Thesis (Ph. D.)--West Virginia University, 2006. / Title from document title page. Document formatted into pages; contains xii, 251 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 203-215).

Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

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.

Submitted in fulfillment of the requirements for the Degree in Master in Technology: Marketing, Technikon Natal, 2003. / Managed care is defined by Chetty (1999: 1) as "the practice of evidence based medicine with an approach to managing both the quality and cost of medical care". Managed care was introduced into South Africa in the last decade due to increasing cost of healthcare. All forms of managed care represent attempts to control costs by modifying the behaviour of general practitioners. / M

M.Comm. / Chapter 2 Chapter 2 researches the literature with regard to the evolvement of health care delivery in the USA and specifically the effect that the development and implementation has had on managed care. Chapter 3 Chapter 3 briefly describes the process of management and the components of strategic management. It also mentions the evolvement of management style proposed by Hickman. Finally it sets out in a graphical format the categories and "levels" into which health care can be divided and delivered. It is suggested that these are the issues to consider when assessing a medical benefit fund. Chapter 4 Chapter 4 presents the results and the findings of the various components and factors that impacted upon the external and internal analysis of the fund. The framework used to analyse the fund for strategic management are those proposed by De Bruyn, Kruger and McKinsey. Comments are made about the extent to which each component of strategic management is being applied within Steelmed based upon the evidence assimilated from the study. Finally the financial statements and membership numbers are used to evaluate how successful Steelmed has been. Chapter 5 Chapter 5 highlights the changes to take place if fourth wave strategic management is to be implemented and makes recommendations about the need for an on-going study to measure the effect this will have.

This dissertation examines the effects of migration and remittances on family members left behind in sending areas. It consists of a systematic review of the literature on the effects of remittances on recipients’ health and empirical analyses that examine the effects of migration and remittances on medical spending and women’s empowerment. In 2019, 270 million international migrants sent over $530 billion dollars in remittances to their home countries. This project advances the literature on the effects of these processes. The empirical analyses use panel and cross-sectional survey data from the 2013 and 2018 waves of the Kerala Migration Survey, a large-scale longitudinal survey conducted in Kerala, India that followed the families of thousands of migrants from 1998 to 2018. The panel analyses used logistic and linear fixed-effects models, and the cross-sectional analyses used factor analysis, linear regression, and two-step Heckman selection models to assess the effects of migration and remittances on medical spending and women’s empowerment. The review found that migration and remittances play an important role in shaping health among individuals in transnational families. Remittances had the most pronounced benefits in areas with limited resources and social protections. They improved health by enabling households to pay for healthy food, medical treatment, and housing, and they improved mental health by easing financial constraints. Remittances were less beneficial in areas with strong safety nets, support systems, and community ties because family members were not dependent on remittances to provide basic needs. Migration and remittances shaped medical spending. Panel and cross-sectional analyses found that migrant households spent more money on medical expenses compared to non-migrant households. The panel analysis found that, compared to non-migrant households, households that received low levels of remittances spent less on medical care and households that received high levels of remittances spent a greater amount of money on medical care. After adjusting for health status and covariates, the cross-sectional analysis found positive and linear relationships between remittances and amount of medical spending. Although out-of-pocket costs of medical care in India can be high and although remittances are often used to maintain and increase social status, remittances were positively associated with increased medical spending in transnational families. Migration and remittances also influenced dimensions of women’s empowerment. They increased women’s management of household responsibilities, including decision-making and income control. However, migration decreased women’s internalized social status and neither migration nor remittances had meaningful effects on spousal attitudes. These findings suggest that women in migrant households may have taken on more household responsibilities, but their social status did not improve. This dissertation’s results suggest that migration and remittances influence health outcomes, certain dimensions of women’s empowerment, and ability to pay for to medical care in Kerala and other settings. However, their effects vary by context and indicators used to measure outcomes. Programs and policies should maximize the benefits of migration and remittances while reducing their associated harms.

The purpose of this study was to examine variations in the surgical rates among the elderly population of hospital service areas of southwest and central Virginia in order to assess whether these variations were influenced by physicians and hospitals. Procedures analyzed were specific to the elderly. Considerable variations in the rates of the selected surgical procedures were found. Some areas were found to be surgically more active than others. The variables that proved to be determinants of surgical rates were availability of general physicians and specialists and hospital occupancy rate. The impact of availability of hospital beds, per capita expenditure and ownership status of facilities were found to be mixed and inconsistent. / Master of Urban Affairs

This study examined whether or not it is in the financial best interest of public school districts, as employers, to promote the health of its employees.

