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A philosophical analysis of America's transformation to universal health care: implications for responsibility and justiceUnknown Date (has links)
Human beings have two apparently conflicting fundamental rights. On the one hand, individuals have a right to health care as the United Nations declared in 1948. On the other hand, individuals have a right to liberty; that is, the freedom to make one's own health related choices, even poor ones. One goal of this essay is to show how to reconcile these two apparently conflicting core American values. This reconciliation is important, because a universal health care system that is fair and just must account for individual rights in tandem with attempts to address matters of social justice. In order for this reconciliation to occur, matters of individual responsibility, social responsibility, and social justice must be central to health care reform. / by Jennifer Lynn Mantoni. / Vita. / Thesis (M.A.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.
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中國城鎮職工醫保覆蓋面影響因素的縱貫分析, 1999-2005. / Longitudinal study of the coverage of the basic medical insurance in urban China, 1999-2005 / CUHK electronic theses & dissertations collection / Zhongguo cheng zhen zhi gong yi bao fu gai mian ying xiang yin su de zong guan fen xi, 1999-2005.January 2009 (has links)
The background variables, GDP per capita, marketization, industrialization and urbanization are used to control different levels of development across provinces. The role of the state is measured in the following ways. First, financial capacity, administrative capacity and coercive capacity are used to measure the role of state capacity in BMI extension. The study examines whether there is a difference in choosing different agencies to collect social insurance premiums: one is local taxation agency and the other is social insurance agency. Third, the performance of BMI is measured through the deposit rates of BMI funding which reflects governments' ability to manage the BMI program. In the current policy, employers are charged largely the social insurance fees. So their willingness and capabilities to pay will affect BMI coverage. The study investigates two kinds of employers: loss making State-Owned-Enterprises (SOE hereafter) and Foreign Invested Enterprises (FIE hereafter). On the employee's part, the percent of informal employment in total urban employment is used to measure the effect of adverse employment conditions on BMI coverage. Trade union density is used to estimate the labor organization strength. / The complicated process of extending coverage is related to three major stakeholders: state, employers and employees. These three stake-holders influence BMI progress. Also, the background factors (such as the economic growth) should be taken into account for the regional variations in development level. Since BMI is a typical social policy field, this study reviews major theories about social policy development: logic of industrialism, power resource theory and state-centered approach and so on. These theories help organize pieces of phenomena into a unified framework and testable hypotheses are also derived. / The contributions of this study can be twofold. First, from the theoretical aspect, this research tests several welfare state development theories using Chinese data. In this way, it does not only expand the scope conditions of theories, but also improves our understanding of the social policy development in China, an outlier of traditional western democracies. Second, this study tests some controversial issues on BMI development and the research findings provide knowledge support for the policy practice in the real world. / The low coverage of social health insurance is one of the causes of the problems in Chinese health care system which is criticized for the rising health cost, large share of out-of-pocket payments and health inequality issue. The Basic Medical Insurance for Urban Employees (BMI hereafter) was chosen as the subject of my investigation. It was established in 1998 for the working population and till now it has not achieved universal coverage yet. The Basic Medical Insurance for Urban Residents (BMI-R hereafter) was started in 2007 and it is still in pilot stage, therefore data are still inadequate. In rural areas, the New Cooperative Medical Scheme (NCMS hereafter) achieved almost full coverage in 2008. Thus extending coverage is not issue at concern for NCMS. Besides, the NCMS data at province level are quite limited. Considering the stages of policy development and data access, BMI-R and NCMS are not included in this study. / The proportion of winning lawsuit in labor disputes is used to measure the function of labor protection system. This study adopts the panel method. Data is ranging from the year 1999 to 2005 and the unit of analysis is province/year. They were collected from various official statistics and constructed into a panel database which can trace the development of BMI from its origin to most recent situation. / The research question is what are the determinants of BMI's coverage? It is originated from some puzzling observations: the NCMS achieved full coverage in four years and it is a voluntary participation insurance program. On the contrary, why the mandatory BMI did not reach universal coverage after almost ten years' development? Besides, the progress of BMI across different provinces varied greatly. Given the policy designing and starting points are rather similar, how can we explain these variations? / The research yields several interesting results. First, the roles of financial capacity and administrative capacity in BMI development are supported by data, especially the social insurance agency. Second, results show that using local taxation to collect social insurance premiums has better effects in extending coverage than the alternative approach. This result will give an end to the decade-long debate on choice of social insurance premiums collection agencies. Third, the deposit rates of BMI funding are negatively related with BMI coverage. It implies that governments should improve the performance of BMI so as to attract more people to enroll in this program. Fourth, the union density in the private sector is positively related with BMI coverage. This result disagrees with the conventional wisdom that the Chinese trade unions are useless. It implies that strengthening the organization of employees (even through the official channel) can protect the rights of employees in some degree. / 劉軍強. / Adviser: Cheek-Kie Wong. / Source: Dissertation Abstracts International, Volume: 73-03, Section: A, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (p. 198-222) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Liu Junqiang.
