In 2010 the new Swedish national system for health care 1177.se was launched in order for users to have one place where to find health care related information. The primary stakeholders of this system, which is online based, are the counties and regions of Sweden. The purpose of the thesis is to identify what improvements can be made on the health care system in order to benefit new technologies and in the end the users. The main question that the thesis will address is: * How can a PACT analysis improve the design of health the health care system 1177.se to benefit new technologies in order to be as available as possible. The method that has been used in order to gain knowledge in the subject has been literature studies, observations, scenario building and also an interview. The analysis of the empirical and theoretical studies has shown that more attention should be placed on people that have different disabilities and people with other origins then Sweden. People that are not so comfortable with Internet technology also is a group of people that needs to be placed in focus. / 1177.se är det nya svenska informationssystemet för vård som lanserades 2010. Initiativtagarna är regioner och landsting i Sverige. Målet med 1177.se är att den ska bli den ledande resursen för de svenska invånarna när det kommer till information och råd om hälsa, sjukvård och tandvård. Det senaste decenniet har Internet utvecklats så pass mycket att vården kan använda dess kapacitet för invånarna i Sverige. Regionerna och landstingen såg en möjlighet att använda en gemensam plats för alla invånare att hitta information om hälsa, sjukvård och tandvård. Sverige har ungefär 9,5 miljoner invånare (SCB, 2011) som alla vid någon tidpunkt kommer i kontakt med det svenska sjukvårdssystemet. De kan lida av alla från sorters sjukdomar till att enbart söka information eller hitta information om vård i närområdet och leta efter fakta själva. Det finns flera olika användningsområden för informationssystemet 1177.se vilket betyder att hur man designar systemet är av yttersta vikt. En PACT (People, Activities, Contexts, Technologies) analys strävar mot att identifiera vilka olika aktiviteter som människor gör och i vilka kontexter samt vilken teknik man använder för att ge en indikation på vad man bör tänka på då ett informationssystem designas. Denna uppsats är ett försök att analysera informationssystemet 1177.se och ge min syn på vilka förbättringar som kan göras efter att ha gjort en PACT analys.

In the South African public health care system, HIV Counselling and Testing (HCT) has become a function that is routinely entrusted to lay counsellors. These counsellors are expected to educate clients about HIV and AIDS, encourage them to be tested and convince them to change risky behavioural practices. They have to convey the clients’ test results and assist those who test HIV-positive and their families to cope with the psychological challenges associated with the diagnosis. The counsellors occupy the front line of HIV and AIDS service delivery, even though they are not formally employed in the health care system. They only have basic training and are not adequately remunerated. The counsellors are confronted with psychological and structural stressors in their work. Psychological stressors include the impact of emotionally challenging work, the lack of appropriate training, debriefing and supervision. Because they are not formally employed in the health care system, there is a lack of formal supervision or channels to discuss their frustrations. This research focuses on the stressors which HIV counsellors experience, how they cope, and the impact it has on their psychological well-being. As part of the mixed methods approach 50 HCT counsellors working at the City of Tshwane clinics completed the Bar-On Emotional Quotient Inventory, the Maslach Burnout Inventory for Human Services Survey (MBI- HSS), the Centre for Epidemiologic Studies Depression scale (CES-D), and the Brief COPE scale to assess their psychological well-being. In addition, they participated in focus group discussions. EQ-i scores indicated that counsellors reported below average emotional skills, with the overall group score of (88.76). Scores that indicated average emotional skills were Self-Regard (101), Interpersonal Relationships (100.12), and Impulse Control (102.66). Scores that indicated low emotional skills were Independence (86.66), Self-Actualization (88.28), and Reality Testing (83.94). Although they reported high levels of Emotional Exhaustion (27.66), they also have a sense of high Personal Accomplishment (38.64) (MBI-HSS). Counsellors reported an overall CES-D score which was indicative of mild depression (26.08). Counsellors used mostly positive coping skills that included religion, planning, and direct action in coping with stressors in their lives. In a regression analysis with depression as the dependent variable, there was a positive relationship between depression and depersonalization and a negative relationship with positive or active coping and assertiveness. It was concluded that counsellors experienced some depression, emotional exhaustion, and lower than average levels of emotional well-being. Despite that, they reported positive ways of coping and high levels of personal accomplishment. Counsellors were motivated by their sense of altruism, compassion towards their clients, the positive changes they see in client’s lives as well as the reciprocal relationships they have formed with their clients. Counsellors thus have strengths to cope with the high level of stressors and challenges related to their work. It can be concluded that their state of mental health is in line with Keyes’ proposal that mental health forms a continuum. They fluctuate between mental well-being and mental ill-being. However, it is necessary to assist HCT counsellors to develop their emotional capacities to enable them to enhance their ability to counsel their clients effectively. / Dissertation (MA)--University of Pretoria, 2013. / gm2014 / Psychology / unrestricted

The diploma paper analyses the health care system in Germany with a view to principles of organization and financial relations in the system. After short description of historical system development follows brief analysis of incomes. Then there is made the analysis of the health care system focused on the expenditures. In this chapter there are presented the segments of health care, way of their organization, forms of payment and analysis of expenditures between the years 1995 and 2007. An unavoidable part of this paper is also the selection of positive constructional elements of health care system and their recommendation for application in the system of Czech Republic.

