The Patient Protection and Affordability Act of 2010 (PPACA) addressed the access to healthcare in the United States. One of the problems of this healthcare access was rooted in disproportionally lower access among minority populations. The purpose of this quantitative study, guided by the consumer behavior theory, was to examine the association between race/ethnicity and enrollment within the Covered California-?¢ (CoveredCA) Insurance Exchange. A cross-sectional study design was used to investigate the association between race/ethnicity and the use of Covered CA health benefit exchange. Logistic regression analysis was used to examine the relationship between enrollment and race/ethnicity, having adjusted for covariates of age, gender, and literacy. The results revealed that, while all other race/ethnicity groups were less likely to purchase Bronze level versus Silver and above coverage compared to the Hispanic race/ethnicity, Asians (OR =1.16, 95% CI: 1.11, 1.20) and Whites (OR = 1.12, 95% CI: 1.02, 1.14) were more likely to purchase Bronze level versus Silver and above coverage compared to the Hispanic group. Chi-square test results indicated a statistically significant difference in the proportion of individuals selecting the Bronze level coverage compared to the Silver and above among the various race/ethnicity groups ï?£2 (13, N= 763,531), 1922.083, p < 0.0001. The Hispanic race/ethnicity was more likely to enroll in the Bronze versus Silver and above compared to other race/ethnicities. The results of this study may contribute to positive social change by informing policy that besides income and age, race/ethnicity is an important determinant of the likelihood of enrollment in the Covered CA health exchange.

The thesis is focused on the health insurance benefits abuse. Generally there is not paid so much attention to this topic but there is a big rise of recovered and proved cases. The theoretic part is divided into nine subchapters describing the subject of social security and its conception in the Czech Republic with an explanation of historical development. Then the theoretic part deals with just health insurance and particular kinds of benefits. In the last subchapter this thesis occupies with international organizations in the field of human and social rights and briefly discusses also about a system of health insurance in some European countries. The practical part describes the research itself which was made by strategy of qualitative research by a technical analysis of documents. The research sample is formed by data and figures in the whole republic, in some respects there are data of South Bohemia region pointed out. The research revers to reality and risks concluded from unwarranted receiving from the social system. The diploma work would like to warn this way about the importance of this issue and contribute to elimination of these unlawful acts.

Den svenska hälso- och sjukvården har begränsade resurser vilket kräver att prioriteringar görsför att resurserna ska fördelas så effektivt och rättvist som möjligt. En reell prioriteringssituationdär avvägningen mellan effektivitet och rättvisa blir särskilt tydlig är vid beslut om subventionav förskrivningsläkemedel. När ett sådant prioriteringsbeslut fattas är det relevant att undersökavad resurserna som krävs för en prioriterad behandling i stället hade kunnat generera i form avannan vård, det vill säga att kvantifiera både vinster och förluster i termer av hälsa. I dennauppsats granskas därför beslut om subvention av läkemedel som fattats av Tandvårds- ochläkemedelsförmånsverket (TLV) mellan 2017 och 2022, för att kvantifiera hur avvägningenmellan effektivitet och rättvisa kan ha påverkat den totala hälsan i Sverige. Med hjälp av etttröskelvärde för marginalproduktiviteten i hälso- och sjukvården på 250 000 kronor beräknasnettohälsoeffekten av TLVs beslut. Resultaten visar att av totalt 49 granskade beslut omsubvention av läkemedel har det i 32 fall gjorts en avvägning mellan effektivitet och rättvisa.Endast åtta av besluten har en positiv nettohälsoeffekt, där hälso- och sjukvårdssystemetgenererar mer hälsa än det förlorar till följd av TLVs beslut. För de 17 läkemedel där antaletpatienter som berörs av ett beslut angetts kan en negativ nettohälsoeffekt på -24 060 år i fullhälsa (QALYs) konstateras. Cirka 84 % av de observerade besluten har en negativnettohälsoeffekt och har därmed också påverkat den totala hälsan i Sverige negativt. Resultatendiskuteras sedan med stöd av den svenska etiska plattformen och olika teorier om distributivrättvisa, vilka är möjliga anledningar till att resultatet ser ut som det gör. Att uttrycka kostnadoch effekt i termer av hälsa, som nettohälsoeffekten, tydliggör beslutsfattandet och är en starttill en mer transparent fördelning av samhällets begränsade resurser. Vårt