Changes in American healthcare over the last half century have created social and economic crises, presenting challenges for doctors and patients. The recently-implemented Patient Protection and Affordable Care Act is an incremental reform that does little to change the complex multi-payer financing characterizing American healthcare. There have been growing demands for more equitable financing arrangements, notably, a single-payer healthcare system in which medical care is financed through a single, non-profit payer and in which medical care is treated as a public good and medically-necessary care is available to everyone. Nationally-representative surveys have demonstrated widespread physician support for single-payer legislation. Yet, very little scholarship has examined physician activism and virtually no studies have examined physician activism for single-payer healthcare. It is important to examine physician activism for single-payer because their participation is considered fundamental to achieving the goals of the movement. If the movement is successful in implementing single-payer financing , more efficient use of healthcare resources will ensure that all residents have access to needed medical care without being saddled by financial burdens from their care. Oregon is one of several US states with a growing grassroots movement to enact single-payer healthcare at the state level. This study seeks to examine the determinants of collective action for physicians in the Oregon movement for single-payer healthcare by answering two research questions. First, what accounts for differences in activism among physicians who support single-payer healthcare system? And second, for those physicians who are active, what activities do they do and what shapes those choices of activities? Data includes 21 semi-structured interviews with physicians around the state of Oregon supplemented with participant observation data. The interview data was analyzed using techniques from grounded theory and thematic analysis. I find that among collective action theories, collective identity theory best accounts for whether or not a physician engages in single-payer activism. A strength of collective identity theory is that it brings to light the importance of subjective interpretations of structural conditions by movement actors. The findings suggest that differences in interpretation shape the influence of motivators for and barriers to an individual's decision to engage in activism. Physicians that become active are primed to engage in single-payer activism because of their moral value sets and frustrating work experiences. They seek out groups of like-minded physicians who then are part of the process of socially-constructing a collective identity. This collective identity is emotionally-laden, is a reaction to state policies, serves to distinguish insiders from outsiders, and facilitates activism. Activist physicians engaging in the process of collective identity come to believe that altering financing is the only way to solve healthcare system issues. The activists view the political and cultural barriers to single-payer as surmountable by their activism. In contrast, non-activists interpret structural conditions like American politics and American culture as immutable barriers that will prevent the attainment of single-payer at the national or state level. In addition, non-activists lack the collective identity activists share because their beliefs contradict key beliefs of activists. The combination of the lack of collective identity and the perception of immutable barriers results in their non-participation.

The purpose of this project was to improve support for victims of domestic violence. To that end, this project developed an evidence-based program to provide information about domestic violence including safe and confidential ways to seek assistance, rights as cohabiting intimate partners, and the resources available to community members. Several approaches were used to develop, validate, and plan for implementation and evaluation of this program, which was developed for 3 sites in Broward and Miami-Dade counties where the project is situated. The program logic model and the social ecological model, including the individual, relationship, community, and societal levels, were used to guide this project. In addition, scholarly works from 2000 to 2013 were selected from ProQuest, CINAHL, Ebscohost, Medline, and Ovid Nursing Journals to develop this program in collaboration with an interdisciplinary team of 7 community stakeholders including a physician, advanced practice nurse, law enforcement officer, pastor, and 3 recovery center directors with knowledge in these areas. Content validation involved incorporating feedback from the project team. The target population for the project includes women and men aged 18 or higher who have experienced domestic violence, homelessness, and drug addiction. Community operationalization of the initiative will be facilitated by implementation and evaluation plans developed as part of this project. The project includes community education that may help organize events and campaigns, increase domestic violence awareness among community members, and influence policy regarding issues pertaining to domestic violence.

"April, 2004." / Includes bibliographical references. / 2 v. : ill (some col.), photos ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Seeks to make visible some of the effects on nursing practice and the nursing profession of the political and organisational changes in the New Zealand health reforms in 1995. / Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2004

Thèse (M.A.)--Université Laval, 1999. / Comprend des réf. bibliogr.

Background: As in the rest of the world, cancer has been a leading killer in Hong Kong. Though technology has been growing rapidly, expensive cancer treatments have continuously been problematic to patients and their families. There are some known risk factors that make some people have a higher risk for cancer than others, but the reason why some develop cancer and some do not is mostly still unknown. In addition, the expensive cancer treatments can distress patients and their families psychologically during the painful and long chemotherapy process which is a common cancer treatment. While it is important for experts to research on effective cancer treatment, it is also important for the government and health care experts to solve associated financial problems. In response to help patients to ease their financial burden of expensive medical treatment, the Hong Kong government has proposed a new health protection scheme (HPS), “My Health, My Choice.” Objective: In this paper, a systematic review on different published literatures is conducted to analyze the prospective outcome of HPS and if it can help patients to ease their financial burden. Results and Discussion: The Health scheme provides a financial aid option for patients who suffer from chemotherapy through monthly premium. However, the implementation of this HPS seems to be difficult both on the patients’ and the providers’ sides. Case study of health care systems in US and Canada is included in this paper to find out what Hong Kong can learn from other countries with completely different payment systems would manage to deal with this problem. Australia which with a universal coverage health care system has also proposed a similar HPS plan aiming to help lower health care cost by increasing individual responsibility on medical expenses. However, it failed by lack of support from the general public. The Australian example would be used to criticize some essential elements that would contribute to the failure of the HPS, and how Hong Kong would use this example to yield a better proposal. Conclusion: As HPS might not be able to ease the burden on cancer patients in Hong Kong, it is suggested for government to allocate more effective and direct resources on helping cancer patients, especially those who are receiving chemotherapy or improve services through better primary care. However, the final outcome remains unknown, and the final option still depends on the ultimate need from the general public. / published_or_final_version / Public Health / Master / Master of Public Health

