Introduction South Africa has a two tiered health care system: a private sector catering for seven of the 47 million people and public sector providing care to the majority. The private sector consists of for-profit providers that are funded either through medical schemes, health insurance policies or out of pocket expenditure. To attain the goal of the health care system of improving health, it is essential that healthcare financing is understood. The provision of quality, accurate and comprehensive financial data is necessary for the efficient mobilization and allocation of financial resources. Health Expenditure Reviews and National Health Accounts provide such invaluable information. Aim To provide a trend analysis of health financing and expenditure data for the private health care sector in South Africa from 01 January 2003 to 31 December 2006. Methods This study is employs an observational, descriptive cross-sectional design. The methodology used in the study is adapted from the World Health Organization’s guide to producing National Health Accounts. Data was obtained from the Council for Medical Schemes annual reports and from Statistics South Africa Income and Expenditure Survey. The annual average medical inflation for each of the years was removed from the nominal value so that a real trend analysis could be observed. Results For the four year period, the overall cost-drivers of consolidated schemes were private hospitals (31.0-35.0%), medical specialists (20.0-21.0%), medicines dispensed out of hospital (17.0-22.0%) and non-healthcare expenditure like administration and broker fees (14.0-15.0%). From the households’ consumable expenditure on health, 37.0% was spent on medical services, 35.0% on pharmaceutical products and 11.0% on hospital services. Discussion The majority of expenditure in the private sector is through medical schemes. The precise amount spent by households is unknown due to the lack of data but it is a large amount for the South African household. Proper National Health Account Matrices could not be constructed since access to data was limited, not routinely available and not disaggregated at the required level. Recommendations Better quality information on out-of-pocket household expenditure and expenditure in the traditional sector is needed. To improve access to the private sector, the proposed policy and legislative changes need to be implemented. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

Thesis (Ph. D.)--University of California, San Diego, 1998. / Vita. Includes bibliographical references (leaves 152-154).

Thesis (LL.M)--York University, 2003. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--Ohio State University, 2007. / Full text release at OhioLINK's ETD Center delayed at author's request

Made available in DSpace on 2016-08-12T18:48:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-23. Added 1 bitstream(s) on 2016-08-12T18:50:53Z : No. of bitstreams: 1 000864877.pdf: 711944 bytes, checksum: 1101fd24cc6abb8252a98e9774afe4c2 (MD5) / 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... / 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 ...

The first chapter examines the impacts of health care provider exits on patient outcomes and subsequent reallocation. Using administrative data on the universe of nursing home patients, I estimate the mortality effects of 1,109 nursing home closures on incumbent residents with a matched difference-in-differences approach. I find that displaced residents face a short-run 15.7% relative increase in their mortality risk. Yet this increase is offset by long-run survival improvements, so the cumulative effect inclusive of the initial spike is a net decline in mortality risk. These gains are driven by patients reallocating to higher quality providers. I also find significant heterogeneity by local market conditions: the survival gains accrue only to patients in competitive nursing home markets, whereas residents in concentrated markets experience no survival improvements. I then develop and estimate a dynamic model of the nursing home industry with endogenous exit. Combining the model estimates with the mortality results, I examine the effects of counterfactual reimbursement policy experiments on nursing home closures and resident life expectancy. A universal 10% increase in the Medicaid rate decreases the frequency of closures, but causes some low-quality providers to remain open in competitive areas. In contrast, targeted subsidies for facilities in areas with limited alternatives improves overall life expectancy by averting the costliest nursing home closures. In the second chapter (co-authored with Szymon Sacher), we estimate a mortality-based Bayesian model of nursing home quality accounting for selection. We then conduct three exercises. First, we examine the correlates of quality, and find that public report cards have near-zero correlation. Second, we show that higher quality nursing homes fared better during the pandemic: a one standard deviation increase in quality corresponds to 2.5% fewer Covid-19 cases. Finally, we show that a 10% increase in the Medicaid reimbursement rate raises quality, leading to a 1.85 percentage point increase in 90-day survival. Such a reform would be cost-effective under conservative estimates of the quality-adjusted statistical value of life. The third chapter (co-authored with Michael Barnett and Adam Sacarny) examines why efforts to raise the productivity of the U.S. health care system have proceeded slowly. One potential explanation is the fragmentation of payment across insurers. Each insurer's efforts to improve care could influence how doctors practice medicine for other insurers, leading to unvalued externalities. We study these externalities by examining the unintended private insurance spillovers of a public insurer's intervention. In 2015, Medicare randomized warning letters to doctors to curtail overuse of antipsychotics. Even though the letters did not mention private insurance, they reduced prescribing to privately insured patients by 12%. The reduction to Medicare patients was 17%, and we cannot reject one-for-one spillovers. If private insurers conducted a similar intervention with their own limited information, they would stem half as much prescribing as a social planner able and willing to better target the intervention. Our findings establish that insurers can affect health care well outside their direct purview, raising the question of how to match their private objectives with their scope of influence.

