This dissertation is a histo-graphic account of the origins and evolution of private health funding in South Africa. It commences with a history of medicine within the context of the provision of health care and health funding. The arrival of the Dutch and the influence of the different rulers are highlighted throughout the different eras, up to the formation of the first private medical scheme in 1889. From this point onward, the historical development of private health funding is recorded with due consideration of the appointed commissions of enquiry and legislative developments. The dissertation concludes with a review of the study.

В магистерской диссертации рассмотрено экономическое и финансовое содержание механизма стимулирования. Дано законодательное и нормативное обоснование стимулирования медицинских организаций. Раскрывается система обязательного медицинского страхования. Обобщен практический опыт функционирования территориального фонда обязательного медицинского страхования Пермского края. Представлены направления совершенствования механизма стимулирования медицинских организаций. Дана характеристика методики расчета показателей результативности деятельности медицинских организаций. / The master's thesis examines the economic and financial content of the incentive mechanism. The legislative and normative substantiation of the stimulation of medical organizations is given. The system of compulsory medical insurance is being disclosed. The practical experience of functioning of territorial fund of obligatory medical insurance of the Perm edge is generalized. The directions of improving the incentive mechanism for medical organizations are presented. The characteristics of the methodology for calculating the performance indicators of medical organizations are given.

В магистерской диссертации рассмотрены теоретические основы организации добровольного медицинского страхования. Представлен национальный и международный опыт. Показана социальная и экономическая роль медицинского страхования. Рассмотрена деятельность страховой компании СОГАЗ. Раскрыто содержание проблем в медицинском страховании. Представлены направления повышения эффективности деятельности страховой компании. / In the master's thesis theoretical bases of the organization of voluntary medical insurance are considered. National and international experience is presented. The social and economic role of health insurance is shown. The activity of the insurance company SOGAZ is considered. The content of problems in medical insurance is disclosed. Are presented directions of increase of efficiency of activity of the insurance company.

一個國家要維持正常穩定的運作狀態，作全面性的有效管理，是立足於現代社會環境的必要條件。如何建立一個低風險、高水準的生活環境與社會保障（Social Security）體制，是現代社會中急切而且必要的措施。 在各項社會保障體制下，醫療保險的保障範圍最大、內容最繁複，且攸關人民健康與生命最密切，世界各國均非常重視。中共在建政之初，醫療制度由國家包攬，由於缺乏成本概念，加上管理制度不健全，造成許多醫藥資源浪費，使國家財政難以負擔。改革開放後，隨著經濟體制的轉軌，原有計劃經濟體制下的醫療保險已不合時宜，因而於1998年正式將以往之醫療保險做全新的變革，由於中國大陸地大人多，各地在醫療改革上的重點及進度不一，且實行上都未臻完善，然改革目標卻是一致的。為配合醫療保險制度的完善，中共政府除於1998年頒訂醫療保險改革措施外，複於2000年推出醫藥衛生體制改革措施與之配套，期能「在醫療保險制度改革中引入分擔機制；在醫藥衛生體制改革中引入競爭機制」。而於其醫療改革實施方式中，多處可見其參酌國外觀念與台灣全民健康保險之蹤影存在。 在連串的試點、擴充改革範圍的執行下，中國大陸一方面發展其既定之改革與配套措施，一方面也面臨許多執行上的瓶頸。然而無可否認的，隨著中國大陸加入WTO，外來醫療資源的進入，對中國大陸醫療相關產業與社會發展造成相當的刺激。中國大陸在躋身國際，走入全球化的腳步中，對於本身特殊條件造成的醫療改革缺點與障礙必須努力排除，否則其與世界的接軌，將因內部貧富不均等社會因素所造成的社會不穩定而功虧一簣。本論文在對中國大陸醫療改革措施的肯定與鼓勵之同時，亦針對轉軌中的改革政策及執行缺失提出檢討。 關鍵辭：社會保障、醫療保險、醫療改革、全民健康保險 / Overall and effective management is indispensable to a nation to assure sound and secure operation. How to set up a low risk, high level social security system is the very essential for the society today. Under all sorts of social security systems, medical insurance offers the largest coverage and most complicated contents. Such medical insurance is closely related to nationals' health and assurance of life. In People's Republic of China, the medical system was provided by the nation in package in the initial phase after it came into being. With lack in cost concept and unsound managerial systems, they have undergone critical waste in medical resources, leading to heavy burden to the nation. After People's Republic of China launched the reform and open-door policy, the economic systems have been restructured. The previous medical insurance system under planned economy no longer oriented itself to the trends. In 1998, therefore, it launched an overall reform. With vast territories and huge number of population, the medical reforms have been launched in varied highlights and paces, not satisfactorily though they have all aimed at the same objectives. The PRC government launched the medical reform in 1998 and further worked out the supporting package for the medical and health system reform in 2000 in an effort to "bring in sharing instrument in the medical insurance reform and bring in competition instrument in the medical & health system reform". In the medical reform, foreign concepts and the National Health Insurance launched in Taiwan have been significantly seen. In the series of tests and expansions. People's Republic of China has launched the established reform policies on the one hand and run into significant bottlenecks on the other. Undeniably, anyway, with foreign medical resources pouring in in the wake of the WTO admission, the business lines and society in China have undergone tremendous stimulation. In the pace of playing a pivotal role in the global village, China must try by all means to remove the stumbling blocks on the way of medical reform otherwise the significant gaps between the rich and the poor and such social problems must ruin the entire efforts. This thesis focuses on the reassessment on the shortcoming China has undergone in enforcement of the policies while approving the praiseworthy performance in the medical reform. Key words: Social security, medical insurance, medical reform, National Health Insurance

