In 2009 China launched an ambitious health care reform to ensure equal and affordable access to basic health care for all by 2020. The reform was not only a response to changing patterns of disease, rising health expenditures, and widening regional inequalities, but part of a wider strategy to improve the social security system covering residents in order to increase domestic consumption. Its success will be defined by the efficient use of funds in financing and delivering health care. Against this backdrop, this dissertation evaluates the importance of health insurance characteristics on measures of financial risk protection, household saving and consumption, and preference for health care providers. It uses an experimental design to study the effect of more generous outpatient coverage and a tiered reimbursement structure that sets rates higher at primary care facilities than tertiary hospitals. While middle income households benefitted most in terms of financial risk protection, poorer and sicker households increased utilization at primary care facilities and food consumption – two pathways by which health insurance can improve health outcomes. This suggests that as outpatient coverage improves those most vulnerable will increase their access to health care, where there was previous underutilization, but not necessarily see an improvement in financial risk protection. The increased cover would also offer greater protection for those already using healthcare, but on its own not necessarily change their utilization patterns or reduce household savings. Looking at the quality-price trade-off in choice of provider reveals that, while at lower levels of household consumption demand for outpatient care is elastic with respect to price, as living standards rise past subsistence, individuals begin to value other provider characteristics. Together, these findings highlight the importance of benefit design and quality improvements at lower levels of care to shift patterns of utilization and ensure health services are accessed cost-effectively.

Thesis (MTech (Information Technology))--Peninsula Technikon, Cape Town, 2005 / The overall objective of this study is to identify the importance of culture in the implementation of Information systems and how output influences the success of a system. • The first objective is to assess the organizational culture in each hospital in terms of one of the dimensions of culture on Hofstede's checklist, namely power distance. • The second objective is to determine whether the speed with which a HIS was implemented was a success at the two academic hospitals in the Western Cape using the reduction of the level of backlog (paper based patient registration records) as a measure of implementation progress.

Thesis (MTech (Information Technology))--Peninsula Technikon, 2005. / This study was initiated to investigate whether power distance facilitates the successful implementation of a hospital information system. A comparative study was done to evaluate the effect of culture on the same information system (CLINICOM), implemented at the same time, but at different locations. The overall objective of this study was to identify the importance of culture in the implementation of In formation systems and how output influences the success of a system. • The first objective was to assess the organizational culture in each hospital in terms of one of the dimensions of culture on Hofstede's check Iist, namely power distance. • The second objective was to determine whether the speed with which a HIS was implemented was a success at the two academic hospitals in the Western Cape using the reduction of the level of backlog (paper based patient registration records) as a measure of implementation progress. The literature was reviewed on what determines the success of an information system. The effects of culture were studied and in particular power distance on the implementation of an information system and how this factor affected the backlog of information entries. Questionnaires were administered to the clerical staff at the hospitals, as they were the high users of the information system. The study showed that both institutions had a high power distance score, but the one institution had a Power distance Index (POI) that was considerable higher than the other. PDr relates to the concentration of authority. This finding suggests that the managers were more autocratic at the one hospital than at the other. The study found that the higher the PDI, the faster the backlog was reduced at implementation. Thus the higher the por the greater the concentration of authority;

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2011. / The research was conducted as part of a socio-tech initiative undertaken at the Cape Peninsula University of Technology. The socio-tech initiative overall focus was on addressing issues faced by rural and under-resourced communities in South Africa, specifically looking at Home-Based Healthcare (HBHC) primarily in the Western Cape. As research into the HBHC context in rural and under-resourced communities continued numerous issues around data and data-elements came to light. These data issues were especially prevalent in relation to the various paper forms being used by the HBHC initiatives that attempt to deliver care in these communities. The communities have the tendency to suffer from poor access to formal healthcare services and healthcare facilities. The data issues were primarily in terms of how data was defines and used within the HBHC initiatives. Within the HBHC initiatives that cater for rural and under-resourced communities there was a clear prevalence of paper-based systems, and a very low penetration of IT-based solution. Because similar and related data-elements are used throughout the paper forms and within different context these data-elements are inconsistently used and presented. The paper forms further obfuscate these inconsistencies as the paper forms regularly change due to internal and external factors. When these paper forms are changed date elements are added or removed without the changes to the underlying ontologies being considered.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016. / Unlike the developed nations, the health sector within the developing countries is faced with the triple challenges of human, financial and technological scarcity of resources. This insufficiency of resources results into amongst other intrapartum mishaps. To ameliorate some of these conditions, the World Health Organization (1994) promoted the use of the pathogram as an informative and data capturing tool that could help reduce intrapartum mishaps. The usage of the partogram within the intrapartum environment also introduced a dilemma as birth attendants spent quite a good amount of time using their eyes and hands (in pen and paper) capturing medical data onto the partogram instead of investing these resources onto the expectant mother and or fetus. This study adopted Design Science Research as a suitable research approach, strengthened by a pragmatic philosophical standpoint. This study involved the following methods; • A review of literature in the intrapartum environment, along with topics from relevant reference disciplines including speech recognition • A series of semi-structured contextual interviews with birth attendants, student nurses and senior midwives • A design science research study using the knowledge from the reference disciplines to design a hands-free voice driven epartogram • A simulation of the capturing of intrapartum data to evaluate and refine the prototype (epartogram) by applying anonymized intrapartum data driven by natural speech • An evaluation of the artifact (epartogram) based on a number of published guidelines recommended by scholars to demonstrate its potential utility as well as to establish if the solution is generic to the contextual environment. Although the introduction of ICT into the problem domain abetted the process of data capturing (specifically the referral process), the fundamental aspect of using the prototype to free the hands and eyes of the birth attendants proved challenging due to issues with the recognition of natural speech by speech recognition systems and background noise. Monitoring of MOU and the referral process from a lower MOU to a higher one could benefit a great deal from this study as the prototype thrived well in that regard. Natural speech recognition by machines in an uncontrolled environment is still at its infancy (some of the most powerful engines can not differentiate between background noise and direct instruction). Not withsatnding the challenges posed by the infancy of speech recognition, the artifact showed potential as a manual epartogram providing spatial access to multiple participating MOU via the cloud.