Community-Based Health Insurance (CBHI) in Rwanda was promulgated as the best alternative to address the financial barriers for accessibility to health care services for the poor population and the informal sector. The purpose of this study was to investigate whether CBHI reduce Out-of-pocket health expenses for their members as compared to non-members and to what extent CBHI provide financial protection for the poorest population. This research based itself on secondary source of data primarily collected for a prospective quasi-experimental design which evaluated the impact of Performance-Based Financing. The primary study had reported on the Out-Of-Pocket expenses for health by members and non-members of CBHI; residing in a sample of 1961 households; in addition to their demographics and socio-economic characteristics. The findings indicate that insured individuals were about 2.6 times more likely to utilize health care services than respondents without health insurance. It is also worth noting that households with health insurance coverage were less likely to experience a catastrophic health expenditure than households without health insurance (aOR: 0.744; 95% CI:[0.586 - 0.945]), and that the effect of health insurance coverage was higher in people living in poor households than in people living in middle or richer households / Health Studies / M.A. (Public Health)

Kuok, Chiu Fai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 139-154). / Abstract and appendix also in Chinese. / Abstract --- p.i / Abstract (in Chinese) --- p.iv / Acknowledgements --- p.vi / Table of Contents --- p.vii / List of Tables --- p.xi / List of Figures --- p.xiv / List of Abbreviations --- p.xv / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- The Impact of Malignant Diseases and Multiple Myeloma --- p.4 / Chapter 1.3 --- Pharmacoeconomics --- p.6 / Chapter 1.4 --- Macao Healthcare System --- p.9 / Chapter 1.5 --- Study Hypothesis --- p.12 / Chapter 1.6 --- Study Objectives --- p.12 / Chapter 1.7 --- Perspective of the Study --- p.13 / Chapter Chapter 2 --- Literature Review / Chapter 2.1 --- Hematopoietic System --- p.14 / Chapter 2.1.1 --- Specific Blood Cell Lineages and Blood Cells --- p.15 / Chapter 2.1.2 --- Bone Marrow Microenvironment --- p.19 / Chapter 2.2 --- The Hematologic Malignancies --- p.20 / Chapter 2.2.1 --- Leukemia --- p.21 / Chapter 2.2.2 --- Lymphoma --- p.23 / Chapter 2.2.3 --- Plasma Cell Disorders --- p.24 / Chapter 2.3 --- Multiple Myeloma --- p.25 / Chapter 2.3.1 --- Epidemiology --- p.26 / Chapter 2.3.2 --- Pathology --- p.29 / Chapter 2.3.3 --- Clinical Presentation and Disease Complications --- p.31 / Chapter 2.3.4 --- Classification and Diagnostic Criteria --- p.35 / Chapter 2.3.5 --- Disease Staging and Prognosis --- p.42 / Chapter 2.3.6 --- Treatment --- p.45 / Chapter 2.3.6.1 --- Treatment Regimens and Strategies --- p.47 / Chapter 2.3.6.1.1 --- Standard Chemotherapy --- p.48 / Chapter 2.3.6.1.1.1 --- Melphalan-based Regimens --- p.51 / Chapter 2.3.6.1.1.2 --- VAD-based Regimens --- p.52 / Chapter 2.3.6.1.1.3 --- High-dose Glucocorticoid Regimens --- p.53 / Chapter 2.3.6.1.2 --- Treatment Strategies --- p.53 / Chapter 2.3.6.1.2.1 --- Initial Chemotherapy --- p.53 / Chapter 2.3.6.1.2.2 --- High-dose Chemotherapy --- p.55 / Chapter 2.3.6.1.2.3 --- Newer Therapeutic Agents for Multiple Myeloma --- p.58 / Chapter 2.3.6.1.2.4 --- Salvage Chemotherapy --- p.60 / Chapter 2.3.6.2 --- Treatment Responses --- p.63 / Chapter 2.3.6.3 --- Treatment for Disease Complications --- p.66 / Chapter Chapter 3 --- Methodology / Chapter 3.1 --- Study Design --- p.69 / Chapter 3.2 --- Patients Selection Criteria --- p.71 / Chapter 3.2.1 --- For Retrospective Cost Analysis --- p.71 / Chapter 3.2.2 --- For Health-related Quality of Life Measurement --- p.71 / Chapter 3.3 --- Patient Screening --- p.72 / Chapter 3.4 --- Data Collection --- p.72 / Chapter 3.5 --- Overview of Assessment Methods --- p.73 / Chapter 3.5.1 --- Outcomes --- p.73 / Chapter 3.5.2 --- Cost Analysis --- p.74 / Chapter 3.5.3 --- Cost Effectiveness Analysis --- p.74 / Chapter 3.5.4 --- Cost Utility Analysis --- p.75 / Chapter 3.5.5 --- Health-related Quality of Life Assessment --- p.75 / Chapter 3.6 --- Statistical Analysis --- p.76 / Chapter 3.7 --- Ethic approval --- p.77 / Chapter Chapter 4 --- Results / Chapter 4.1 --- Study Population --- p.78 / Chapter 4.1.1 --- Cost and Pharmacoeconomic Analysis --- p.78 / Chapter 4.1.2 --- Health-related Quality of Life Assessment --- p.79 / Chapter 4.2 --- Study Results --- p.81 / Chapter 4.2.1 --- Comparison of All Patients --- p.81 / Chapter 4.2.1.1 --- Differences in Treatment Protocols --- p.81 / Chapter 4.2.1.2 --- Differences in Treatment Responses --- p.82 / Chapter 4.2.1.3 --- Differences in Treatment Outcomes --- p.82 / Chapter 4.2.1.4 --- Differences in Treatment Costs --- p.84 / Chapter 4.2.2 --- Comparison for Patients Treated by Melphalan-based Regimens and VAD-based Regimens --- p.90 / Chapter 4.2.2.1 --- Differences in Treatment Responses --- p.90 / Chapter 4.2.2.2 --- Differences in Treatment Outcomes --- p.90 / Chapter 4.2.2.3 --- Differences in Treatment Costs --- p.93 / Chapter 4.2.3 --- Melphalan-based Regimens Versus VAD-based Regimens by Patients with Different DS Staging --- p.96 / Chapter 4.2.3.1 --- Patients in Stage 3-A MM --- p.96 / Chapter 4.2.3.2 --- Patients in Stage 3-B MM --- p.98 / Chapter 4.2.4 --- Melphalan-based Regimens versus VAD-based Regimens in Patients with Different IS Staging --- p.101 / Chapter 4.2.4.1 --- Patients in Stage I MM --- p.101 / Chapter 4.2.4.2 --- Patients in Stage II MM --- p.104 / Chapter 4.2.4.3 --- Patients in Stage III MM --- p.107 / Chapter 4.2.5 --- Comparison for Patients with and without Transplantation --- p.110 / Chapter 4.2.6 --- Cost-effectiveness Assessment --- p.117 / Chapter 4.2.7 --- Cost-utility Assessment --- p.118 / Chapter 4.2.8 --- Sensitivity Analysis --- p.119 / Chapter 4.2.9 --- Health-related Quality of Life Assessment --- p.120 / Chapter Chapter 5 --- Discussion and Conclusion / Chapter 5.1 --- Summary of Results --- p.123 / Chapter 5.2 --- Implication for Treatment --- p.126 / Chapter 5.3 --- Economic Evaluation --- p.129 / Chapter 5.4 --- Health-related Quality of Life --- p.132 / Chapter 5.5 --- Limitations of the Study --- p.134 / Chapter 5.6 --- Conclusion and Implications for Future Studies --- p.135 / Appendix --- p.137 / References --- p.139

