Thesis (Ph. D.)--RAND Graduate School, 2000. / Includes bibliographical references (p. 123-131).

Thesis (Ph. D.)--RAND Graduate School, 2000. / Includes bibliographical references (p. 123-131). Also available on the Internet.

Bibliography: pages 94-102. / There is currently much work underway internationally to improve the accuracy and to refine the detail of accounting for health care expenditures. This research was initiated by the increasing activity in the field of national health accounting, as well as by previous research indicating that the Reserve Bank might be underestimating private health care expenditure in the national accounts. The Reserve Bank estimate of health care expenditure is important as it is the only complete and regularly produced estimate of private sector health care expenditure for South Africa. It was posited that an independent estimation of private health care expenditure would show that its magnitude is underestimated in the expenditure estimates published by the Reserve Bank for the national accounts. This thesis was upheld by the results of the research. The thesis estimate of private health care expenditure was R15 billion, 39% higher than the Reserve Bank estimate available at the time. It was also 21% higher than the final Reserve Bank estimate published in December 1995. The methodology used to derive the thesis estimate involved a survey of national income accounting concepts and guidelines embodied in the internationally used publication, the 1993 System of National Accounts. Primary data was collected from a wide range of institutions in the South African health sector. Secondary data sources were also consulted in several instances. In particular, the Registrar of Medical Schemes was consulted for medical scheme expenditure estimates as they constitute the largest portion of private sector health care expenditure in South Africa. The thesis estimate was then calculated for a single year according to the 1993 System of National Accounts guidelines. The year chosen was the government financial year from April 1992 to March 1993. The year was chosen to coincide with the year chosen for a national health expenditure review. In the presentation of the results, the estimate was broken down in separate "sources" and "uses" matrices, which are being used internationally to present national health accounting information. From the comparison of the Reserve Bank and thesis expenditure estimates, one of the most important recommendations that emerged was that the Reserve Bank should consult a wider range of expenditure data sources, more timeously and regularly. In particular, it was suggested that the Reserve Bank should negotiate earlier access to the data held by the Registrar of Medical Schemes, as well as cross-check household survey data with independent estimates of out-of-pocket and statutory scheme health care expenditure. In addition to providing a new benchmark estimate for private sector health care expenditure in the government financial year 1992/93, the breakdown of the estimate into matrices provides a framework that could be used as the basis for the development of more detailed satellite national health accounts, in accordance with 1993 SNA standards.

No description available.

