Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena. / Graduation date: 2012

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)

Text in Afrikaans / The purpose of this research study is to determine the extent to which employee assistance programmes can be utilised by welfare agencies to ensure that work-related and personal problems do not negatively influence the productivity of social workers. The group of respondents consisted of ten social work supervisors from ten different welfare agencies, which included civil sevice organisations, specialist organisations and family welfare organisations. The conclusion that was reached based on the findings of the empirical study is that social workers have a need for services that will prevent, relieve or eliminate their work-related and personal problems, in order to improve the productivity and general functioning of social workers. It is recommended that welfare agencies in accordence with their unique nature and functioning and the specific needs of the social workers, utilise employee assistance programmes so as to ensure optimal productivity of social workers / Die doel van die navorsingstudie is om te bepaal tot watter mate werknemerhulpprogramme deur welsynsinstansies aangewend kan word ten einde te verseker dat werkverwante en persoonlike probleme nie die produktiwiteit van maatskaplike werkers negatief beinvloed nie. Die ondersoekgroep het bestaan uit tien maatskaplikewerksupervisors van tien verskillende welsynsinstansies, te wete staatsdiensorganisasies, spesialiteitsorganisasies en gesinsorgorganisasies. Na aanleiding van die empiriese ondersoek is daar tot die gevolgtrekking gekom dat maatskaplike werkers 'n behoefte aan dienste het wat hul werkverwante en persoonlike probleme voorkom, verlig of uit die weg ruim ten einde produktiwiteit en algemene funksionering van maatskaplike werkers te bevorder. Daar word aanbeveel dat welsynsinstansies, na gelang van hul unieke aard en funksionering en die spesifieke behoeftes van die maatskaplike werker, werknemerhulpprogramme sal aanwend ten einde optimale produktiwiteit van maatskaplike werkers te verseker. / Social Work / M.Diac. (Social Work)

Text in Afrikaans / The purpose of this research study is to determine the extent to which employee assistance programmes can be utilised by welfare agencies to ensure that work-related and personal problems do not negatively influence the productivity of social workers. The group of respondents consisted of ten social work supervisors from ten different welfare agencies, which included civil sevice organisations, specialist organisations and family welfare organisations. The conclusion that was reached based on the findings of the empirical study is that social workers have a need for services that will prevent, relieve or eliminate their work-related and personal problems, in order to improve the productivity and general functioning of social workers. It is recommended that welfare agencies in accordence with their unique nature and functioning and the specific needs of the social workers, utilise employee assistance programmes so as to ensure optimal productivity of social workers / Die doel van die navorsingstudie is om te bepaal tot watter mate werknemerhulpprogramme deur welsynsinstansies aangewend kan word ten einde te verseker dat werkverwante en persoonlike probleme nie die produktiwiteit van maatskaplike werkers negatief beinvloed nie. Die ondersoekgroep het bestaan uit tien maatskaplikewerksupervisors van tien verskillende welsynsinstansies, te wete staatsdiensorganisasies, spesialiteitsorganisasies en gesinsorgorganisasies. Na aanleiding van die empiriese ondersoek is daar tot die gevolgtrekking gekom dat maatskaplike werkers 'n behoefte aan dienste het wat hul werkverwante en persoonlike probleme voorkom, verlig of uit die weg ruim ten einde produktiwiteit en algemene funksionering van maatskaplike werkers te bevorder. Daar word aanbeveel dat welsynsinstansies, na gelang van hul unieke aard en funksionering en die spesifieke behoeftes van die maatskaplike werker, werknemerhulpprogramme sal aanwend ten einde optimale produktiwiteit van maatskaplike werkers te verseker. / Social Work / M.Diac. (Social Work)