förslag är att införaberäkning av nettohälsoeffekten som komplement till nuvarande metod i svenskahälsoekonomiska utvärderingar. / The Swedish healthcare system has limited resources which requires prioritization in order todistribute resources as efficiently and fairly as possible. A real prioritization situation where thetrade-off between efficiency and fairness becomes particularly clear is when deciding tosubsidize prescription drugs. When such prioritization decisions are made, it is relevant toexamine what the resources required for a prioritized treatment could instead have generated inthe form of other care, i.e., to quantify both gains and losses in terms of health. This thesistherefore examines decisions on subsidizing pharmaceuticals made by the Swedish Dental andPharmaceutical Benefits Agency (TLV) between 2017 and 2022, to quantify how the trade-offbetween efficiency and equity may have affected the overall health in Sweden. Using athreshold value for marginal productivity in health care of 250 000 SEK, calculations are madeto determine the Net Health Benefit. The results show that out of a total of 49 revieweddecisions on the subsidization of pharmaceuticals, a trade-off between efficiency and fairnesshas been made in 32 of these. Only eight of the decisions have a positive net health effect, wherethe healthcare system gains more health than it loses. For the 17 drugs where the number ofpatients affected by the decision could be quantified, a negative total Net Health Benefit of -24,060 years of full health (QALYs) was calculated. Approximately 84 % of the observeddecisions have a negative Net Health Benefit and have thus also had a negative impact onoverall health in Sweden. The results are then discussed with support of the Swedish ethicalplatform and various theories concerning distributive justice, which are possible reasons for theresults. Expressing cost and impact in terms of health, as the Net Health Benefit, clarifiesdecision-making and is a start towards a more transparent distribution of society's limitedresources. Our proposal is to introduce calculation of the Net Health Benefit as a complementto the current method in Swedish health economic evaluations.

Att sträva mot en hållbar utveckling, inom alla dess aspekter, är i dagsläget högst aktuellt. Särskilt då medvetenheten ökat kring de negativa effekter som exempelvis utsläpp, föroreningar och buller ger upphov till. Dessa effekter finns alla närvarande när man utvecklar en av samhällets allra mest vitala funktioner, nämligen transportinfrastruktur. Transportsystemen är, och har länge varit, ohållbara då bilar och andra motorfordon, som har stor miljöpåverkan, har prioriterats. För att minska utsläppen från transporter har Europeiska kommissionen uttryckt att andra typer av transportmedel, som kollektivtrafik, gång och cykling, bör ges högre prioritet. Flera stora städer i Europa har infört cykelvisioner och planer för att förbättra möjligheterna för att just cykla. Stockholm är en av dessa städer och en handfull projekt har därför införts för att rusta upp stadens cykelnät. Trots dessa cykelsatsningar görs dock få hållbarhetsanalyser av cykelinfrastrukturprojekt, vilket kan vara problematiskt då beslutsfattare ofta saknar adekvat underlag för att motivera investeringar. Arbetet har undersökt den sociala, ekonomiska och ekologiska hållbarheten hos ett cykelinfrastrukturprojekt genom att jämföra projektets investeringskostnad mot dess samhällsvinster via kostnads- och nyttoanalys (CBA). Projektet som har undersökts innefattar en byggnation av en 400 m lång gång- och cykelbana längs Skärholmsvägen i sydvästra Stockholm. Tidigare har vägen kantats av cykelfält på vardera sida och ingen gångväg har funnits längs sträckan. Projektet väntas vara klart under 2015 och beräknas kosta 4,16-5 miljoner kronor. Vid CBA utreds inledningsvis vilka effekter, som projektet ger upphov till, som ska beaktas i analysen. I detta arbete har hälsovinst, tidsvinst, bekvämlighetsvinst, olycksriskskillnad och miljövinst analyserats. Efter att effekterna kvantifierats omvandlas dessa kvantiteter till monetära termer för att kunna jämföras med projektets budget. Värdet för hälsovinster ges av minskad dödsrisk och värdet av ett statistiskt liv (VSL), tidsvinsten fås av ökad medelhastighet, bekvämlighetsvinsten beräknas genom att cyklisterna separeras från biltrafik, olycksriskskillnaden ges av förändringar i cyklisternas trafiksituation och miljövinsten fås av den andel nytillkomna cyklister som tidigare pendlade via bil. Projektet kommer, enligt utförda beräkningar, resultera i en samhällsnytta på mellan 1,05 miljoner kronor och 2,88 miljoner kronor beroende på mängden genomförda antaganden. Den effekt som bidrog mest till denna nytta är hälsoeffekter med ett bidrag på mellan 919 000 kr och 2,76 miljoner