Text in English / This study investigated practices, motivations, perceived benefits and barriers to outsourcing of support services by general hospitals in Uganda. The aim was to contribute to the evidence base to increase adoption and effectiveness of outsourcing by hospitals in Uganda. An explanatory sequential mixed methods design was used. Quantitative data was collected from hospital managers in 32 randomly selected hospitals using a self-administered questionnaire. Qualitative data was collected through in-depth interviews from 8 purposively selected hospital managers using an interview guide. Quantitative data was statistical analysed (frequencies, contingency tables and Wilcoxon-Mann-Whitney tests) using SAS 9.3. Qualitative data was managed using ATLAS ti 7, coded manually and content analysis conducted to identify emerging themes, subthemes and categories. A cost benefit analysis was conducted for outsourcing cleaning services in a selected hospital using financial data provided by the managers. Quantitative findings indicate that many (72%) hospitals were outsourcing some of their support services; many were satisfied with their outsourcing (>60%). The key motivation for outsourcing was to gain access to quality service (68%). Most hospitals have a system for monitoring outsourcing (71%). Managers perceive improved productivity and better services as the main benefit from outsourcing (90%). The main barrier to outsourcing is limited financing. A key challenge encountered during outsourcing was limited number of service providers (57%). Managers perceive regulatory violations as a key risk during outsourcing (87%). Hospital location is a determinant of outsourcing (p=0.0033). Managers’ perceptions towards outsourcing have no impact on outsourcing (p>0.05). These findings were confirmed and explained by the qualitative data. Qualitative findings reveal masquerading, impersonation and extortion of patients by outsourced staff as an outsourcing risk. They reveal a concern that outsourcing may lead to job loss for community members. The cost benefit analysis indicates that outsourcing in the studied hospital for the year considered was cheaper than insourcing by UGX 669,575.00. The savings increase to UGX 48,753,689.94 when adjusted for quality differences between insourced and outsourced services. Sensitivity analysis shows that the assumptions used in the analysis were robust. Recommendations, interventions and guidelines are proposed for increasing outsourcing and its effectiveness. / Health Studies / D. Litt. et Phil. (Health Studies)

The main aim of this research study was to explore attraction factors pertaining to the literature and to the occupational context of nursing personnel who have exhibited employment interest in a managed care organisation. A qualitative research approach was adopted in which semi-structured interviews were held to collect rich exploratory data from the purposeful sample of nine applicants with nursing qualifications. Twenty-five themes were identified through interpretive data analysis as being important factors in the pre-interview attraction process. The highest ranking of these were identified to be opportunities for professional and personal growth and the relationship with the managed care client, followed by salary and working hours. This study contributes knowledge to Personnel and Career Psychology in the field of Industrial and Organisational Psychology and is pertinent to organisations recruiting nurses, advising them in the formulation of contextually appropriate attraction strategies that attend to the most notable attraction factors / Industrial and Organisational Psychology / M.Com. (Industrial and Organizational Psychology)

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.

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.

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)

Includes publications published as a result of ideas developed in this thesis, inserted at end. / "April 2005" / Includes bibliographical references (leaves 210-242) / 242 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population. / Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005

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.

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)

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)

Text in English / South Africa is currently in the process health care reform as the Government has undertaken the task of providing universal health care to all South Africans through the implementation of the National Health Insurance Scheme (NHI). This study took an in-depth look at the history and progression of the post-1994 South African health care policy, and applied the Power Resources Theory to the political economy of the current health care reform process in South Africa. Through a comparative study of the pivotal elements in the phases of health reform in Canada and Sweden this study drew lessons for the design and implementation of universal public health care provision in South Africa. This study found that a strong culture of care, strong political will, active civil society participation and a focus on equality as opposed to poverty in the creation of policy is essential to a successful implementation of universal health care. / Sociology / M.A. (Sociology)