This dissertation aimed to examine the consequence of health-induced poverty and two policy responses to address this issue among older adults in the United States and China. Specifically, Paper I investigates whether public transfers crowded out private transfers among rural and urban Chinese older families and if this dynamic would change when health care expenses were high. Paper II examines the effect of New Rural Cooperative Medical Insurance, a national health insurance program for rural residents in China, on changing the incidence of health-induced poverty among middle-aged and older beneficiaries. Paper III tests the effects of closing the Medicare Part D donut hole (coverage gap) through the Affordable Care Act (ACA) on changing prescription drug cost-induced poverty. Overall, the findings obtained from these three papers provide empirical evidence that health-induced poverty is prevalent among older adults in both China and the United States and the current public transfers and health policies are either ineffective or insufficient to reduce health-induced poverty as intended.

Low-income communities are potentially more vulnerable to physical, social and environmental hazards than wealthier communities. The lack of services associated with these communities (such as water supply, sanitation facilities and electrification) has increased the exposure of households to health hazards. These households also lack the coping mechanisms and resources to deal with the stress that these hazards impose on them. This study is concerned with the potential health hazards imposed from indoor air pollution. Traditional health risk assessments are used to determine the level of risk to human health from a variety of chemical or biological hazards. What these assessments do not include however, is a measure of the vulnerability of the household. The aim of this study therefore, was to develop a methodology for generating a vulnerability index for the inclusion of factors underlying urban poverty and vulnerability into a risk assessment of indoor air pollution. The approach adopted in this study followed an iterative and inductive pathway. Theories on risk assessment and urban vulnerability were explored in order to understand the manner in which risk to human health is assessed and compounded by vulnerability. Secondary data sources as well as a household survey provided information that aided the selection of a number of vulnerability indicators. These indicators were chosen as measures of vulnerability specifically for low-income households in South African settlements. The findings of the research show that there are a number of factors or issues which underlie vulnerability. The issues are related to demographics, livelihoods, physical exposures, externalities, services and general health. This study used a four-tiered selection approach to sift through the issues of vulnerability and to transform the key issues into a set of vulnerability indicators which make up the vulnerability index. / Thesis (M.Sc.)-University of Natal, Durban, 2003.

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)