This research investigated physician and emergency room use among representative samples of children in the Dallas metropolitan area (N = 1606) and among patients who used Children's Medical Center of Dallas' First Care services (N = 612). Through telephone interviewing, caregivers to children under fifteen years of age were asked about an array of health service use behaviors, social-psychological issues related to acquiring health care for their children, and demographic characteristics as outlined by the Andersen & Newman model of health care service use. Children's use of physician services is best predicted by whether or not they have medical insurance, their level of income, and whether or not they have medical homes. Although having commercial managed care and fee-for-service Medicaid insurance consistently predicted increased physician use, neither independently reduced reliance on emergency rooms for non-emergent care. Managed care insurance and Medicaid did, however, significantly improve the odds that children would have medical homes, which significantly decreased emergency room use for non-emergent care. Further, increasing physician use and reducing reliance on hospital emergency rooms for non-emergent care will require ensuring that children have medical homeseither private physicians or community health centersat which they can readily and consistently receive sick and well care. Although some ethnic differences were observed, few of the broad array of factors in the Behavioral Model significantly predicted either physician or emergency room use. Moreover, educational levels and health beliefs rarely, and if significant negligibly, influenced physician and emergency room use. Health policy for children would best be served by focusing on programs that facilitate parent's ability to secure health insurance for their children and allocating children to medical homes where they can readily and consistently access sick and well care.

現行醫療保險理賠申請流程相當繁複，被保險人需要向醫療機構申請診斷證明，填具理賠申請書向保險公司提出理賠申請，再由保險公司進行審核。若遇到無法從診斷書直接審核之個案，保險公司需先取得被保險人簽署之調閱病歷同意書後，方能至醫療機構調閱病歷，以利後續理賠審核。這樣的流程，對保險公司來說，需耗費大量人工成本；對被保險人來說，則也有資訊不夠透明的疑慮。 區塊鏈的運作有著公開透明，且難以造假的不可否認性。智能合約是在區塊鏈平台上執行的協議落實程式，既能確保程式不會被竄改，又可保留所有執行紀錄。若能透過這些特性來做為醫療保險理賠傳遞訊息的媒介，除了能提昇保險公司審核流程的時效性，被保險人也能獲得公開透明的資訊。 本論文提出了一套基於智能合約來實現快速醫療保險理賠的方案，我們在以太坊上實作智能合約，我們的方案除了能改善現有的問題，也建構出一套公開透明，且兼顧病人隱私的理賠系統，並考量實際狀況，讓保險公司的業務邏輯可以重用，在理想與現實之間取得一個適當之平衡點。 / Current medical insurance claims application process is complex. It requires the insured to apply for medical diagnosis, and to fill out an application form to the insurance company. The insurance company then reviews the case. If they are unable to approve the claims, they must first obtain the consent form from the insured in order to access to his or her medical records to facilitate subsequent claims review. Throughout the process, the insurance company needs to pay a lot of labor costs; while the insured will have many concerns of information transparency. Blockchain operates in an open and transparent manner and maintains its data in a tamper-free way. Smart contracts are programs executed on a blockchain platform to enforce an agreement such that the program will not be tampered with, and all records of execution will be kept from modification. These characteristics of a smart contract make it very good as a tool for streamlining the medical insurance claims process, as it will greatly reduce the human efforts involved on the insurance company side while increase the information transparency from the perspective of the insured. This thesis presents a smart contract based solution for streamlining the medical insurance claims process. We design and implement the con-tract on the Ethereum platform. In addition to improving the existing problems, our solution builds an open and transparent claims system that takes into account the patient privacy and the practical requirement of re-using the existing claims processing system of the insurance company, thus achieving a proper balance between the ideal and reality.