Thesis (MPhil)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: This thesis discusses the value of medical futility as an action guide for neonatal endof- life decisions. The concept is contextualized within the narrative of medical progress, the uncertainty of medical prognostication and the difficulty of just resource allocation, within the unique African situation where children are worse off today than they were at the beginning of the last century. parties actively engage in an interactive deliberation for a plan of action. Both parties ought to accept moral responsibility. Such a model of deliberation has the added advantage of transcending the limitations of the participants to arrive at a higher-level solution, which is considered more than just a consensus. It has been argued that medical progress has obscured the basic need for human compassion for the dying and for their loved ones. The literature furthermore reports that the quality of end-of-life care is unsatisfactory for both patients and their families. It is within this context that the concept of medical futility is positioned as a useful action guide. As we do not have the luxury of withdrawing from the responsibility to engage in the deliberation of end-of-life decisions, such responsibility demands an increasing awareness of ethical dilemmas and a model of medical training where communication, conflict-resolution, inclusive history taking, with assessment of patient values and preferences, is focussed on. The capacity for empathetic care has to be emphasized as an integral part of such approach. Finally, in this thesis, the concept of medical futility is tested and applied to clinical case scenarios. It is argued that the traditional medical paradigm, with its justification of an 'all out war' against disease and death, in order to achieve utopia for all, is outdated. Death in the neonatal intensive care unit is increasingly attributed to end-of-life decisions. Futile treatment could be considered a waste of scarce resources, contradicting the principle of nonmaleficence and justice, particularly in an African context. The ongoing confidence in, and uncritical submission to the technological progress in medicine is understood as a defence and coping mechanism against the backdrop of the experience of life's fragility, suffering and the inevitability of death. Such uncritical acceptance of the technological imperative could lead to a harmful fallacy that cure is effected by prolonging life at all cost. What actually occurs, instead, is the prolongation of the dying process, increasing suffering for all parties involved. The historical development of the concept of medical futility is discussed, highlighting its applicability to the paradigmatic scenario of cardio-pulmonary resuscitation. Particular attention is given to ways in which the concept could endanger patient-autonomy by allowing physicians to make unilateral, paternalistic decisions. It is argued that the informative model of the patient-physician relationship, where the physician's role is to disclose information in order for the patient to indicate her preferences, ought to be replaced by a more adequate deliberative model, where both / AFRIKAANSE OPSOMMING: Hierdie tesis bespreek die waarde van mediese futiliteit as 'n maatstaf vir aksie in gevalle van neonatale 'einde-van-lewe' besluite. Die konsep word gekontekstualiseer binne die wêreldbeskouing van mediese vooruitgang, die onsekerheid van mediese prognostikering en die probleme wat geassosieer IS met regverdige hulpbrontoekenning; spesifiek binne die unieke Afrika-situasie. Dit word aangevoer dat die tradisionele mediese paradigma, met regverdiging vir voorkoming van siekte en dood ten alle koste, verouderd is. Sterftes in neonatale intensiewe sorgeenhede word toenemend toegeskryf aan 'einde-van-lewe' besluite Futiele behandeling sou dus beskou kon word as 'n vermorsing van skaars hulpbronne, wat teenstrydig sou wees met die beginsels nie-skadelikheid ('nonmaleficence') en regverdigheid. Die volgehoue vertroue in en onkritiese aanvaarding van aansprake op tegnologiese vooruitgang lil geneeskunde, kan beskou word as verdediging- en hanteringsmeganisme in die belewenis van lewenskwesbaarheid, lyding en die onafwendbaarheid van die dood. Sodanige onkritiese aanvaarding van die tegnologiese imperatief kan tot 'n onverantwoordbare denkfout, naamlik dat genesing plaasvind deur verlenging van lewe ten alle koste, lei. Wat hierteenoor eerder mag plaasvind, is 'n verlenging die sterwensproses en, gepaard daarmee, toenemende lyding van all betrokke partye. Die historiese ontwikkeling van die konsep van mediese futiliteit word bespreek met klem op die toepaslikheid daarvan op die paradigmatiese situasie van kardiopulmonêre resussitasie. Spesifieke aandag word gegee aan maniere waarop die konsep pasiënte se outonomie in gevaar stel, deur die betrokke medici die reg te gee tot eensydige, paternalistiese besluitneming. Die argument is dan dat die informatiewe model, waar die verhouding tussen die dokter en pasiënt gebasseer is op die beginsel dat die dokter inligting moet verskaf aan die pasiënt sodat die pasiënt 'n ingeligte besluit kan neem, vervang moet word met 'n meer toepaslike beraadslagende model, waar sowel die dokter as die pasiënt aktief deelneem aan interaktiewe beraadslaging oor 'n aksieplan. Albei partye word dan moreel verantwoordbaar. So 'n model van beraadslaging het die bykomende voordeel dat dit die beperkings van die deelnemers kan transendeer. Sodoende word 'n hoër-vlak oplossing - iets meer as 'n blote consensus - te weeg gebring. Die argument word ontwikkel dat mediese vooruitgang meelewing met die sterwendes en hul geliefdes mag verberg. Verder dui die literatuur daarop dat die kwaliteit van einde-van-lewe-sorg vir sowel die pasiënte as hul familie onaanvaarbaar is. Dit is binne hierdie konteks dat die konsep van mediese futiliteit kan dien as 'n maatstaf vir aksie. Medici kan nie verantwoordelikheid vir deelname aan beraadslaging rondom eindevan- lewe beluitneming vermy nie, en as sodanig vereis die situasie toenemende bewustheid van sowel die etiese dilemmas as 'n mediese opleidingsmodel waann kommunikasie, konflikhantering, omvattende geskiedenis-neming, met insluiting van die pasient se waardes en voorkeure, beklemtoon word. Die kapasiteit vir empatiese sorg moet weer eens beklemtoon word as 'n integrale deel van hierdie benadering. Ten slotte, hierdie tesis poog om die konsep van mediese futiliteit te toets en toe te pas op kliniese situasies.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-06-26T12:37:57Z No. of bitstreams: 1 Vicente Arouche Santos Filho.pdf: 1185882 bytes, checksum: 0e80810faa5ae003c3af669dfe7a3238 (MD5) / Made available in DSpace on 2018-06-26T12:37:57Z (GMT). No. of bitstreams: 1 Vicente Arouche Santos Filho.pdf: 1185882 bytes, checksum: 0e80810faa5ae003c3af669dfe7a3238 (MD5) Previous issue date: 2018-03-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The objective of this research is to explain and understand the implications of changing legislation regarding the release of foreign capital in public health care. Health policy was shaped by the 1988 Constitution to meet all Brazilians and has undergone several changes over the last 30 years, in which public spending has been surpassed by private spending with the introduction of health insurance regulations and with the permission of the presence of foreign capital in this area, besides the existence of problems of underfunding of the Unified Health System (SUS) by the budgetary mechanisms that prioritize the payment of interest on public debt. This paper exposes the process of development of neoliberalism in Brazil that can be understood as the scenario for identifying the problems of the implantation of the SUS and for the growth of the private sector in the health area. The focus of this study is the introduction of Federal Law 13.097, which allows the entry of foreign capital from the health care area in the country, highlighting the controversy about its introduction / O objetivo desta pesquisa é expor e compreender as implicações da alteração da legislação no que diz respeito a liberação do capital estrangeiro no setor público da saúde. A política de saúde foi moldada a partir da Constituição de 1988 para atender a todos os brasileiros e sofreu diversas alterações ao longo dos últimos 30 anos, em que o gasto público foi sendo superado pelo gasto privado com a introdução da regulamentação dos planos de saúde e com a permissão da presença de capital estrangeiro nessa área, além da existência de problemas de subfinanciamento do Sistema Único de Saúde (SUS) pelos mecanismos orçamentários que priorizam o pagamento dos juros da dívida pública. Este trabalho expõe o processo de desenvolvimento do neoliberalismo no Brasil que pode ser entendido como o cenário para a identificação dos problemas da implantação do SUS e para o crescimento do setor privado na área da saúde. O foco de análise desse trabalho refere-se à introdução da Lei Federal 13.097 que permite o ingresso do capital estrangeiro da área de assistência à saúde no país, evidenciando as controvérsias acerca de sua introdução