Since the late 1990s accelerated growth in health care spending coupled with a cost shift of health insurance from employers to employees has created an increased financial burden for many families. Past research suggests that financial burden due to out-of-pocket (OOP) health care costs limits access to health care and may reduce spending on other basic needs, such as food. The primary objective of this study was to assess the relationship between out-of-pocket health care expenditures and food insecurity among families with children. Secondarily, this study examined the relationship between the health status of children and household food security. This study used data from the Panel Study of Income Dynamics (PSID, 2003) to test whether higher out of pocket health care expenditures increase household food insecurity for families with children. Respondents reported out of pocket expenditures for both medical services and insurance premiums in 2001 and 2002. Food insecurity was measured for the previous 12 months using the 18-item USDA Food Security Survey Module. Multivariate weighted logit analysis was conducted to model the relationship between OOP health care costs and household food security status; and child health status and household food security. There was no evidence that higher OOP health care costs were associated with household food insecurity. However, among families earning less than 300 percent of the federal poverty threshold, having private insurance did increase the likelihood of experiencing food insecurity (OR =4.77, 95% CI = 0.05 - 1.02). Households with a child in poor health were not more likely to experience food insecurity; however having a wife in poor health was associated with food insecurity (OR = 4.00, 95% CI =1.67-9.52). The findings from this study suggest that programs designed to limit OOP health care spending among moderate and low income families should evaluate the impact on household food security. / Graduation date: 2013 / Access restricted to the OSU Community at author's request from July 23, 2012 - July 23, 2013

Over the past decade, chronic illnesses have increased significantly in developing regions around the world, with implications for health service provision. Research shows that morbidity follows a social gradient in many countries around the world. Though various studies highlight the importance of socioeconomic status as a predictor of a person’s morbidity and mortality experience, there is a dearth of data and literature in the South African context. This study aimed to address this gap by examining the association between socioeconomic status and diabetes and hypertension among participants aged 35 years and older. This was achieved by undertaking the analysis of secondary data from the National Income Dynamic Study. The findings of the study reveal that there is a significant relationship between socioeconomic factors and chronic health outcomes of individuals. People with lower levels of education were more likely to have a chronic illness than those with higher levels of education. However, interestingly the lowest rates of prevalence were found in the unemployed category in South Africa. This draws attention to the need for further research on employment and chronic disease prevalence. An important finding of the study was the relatively higher prevalence of chronic conditions in rural areas and among the Black/African population. This data suggests that changes in lifestyle and behavior in the context of globalization and urbanization may be contributing to changes in the health profile of these communities. Policy makers need to acknowledge that chronic diseases are no longer the preserve of the wealthy with diseases such as diabetes and hypertension evident across all sectors of South African society. By addressing the causes of chronic conditions policies and programs can aim to prevent the emergence of future epidemics. In the long-term, sustainable progress will only be achieved with greater attention directed towards the socioeconomic factors underlying the health profile of the country. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.