University of Macau / Faculty of Social Sciences / Department of Government and Public Administration

The primary health care (PHC) institution has a core value in comprehensive health care systems. PHC have been presented as an effective resolution in improving health care, because it is associated with the better health outcomes, lowers health care costs and is related to a greater equity in health. PHC institution was newly established in Lithuania in 1992, when the health care reform was started. Family physicians were retrained from district doctors (pediatricians and internists) or graduated family medicine residency. The recent years have been challenging for Lithuanian family medicine institution. This is the first national study, which evaluates changes in the task profiles and workload of family physicians ten years after the beginning of PHC reform in Lithuania. It provides new information about the differences and similarities in the services of retrained district physicians and physicians after family medicine residency. First time was evaluated family physicians’ satisfaction at national level: are they happy with new role? The study is exceptional because it combines data from patients and their family physicians and gives insight into the attitudes of PHC services users, an important indicator of the quality of health care. Aim of the study: to evaluate changes in family physicians’ task profiles and job satisfaction, and to assess patients’ attitudes towards PHC during ten years of PHC reform in Lithuania. Objectives of the study: 1. To evaluate and... [to full text] / Pirminei sveikatos priežiūrai (PSP) šiuolaikinėje sveikatos priežiūros sistemoje skiriamas ypatingas dėmesys, nes šios institucijos plėtojimas gerina visuomenės sveikatą, paslaugų prieinamumą bei mažina sveikatos sistemos išlaidas. Šeimos gydytojai Lietuvoje nuo 1992 metų pradėti ruošti dvejopai: dalis jų buvo perkvalifikuojami iš apylinkės gydytojų (terapeutų ir pediatrų), kita dalis buvo ruošiama stacionarinėje šeimos medicinos rezidentūroje. Neabejotinai pastarieji PSP reformos metai buvo iššūkis tiek visuomenei, tiek šeimos medicinos institucijai. Tai pirmasis nacionalinis tyrimas, kuriame vertinti šeimos gydytojų veiklos apimčių, darbo krūvio pokyčiai vykdant PSP reformą per dešimtį jos metų. Tyrimo rezultatai atskleidžia šeimos gydytojų baigusių stacionarinę rezidentūrą panašumus ir skirtumus su šeimos gydytojais, persikvalifikavusiais iš apylinkės gydytojų. Pirmą kartą Lietuvoje šeimos gydytojų buvo klausiama, ar jie patenkinti savo darbu? Be to, tyrimo metu vienu mtu buvo apklausiami ne tik šeimos gydytojai, bet ir jų pacientai, kurių nuomonė labai svarbi vertinat sveikatos priežiūros paslaugų kokybę. Darbo tikslas: nustatyti šeimos gydytojų veiklos apimtis, jų nuomonę apie darbą ir įvertinti pacientų požiūrį apie pirminę sveikatos priežiūrą per pirminės sveikatos priežiūros reformos dešimtmetį. Tyrimo uždaviniai: 1. Nustatyti ir palyginti apylinkės ir šeimos gydytojų darbo krūvį, veiklos apimtis ir jų pokyčius. 2. Palyginti šeimos gydytojų nuomonę apie jų darbą ir... [toliau žr. visą tekstą]