Thesis (MTech (Emergency Medical Care))--Cape Peninsula University of Technology, 2016. / Background - As emergency medical care students approach the exit level of their four-year qualification, additional focus get placed on assessment of their ability provide patient care in the real world pre-hospital emergency care environment. Upon graduation, there is no opportunity for newly graduated emergency care practitioners to complete an internship programme. The assessment of clinical competence is therefore regarded as a critically important and invaluable activity within the academic unit. Academic staff within the Emergency Medical Care department at UJ recognised the need for the development of a standardised assessment instrument to purposefully assess pre-hospital clinical performance and developed an assessment instrument referred to as the University of Johannesburg Clinical Performance Assessment Instrument (UJ CPAI). Having developed the UJ CPAI it became necessary and important to scientifically investigate and evaluate the extent to which the CPAI (as a newly developed instrument) meets the requirements of what is considered to be a "good assessment instrument". For this reason investigation of the validity, reliability and end-user support for the implementation of the UJ CPAI became the central aim and focus of this study.

Orientador: Sérgio Resende Carvalho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T00:02:45Z (GMT). No. of bitstreams: 1 Martins_AndersonLuizBarbosa_D.pdf: 2013028 bytes, checksum: 63d7de08d03d6bb1e4e17f09c1245cb9 (MD5) Previous issue date: 2012 / Resumo: A arte de governar a própria existência e a dos outros tornou-se uma questão imprescindível para a constituição dos modos de subjetivação na modernidade. Michel Foucault desenvolveu uma perspectiva analítica rica e complexa desse tema a partir dos estudos sobre a governamentalidade liberal. Na atualidade, uma série de transformações no território do governo imprimiu uma nova configuração a essa questão. Na nova arte liberal de governar que se constituiu no segundo pós-guerra, vê-se fortalecer progressivamente a ideia de que o indivíduo deve ser o autor ativo de suas escolhas de vida e também o único responsável pelos riscos e perigos que essas escolhas implicam. Compondo uma abordagem metodológica com base nos trabalhos genealógicos de Michel Foucault e nos estudos de Gilles Deleuze, esta pesquisa tem como objetivo delinear uma cartografia das relações de forças que fazem da gestão dos riscos na busca da saúde perfeita uma tecnologia biomédica de governo da subjetividade. Inicialmente, no cenário econômico e político caracterizado pelo liberalismo clássico, os elementos dessa arte de governo são apresentados através da análise da tecnologia de segurança, tendo em seu centro a medicalização da vida e a normalização da sociedade disciplinar, da constituição e afirmação do individualismo burguês e da consolidação do Estado-nação. Em seguida, na passagem da sociedade disciplinar para a de controle, procuramos apontar para a afinidade existente entre a racionalidade política de um liberalismo avançado e sua ética da autonomia, com o discurso do risco à saúde na atualidade. No interior desse novo cenário, examinamos os novos procedimentos e técnicas de biomedicalização e seus efeitos sobre a produção de subjetividade. As análises sobre o governo da subjetividade possibilitam a construção de um pensamento crítico sobre nossa relação com as práticas históricas e seus efeitos. Pois arguir a história é desnaturalizar seus eventos, fazendo aparecer o jogo de forças que dá corpo à realidade / Abstract: The art of governing our own existence and of others has become an indispensable question for the constitution of the ways of subjectivity at the modernity. Michel Foucault has developed a rich and complex analytical perspective of this theme starting from the studies about the liberal governmentality. At the present time, a series of transformations on the government territory has given a new configuration to this question. In the new art of governing that was constituted in the second post-war, we see the progressive strengthening of the idea that the individual should be the active author of his life choices and also the only responsible for the risks and dangers that these choices implicate. The objective of this research is to delineate the map of the relations of forces that make the management of the risks in the search of the perfect health a technology of government of the subjectivity. Initially, in the economical and political scenery characterized by the classical liberalism, the elements of that art of government are presented through the analysis of the technology of safety, having in its center the medicalization of life and normalization of the disciplinary society, of the constitution and statement of the bourgeois individualism and of the consolidation of the nation-State. Next, in the passing from the disciplinary society to the control society, we attempt to point at the existent affinity between the political rationality of an advanced liberalism and its autonomy ethics, with the speech of the risk to health at the present time. Inside this new scenery, we examine the new procedures and techniques of the health medicalization and their effects on the subjectivity production. The analyses on the government of conduct make possible the construction of a critical thought about our relationship with the historical practices and their effects. Because to interrogate the history is to denaturalize its events, making the game of forces that gives body to reality appear / Doutorado / Ciências Sociais em Saúde / Saude Coletiva

