Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta dissertação analisou as Empresas Promotoras de Salud (EPS), seguradoras de saúde introduzidas no sistema de saúde colombiano através da reforma sanitária instaurada com a Lei n 100/1993, desde uma perspectiva de economia política crítica, através do método de análise documental. A maioria delas são empresas privadas com finalidade lucrativa que conformaram rapidamente um oligopólio que reproduziu problemas dos modelos de Managed Care e Managed Competition já conhecidos internacionalmente. Esta dissertação analisou as relações entre os processos de financeirização do sistema capitalista e o processo de ajuste estrutural na Colômbia, com a reforma sanitária e a dinâmica financeira das EPS. Também foi analisada a introdução de mecanismos próprios do processo de financeirização na gestão financeira das EPS, como: a alavancagem; a reprodução ampliada de capital através da dívida pública; e os investimentos em ativos securitizados. Dado que o sistema de saúde atual se caracteriza por altos níveis de inequidade e injustiça, as consequências da finalidade lucrativa neste, com suas expressões concretas de sofrimento e morte na população, foram preocupações transversais deste trabalho. Os resultados desta dissertação demonstraram a concentração oligopólica do mercado de seguros privados de saúde, cujas empresas se organizaram como um cartel, dificultando o acesso aos serviços de saúde para seus segurados, o que contribuiu para a piora de indicadores de saúde da população. Quando a mobilização social obrigou a aumentar o controle sobre as EPS, estas começaram a sair do mercado declarando-se em falência, ou entrando subitamente em balanços financeiros negativos. / This thesis analyzes the Empresas Promotoras de Salud (EPS meaning health promoting entity), which are health insurance companies that act in the Colombian health system since the health reform law of 1993 (Law 100). Based on a document analysis and within a critical political economy framework, we firstly address the relations between the financialization process in the capitalist system, the structural reforms and the health care reform, with the EPSs financial dynamics, and secondly address the reproduction of financialization mechanism inside the EPS including financial leverage; expanded reproduction of capital through the public debt; and investments in securitized assets. Most EPS are private for profit companies, which quickly formed an oligopolistic market and exemplify internationally recognized contradictions of the Managed Care and Managed Competition models, also as its forprofit orientation and functioning has been related to the exacerbation of health inequities and has further been recognized as a driver of suffering and death in the population. This has primarily been related to the oligopolistic concentration of the private health insurance market, whose companies are organized as a cartel, hindering access to health services for the population. When social mobilization forced to increase control over the EPS, they began to leave the market declaring themselves bankrupt, or suddenly entered negative financial statements.

It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to provide information about their payer mix, implementation barriers, registry implementation, registry use, and clinic satisfaction. The survey instrument was validated by an expert panel which included practitioners and researchers. Statistical methods including Structural Equation Modeling were used for analysis and to test the research hypotheses. The majority of medical home practices that responded used some type of computerized registry, either with basic patient information or integrated with detailed clinical information. And on average, they somewhat used registries for population management, individual health management, proactive care and planned care visits. All practices encountered some combination of barriers when implementing a medical home program. Most practices reported clinic satisfaction at least improved after becoming a medical home. The results of the analysis show that indeed payer mix, in particular Medicare and private insurance, has a significant relationship with level of registry implementation. There were no significant relationships between barriers and registry implementation or use. More sophisticated registry implementation led to greater registry use. And registry use is associated with increased clinic satisfaction. This research fills an important gap in understanding Health IT use, registries in particular, among Patient-Centered Medical Homes. The findings suggest that: 1) Implementation barriers may not be influencing use of computerized registries in medical home practices; 2) Using more sophisticated computerized registries facilitates registry use, which can help improve clinic satisfaction; 3) Payer mix may influence use of more sophisticated Health IT in medical home practices.

No description available.

The study was aimed at furthering the health objectives of the government's Reconstruction and Development Programme (ANC 1994b) in the area of primary health care. . The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary health care, so that medical scheme benefits do not become exhausted so rapidly. The overall outcome of the study showed that if cardiovascular disease could be diagnosed and treated early, the financial benefits could be substantial. This was illustrated by the comparison of primary, secondary and tertiary treatment of cardiovascular disease using case studies over a period of one year. Recommendations centered around nurse-based primary health care for cardiovascular disease and the cost-effective management of the medical scheme. It was concluded that as a result of nurse-based primary health care, costs could be contained so that medical scheme benefits would not become exhausted so rapidly. / Health Studies / M.A. (Nursing Science)