This thesis centres on the lives of women who live in Khayelitsha and who receive AIDS biomedicines through South Africa's public health system. It is tiered across five ethnographic chapters to elucidate a single overarching argument: biopolitical precarity is networked into the permeable body. This argument is based on ethnographic research and seeks to challenge the discursive construction of distance that divorces women's lives and bodies from the governance of AIDS biomedicines as life-­giving technologies. The multi-­sited ethnography underpinning this thesis was configured to follow the networked threads that weave women's embodied precarity into the governance of technologies and the technologies of governance. To this end, fieldwork was conducted in South Africa from October 2010 – July 2011 in order to understand the embodied and political dimensions of access to AIDS biomedicine. Thereafter, fieldwork was conducted in Brazil from August 2011 – September 2011 to explore the networked connections spanning activist organisations, government coalitions and economic blocs to move out from the intimate spaces of women's lives and bodies to locate them in the regional and global spaces of biomedical developments and health policy dynamics. This thesis argues that although it is crucial to anchor technologies in people's lives, it is also analytically and politically necessary to link people's lives - and the technologies that sustain them - back into the global assemblage that is networked around the governance of medicine. Therefore, I locate biomedical technologies in social and political contexts of lives of the people with whom I worked in Khayelitsha, and I argue further that their lives also need to be understood as part of a complex network of actors (spanning international organisations, regional coalitions and national governments) and actants (HIV and ARVs) that assemble in dynamic configurations and that are woven into and through the body.

