No description available.

No description available.

<p><strong>Research objectives</strong>: 1) Develop an online repository of policy-relevant documents addressing healthcare renewal in Canada; and 2) describe the general contents of policy-relevant documents addressing healthcare renewal in Canada. <strong>Methods</strong>: The methods for this study were iteratively developed using an approach similar to a scoping review. Documents were identified through website hand-searches and sixteen Canadian health organizations that contributed to the development of the online repository. The majority of organizations are government health ministries/departments or government-supported health organizations. The focus of the analysis was to calculate general descriptive frequencies of the distribution of documents included in the online repository, specifically: 1) the general characteristics of the documents, such as document type, publication year and jurisdictional focus; 2) document themes by national priority areas; 3) document themes by health system topics; and 4) contributing organizations. <strong>Results</strong>: A total of 304 documents were coded for inclusion in the online repository<br />(<a href="http://eihrportal.org/">http://eihrportal.org</a>). The Health Council of Canada contributed the largest amount of documents (n=60, 19%). The top three types of documents are health and health system data (n=75, 25%), situation analysis (n=72, 24%) and jurisdictional review (n=49, 16%). The top three national priority areas addressed in the documents are health human resources (n=270, 89%), quality as a performance indicator (n=210, 69%) and information technology (n=183, 60%). The least commonly addressed national priority areas are technology assessment (n=19, 6%), prescription drug coverage (n=68, 22%) and Aboriginal health (n=87, 29%). <strong>Conclusion</strong>: The process of developing a systematic method for identifying policy-relevant documents and retrieving useful information from these documents can be reproduced by anyone interested in using this type of evidence to inform their health policymaking. A number of implications exist for policy and research, both in Canada and in low- and middle-income countries, which have to be considered in relation to the unique nature of this type of evidence.</p> / Master of Science (MSc)

The threat of a pandemic influenza outbreak is considered imminent and could cause severe morbidity and mortality as well as devastating economic losses. The U.S. government has worked to empower states to respond to a pandemic, but there has been minimal evaluation to determine the success of such efforts. The purpose of this study was to examine states' preparedness for a pandemic as documented by states' written pandemic plans and evaluate what political and structural factors may be associated with pandemic plan inclusion of federal recommendations. This was a cross-sectional comparative analysis of 50 states' pandemic influenza plans as of March 2008. The Centers for Disease Control and Prevention's (CDC) State and Local Pandemic Influenza Planning Checklist was turned into a matrix with each of 85 recommendations making up 10 overarching domains coded as "no mention" = 1, "brief mention but no description or action item" = 2, or "description or action of the item" = 3. Forty-nine complete plans and one state's plan summary were included in the analysis. Each state's domain scores were calculated by adding the scores of each factor within the domain. A "total preparedness score" for each state, was derived by adding the unweighted scores of each domain. Federal recommendations surrounding leadership, networking and surveillance have been well-integrated, but greater efforts are needed to develop partnerships with health care agencies and to focus on antiviral preparedness and infection controls. Federal and state governments have invested resources in pandemic planning and published recommendations for such planning; however, little research has been conducted focusing on what predicts integration of federal recommendations in written state plans. Understanding the factors that influence state plans can offer health departments strategies for increasing their effectiveness in pandemic preparedness and response. This study compared models for bureaucratic behavior and health department structural variables to evaluate what factors may be associated with pandemic plans. The findings showed that structural variables offer greater explanation for pandemic plan comprehensiveness than political theory models, but more work is needed to glean causal relationships. Recommendations to assist state health departments, legislators, and responders in improving state pandemic plans are presented as well as suggested areas for future research. / Public Health

The research reported in this dissertation examines the dissemination of heart health promotion within the Ontario public health system. It contributes to a relatively new research agenda to understand how to enhance implementation of the new public health; to apply knowledge of effective community- and population-based prevention. Three studies are reported, which extend research conducted in Ontario from 1994 to 1998 as part of the Canadian Heart Health Initiative Ontario Project (CHHIOP). Study one combined diffusion and social ecological theories to examine the dissemination process at the level of the public health system and over a ten year period. Studies two and three examined the implementation stage in more depth, with a view to understand variability across Ontario communities. Study two was a quantitative path analysis to identify determinants of 1997 levels of implementation, and study three was a comparative case study to understand change in implementation from 1994 to 1996. Main data sources were quantitative and qualitative data from CHHIOP. Findings reinforce the need for a systems view of dissemination; that dissemination is a long-term, iterative process; and that organizational capacity building is a vital part of the dissemination process, especially when new practices represent a significant departure from traditional concepts and ways of doing business. The research demonstrates that the interplay of internal organizational factors (e.g. champions, leadership, organizational structure) and external system factors (e.g. research, political priorities, experiences of other jurisdictions, partnerships) helps to explain movement within and across dissemination stages. Findings suggest promising areas for dissemination research, including replicating similar research in other public health systems. Findings also suggest promising strategies to accelerate the dissemination of effective health promotion, including specific strategies to further enhance heart health promotion in Ontario. / Thesis / Doctor of Philosophy (PhD)