kr. Den effekt som bidrog med minst nytta är miljövinst med ett bidrag på mellan 168 kr och 630 kr. Nyttan kan sedan jämföras med projektets budget vilken förmodas minst uppgå till 4.16 miljoner kronor. Den planerade kostnaden för projektet uppgår dock till 5 miljoner kronor. Projektet kommer alltså slutligen ge upphov till en samhällskostnad på mellan 1,28 miljoner kr och 3,95 miljoner kr enligt genomförda beräkningar. Projektet kan möjligtvis anses vara samhällsekonomiskt gångbart om den procentuella bredden av gångbanan även motsvarar dess procentuella kostnad. Sedan miljöeffekten för projektet blev försumbar jämfört med övriga effekter kan ytterligare analysverktyg dock behövas för att vidare bedöma projektets miljöpåverkan. Detta är en indikation på att CBA är ett ofullständigt analysverktyg för att bedöma hållbarhet vad gäller cykelinfrastrukturprojekt. / Striving towards sustainable development, in all of its aspects, is currently exceedingly relevant. Particularly since the awareness of the negative side effects caused by emissions, pollution and noise have increased. These effects are all present while developing one of society’s most vital functions, namely transport infrastructure. The transport system is, and has long been, unsustainable as cars and other motor vehicles, having a large environmental impact, have been prioritized. To reduce transport emissions the European Commission has stated that other modes of transportation, such as commuting, walking and cycling, should be given higher priority. Several major European cities have implemented visions and plans to improve the possibility to bicycle. Stockholm is one of these cities and a handful of projects have thus been implemented to renovate the city’s cycling network. Despite these bicycle investments few sustainability analyses are made for bicycle infrastructure projects, which can be problematic since decision makers often lack proper support to justify investments. This work has examined the social, economic and ecological sustainability of a bicycle infrastructure project by comparing the investment costs of the project against its social benefits in a cost-benefit analysis (CBA). These benefits include health, time, comfort, accident risk and environment, which have been calculated through a cost benefit analysis (CBA). The examined project consists of a roughly 440 yard path for pedestrians and bicyclists located along Skärholmsvägen, southwest of the Stockholm city centre. Previously the road was lined with two bicycle fields on either side of the road with no path for pedestrians existing prior to the renovation. The project is planned to end during 2015 and the estimated cost amounts to 4,16-5 million SEK. In a CBA the effects which the project generates are initially investigated to assess which of the effects to consider in the analysis. In this work, health benefits, time benefits, comfort benefits, traffic accidents and environmental benefits have been analyzed. After the effects have been quantified these quantities are converted into monetary values to enable a comparison between the effects and the budget of the project. The value for health benefit is determined through decreased mortality risk and the value of a statistical life (VSL), the time benefit is calculated through an increased average velocity, the comfort benefit is determined through separating cyclists from car traffic, accident risk is estimated through the change in the bicyclists traffic conditions and the environmental benefit is calculated through the share of new cyclists who previously commuted by car. The project will, according to performed calculations, result in a societal benefit of in between 1.05 million SEK and 2.88 million SEK depending on the amount of performed assumptions. The effect which contributed the most to this benefit is the health benefit with a contribution of in between 919,000 SEK and 2.76 million SEK. The effect which contributed the least to the societal benefit is the environmental benefit with a contribution of in between 168 SEK and 630 SEK. The benefit can then be compared with the budget of the project which is estimated to amount to at least 4.16 million SEK. However the planned cost for the project amounts to 5 million SEK. The project will thus eventually yield a societal cost of in between 1.28 million SEK and 3.95 million SEK according to the calculations performed. The project can possibly be considered sustainable if the percentage of the width of the path corresponds to the percentage of its cost. Since the environmental effect could be neglected in this project compared to the other effects additional tools would thus be required to assess the environmental aspects of the project. This is an indication of CBA being an incomplete analysis tool to assess sustainability.