The development of health systems in sub-Saharan Africa has been seriously challenged in the last two decades by the rise of HIV/AIDS. In this thesis I argue that the interface between health policy and HIV/AIDS in South Africa is poorly understood and that this has been to the detriment of fairly radical health care reforms as well as more general health systems development. The research problem outlined above is two-fold, requiring different types of enquiry and analysis. Firstly, there is a gap in our understanding of the impact of HIV/AIDS on health systems. Empirical evidence is presented from research on health facilities and health management structures in Ugu district, KwaZulu-Natal to address this concern. Secondly, it is asserted that our limited understanding of the impact of HIV/AIDS and the nature of the epidemic have prevented a true appreciation of its significance for health policy. This dimension of the problem is addressed through an analysis of South African health policy from 1994 through to the present, as well as a more theoretical look at the potential future influence of the antiretroviral therapy programme on the health system. Both quantitative and qualitative methodologies are employed in this research to acquire empirical insights. Health service utilisation trends are assessed retrospectively by quantitative analysis of key indicators from district and provincial information systems. Meanwhile, the prospective component of the quantitative research can best be described as repeat cross-sectional surveys of a selection of health facilities in Ugu district. These surveys capture data on the profile of patients seeking care and the resource requirements for managing these patients. Qualitative methodologies (predominantly semi-structured interviews) are used at facility level to gain insight into human resource issues and at the management level to better understand health system functioning in relation to HIV/AIDS. One would expect the increasing HIV prevalence and burden of AIDS illness in South Africa to translate into a higher demand for health care. However, this has not occurred in Ugu district, largely because of difficulties with access to care. Despite this, at lower level health services, namely clinics and district hospitals, HIV-related service provision has outpaced an increase in resources. Specifically, the introduction of the antiretroviral therapy programme and the decentralisation of a range of HIV/AIDS services are causing new strains on the system. In essence, the epidemic has created a need to address barriers to accessing care and to expand support for district health services. HIV/AIDS not only increases the demand for health care, but on the supply side erodes the capacity of the health system to deliver care. My research demonstrates that health care workers in KwaZulu-Natal are being severely impacted by the epidemic, with the nature of their work contributing to both their susceptibly and vulnerability. Not only is HIV/AIDS increasing absenteeism and attrition through escalating morbidity and mortality, but it is also working in more subtle ways to contribute to a range of 'push' factors driving health workers from the public health sector. None of these issues have been addressed because of the narrow definition of 'human resource management', despite the obviously heightened need to monitor attrition trends and develop creative retention strategies. My research looks not only at the impact of HIV/AIDS impact on health services in Ugu district, but also at the impact of the epidemic on higher levels of the health system which constitute management structures. At these levels, the health system is challenged by an urgency to deliver HIV/AIDS services, as well as an increasing involvement of donors and partners such as civil society organisations or faith based organisations. This has resulted in trends towards more centralised control of planning and management and, in some instances, a deflection of resources towards HIV/AIDS issues and programmes. This context has called for a strong focus on capacity development and means to ensure the integration of health programmes. Many of the trends in Ugu district demonstrate the insidious nature of HIV/AIDS impact and give some insight into why these trends have not been adequately addressed by South African health policies. My analysis suggests that despite the appropriateness of the overarching direction of health reforms, some concerns arising from the HIV/AIDS epidemic have received little attention. These include a need to: 1) manage human resource impacts, 2) develop home community based care and establish a continuum of care, and 3) lead and direct the involvement of donors and partners in the health sector. On the other hand, there have been some beneficial policy developments, such as the elimination of user fees for certain services and the attention paid to the way in which a focus on HIV/AIDS care can potentially weaken the health system. Unfortunately, in many instances HIV/AIDS has also widened the gap between policy and implementation and opportunities have been missed to develop the health system in an appropriate manner. The South African antiretroviral therapy programme, launched in 2003, is a source of uncertainty regarding the future development of health policy in the country. My analysis makes use of scenarios to explore the potential future impact of the programme. I consider the ways in which the programme is steering us away from our post-apartheid vision of an equitable and well functioning national health system and towards 'AIDS exceptionalism'. I look to Botswana, the first country in southern Africa to provide antiretroviral therapy in the public health sector, for early lessons as to what we might expect. My case study of this programme suggests that HIV/AIDS care can be integrated with time, so limiting damage to the development of fragile health systems. Only through ongoing reassessment of the South African situation will it become apparent whether such lessons are transferable. Nonetheless, forward thinking should allow us to move from a crisis-orientated response to one that is more strategic. This thesis concludes with four key messages (or recommendations) emerging from both the empirical research and the health policy analysis. Firstly, there is a clear need to establish systems that can provide comprehensive and timely information concerning the impact of HIV/AIDS on public health services. Secondly, trusting relationships have to be built between academics/researchers and health policy makers so that research informs policy. Thirdly, there is a need to (re)establish a shared vision of the national health system and maintain a focus on achieving this vision. Finally, priority programmes and resources allocated to these must be used to strengthen our national health system in creative ways. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

Nearly 11 million deaths in 2012 can be attributed to ischemic and hypertensive heart disease, stroke, and diabetes. Yet, these diseases are highly preventable and even treatable via improvement in nutritional intake and physical activity. From a public health perspective, primary care providers have promising and population-wide potential for modifying patient behavior to reduce dietary risk factors. However substantial socio-structural barriers prevent physicians from applying nutrition to improve patient outcomes. In my thesis, I first examine the epidemiological context in both the populations of United States and Switzerland. I then elucidate the importance and context of the application of nutrition knowledge in primary care based on the ideologies of holistic, patient-centered health. Then, I identify and analyze the obstacles physicians face in applying nutrition in patient care, as well as the sociological structures in which these barriers arise. Lastly, I set forth models of progress to improve patient outcome via reformed and restructured application of nutrition in primary care, using studies of exemplary strategies for addressing these barriers to nutrition counseling.

<p>This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.</p>