Child rights, especially the right to health for children, is a concept of human development. The aim of this qualitative study is to explore the obstacles to gender equality in the right to healthcare for children under five years in East Champaran, Bihar, North India. Ten key informant interviews and nine focus group discussions with mothers, fathers, grandmothers and grandfathers were conducted to research the barriers of guardians to accessing healthcare for their children, including their root beliefs and choices, which causes health inequalities. It was found that a strong patriarchal tradition predominates in these communities in North India, which favour sons and disadvantages daughters in healthcare provision. Despite the existing child rights and human rights policies that have been legislated, in India traditional practices that discriminate against female children remain dominant in the society, and limit development in East Champaran, Bihar, North India. / Development Studies / M.A. (Development Studies)

The proposition that inadequate health literacy on antenatal care (ANC) is exacerbating maternal mortality in sub Saharan Africa (SSA) is undisputable. Yet, little is known about ANC literacy in Lesotho, an SSA country with high maternal mortality rates. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts using a semi-structured questionnaire making recourse to statistical principles. Overall, 16.4% of the participants had grossly inadequate ANC literacy, while 79.8% had marginal levels. Geographic location and level of education were the most significant predictors of ANC literacy. Participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Furthermore, significant knowledge gaps on baby layette and mother’s essential items for delivery were found. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas is recommended. / Health Studies / M.A. (Nursing Science)

The study was aimed at furthering the health objectives of the government's Reconstruction and Development Programme (ANC 1994b) in the area of primary health care. . The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary health care, so that medical scheme benefits do not become exhausted so rapidly. The overall outcome of the study showed that if cardiovascular disease could be diagnosed and treated early, the financial benefits could be substantial. This was illustrated by the comparison of primary, secondary and tertiary treatment of cardiovascular disease using case studies over a period of one year. Recommendations centered around nurse-based primary health care for cardiovascular disease and the cost-effective management of the medical scheme. It was concluded that as a result of nurse-based primary health care, costs could be contained so that medical scheme benefits would not become exhausted so rapidly. / Health Studies / M.A. (Nursing Science)

The South African health care environment is a two-tier health care delivery system consisting of the public sector and the private sector. The focus of this study is on the private health care sector. Private health care is funded by medical schemes through employer and employee contributions. The private sector is also the most profitable sector for multinational pharmaceutical organisations to market and sell their products within the South African health care environment. The major cost saving initiative by employers and medical schemes in the private health care sector has also been the introduction of managed health care initiatives. The goal of managed health care is to establish a system which delivers value by giving people access to quality and cost-effective healthcare. The new reality of managed health care initiatives are changing the boundaries of the South African pharmaceutical industry. The managed health care wake is overturning the business processes which made the pharmaceutical industry so successful and are rendering obsolete the industry's conventional models of corporate strategy and management systems. In the context of these turbulent changes, pharmaceutical companies are being forced simultaneously to develop new strategic approaches for the future, design new business processes which will link them more firmly to their new customers, and implement the cultural changes neccessary to accomplish the transformation from yesterday's successful pharmaceutical company to tomorrow's customer-led, integrated health care supplier. The way forward lies in three organising concepts. The first is cutomer alignment. The effort of transformation must start with an understanding of how the customer defines the value of the services and/or products offered by the organisation. Everything that follows involves aligning internal processes with external contingencies. The second is sequencing. It is vital to understand not just what needs to happen first in the transformation process, but also what the subsequent steps is and in what order the steps need to be undertaken. The third organising concept is learning. The sequence of interventions that lead to organisational transformation must occur in such a way as to maximize the ability of the organisation to learn: from customers and the marketplace, and from itself. / Business Management / D.B.L.

The aim of the study was to investigate the knowledge and utilisation of antenatal care (ANC) services by pregnant women at a clinic in Ekurhuleni. A quantitative, descriptive correlational study was carried out on 90 eligible pregnant women. Data were collected with a self-administered questionnaire and analysed with the help of a statistician using the Epi Info version 7 computer program. The results of the study indicate that most women initiated ANC later than the recommendations by the World Health Organization (WHO). Over half of the respondents had overall good knowledge of ANC, but lacked knowledge of medication and screening tests done during pregnancy, some danger signs during pregnancy and of exclusive breastfeeding. Factors that were identified as associated with late initiation of ANC were current employment status, number of children, transport costs to clinic and number of antenatal visits. / Department of Health Studies / M.A. (Public Health)

Risk management strategy is a broad discipline aimed at identifying, evaluating and handling risks by both physical and financial means. The medical aid industry in South Africa has experienced a disproportionate increase in expenditure relative to the overall economic growth. These cost pressures have placed restraints on their ability to obtain new members, which is vital when subsidizing higher risks with younger healthier members, and has resulted in losses for many schemes. Compounding the problem has been political and regulatory health care reforms as well as technological advances, which have initiated a complete restructure of the industry. This dissertation reviews the risk management strategies implemented by medical insurers in South Africa. An analysis of alternate risk management strategies is taken with the view of recommending a tentative means of making medical aids more efficient in an increasingly difficult market. / Business Management / M. Comm. (Business Management)