Bakgrund: Kvinnlig könsstympning är en djupgående tradition som främst utövas inom länder i Afrika, Asien och mellanöstern. På grund av den ökande migrationen har detta blivit ett globalt problem. Kvinnor med könsstympning möter flertal komplikationer, fysiska, psykiska och inom nära relationer. Syfte: Syftet med studien är att beskriva hur kvinnor med könsstympning upplever vårdmötet.Metod: En kvalitativ litteraturstudie genomfördes där systematisk sökning av vetenskapliga artiklar gjordes. Data samlades in genom användandet av relevanta databaser i Cinahl, Medline och Pubmed, och utvalda vetenskapliga artiklar analyserades.Resultat: Utvalda vetenskapliga artiklar beskrev hur kvinnor rapporterade att vårdmötet upplevdes varierande, dock hade flertal kvinnor upplevt rädsla och stress i samband med undersökningar. Vidare beskriver kvinnorna upplevelsen av bristande kunskap hos vårdpersonal då vårdpersonalen oftast inte visste vad kvinnlig könsstympning var. Kvinnorna rapporterade att vårdpersonal inte ställer frågor om könsstympning. Och om frågan ställs, upplevs brister med vidare hantering, då vårdpersonalen upplevs osäkra på vad som skall ske efter. Slutsats: Kvinnorna rapporterade att vårdpersonalen behöver våga ställa frågor kring kvinnlig könsstympning, samt inleda samtalet kring det då kvinnorna upplever det svårt att inleda samtalen själva. Fynden i denna studie visar att utbildning för vårdpersonal om kvinnor med könsstympning bör implementeras för att öka kunskapen och kvaliteten på omvårdnaden för dessa kvinnor. Framtida forskning bör fortsätta undersöka hur kvinnor med könsstympning upplever vården.

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The risk adjustment model currently used does not adequately compensate insurers for predictable differences in individuals' health care expenditures in the Czech Republic. It then leads to financial inequality in the redistribution of funds to the insurance companies and causes their financial problems. This study introduces a PCG model as another method for risk adjustment and determines to what extent the predictive performance of the model can be improved when applied to Czech data. We analyze 10% of population sample in the Czech Republic in years 2011 and 2012. Our results confirm the appropriateness of the PCG model for the Czech environment. When the PCG variables are added to the demographic model, R2 value of the prediction model increases from 2.03% to 13.87%.