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Impact of type of drug insurance on adherence, persistence and costs of antidepressant drugs : a Quebec population-based studyAssayag, Jonathan 01 1900 (has links)
Contexte: À date, il existe peu de données sur l’adhésion, la persistance et les coûts associés aux antidépresseurs selon le type d’assurance médicament (privé ou public).
Objectif: Comparer selon le régime d’assurance médicament (privé ou public), l'adhésion, la persistance et les coûts des antidépresseurs.
Méthodes de recherche: Une étude de cohorte appariée a été réalisée en utilisant des bases de données du Québec.
Sujets: Nous avons sélectionné 194 patients assurés par un régime privé et 1923 patients assurés par le régime public de la Régie de l’assurance maladie du Québec (RAMQ) (18-64 ans) qui ont rempli au moins une ordonnance pour un antidépresseur entre décembre 2007 et septembre 2009.
Mesures: L’adhésion, mesurée sur une période d’un an, a été estimée en utilisant le proportion of prescribed days covered (PPDC). Un modèle de régression linéaire a été utilisé afin d’estimer la différence moyenne en PPDC entre les patients assurés par un régime privé et ceux assurés par le régime public de la RAMQ. La persistance a été comparé entre ces deux groupes avec un modèle de régression de survie Cox, et le coût mensuel d'antidépresseurs ($ CAN) a été comparé entre ces deux groupes en utilisant un modèle de régression linéaire.
Résultats: Le PPDC parmi les patients assurés par un régime privé était de 86,4% (intervalle de confiance (IC) 95%: 83,3%-89,5%) versus 81,3% (IC 95%: 80,1%-82,5%) pour les patients assurés par le régime public de la RAMQ, pour une différence moyenne ajustée de 6,7% (IC 95%: 3,0%-10,4%). La persistance après un an parmi les patients assurés par un régime privé était de 49,5% versus 18,9% pour les patients assurés par le régime public de la RAMQ (p <0,001), et le rapport de risque ajusté était de 0,48 (IC 95%: 0,30-0,76). Comparativement aux patients assurés par le régime public de la RAMQ, les patients ayant une assurance privée ont payé 14,94 $ CAD (95% CI: $12,30-$17,58) de plus par mois en moyenne pour leurs antidépresseurs.
Conclusion: Les patients assurés par un régime privé avaient une meilleure adhésion, persistance, mais avaient aussi un plus haut coût pour leurs antidépresseurs que ceux assurés par le régime public de la RAMQ. Cette différence de coûts peut être due aux différentes exigences de paiement en pharmacie entre les deux régimes ainsi qu’aux limites des honoraires des pharmaciens imposés par le régime public. / Background: The influence of the type of drug insurance on adherence, persistence and cost of antidepressants is not well known.
Objective: To compare adherence, persistence and cost of antidepressants in patients with private and public drug insurance.
Research Design: A matched cohort study was conducted using prescription claims databases from Quebec, Canada.
Subjects: 194 privately and 1923 publicly insured patients (18-64 years) who filled at least one prescription for an antidepressant between December 2007 and September 2009.
Measures: Adherence over one year was estimated using the proportion of prescribed days covered (PPDC). The difference in mean PPDC between patients with private and public drug insurance was estimated with a linear regression model. Persistence was compared between the groups with a Cox regression model, and the monthly cost of antidepressants (CAD$) was compared between the two groups using linear regression.