O aumento de gastos com a atenção à saúde apresenta-se como um fato econômico de merecida relevância no cenário internacional, sendo resultante da elevação progressiva de preços dos produtos e serviços deste mercado. Pela sua importância social e peculiaridades recebe um tratamento especial nos estudos econômicos. A economia da saúde avalia os fatores que influenciam demanda e oferta neste mercado, direcionando suas observações à interação entre seus agentes e atores, destacando seus comportamentos em relação às suas reações com o tratamento do risco de ficar doente. Possíveis falhas de mercado, envolvendo risco moral, assimetria de informação e seleção adversa, podem ser atribuídas como causas de uma demanda que foge às regras de equilíbrio econômico e favorece a elevação da oferta. Esses problemas remetem à discussão sobre como a mudança de incentivos pode acarretar aumento de gastos e perda de eficiência no provimento dos bens e serviços de saúde dos Estados Unidos da América (EUA) e no mercado de saúde suplementar brasileiro, levando em conta que a situação de elevação dos gastos com saúde, que se agrava no Brasil nos últimos dez anos, já vem sendo vivida há mais tempo em outros países e particularmente nos EUA, mostrando que o problema apresenta tendência de ser persistente. / The health care expenditure increase that presents itself as an economic fact of worldly relevance on the international scene, being the result of the gradual increase of prices of products and services in this market. Due to its social relevance and peculiarities it deserves a special treatment in economic studies. Health economics evaluates the factors influencing supply and demand in this market, directing its comments to the interaction between actors and their agents, highlighting their behaviors in relation to their reactions to the treatment of the risk of getting sick. Possible flaws in this market , involving moral hazard, information asymmetry and adverse selection can be attributed as causes of a demand that evades the rules of economic equilibrium and favors lifting the offer. These problems relate to discuss how changing incentives may lead to increased expenses and loss of efficiency in the provision of goods and services of health of United States of America (USA) and the Brazilian health plan market, taking into account the situation of rising health spending, which deepens in Brazil over the past ten years, as has been the longest lived in other countries and particularly the USA, showing that the problem shows a trend to be persistent.

O aumento de gastos com a atenção à saúde apresenta-se como um fato econômico de merecida relevância no cenário internacional, sendo resultante da elevação progressiva de preços dos produtos e serviços deste mercado. Pela sua importância social e peculiaridades recebe um tratamento especial nos estudos econômicos. A economia da saúde avalia os fatores que influenciam demanda e oferta neste mercado, direcionando suas observações à interação entre seus agentes e atores, destacando seus comportamentos em relação às suas reações com o tratamento do risco de ficar doente. Possíveis falhas de mercado, envolvendo risco moral, assimetria de informação e seleção adversa, podem ser atribuídas como causas de uma demanda que foge às regras de equilíbrio econômico e favorece a elevação da oferta. Esses problemas remetem à discussão sobre como a mudança de incentivos pode acarretar aumento de gastos e perda de eficiência no provimento dos bens e serviços de saúde dos Estados Unidos da América (EUA) e no mercado de saúde suplementar brasileiro, levando em conta que a situação de elevação dos gastos com saúde, que se agrava no Brasil nos últimos dez anos, já vem sendo vivida há mais tempo em outros países e particularmente nos EUA, mostrando que o problema apresenta tendência de ser persistente. / The health care expenditure increase that presents itself as an economic fact of worldly relevance on the international scene, being the result of the gradual increase of prices of products and services in this market. Due to its social relevance and peculiarities it deserves a special treatment in economic studies. Health economics evaluates the factors influencing supply and demand in this market, directing its comments to the interaction between actors and their agents, highlighting their behaviors in relation to their reactions to the treatment of the risk of getting sick. Possible flaws in this market , involving moral hazard, information asymmetry and adverse selection can be attributed as causes of a demand that evades the rules of economic equilibrium and favors lifting the offer. These problems relate to discuss how changing incentives may lead to increased expenses and loss of efficiency in the provision of goods and services of health of United States of America (USA) and the Brazilian health plan market, taking into account the situation of rising health spending, which deepens in Brazil over the past ten years, as has been the longest lived in other countries and particularly the USA, showing that the problem shows a trend to be persistent.