O presente estudo buscou compreender a dimensão política no trabalho do enfermeiro da atenção básica em um município paulista. Consideramos como dimensão política a relação que os trabalhadores estabelecem com a gestão pública em saúde e seus desdobramentos no trabalho na Atenção Básica nas distintas modalidades de organização da Atenção Básica (AB). Relação esta que não se limita aos espaços formais, como reuniões e normativas, mas que também se refletem nos modelos de atenção e organização do trabalho presentes nos serviços de saúde. Dessa forma, ao resgatar o caráter político da Reforma Sanitária Brasileira e o papel estratégico do SUS como política de Estado, este estudo pretende colaborar com o atual debate em torno da politização da saúde. O método utilizado para o desenvolvimento deste estudo foi o Estudo de Caso, alicerçado pela abordagem qualitativa, do tipo instrumental, a partir das seguintes fontes de dados: observação participante em cinco unidades de saúde de distintas modalidades de organização da AB, entrevista semiestruturada com oito enfermeiros, considerados informantes chaves e documentos oficiais de planejamento em saúde de instancia municipal de cinco quadriênios de gestão municipal. A coleta de dados foi realizada nos meses de outubro de 2013 a março de 2014. Foi realizada análise discursiva na perspectiva de Pêcheux com o material produzido nas entrevistas. Na análise documental, o que encontramos foi que, não obstante as dificuldades vividas pelos grandes municípios, mencionadas na literatura, é uma transição incompleta do modelo de AB, mais como mistura do que de transição, com uma implantação incipiente e incompleta da estratégia Saúde da Família, apesar dos documentos de planejamento, reiteradamente, colocarem essa estratégia como a opção municipal para a AB. Fica claro que a relação entre trabalhadores e gestão, por parte dos enfermeiros, não é de confiança, nem de corresponsabilidade. Não há a perspectiva de participação nos processos de decisão. Surgem críticas, responsabilizando a gestão, pela forma como são conduzidas determinadas políticas de saúde. É interessante observar que a crítica mais veemente surja justamente numa temática que envolve o interesse direto, poderíamos dizer até corporativo, dos trabalhadores. Por fim, parece ficar reforçada a ideia de Maria Cecília Puntel de Almeida, de que há entre as enfermeiras uma aceitação das limitações de poder, de forma relativamente passiva / This study sought to understand the political dimension of the work of the primary care nurse in a city in São Paulo. We consider the political dimension as the relationship that workers have with the public health management at work and its developments in Primary Care services in different modalities of Primary Care organization. A relationship that is not confined to formal settings, such as meetings and norms, but is also reflected in models of care and work organization present in health services. Thus, by returning to the political nature of the Brasilian Heath Reform and the strategic role of the SUS as a state policy, this research intends to collaborate with the current debate on the politicization of health. An instrumental case study was the method of choice for the development of this study, with a qualitative approach, using the following data sources: participant observation involving five health units of different modalities of organization, semi-structured interviews with eight nurses we considered to be key informants and official documents in health planning from the municipal management in five four-year periods. Data collection was conducted from October 2013 to March 2014. Pêcheux\'s discourse analysis was used for the interview data. In document analysis, what we found was, despite the difficulties experienced by large municipalities mentioned in the literature, an incomplete transition of the Primary Care model, more like a mixed system than a transition, with an incipient and incomplete implementation of the Family Heath strategy despite planning documents repeatedly putting this strategy as the municipal option for Primary Care. It is clear that the relationship between workers and management is not of trust. There is no prospect of participation in decision-making. Criticism does appear, blaming the management by the way they conducted certain health policies. It is interesting to note that the most vehement criticism arises precisely in a theme that involves direct interest of the workers. Finally, it seems the idea of Maria Cecilia Puntel de Almeida is reinforced, that between nurses there is an acceptance of the limitations of power, in a relatively passive way

Made available in DSpace on 2016-04-26T20:23:12Z (GMT). No. of bitstreams: 1 Jaqueline Suryan.pdf: 4454239 bytes, checksum: d351c14e540715f573169418f6e5644f (MD5) Previous issue date: 2014-09-17 / This is a study of a review of the constitutional right to health care and its impacts on the Complementary Health System provided for by the Brazilian Federal Constitution of 1988. From a study of the historical background of fundamental rights and the evolution of social rights as positive actions by the State, we can verify the importance given to these rights throughout the centuries. From this scenario of evolution of rights worldwide, it is relevant a historical and evolutional review of the constitutional right to health care within the Brazilian constitutional system, showing the passage of a legislative and constitutional gap of protection of the right to health care until the comprehensive and universal protection of this right, as established in Sections 6 and 196 of the Brazilian Federal Constitution of 1988. A study on the Social Security System and the constitutional principles inherent to it serves as a basis for structuring the Complementary Health System innovated by the Federal Constitution of 1988. The international protection of the constitutional right to health care was reviewed through study of Comparative Law, based on the constitutions of the American and European states and Public International Law, as well as international and specific doctrines on this regard. Once examined the origin and importance of the constitutional right to health care, nationally and internationally, an analysis was made of the Complementary Health System, through the verification of a positivistic validity of its main rules, such as the Law No. 9,656, of June 3, 1998, which regulates the of Complementary Health System at a federal level, and the Law No. 9,961, of January 28, 2000, that creates the state s sector regulatory agency, as well as the enforcement of the constitutional right to health care by means of the state provisions of healthcare services and the impact of this fundamental right in private actions related to complementary health. Finally, some of the main provisions of Law no. 9,661/1998 were reviewed in order to study the social impacts and liberty of the performance of services by the private initiative related to complementary healthcare, without shackling or reducing the right of health care as established in the Brazilian Federal Constitution of 1988 / Trata-se o presente estudo de uma análise do direito constitucional à saúde e seus impactos no Sistema de Saúde Complementar previstos pela Constituição Federal de 1988. A partir de um estudo do panorama histórico dos direitos fundamentais e da evolução aos direitos sociais como ações positivas do Estado, podemos verificar a importância dada a esses direitos ao longo dos séculos. Partindo deste cenário de evolução dos direitos em nível mundial, faz-se relevante a análise histórica e evolutiva do direito constitucional à saúde dentro do ordenamento constitucional pátrio, que mostra a passagem de uma lacuna normativo-constitucional expressa de proteção ao direito à saúde até a proteção integral e universal desse direito, tal como estabelecido nos artigos 6º e 196 da Constituição Federal de 1988. Um estudo sobre o Sistema da Seguridade Social e dos princípios constitucionais a ele inerentes serve como base para a estruturação do Sistema de Saúde Complementar inovado pela Constituição Federal de 1988. A proteção internacional do direito constitucional à saúde foi analisada por meio de estudo do Direito Comparado, com base nas Constituições dos Estados americanos e europeus e no Direito Internacional Público, bem como de doutrinas internacionais específicas sobre o tema. Uma vez examinada a origem e importância do direito constitucional à saúde, nacional e internacionalmente, fez-se uma análise do Sistema de Saúde Complementar, por meio de verificação da validade de suas principais normas, a Lei nº. 9.656, de 3 de junho de 1998, que regulamenta o Sistema de Saúde Complementar em âmbito federal, e a Lei nº. 9.961, de 28 de janeiro de 2000, de criação da Agência Reguladora do setor, e da efetivação do direito constitucional à saúde pela prestação estatal de serviços de saúde, bem como do impacto deste direito fundamental nas ações privadas ligadas à saúde complementar. Por fim, foram analisados alguns dos principais dispositivos da Lei nº. 9.66/1998 a fim de se estudar os impactos sociais e a liberdade de atuação da iniciativa privada nos serviços ligados à saúde complementar, sem restringir ou reduzir o direito à saúde previsto na Constituição Federal de 1988