Results: The PPDC was 86.4% (95% CI: 83.3-89.5) in patients with private and 81.3% (95%CI: 80.1-82.5) in patients with public drug insurance and the adjusted mean difference was 6.7% (95% CI: 3.0-10.4). Persistence was 49.5% in patients with private and 18.9% in patients with public drug insurance at one year (p<0.001), and the adjusted hazard ratio was 0.48 (95%CI: 0.30-0.76). Patients privately insured paid 14.94$ CAD (95% CI: 12.30; 17.58) more per month on average for their antidepressants.
Conclusion: Better adherence and persistence and higher costs were observed in privately insured patients. Cost difference might be due to different pharmacy payment requirements and pharmacists’ honorary restrictions under the public plan.
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O uso das informa????es de um sistema de custeio ABC no processo or??ament??rio : um estudo de caso no setor de seguro sa??deSilveira Neto, Manoel Pinto 26 August 2004 (has links)
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Previous issue date: 2004-08-26 / The prime reason for the frequent criticism users in organizations make over the traditional budgeting process are based on the fact of it being apart of the actual company operational scenario, quite often due to the lack of commitment regarding the planned numbers and the inappropriate input of the system. The activity-based costing (ABC) system shows the detailed use of resources on the organization business processes, providing important means for both a cost strategic management and operational performance measurement, being so an adequate instrument to support planning. This work analyzes the applications of an ABC system information on a health insurance budgeting process, standing out the improvement obtained in the financial forecasts development and the decision making process quality. The analysis is focused on the traditional budgeting procedures (planning and control) improvements when the company begun to use the ABC system, giving the details of its applications in product cost allocation and profitability analysis, capacity planning, activity-based cost forecasts, diagnostic variance analysis and information technology projects control. The importance of the research problem, that intends to examine if the ABC system information being integrated with the traditional budgeting process improves the effectiveness of that management instrument in services organizations, is also justified because the case study evaluates a company that takes part of the Supplement Health Services System, a widely discussed subject in Brazil nowadays. The conclusions of this research indicate that an ABC system fits as a support tool for the budgeting process, showing different approaches that could be applied or tested in other organizations. / As freq??entes cr??ticas que o processo de or??amento tradicional recebe dos usu??rios as organiza????es est??o principalmente baseadas no seu distanciamento da realidade operacional da empresa, ocasionado muitas vezes pela falta de compromisso com os n??meros planejados e a inadequa????o das informa????es que o alimentam. O sistema de custeio baseado em atividades (ABC) demonstra detalhadamente o consumo dos recursos pelos processos de neg??cio realizados nas organiza????es, fornecendo subs??dios importantes para o gerenciamento estrat??gico dos custos e acompanhamento do desempenho operacional, sendo, portanto, um instrumento adequado para apoiar o planejamento das empresas. Este trabalho analisa a aplica????o das informa????es de um sistema ABC no processo or??ament??rio de uma empresa do ramo de seguro sa??de, ressaltando o aperfei??oamento qualitativo alcan??ado no desenvolvimento das proje????es financeiras e na tomada de decis??es. A an??lise est?? focada nas melhorias apresentadas pelos procedimentos (planejamento e controle) relacionados ao or??amento tradicional a partir do uso do ABC, detalhando-se suas aplica????es a aloca????o dos custos aos produtos e an??lise de rentabilidade, dimensionamento de capacidade instalada, proje????o de custos com base nas atividades, an??lise diagn??stica da varia????o e controle de projetos de tecnologia da informa????o. A relev??ncia do problema de pesquisa, que visa examinar se a integra????o das informa????es de um sistema ABC ao processo tradicional de or??amento empresarial melhora a efic??cia deste instrumento gerencial em empresas prestadoras de servi??o, se justifica tamb??m pelo fato do estudo de caso avaliar uma empresa que faz parte do Sistema Supletivo de Sa??de, ??rea que atualmente ?? tema de amplo debate no Brasil. As conclus??es obtidas as pesquisa apontam para adequa????o do sistema ABC como ferramenta de apoio ao processo or??ament??rio, apresentando diferentes abordagens que poderiam ser aplicadas ou testadas em outras organiza????es.
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Costs of illness, demand for medical care, and the prospect of community health insurance schemes in the rural areas of Ethiopia /Asfaw, Abay. January 2003 (has links)
Thesis (doctoral)--Universität, Bonn, 2002. / Includes bibliographical references (p. 207-218).
