Thesis (M.Dev.) -- University of Limpopo, 2017. / This mini-dissertation examines the policies regulating the National Health Insurance Scheme. It explores the reforms on the health care system in South Africa. In addressing this issue, the mini-dissertation investigates the constitutional obligation of the South African government regarding the provision of health care services. It also focuses on the two primary issues relating to health care services. Firstly, South Africa has allocated significant budget to fix the ailing health care system. Secondly, South Africa commands huge health care resources compared with many other middle-income countries, however the bulk of these resources are in the private sector and serve a minority of the population. It further looks at the lessons that South Africa could learn from the successes of the National Health Insurance Scheme implementation in Organisation for Economic Co-operation and Development (OECD) countries as it proceeds with the implementation of the National Health Insurance.

Thesis (LLM. (Labour Law)) -- University of Limpopo, 2013 / The South African government gazzetted the Green Paper introducing the NHI on 12 August 2012. This policy seeks to progressively realize the right of access to quality health care services for everyone. Those who cannot provide for themselves will be assisted by government at the expense of the elite. The NHI was first recommended by the Taylor Commission and it has been under the discussion since then. Since this announcement, there has been growing pressure for mandatory health insurance to be included in the development of a comprehensive social security system, as was envisaged by the Taylor Committee of Inquiry. This discussion was further debated at the 52nd conference of the African National Congress (ANC) in Polokwane in December 2007 where numerous resolutions were taken with regard to the NHI. The Freedom Charter of 1955 and also section 27 and 28 also provided some guidance.

Thesis (LLM ( Labour law)) --University of Limpopo, 2013 / Refer to document

Healthcare fraud is a major problem within the healthcare industry. The study examined medical fraud, its laws, and punishments on federal and state levels. It compared medical fraud to non-fraud crimes done in the healthcare industry. This comparison will be done on a state level. The study attempted to analyze the severity of fraud against non-fraud and that doctors would commit fraud offenses more often than non-fraud offenses.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-11-21T08:58:05Z No. of bitstreams: 1 Bruno Garbelini Chiquito.pdf: 1661155 bytes, checksum: 51c1d3fd662927bf2049fda1d247cd3c (MD5) / Made available in DSpace on 2018-11-21T08:58:05Z (GMT). No. of bitstreams: 1 Bruno Garbelini Chiquito.pdf: 1661155 bytes, checksum: 51c1d3fd662927bf2049fda1d247cd3c (MD5) Previous issue date: 2018-09-24 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The present study aims to analyze the structure and legal and economic bases of the health insurance contract. In a first moment, we will analyze the historical evolution of the insurance operation in the world, its essential characteristics and its legal nature in order to show the economic base that underlies it with due note of the main obligations of the parties involved in this type of contract. In a second moment, comments are made on contractual developments to demonstrate the overcoming of individual interests in a favor of a free, fair, egalitarian and solidary society. The guidelines and mechanisms introduced by the Civil Code of 2002 will be studied in an attempt to better adapt the institutes of private law to social and economic evolution, with emphasis on the incidence of the fundamentally constitucional rights guaranteed in private law relations and institutes. Also detailed are the classic principles of insurance contracts, with emphasis on the accessory duties of the parties to the relationship and their relevant social interest. Finally, the structure, functioning, legal and economic aspects of health insurance contracts will be evaluated, in order to highlight the factors and problems that the sector faces due to the increasing increases in the insurance costs, creating alternatives to mitigate this problem, without going into detail in the aspecto related to the judicialization of health. The approach adopted is not only legalistic in the doctrinal sense, but rather, there was a great concern to explain the phenomenon from its historical origins, as well as to relate them to the causes that have shaped its features, guidelines and principles. The aim was to demonstrate the appropriate degree of state intervention on contractual freedom without detracting the attributes that are essential to it, emphasizing the role of the judge in the application of general clauses and principles, as well as in the necessary self-responsibility, solidarity and cooperation of the members of the relationship of insurance so that the contract transcends the intersubjective relationship and reaches a social pacification / O presente trabalho tem como objetivo analisar a estrutura e as bases jurídicas e econômicas do contrato de seguro relativo à saúde. Em um primeiro momento, analisa-se a evolução histórica da operação de seguro no mundo, suas características essenciais e sua natureza jurídica, de forma a evidenciar a base econômica que lhe fundamenta com o devido apontamento das principais obrigações das partes envolvidas nesse tipo de contrato. Em um segundo momento, são tecidos comentários a respeito da evolução contratual para demonstrar a superação dos interesses individuais em prol de uma sociedade livre, justa, igualitária e solidária. Ainda são estudadas as diretrizes e os mecanimos introduzidos pelo Código Civil de 2002, na tentativa de melhor adequar os institutos de direito privado à evolução social e econômica, com ênfase na incidência dos direitos fundamentais constitucionalmente assegurados nas relações e institutos de direito privado. Também são pormenorizados os princípios clássicos atinentes aos contratos de seguro, com ênfase nos deveres acessórios das partes integrantes da relação e no seu relevante interesse social. Por último, são avaliadas as estruturas, o funcionamento, os aspectos jurídicos e econômicos dos contratos de seguro saúde, de modo a ressaltar os fatores e os problemas a serem enfrentados pelo setor em razão do crescente aumento dos custos do seguro, criando alternativas para amenizar este problema, sem adentrar, pormenorizadamente, no aspecto relativo à judicialização da saúde. A abordagem adotada não é apenas legalista no sentido doutrinário, mas sim houve uma grande preocupação em explicar o fenômeno a partir de suas origens históricas, assim como relacioná-las às causas que teceram suas feições, diretrizes e princípios. Buscou-se evidenciar o grau adequado de intervenção estatal sobre a liberdade contratual sem descaracterizar os atributos que lhe são essenciais, ressaltando o papel do juiz na aplicação das cláusulas gerais e dos princípios, bem como na necessária autorresponsabilidade, solidariedade e coperação dos integrantes da relação de seguro para que o contrato transcenda a relação intersubjetiva e alcance uma pacificação social