University of Macau / Institute of Chinese Medical Sciences

El percentatge de població immigrant a l'estat espanyol oscil·la al voltant d'un 14%. Les característiques sociodemogràfiques d'aquests col·lectius nouvinguts ha suposat una alteració en la utilització dels recursos públics (sanitat o educació). Si pretenem garantir l'equitat en la prestació d'aquests serveis, cal identificar els factors que influeixen en la seva utilització. Definim i comparem el perfil demogràfic, socioeconòmic, de morbiditat atesa i d'utilització dels serveis sanitaris d'atenció primària pels usuaris immigrants i autòctons de la Regió Sanitaria Girona. Alhora, determinem quins d'aquests factors influeixen en l'accés i en l'ús d'aquests serveis. Les dades analitzades provenen d'un qüestionari administrat a una mostra d'usuaris dels serveis d'atenció primària de la Regió Sanitària Girona durant l'any 2006 i dels registres mèdics de l'Institut Català de la Salut. Les comparacions demogràfiques, socieconòmiques, de morbiditat atesa i utilització dels serveis sanitaris entre immigrants i autòctons es realitzen a través de contrastos paramètrics i no paramètrics. La identificació dels factors que influeixen en el primer contacte i en la freqüentació dels serveis d'atenció primària, es formula mitjançant l'especificació d'un model en dues parts. Els resultats evidencien l'existència de diferències demogràfiques, socioeconòmiques, culturals i d'estat de salut entre immigrants i autòctons. La modelització dels factors que intervenen en l'accés i freqüentació dels serveis d'atenció primària ens indica que realitzar el primer contacte amb els serveis de salut només es veu influenciat per factors relacionats amb la morbiditat. En canvi, una major o menor freqüentació depèn tant de factors relacionats amb la pròpia salut com dels elements socioeconòmics i demogràfics abans esmentats. Addicionalment, l'anàlisi fa evident no es pot considerar el col·lectiu d'immigrants com un tot homogeni, doncs l'origen de l'usuari és un element clau a l'hora de determinar diferents intensitats en l'accés i freqüentació. / The proportion of immigrants in Spain ranges around 14%. Sociodemographic characteristics of these newcomer's groups has meant an alteration in the use of public resources (health or education). If we want to ensure equity in the provision of these services, we must identify the factors that influence their use. We have defined and we have compared demographic profile, socioeconomic status, morbidity and the utilization of primary health care services for immigrant and native users in Girona Health Region. Likewise, we have determined which of these factors influence into the access and into the use of these services. The data come from a questionnaire administered to a sample of users of primary health cares services in Girona Health Region during 2006, and from the medical records of the Catalan Health Institute. Comparisons of demographic, socioeconomic, morbidity and health care services utilization between immigrants and natives are performed through parametric and nonparametric contrasts. The identification of factors that influence into the initial contact and into the frequency of primary care services utilization is formulated by specifying a model in two parts. The results show the existence of differences in demographic, socioeconomic, cultural and health status between immigrants and natives. The modeling of factors that affect access and frequency of primary health care services shows that make the first contact with health services is influenced only by factors related to morbidity. In contrast, a greater or lesser frequency depends on both their own health-related factors such as socioeconomic and demographic elements mentioned above. Additionally, the analysis evidences that immigrants are not an homogeneous collective, so the user origin is a key element in determining access to different intensities and frequency.

Thesis (D.P.H.)--University of Michigan.