The ambulatory care facility is a new phenomenon in the British Columbia health care delivery system. Therefore, not only is its planner faced with the uncertainty of predicting future need, but also the perplexity of not having the very basis for his predictions: past utilization data from existing facilities. Moreover, there is no real agreement on what services should be provided in an ambulatory care facility. This thesis attempts to at least partially allay these uncertainties by setting down a format for planning an ambulatory care facility in and for the community of Delta, B. C. The planning method was divided into four parts: ambulatory care definition, data assemblage, data projection and facility simulation. Delta practitioners and several health care consultants co-operated in the production of an exhaustive list of medical, surgical and dental procedures defining ambulatory care. In accordance with this list, data was assembled regarding the number of ambulatory procedures regularly performed for Delta residents, by Delta practitioners. Medical and surgical data was taken from Provincial Department of Health computer data files; while dental data was gathered by questionnaire. The data trend for each procedure was then projected to the Target Years 1978 and 1982. Following these initial steps, a General Purpose Simulation System (G.P.S.S.) analysis was performed on the data gathered. Other information required for the simulation was gathered through questionnaires to Delta practitioners and private conferences with health care consultants. The results from the simulation were expressed in "work areas" (i.e. examination rooms, stretcher-beds, etc.) required in the major departments or service areas. The simulation analysis could only be completed for the Surgical Day Care Services area, because the data from Provincial computer data files, relevant to other departments or service areas, was found to be insufficient. The main problem encountered was an imprecise identification of patients' geographic origin; which in some instances made it impossible to identify procedures performed for Delta residents. Detailed suggestions for improving the method are presented in the Discussion. However, one should at least do the following: endeavour to use more than two years of data to project the trend in the Provincial computer data files; and explain the questionnaires circulated to practitioners by giving individual person-to-person instructions, rather than group verbal and individual written instructions. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The rising costs of health care and the lack of integration between parts of the delivery system has led to discussion and experiments on new forms of delivering care. Governments have included the development of ambulatory care in new statements of objectives and goals in the hope that expenditures might be reduced through the reduced use of acute care hospital beds. This is a study of the experience surrounding an acute care hospital's attempts to have a Medical Day Care Program accepted by the government as an adjunct to the existing Ambulatory Care Services of the hospital. As Director of Nursing at the hospital it was possible to follow the sequence of events, concept development, proposal design, ministry involvement, implementation and evaluation. A diary was kept for one year following implementation of the program as a pilot project and project documents have contributed to the analysis of events. What was not readily apparent were the many forces outside the hospital which were impacting on the likelihood of the proposal's acceptance. Since Ambulatory Care was the health policy of the 1970's it was puzzling to find the Ministry of Health unresponsive to a proposal which seemed most appropriate. In attempts to resolve the puzzle regarding the lack of interest in ambulatory care at the hospital level, other developments in the province were reviewed. Planning models were explored seeking explanation for inconsistencies observed between stated government objectives and government behavior in relation to the development of hospital ambulatory care. More satisfactory explanations were found in a political model than in planning models, in the light of actual developments. Some conclusions are drawn about the impact of political realities on management functions in health care institutions. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Thesis (M.S.)--Boston University

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

Faced with mounting health care costs, the United States needs to learn more cost-cutting options. The U.S. ranks at the top of lists on health care spending by country.1 The factors that drive American spending are complicated, and experts disagree with each other about which ones are most responsible for the country’s high medical costs; some commonly cited cost drivers include Medicaid, Medicare, fee-for-service and malpractice law. There are currently a number of methods employed by the government, hospitals, and insurance companies to keep costs down, including the increased use of Licensed Practical Nurses and Physicians Assistants, acute care and cost shifting,and Health Maintenance Organizations. In order to learn more about ways to save money on health care, the United States should look to other countries for examples. Switzerland enacted universal health care in 1994; in the nearly twenty years since, the government and insurance companies have instituted measures to control spending. These are practices and policies such as, blue letters of warning for seemingly frivolous doctors, no special insurance program or extra coverage for the elderly, and increased competition. Switzerland spends less on health care each year than the United States and yet has a higher life expectancy. 2 Furthermore, Switzerland celebrates twenty years of universal health care in the same year the individual mandate takes effect in the United States, 2014. Now is a timely moment to see if studying Switzerland’s health care system illuminates the options to American policymakers. Drawing information from scholarly articles, web articles, and website data, I will begin with a literature review section that underscores why a comparison between the Swiss and American health care systems can deepen our understanding of the policy options facing contemporary U.S. policymakers. I will then compare and contrast some specific features of the two health care systems. I will conclude by reflecting on whether and how lessons learned from Switzerland's health care policy can guide the American health care debate. / Department of Political Science

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (p. [84]-89).

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2000. / Includes bibliographical references (leaves 135-137).

published_or_final_version / Public Administration / Master / Master of Public Administration

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.