on Drug Use and Health (NSDUH 2011). To analyze the likelihood of being uninsured we performed weighted binomial logistic regression analyses. The results show that the overall prevalence of lacking insurance was 19.6 %. However, race differences in lack of insurance exist, especially for Hispanics who observe the highest probability of being uninsured (38.5 %). Furthermore, we observe that the lowest income level bracket (annual income <$20,000) is associated with the highest likelihood of being uninsured (37.3 %). As the result of this investigation, we observed the following relationship between drug use and lack of insurance: alcohol abuse/dependence and nicotine dependence tend to increase the risk of lack of insurance for African Americans and whites, respectively; illicit drug use increases such risk for whites; alcohol abuse/dependence increases the likelihood of lack of insurance for the group with incomes $20,000–$49,999, whereas nicotine dependence is associated with higher probability of lack of insurance for most income groups. These findings provide some useful insights for policy makers in making decisions regarding unmet health insurance coverage.

In the first chapter of this dissertation, I ask what role bank presence plays in improving health of households. To explore this question, I use a policy of the Reserve Bank of India from 2005 that incentivizes banks to set up new branches in underbanked districts, defined as having a population-to-branch ratio larger than the national average. In a regression discontinuity design, I compare households in districts just above and just below the national average. Six years after the policy introduction, households in treatment districts are a third less likely to be affected by an illness in a month. They miss fewer days of work or school due to an illness and have lower medical expenses. Ten years after the policy was introduced, I observe persistently lower morbidity rates, higher vaccination rates, and lower risks associated with pregnancies. I provide evidence that two previously understudied aspects of banking contribute to the effect: households gain access to health insurance and health care providers gain access to credit. In equilibrium, I observe an increase in healthcare demand and supply. In the second chapter of this dissertation, co-authored with Naz Koont, we provide first empirical evidence that consumer peer effects matter for banks’ deposit demand. Using a novel measure that depicts for each county how exposed peers are to a specific bank in a given year, we tightly identify the causal effect of peer exposure on deposit demand through a fixed effects identification strategy. We address key empirical challenges such as time-invariant homophily. We find that a one percent increase in a bank’s peer exposure leads to a 0.05 percent increase in deposit market share. This effect has become stronger over time with the rise of the internet and social media, which facilitate cross-county communication. Peer exposure is especially relevant for smaller banks and customers that have access to the internet.

Magister Legum - LLM / In South Africa, there are two health systems through which health services are delivered,1 namely private and public. These two systems were inherited from the apartheid regime.2 With South Africa’s political change from a system of parliamentary sovereignty to a constitutionally supreme system in 1996, huge changes were bound to come including changes to the health sector.3 This meant the overhauling of health legislation, as the right of access to health care services became guaranteed in the Constitution of the Republic of South Africa, 1996.4 In 1997, the White Paper on the Transformation of the Health System (White Paper on Health)5 was introduced with the aim of developing a national health system.6 There has been a lot of progress made in reforming the health sector, however there are still many cracks that the national government aims to remedy through the realisation of universal health coverage (UHC).

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Background: Bariatric surgery is the most effective treatment for severe obesity, resulting in much larger and longer-lasting weight loss compared with those seen with other treatment options. It also results in significant improvements in several weight-related comorbidities. Despite these favorable outcomes, bariatric surgery remains underused in the United States. Objective: The goal of this dissertation was to investigate the impact of insurance-related factors on the access and utilization of bariatric procedures. The goal was achieved via three studies. The first study examined temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in Southeastern Pennsylvania, as well as the associations between payer type, insurance plan type, cost-sharing arrangements (among traditional Medicare beneficiaries), and bariatric surgery utilization. The second study investigated whether there is an association between precertification criteria, such as 3-6 months preoperative supervised medical weight management (MWM), and documented 2-year weight history and the likelihood of undergoing bariatric surgery. The third study examined whether there is an association between insurance-mandated MWM requirement, as well as cardiology and pulmonology evaluations and short-term inpatient healthcare utilization. Data Source: Pennsylvania Health Care Cost Containment Council’s (PHC4) databases in Southeastern Pennsylvania during 2014-2018. Study Population: In Study 1, all adult patients in the PHC4 dataset who underwent the most common types of bariatric surgery during 2014-2018 (N = 14,348) and a 1:1 matched sample of surgery patients and those who were eligible for surgery but did not undergo surgery were identified. In Study 2, privately insured patients within the PHC4 dataset who underwent bariatric surgery in 2016 and individuals who met the eligibility criteria but did not undergo surgery were identified and 1:1 matched (N = 1,054). The population of Study 3 consisted of all adult patients within the PHC4 dataset with a diagnosis of severe obesity who underwent the most common bariatric surgical procedures in 2016 and for whom the insurance-mandated precertification requirements were known (N = 2,717). Results: Over the five years, there was an increase in the proportion of Black individuals (37.1% in 2014 vs 43.0% in 2018), Hispanics (5.4% vs 8.0%), and Medicaid beneficiaries (18.5% in 2014 vs 26.9% in 2018) who underwent surgery. The odds of undergoing bariatric surgery based on payer type were statistically different (22% smaller odds) only between Medicare beneficiaries compared to privately insured individuals. There were significantly different odds of undergoing surgery based on insurance plan type within Medicare and private insurance payer categories. Individuals with traditional Medicare plans with no supplementary insurance and those with dual eligibility had smaller odds of undergoing surgery (42% and 32%, respectively) compared to those with private secondary insurance. The insurance requirement for 3-6 months MWM was associated with smaller odds of undergoing surgery (odds ratio [OR] = 0.459, 95% confidence interval [CI] 0.253 to 0.832, P = 0.010), after controlling for insurance plan type and the requirement for documented weight history. The documented weight history requirement was not a significant predictor of the odds of undergoing surgery (P = 0.132). The requirement for MWM, as well as pulmonology and cardiology examinations, were not associated with the patient length of stay, the number of all-cause rehospitalizations, and the number of all-cause rehospitalization days, after adjusting for patient age, sex, race, ethnicity, the Elixhauser Comorbidity Score, type of the surgery, facility where the surgery was performed, primary payer type, and the estimated median household income. The absence of the precertification requirement for pulmonology and cardiology evaluations was associated with smaller odds of rehospitalizations with common cardiac and pulmonary conditions during the study period, (OR = 0.43, 95% CI 0.23 to 0.80, P = 0.008), after controlling for patient age, sex, race, ethnicity, estimated median household income, and the Elixhauser Comorbidity Score. Conclusions and Significance: Medicaid expansion in Pennsylvania appears to have improved access to bariatric surgery among Black and Hispanic individuals. Nevertheless, insurance plan type, cost-sharing arrangements, and precertification requirements, such as insurance-mandated 3-6 months of MWM requirement, remain key determinants for the access and utilization of bariatric surgery. Additionally, the MWM requirement, as well as the preoperative cardiology and pulmonology evaluations, were not associated with a reduction in inpatient healthcare utilization during the first postoperative year. Careful examination of the bariatric surgery benefit design and application of value-based insurance design to bariatric surgery may improve the access to this potentially life-saving surgery for many Americans. / Public Health