O aumento de gastos com a atenção à saúde apresenta-se como um fato econômico de merecida relevância no cenário internacional, sendo resultante da elevação progressiva de preços dos produtos e serviços deste mercado. Pela sua importância social e peculiaridades recebe um tratamento especial nos estudos econômicos. A economia da saúde avalia os fatores que influenciam demanda e oferta neste mercado, direcionando suas observações à interação entre seus agentes e atores, destacando seus comportamentos em relação às suas reações com o tratamento do risco de ficar doente. Possíveis falhas de mercado, envolvendo risco moral, assimetria de informação e seleção adversa, podem ser atribuídas como causas de uma demanda que foge às regras de equilíbrio econômico e favorece a elevação da oferta. Esses problemas remetem à discussão sobre como a mudança de incentivos pode acarretar aumento de gastos e perda de eficiência no provimento dos bens e serviços de saúde dos Estados Unidos da América (EUA) e no mercado de saúde suplementar brasileiro, levando em conta que a situação de elevação dos gastos com saúde, que se agrava no Brasil nos últimos dez anos, já vem sendo vivida há mais tempo em outros países e particularmente nos EUA, mostrando que o problema apresenta tendência de ser persistente. / The health care expenditure increase that presents itself as an economic fact of worldly relevance on the international scene, being the result of the gradual increase of prices of products and services in this market. Due to its social relevance and peculiarities it deserves a special treatment in economic studies. Health economics evaluates the factors influencing supply and demand in this market, directing its comments to the interaction between actors and their agents, highlighting their behaviors in relation to their reactions to the treatment of the risk of getting sick. Possible flaws in this market , involving moral hazard, information asymmetry and adverse selection can be attributed as causes of a demand that evades the rules of economic equilibrium and favors lifting the offer. These problems relate to discuss how changing incentives may lead to increased expenses and loss of efficiency in the provision of goods and services of health of United States of America (USA) and the Brazilian health plan market, taking into account the situation of rising health spending, which deepens in Brazil over the past ten years, as has been the longest lived in other countries and particularly the USA, showing that the problem shows a trend to be persistent.

The purpose of this study was to show how information from the District Health Information System can be used to empower managers to make evidence-based decisions that will strengthen the health care system to reduce the under-five mortality rate. A quantitative, contextual, exploratory evaluative and descriptive approach was followed and a data extraction framework, based on systems theory, was developed to guide the process of extracting existing routine data. A results-based approach was used to measure under-five mortality related health care in terms of impact, outcomes, outputs, processes and inputs. The study has highlighted that proxy indicators obtained this way places health care managers in the position to monitor progress towards achieving the Millennium Development Goal for child mortality in the interim periods between large population surveys. The findings displayed in the diagnostic performance profile revealed that drastic interventions are required to reduce the under-five mortality rate. / Health Studies / M.A. (Health Studies)

Reduction in the price of oil in the mid-eighties forced the Saudi government to adopt new health policies in order to finance health services. On August 11, 1999, the Saudi government approved a new Mandatory Cooperative Health Insurance Program (MCHIP). This new health policy was enacted to replace the current policy of providing free health care. MCHIP is intended to reduce the financial burden on government by sharing the costs of health care with the public. This study had a dual purpose: to analyze the components of MCHIP program by comparing it with the American health system, and to investigate the perceptions of Saudi students attending American universities towards MCHIP program, based on the students' experiences with the American health care system.A multiple methods approach was used to conduct the study. A descriptive approach was employed to compare components of the MCHIP program with similar components of the American health care system. A survey method was used to investigate the perceptions of Saudi students attending American universities toward the new MCHIP program. Scales were constructed to measure the students' expectations of the MCHIP program with respect to cost, quality, and access of health care. Additional scales were used to measure the students' knowledge of the MCHIP program, knowledge of the American health system, and total health insurance knowledge. An electronic survey was posted on the VCU SERL Web page, and a link was e-mailed to 2210 Saudi students using a list provided by the Saudi Arabian Cultural Mission (SACM). The survey response rate was 40.6 percent.During the first phase of the research, the comparison to American health care identified areas in which the United States of America experience could be useful in promoting effective implementation of the MCHIP program in Saudi Arabia. In sum, the comparison indicated that the American health insurance model may not be an ideal approach for the Saudi health system. During the second phase of the study, survey results indicated that students expected MCHIP implementation to increase total health costs, improve quality of health care, and increase access to health care in Saudi Arabia. The students' total knowledge of health insurance had a significant effect on students' perceptions of cost and a non-significant effect on their perceptions of quality and access to health care. In order for the MCHIP program to be effectively implemented, study results point to the need for regulation of the Saudi insurance market and for health insurance-related systems (such as for coding, billing, and maintaining effective medical records) to be established. American health insurance system models are not ideal for the Saudi health system, although certain aspects may be useful. To promote success, the MCHIP program should be structured to meet the goal of providing affordable and accessible quality health care to the population, based on Islamic principles.