Introduction : Les pays de l’OCDE, dont la France, sont confrontés à une pénurie de médecins généralistes. De nombreuses recherches étudient les côtés négatifs de la spécialité pour l’expliquer. Il existe cependant des médecins heureux d’être généralistes et souhaitant rester en soins primaires. Le projet de recherche de l’EGPRN était de mettre en évidence les facteurs de satisfaction du médecin généraliste, dans les pays participants. L’hypothèse de recherche de ce projet est qu’il doit exister des médecins généralistes heureux et motivés par leur métier et que ces facteurs positifs pourraient être utilisés pour promouvoir l'attrait vers la Médecine Générale et le maintien dans la pratique clinique. Méthode : La première étape de cette thèse a été la réalisation d’une revue systématique de la littérature pour répertorier les différents facteurs de satisfaction des médecins généralistes déjà étudiés. Pour la seconde étape, des études qualitatives par entretiens semi-dirigés ou par focus groups ont ensuite été menées auprès de médecins généralistes dans les huit pays participants. La troisième étape consistait en une recherche de consensus par la méthode Delphi puis hiérarchisation par groupe nominal. Résultats : Les enquêtes qualitatives par entretiens semi-dirigés ou par focus groups réalisées dans les pays participants ont permis d’interroger 183 médecins généralistes ont été interviewés dans les huit pays. Des codes issus des verbatims a été créé un « livre de codes » comprenant 31 items qui ont été classés en 6 thèmes : le médecin généraliste en tant que personne, les compétences particulières au métier de médecin généraliste, l’organisation positive du métier de médecin généraliste, la relation médecin-patient, l’enseignement de la médecine générale et les facteurs qui soutiennent le médecin généraliste. Conclusion : Les résultats de l’étude de consensus ont montré que pour recruter en médecine générale il est nécessaire de développer la coordination des soins, l’approche centrée sur le patient, l’enseignement et la maîtrise de stage et de prêter attention aux facteurs d’organisation. / Introduction: OECD countries, including France, face a shortage of general practitioners. Many research studies the negative sides of the specialty to explain it. The research project of the EGPRN was to highlight the factors of satisfaction of the general practitioner, in the participating countries. The research hypothesis of this project is that there must be well being and motivated GPs and that these positive factors could be used to promote attractiveness to General Medicine and maintenance in clinical practice.Method: The first step of this thesis was the realization of a systematic review of the literature to list the various factors of satisfaction of general practitioners already studied. For the second stage, qualitative studies by semi-structured interviews or focus groups were then conducted with general practitioners in the eight participating countries. The third step consisted of a consensus search by the Delphi method then hierarchization by nominal group.Results: Qualitative surveys by semi-structured interviews or focus groups conducted in the participating countries were used to interview 183 general practitioners interviewed in the eight countries.Codes from verbatim were created a "codebook" comprising 31 items that were classified into 6 themes: the general practitioner as a person, the skills specific to the profession of general practitioner, the positive organization of the profession of doctor generalist, the doctor-patient relationship, the teaching of general medicine and the factors that support the general practitioner.Conclusion: The results of the consensus study showed that to recruit in general practice it is necessary to develop care coordination, patient-centered approach, teaching and internship control and to pay attention to factors organization.