Made available in DSpace on 2015-12-03T18:35:28Z (GMT). No. of bitstreams: 1 Isabel_Cristina_Barbosa_Pinheiro.pdf: 2622902 bytes, checksum: 749431cab43b468b437e27cb0f5a0567 (MD5) Previous issue date: 2014-01-24 / The Brazilian public health system is deficient and doesn't fully meet the needs of the population. As a result, the private health care market has grown in recent years, which has changed the role of the state from executive to regulator of that sector. Regulation includes tackling the economic and financial issue. Our study aimed to identify the behavior of financing strategies adopted by medical cooperatives and group medicines to meet the regulatory benchmarks of the supplementary health care sector in Brazil. The survey results show that the mandatory Guaranteeing Assets (Ativos Garantidores, AG), 1st regulatory moment, resulted in a significant increase of both the overall and the long term indebtedness indexes, which reveals the use of Third-party capital instead of Equity capital. Only the Medical Cooperatives featured increased Overall Indebtedness, which means that the Medical Cooperatives, unlike Group Medicines, are capitalized by third party funds rather than by Equity Capital. Both modalities adopted the strategy of increasing their long-term debt and reducing their short term debt (debt composition). With the introduction of the Health Guarantor Fund (Fundo Garantidor da Sa??de, FGS), 2nd regulatory moment, the Overall and Current Liquidity indexes decreased, showing that the goal of the FGS program to reduce financial guarantees and to improve working capital wasn't met. Medical Cooperatives managed to reduce their overall debt, whereas the overall debt of Group Medicines increased. We conclude that there was a balance between the Indebtedness indexes and Liquidity over the period and that operators who wish to remain in the market must comply with the rules, adapting and improving the quality of their management / A rede p??blica de sa??de no Brasil ?? prec??ria e n??o atende de forma plena ??s necessidades da popula????o. Consequentemente, o mercado privado de assist??ncia ?? sa??de tem crescido nos ??ltimos anos e com isso a fun????o do Estado vem se alterando, passando de executor para regulador deste setor de atividade. Um alvo da regula????o ?? a quest??o econ??mico-financeira. Nesse sentido, este trabalho tem como objetivo identificar o comportamento das estrat??gias de financiamento adotadas pelas cooperativas m??dicas e medicinas de grupo frente aos marcos regulat??rios do setor de sa??de suplementar no Brasil. Os resultados da pesquisa indicam que com a obrigatoriedade dos Ativos Garantidores - AG, 1?? momento regulat??rio, os ??ndices de Endividamento, tanto geral quanto de longo prazo tiveram um aumento significativo, o que indica a utiliza????o de Capital de Terceiros ao inv??s do Capital Pr??prio. Observou-se que apenas as Cooperativas M??dicas apresentaram um aumento no Endividamento Geral. Isso indicou que as Cooperativas M??dicas, diferentemente, das Medicinas de Grupo, se capitalizaram com recursos de terceiros ao inv??s do Capital Pr??prio. Notou-se que ambas as modalidades adotaram a estrat??gia de aumentar a d??vida de longo prazo e reduzir as de curto prazo (composi????o do endividamento). Com a institui????o do Fundo Garantidor da Sa??de - FGS, 2?? momento regulat??rio, os ??ndices de Liquidez Geral e Corrente diminu??ram, indicando que a proposta do programa FGS, de reduzir as garantias financeiras e melhorar o capital de giro, n??o ocorreu. Observou-se que para as Cooperativas M??dicas o endividamento geral diminuiu e em contrapartida para as Medicinas de Grupo aumentou. Contudo, conclui-se que houve um equil??brio entre os ??ndices de Endividamento e Liquidez ao longo do per??odo e que para as operadoras se manterem no mercado ter??o que atender as regras, adaptando-se e melhorando a qualidade da sua gest??o

Medical expenses refer to all medical and related expenditure reasonably incurred in respect of bodily injuries sustained. This then constitutes the primary loss in incidences of bodily injuries. However, it is accepted that bodily injuries infringe in the main the non-patrimonial aspects of the individual’s bodily integrity which is a personality right. Notwithstanding this trite provision of our law, the dissertation contends that medical expenses as a head of damages is inherently patrimonial. In essence, the true nature of medical expenses as a loss that ultimately affects both the patrimonial and non-patrimonial interests of the individual, is considered. Furthermore, the dissertation analyses the assessment and quantification mechanisms in our law, and makes a comparative study with the corresponding positions in England and Australia. The intended outcome of this dissertation is to provide clear guidelines for the award of damages, particularly where future loss is involved. / Private Law / LLM

Medical expenses refer to all medical and related expenditure reasonably incurred in respect of bodily injuries sustained. This then constitutes the primary loss in incidences of bodily injuries. However, it is accepted that bodily injuries infringe in the main the non-patrimonial aspects of the individual’s bodily integrity which is a personality right. Notwithstanding this trite provision of our law, the dissertation contends that medical expenses as a head of damages is inherently patrimonial. In essence, the true nature of medical expenses as a loss that ultimately affects both the patrimonial and non-patrimonial interests of the individual, is considered. Furthermore, the dissertation analyses the assessment and quantification mechanisms in our law, and makes a comparative study with the corresponding positions in England and Australia. The intended outcome of this dissertation is to provide clear guidelines for the award of damages, particularly where future loss is involved. / Private Law / LLM