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Health insurance, employment-sector choices and job attachment patterns of men and womenVelamuri, Malathi Rao 28 August 2008 (has links)
Not available / text
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Impact of type of drug insurance on adherence, persistence and costs of antidepressant drugs : a Quebec population-based studyAssayag, Jonathan 01 1900 (has links)
Contexte: À date, il existe peu de données sur l’adhésion, la persistance et les coûts associés aux antidépresseurs selon le type d’assurance médicament (privé ou public).
Objectif: Comparer selon le régime d’assurance médicament (privé ou public), l'adhésion, la persistance et les coûts des antidépresseurs.
Méthodes de recherche: Une étude de cohorte appariée a été réalisée en utilisant des bases de données du Québec.
Sujets: Nous avons sélectionné 194 patients assurés par un régime privé et 1923 patients assurés par le régime public de la Régie de l’assurance maladie du Québec (RAMQ) (18-64 ans) qui ont rempli au moins une ordonnance pour un antidépresseur entre décembre 2007 et septembre 2009.
Mesures: L’adhésion, mesurée sur une période d’un an, a été estimée en utilisant le proportion of prescribed days covered (PPDC). Un modèle de régression linéaire a été utilisé afin d’estimer la différence moyenne en PPDC entre les patients assurés par un régime privé et ceux assurés par le régime public de la RAMQ. La persistance a été comparé entre ces deux groupes avec un modèle de régression de survie Cox, et le coût mensuel d'antidépresseurs ($ CAN) a été comparé entre ces deux groupes en utilisant un modèle de régression linéaire.
Résultats: Le PPDC parmi les patients assurés par un régime privé était de 86,4% (intervalle de confiance (IC) 95%: 83,3%-89,5%) versus 81,3% (IC 95%: 80,1%-82,5%) pour les patients assurés par le régime public de la RAMQ, pour une différence moyenne ajustée de 6,7% (IC 95%: 3,0%-10,4%). La persistance après un an parmi les patients assurés par un régime privé était de 49,5% versus 18,9% pour les patients assurés par le régime public de la RAMQ (p <0,001), et le rapport de risque ajusté était de 0,48 (IC 95%: 0,30-0,76). Comparativement aux patients assurés par le régime public de la RAMQ, les patients ayant une assurance privée ont payé 14,94 $ CAD (95% CI: $12,30-$17,58) de plus par mois en moyenne pour leurs antidépresseurs.
Conclusion: Les patients assurés par un régime privé avaient une meilleure adhésion, persistance, mais avaient aussi un plus haut coût pour leurs antidépresseurs que ceux assurés par le régime public de la RAMQ. Cette différence de coûts peut être due aux différentes exigences de paiement en pharmacie entre les deux régimes ainsi qu’aux limites des honoraires des pharmaciens imposés par le régime public. / Background: The influence of the type of drug insurance on adherence, persistence and cost of antidepressants is not well known.
Objective: To compare adherence, persistence and cost of antidepressants in patients with private and public drug insurance.
Research Design: A matched cohort study was conducted using prescription claims databases from Quebec, Canada.
Subjects: 194 privately and 1923 publicly insured patients (18-64 years) who filled at least one prescription for an antidepressant between December 2007 and September 2009.
Measures: Adherence over one year was estimated using the proportion of prescribed days covered (PPDC). The difference in mean PPDC between patients with private and public drug insurance was estimated with a linear regression model. Persistence was compared between the groups with a Cox regression model, and the monthly cost of antidepressants (CAD$) was compared between the two groups using linear regression.
Results: The PPDC was 86.4% (95% CI: 83.3-89.5) in patients with private and 81.3% (95%CI: 80.1-82.5) in patients with public drug insurance and the adjusted mean difference was 6.7% (95% CI: 3.0-10.4). Persistence was 49.5% in patients with private and 18.9% in patients with public drug insurance at one year (p<0.001), and the adjusted hazard ratio was 0.48 (95%CI: 0.30-0.76). Patients privately insured paid 14.94$ CAD (95% CI: 12.30; 17.58) more per month on average for their antidepressants.
Conclusion: Better adherence and persistence and higher costs were observed in privately insured patients. Cost difference might be due to different pharmacy payment requirements and pharmacists’ honorary restrictions under the public plan.
