This ethnography explores the varied contours of a national health care system and how it is used in conjunction with traditional forms of health care in Toledo District, Belize, focused on the largest town of Punta Gorda (P.G.), In a medically plural environment, a variety of health care options are used based on a wide range of social, economic, and structural factors that shape people's choices and decisions. The convenience of and experience with low-cost home- and self-care options make these the most common first choice during an illness event in P.G., however a deeper exploration of health behavior reveals that people will exhaust all options in their quest for health. In an era when neoliberal trends have a direct effect on people's lives, including a negative impact on health and well-being, Belize stands out as an interesting case. The small Central American/Caribbean nation has taken actions that appear to be contradictory to broader neoliberal policies that encourage privatization of government services, by implementing a national health care system that provides low-cost and free health services to its citizens. While new health facilities have been opened, and health services have become more widely available throughout Belize, an analysis of how and why the health care system functions shows that such programs may actually function as mechanisms of control and surveillance, thus aligning with neoliberal aims such as decentralization and privatization of services. As it has been implemented in southern Belize, the national health care system also replicates and extends an historic trend of marginalization and neglect to the region, showing that from the perspective of the State, and by extension, the powerful and elite of the nation, the citizens of P.G. are seen as less deserving of the quality of health care services that are necessary to lead healthy and productive lives.

The aim of this thesis is to investigate ways of assessing economic efficiency of outpatient health care providers. It analyzes feasibility of employment of risk-adjustment and profiling in the Czech Republic using administrative data reported to health insurance company in the field of otorhinolaryngology. First, the thesis provides an overview of economic profiling methods. Out of these, indirect standardization of costs with risk-adjustment on patient level was used in the empirical part. Next, methods addressing specific problems of health care data (in particular, skewness, excess of zero values and non-negativity) are explored. Using OLS on logarithms on positive part of the distribution, three representations of costs were estimated, based on selected risk-factors. Several patient factors proved significant in final models (specifically, age, gender, number of hospitalizations, region of residence and chronic conditions asthma, COPD and depression), however, the quality of the model is extremely poor. Reasons for dissatisfactory fit of models are various. We conclude that data-selection process is not appropriate to perform economic comparison. And care of outpatient otorhinolaryngology is extremely specific to be captured by information provided. Still, profiling of providers is performed...