Esse estudo tem por finalidade contribuir para a discussão e o aprimoramento da gestão econômica e do desenvolvimento de ferramentas de apoio à decisão estratégica para empresas de serviços de saúde suplementar. Com base nos fundamentos teóricos sobre serviços, serviços de saúde suplementar, gerenciamento estratégico de custos e sistemas ABC/ABM, o estudo propõe um modelo de sistema de gestão de custos indiretos em planos de saúde sob a óptica do ABC/ABM, que visa proporcionar aos gestores uma visão ampla sobre o desempenho econômico dos planos e dos clientes. Assim, este estudo pretende colaborar com o desenvolvimento desse setor, que tem sofrido nos últimos anos o impacto da evolução da tecnologia e da medicina, provocando a constante elevação dos custos da assistência à saúde. Com a finalidade de justificar o estudo, o modelo é testado com a sua implementação em uma operadora de planos de saúde, possibilitando a discussão sobre as conclusões obtidas em relação ao problema abordado. / The purpose of this study is to contribute towards the indirect cost management discussion and betterment of supplementary health care services companies as well as to strategic decision supporting tools development. On the basis of the theoretical beddings on services, supplementary health care services, strategic management of costs and ABC/ABM systems, this study proposes an indirect costs management model for health insurance based on the ABC/ABM optics that provide managers a wide vision on the economic performance of medical insurance plans and customers.Thus, this study intends to contribute towards this sector development that has been suffering in the last years the impact of the technology medicine evolution provoking constant rise on health care costs. In order to justify this study, the model is tested by its implementation in a medical insurance operator making possible the discussion about conclusions obtained from the approached problem.

Esse estudo tem por finalidade contribuir para a discussão e o aprimoramento da gestão econômica e do desenvolvimento de ferramentas de apoio à decisão estratégica para empresas de serviços de saúde suplementar. Com base nos fundamentos teóricos sobre serviços, serviços de saúde suplementar, gerenciamento estratégico de custos e sistemas ABC/ABM, o estudo propõe um modelo de sistema de gestão de custos indiretos em planos de saúde sob a óptica do ABC/ABM, que visa proporcionar aos gestores uma visão ampla sobre o desempenho econômico dos planos e dos clientes. Assim, este estudo pretende colaborar com o desenvolvimento desse setor, que tem sofrido nos últimos anos o impacto da evolução da tecnologia e da medicina, provocando a constante elevação dos custos da assistência à saúde. Com a finalidade de justificar o estudo, o modelo é testado com a sua implementação em uma operadora de planos de saúde, possibilitando a discussão sobre as conclusões obtidas em relação ao problema abordado. / The purpose of this study is to contribute towards the indirect cost management discussion and betterment of supplementary health care services companies as well as to strategic decision supporting tools development. On the basis of the theoretical beddings on services, supplementary health care services, strategic management of costs and ABC/ABM systems, this study proposes an indirect costs management model for health insurance based on the ABC/ABM optics that provide managers a wide vision on the economic performance of medical insurance plans and customers.Thus, this study intends to contribute towards this sector development that has been suffering in the last years the impact of the technology medicine evolution provoking constant rise on health care costs. In order to justify this study, the model is tested by its implementation in a medical insurance operator making possible the discussion about conclusions obtained from the approached problem.

Esse estudo tem por finalidade contribuir para a discussão e o aprimoramento da gestão econômica e do desenvolvimento de ferramentas de apoio à decisão estratégica para empresas de serviços de saúde suplementar. Com base nos fundamentos teóricos sobre serviços, serviços de saúde suplementar, gerenciamento estratégico de custos e sistemas ABC/ABM, o estudo propõe um modelo de sistema de gestão de custos indiretos em planos de saúde sob a óptica do ABC/ABM, que visa proporcionar aos gestores uma visão ampla sobre o desempenho econômico dos planos e dos clientes. Assim, este estudo pretende colaborar com o desenvolvimento desse setor, que tem sofrido nos últimos anos o impacto da evolução da tecnologia e da medicina, provocando a constante elevação dos custos da assistência à saúde. Com a finalidade de justificar o estudo, o modelo é testado com a sua implementação em uma operadora de planos de saúde, possibilitando a discussão sobre as conclusões obtidas em relação ao problema abordado. / The purpose of this study is to contribute towards the indirect cost management discussion and betterment of supplementary health care services companies as well as to strategic decision supporting tools development. On the basis of the theoretical beddings on services, supplementary health care services, strategic management of costs and ABC/ABM systems, this study proposes an indirect costs management model for health insurance based on the ABC/ABM optics that provide managers a wide vision on the economic performance of medical insurance plans and customers.Thus, this study intends to contribute towards this sector development that has been suffering in the last years the impact of the technology medicine evolution provoking constant rise on health care costs. In order to justify this study, the model is tested by its implementation in a medical insurance operator making possible the discussion about conclusions obtained from the approached problem.

Выпускная квалификационная работа (магистерская диссертация) посвящена исследованию финансирования здравоохранения населения в Сингапуре. Предметом исследования являются медицинские накопительные счета Сингапура, которые играют основную роль в финансировании здравоохранения страны. Основной целью магистерской диссертации является рассмотрение успешного опыта финансирования здравоохранения в Сингапуре, которой возможно применить в отечественной системе здравоохранения. В заключении обозначены рекомендации по совершенствованию дальнейшего улучшения отечественной системы финансирования здравоохранения. / The final qualifying work (master's thesis) is devoted to the study of the financing of public health in Singapore. The subject of study is Singapore's medical savings accounts, which play a major role in financing the country's health care. The main purpose of the master's thesis is to consider the successful experience of financing health care in Singapore, which can be applied in the domestic health care system. In the conclusion, recommendations for improving the further improvement of the domestic system of health care financing are indicated.