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POROZUMĚNÍ A POSTOJE LÉKAŘŮ K SOUČASNÉ REFORMĚ ZDRAVOTNICTVÍ / UNDERSTANDING AND DOCTORS` APPROACHES TOWARDS THE CURRENT HEALTH SERVICE REFORMTVRDÁ, Lenka January 2009 (has links)
Health care concerns everybody. Man{\crq}s right to health care is one of the fundamental human rights. There is no ideal health care system as yet, and states reform their health care systems and the ways of their funding. The reform of the health care system has been conducted in this country for a long time. No minister, however, has introduced more substantial changes and interferences in the present system than the Health Minister MUDr. Tomáš Julínek. This reform is known to citizens especially because of the introduction of fees for health treatment. However, the reform reaches farther. Further steps of the reform propose changes in the public health insurance, providing health care and in education, science and research. The transformation of the health care system of the Czech Republic has not completely resolved and finished a number of matters. Finishing these matters is braked by disputes in the political representation. This thesis is focused on finding out the understanding and attitudes of physicians towards the present reform of the health care system. To collect data, I used the questionnaire method. Its data were collected between January and March 2009. The return rate of questionnaires reached 84 per cent. The set of respondents consisted of physicians from the Vysočina Region in the districts of Havlíčkův Brod and Jihlava. The objective of my thesis was to find out the attitudes of physicians towards the present reform of the health care system. The objective of my thesis was fulfilled. I verified the following hypotheses by my research: Hypothesis 1: Opinions of self-employed physicians are different from those in employment relationship. Hypothesis 2: Differences in physicians{\crq} opinions are also dependent on their specialisations. Both hypotheses were confirmed in most aspects. I suppose that my research has brought new information concerning the opinions of physicians of the Czech health care system and of the changes going on in it. A number of things changed while this diploma thesis was being written, and the reform of the health care system did not proceed in the way it had been planned. I think that despite this the research results are useful and may be used as a basis for further research in this field, and thus enlarge information concerning this subject.
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Optimalizace výplaty příjmů společníků a jednatelů od obchodní společnosti / Optimalizacion of Taxation on Incomes for the Stockholder and Executive Head of the CompaniesMajtanová, Marie January 2011 (has links)
The diploma thesis focuses on the optimization of the income payment the partner (shareholder), who is also the executive heads of a trading company with limited liability. An analysis of the incomes paid according to their amount and type is fundamental for the choice of the optimum variants in the particular trading company. The result achieved is a reduction of the costs associated with the payment of the company´s and the partner´s financial resources. The thesis will help founders of companies to save costs related to expenditure incurred in the disbursement of financial resources for their personal use.
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Differences in Access to Care and Healthcare Utilization Among Sexual Minorities: A Master's ThesisPham, Tan Phu 02 June 2014 (has links)
BACKGROUND: The barriers in accessing healthcare for gay, lesbian and bisexuals individuals are not well explored. These challenges as well as a lack of knowledge concerning this understudied group has prompted the Institute of Medicine to create a research agenda to build a foundational understanding of gay, lesbian and bisexual health and the barriers they encounter.1 the primary aim of this study will be to compare the differences in health care access and utilization between gay/lesbian, bisexual and heterosexual individuals using a large, nationally representative dataset of the U.S. population.
METHODS: Data from 2001 to 2012 from the National Health and Nutrition Examination Survey was pooled. Using logistic regression, we calculated the unadjusted and adjusted odds ratios of having health insurance, having a routine place and seeing a provider at least one in the past year.
RESULTS: We found that gay men were more likely to have health insurance coverage (ORadj:2.13 95%CI: 1.15,3.92), while bisexual men were at a small disadvantage in having health insurance coverage (ORadj:0.82 95%CI: 0.46,1.46). Bisexual men were more likely to have received health care in the past 12 months (ORadj:3.11 95%CI: 1.74,5.55). Lesbian women were less likely to have health insurance coverage (ORadj-lesbian:0.58 95%CI: 0.34,0.97).
CONCLUSION: This study contributed to the limited knowledge on understanding the health care access and utilization among gay, lesbian and bisexual individuals, which was classified as a high priority by the Institute of Medicine. Expanding health insurance coverage through the Affordable Care Act and Universal Partnership Coverage may reduce the disparities among gay, lesbian and bisexual individuals.
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