This study evaluated the relationship of varying body mass index and average annual health care costs and absenteeism in a group of 524 municipal employees. The 269 employees with health care claims and the 487 employees with attendance records were categorized into five different BMI categories based on self-reported weight and height. Findings from the study suggest that as BMI increases, average annual health care costs and average annual absenteeism increase. However, BMI was only significantly related to absenteeism. The study also found significant relationships between education and health care costs and absenteeism. No significant differences for health care costs or absenteeism were found based on race, age, gender, wellness center membership, or smoking status.

Orientador: José Carlos Peraçoli / Coorientador: Silvana Andréa Molina Lima / Banca: Carmen Maria Casquel Monti Juliani / Banca: Roberto Antonio de Araujo Costa / Banca: Nelson Lourenço Maia Filho / Banca: Mary Angela Parpinelli / Resumo: Introdução: a hipertensão arterial complica entre 7% e 10% de todas as gestações. As síndromes hipertensivas determinam repetidas internações, maior tempo de internação e aumento das taxas de internação em unidade de cuidados intensivos, o que eleva os custos hospitalares. Ter conhecimento dos custos dos serviços de saúde prestados é essencial para identificar as unidades que precisam reduzi-lo, controlar os gastos e eliminar os desperdícios. Objetivo: identificar e analisar os custos (diretos, indiretos e total) da assistência prestada às gestantes hipertensas durante o pré-natal, a internação e o parto. Sujeitos e métodos: foi realizado estudo retrospectivo, exploratório e quantitativo de gestantes que receberam assistência pré-natal e ao parto no Hospital das Clínicas da Faculdade de Medicina de Botucatu - Unesp (HC-FMB-Unesp)no período de um ano (janeiro a dezembro de 2011). Foram analisados os custos de 80 gestantes com diagnóstico de hipertensão arterial e 80 gestantes normotensas (grupo controle). Utilizou-se um instrumento constituído por duas planilhas, no qual os dados foram obtidos dos prontuários e de informações disponibilizadas pelo Núcleo de Custos do HC-FMB-Unesp. Resultados: os valores dos custos indiretos, diretos e total, correspondentes à assistência pré-natal não diferenciam os grupos estudados. Na internação houve diferença significativa entre os valores dos custos analisados (indireto, direto e total), quando se comparou o grupo controle e o grupo de gestantes hipertensas. O valor do custo total do parto também foi significativamente maior no grupo de gestantes hipertensas quando comparado com o grupo controle. Quando se analisou o grupo de gestantes hipertensas, estratificado segundo a forma de manifestação clínica da hipertensão, as formas pré-eclâmpsia e hipertensão crônica superposta por préeclâmpsia foram responsáveis pelo maior custo. Conclusão: o custo total da... / Abstract: Introduction: hypertension complicates between 7% and 10% of all pregnancies. Hypertensive disorders determine repeated hospitalizations, longer hospital stays and increased rates of hospitalization in the intensive care unit, which increases hospital costs. It is essential to know the costs of health services to identify the units that need to reduce it, to control spending and eliminate wastes. Objective: To identify and analyze the costs (direct, indirect and total) of assistance provided to hypertensive pregnant women during prenatal care, hospitalization and childbirth. Subjects and Methods: We performed a retrospective, exploratory and quantitative study of pregnant women who received prenatal and delivery care at the Hospital of the Botucatu Medical School - UNESP (HC-FMB-UNESP) in the period of one year (January to December 2011). Costs of 80 patients diagnosed with hypertension and 80 normotensive pregnant women (control group) were analyzed. We used an instrument consisting of two worksheets, in which the data were obtained from medical records and information provided by Cost Center of HC-FMB-UNESP. Results: The indirect, direct and total costs corresponding to prenatal care did not differentiate the groups. On admission there was a significant difference between the control and hypertensive pregnant women when the values of costs (indirect, direct and total) were compared. The value of the total cost of delivery was also significantly higher in the group of hypertensive pregnant women than in the control group. When we analyzed the group of hypertensive pregnant women, stratified according to the clinical manifestation of hypertension, preeclampsia and chronic hypertension superimposed by preeclampsia were both responsible for the higher cost. Conclusion: the total cost of health care for hypertensive pregnant women is greater than that of normotensive pregnant women and among hypertensive women, forms of manifestation ... / Doutor