The study was conducted to describe how socio-economic characteristics (SEC) of women affect their utilization of maternal healthcare services in Abuja Municipal Areas Council (AMAC) in Abuja Nigeria. A non-experimental, facility-based cross-sectional survey was done. Data was collected using structured interviewer administered questionnaire in 5 district hospitals in AMAC. Sample size of 384 was calculated a priori based on the assumption that 50% of the target population utilized maternal healthcare services during their last pregnancy. Equal allocation of samples per facility was done. The ANC register was used as the sampling frame and proportionate allocation of samples per clinic days was undertaken in each facility. Data analysis included descriptive statistics, cross tabulations and measures of inequality. Logistic regression analysis was used to test the hypothesized relationship between socioeconomic characteristics (predictors) and maternal healthcare service utilization. Other than birth order that showed consistent effect, the results of this study indicated that the predictive effect (predisposing and enabling factors) of the SEC of women included in this study (age, education, birth order, location of residence, income group and coverage by health insurance) on maternal healthcare service utilization were not consistent when considered independently (bivariate analysis) as opposed to when considered together through logistic regression. In addition, the study revealed that there was inequality in the utilization of maternal healthcare services (ante-natal care - ANC, delivery care and post natal care - PNC, and contraceptive services) among women with different SEC, and the payment system for maternal healthcare services was regressive. Addressing these predictors in the natural co-existing state (as indicated by the logistic regression) is essential for equitable access and utilization of healthcare during pregnancy, delivery and the postnatal period, and for contraceptive services in AMAC, Abuja Nigeria. Targeted policy measures and programme actions guided by these findings are recommended to optimise returns on investment towards achieving national and global goals on maternal health in Nigeria / Health Studies / D. Litt. et Phil. (Health Studies)

The study was conducted to describe how socio-economic characteristics (SEC) of women affect their utilization of maternal healthcare services in Abuja Municipal Areas Council (AMAC) in Abuja Nigeria. A non-experimental, facility-based cross-sectional survey was done. Data was collected using structured interviewer administered questionnaire in 5 district hospitals in AMAC. Sample size of 384 was calculated a priori based on the assumption that 50% of the target population utilized maternal healthcare services during their last pregnancy. Equal allocation of samples per facility was done. The ANC register was used as the sampling frame and proportionate allocation of samples per clinic days was undertaken in each facility. Data analysis included descriptive statistics, cross tabulations and measures of inequality. Logistic regression analysis was used to test the hypothesized relationship between socioeconomic characteristics (predictors) and maternal healthcare service utilization. Other than birth order that showed consistent effect, the results of this study indicated that the predictive effect (predisposing and enabling factors) of the SEC of women included in this study (age, education, birth order, location of residence, income group and coverage by health insurance) on maternal healthcare service utilization were not consistent when considered independently (bivariate analysis) as opposed to when considered together through logistic regression. In addition, the study revealed that there was inequality in the utilization of maternal healthcare services (ante-natal care - ANC, delivery care and post natal care - PNC, and contraceptive services) among women with different SEC, and the payment system for maternal healthcare services was regressive. Addressing these predictors in the natural co-existing state (as indicated by the logistic regression) is essential for equitable access and utilization of healthcare during pregnancy, delivery and the postnatal period, and for contraceptive services in AMAC, Abuja Nigeria. Targeted policy measures and programme actions guided by these findings are recommended to optimise returns on investment towards achieving national and global goals on maternal health in Nigeria / Health Studies / D. Litt. et Phil. (Health Studies)