D.Cur. (Nursing Management) / A health maintenance organisation (HMO) that implements managed care is the health care service provider for a mine group. Case management is an integral part of managed care. Case management in a managed care setting within this mine group should be to the holistic benefit of both the client/patient and the service provider. Within the case management environment, nurse case managers (CMs) and their counterparts (professional nurses) should provide and facilitate quality patient care. However, they face many challenges, such as working in isolation from one another. The purpose of the study was to develop a training programme for CMs and professional nurses (PNs) to facilitate quality patient care in a managed care environment for the health care service provider for a mine group. In this study a qualitative, exploratory, descriptive, and contextual design was followed. Purposive sampling was conducted from the populations of six CMs (N=6) and thirty PNs (N=30). Focus group discussions with twenty-eight (28) PNs and individual unstructured interviews with four (4) CMs were conducted to describe their experiences in the case management environment. Open coding followed, based on Tesch’s (1990) method of qualitative analysis (De Vos, 1998:343), and a conceptual framework emerged from the data analysis. A programme to facilitate quality patient care in a case management environment of the HMO was described for stakeholders (nurse case-managers and PNs). Recommendations for implementing the programme were described. Adapted phases of the programme development process of Meyer and van Niekerk (2008) were used in developing the programme. The survey list of the Practice Oriented Theory of Dickhoff, James and Wiedenbach (1968:434) formed the basis for developing a conceptual framework for the programme. Principles of case- and problem-based approaches (Scheider, 2010) served as a point of departure to develop the context-specific training programme. Trustworthiness was maintained by using Guba’s (De Vos, 2006:346; Babbie & Mouton, 2001: 276) model criteria, which are credibility, transferability, conformability and dependability. Ethical standards were adhered to throughout the study.

Whereas there are various initiatives to standardize the storage, processing and use of electronic patient information in the South African health sector, the sector is fragmented through the adoption of various approaches on national, provincial and district levels. Divergent IT systems are used in the public and private health sectors (“Recommendations of the Committee on …” 2003). Furthermore, general practitioners in some parts of the country still use paper as a primary means of documentation and storage. Nonetheless, the use of computerized systems is increasing, even in the most remote rural areas. This leads to the exposure of patient information to various threats that are perpetuated through the use of information technology. Irrespective of the level of technology adoption by practitioners in private healthcare practice, the security and privacy of patient information remains of critical importance. The disclosure of patient information whether intentional or not, can have dire consequences for a patient. In general, the requirements pertaining to the privacy of patient information are controlled and enforced through the adoption of legislation by the governing body of a country. Compared with developed nations, South Africa has limited legislation to help enforce privacy in the health sector. Conversely, Australia, New Zealand and Canada have some of the most advanced legislative frameworks when it comes to the privacy of patient information. In this dissertation, the Australian, New Zealand, Canadian and South African health sectors and the legislation they have in place to ensure the privacy of health information, will be investigated. Additionally, codes of practice and guidelines on privacy of patient information for GPs, in the afore-mentioned countries, will be investigated to form an idea as to what is needed in creating and formulating a new code of practice for the South African GP, as well as a pragmatic tool (checklist) to check adherence to privacy requirements.

This research sought to identify the determinants of nonuse and high use of physician services and assess whether or not patterns of nonuse and high use changed over time. The population of interest was a group of elderly unmarried women who participated in the Longitudinal Retirement History Survey from 1969 to 1979. Andersen and Newman's (2) health care services utilization model served as the conceptual framework for this research. Of specific interest was the relationship between age strata and health care behavior. Age proved to be a stratifying variable within the health care delivery system. Over the ten year survey period, the health care behavior of preretirement and postretirement nonusers and high users differed significantly. A decline in nonuse was also associated with the transition years. This finding could be attributed to the "near poor" becoming eligible for Medicare. In any event, these data show that utilization of physician services is likely to increase among some unmarried women in their middle 60's.