Esta tese realiza uma análise de custo de um programa de prevenção de internação hospitalar para idosos (acima de 65 anos), no ambiente da saúde suplementar. Trata-se um programa voltado para idosos considerados de risco, de acordo com um questionário que avalia a probabilidade de risco de internação hospitalar. Indivíduos de risco são convidados a participar do programa, quando se estabelecem dois grupos: um que aceita a intervenção do programa (Grupo Bem Viver) e outro que recusa (Grupo Recusa). A intervenção do programa está voltada para o acompanhamento domiciliar, com equipe multidisciplinar, que se efetiva de acordo com uma estratificação, segundo a avaliação da dependência funcional para os indivíduos. Essa estratificação funcional divide os idosos do programa em cinco grupos distintos, denominados grupos funcionais. Indivíduos que recusam a intervenção mantêm a assistência com cuidado usual. A análise de custo é uma avaliação econômica parcial que estabelece uma comparação da utilização de serviços de saúde entre os dois grupos de idosos: um sob intervenção, grupo Bem Viver, e outro em cuidado usual, grupo Recusa. Esta análise foi realizada para um período dividido em 12 meses antes do evento (intervenção ou recusa) e 12 meses após o evento. Levantou-se a utilização de serviços de saúde de acordo com os indicadores de consultas, exames, procedimentos ambulatoriais, internações e consultas hospitalares. O custo do programa foi incluído também na análise final. Comparações foram estabelecidas entre os grupos no padrão de utilização, considerando-se os períodos antes e depois do evento. Os grupos funcionais foram analisados dentro da perspectiva da utilização para os mesmos períodos. Os resultados demonstraram que o grupo com adesão tem um grande percentual de indivíduos com dependência funcional, sugerindo que existe uma seleção adversa na aceitação do programa, quando indivíduos de maior risco têm adesão. Para o grupo sob intervenção, ocorreu um aumento da utilização com os serviços de saúde no conjunto de consultas, exames e procedimentos ambulatoriais, havendo diminuição com o custo unitário das internações hospitalares e consultas hospitalares. O grupo que recusa tem discreto aumento para o conjunto de consultas, exames e procedimentos ambulatoriais e um grande percentual de aumento para as internações (+40.2%) e consultas hospitalares (34.3%). Este resultado para internações foi analisado também através da transformação logarítmica, com uso da função inversa para a base de cálculo. Nesta aplicação estatística foi confirmado esse resultado para o padrão de utilização de internações. Na análise final, que incluiu o custo do programa propriamente dito, foi apresentada uma hipótese de avaliação para o grupo Bem Viver, sem a intervenção do programa. Desta maneira, realizou-se uma projeção para a utilização do grupo Bem Viver, a partir dos percentuais atingidos pelo grupo Recusa. / This thesis is a cost analysis study of a health care program for the elderly (individuals over 65 years old) in the context of a private health care organization. The program is designed for individuals at risk of hospitalization according to a screening questionnaire. Elders at risk are invited to participate in the health care Program, when there is an outcome of two groups: one which accepts the Program (and it is called grupo Bem Viver, named after the Program) and one which refuses to participate (and it is called grupo Recusa). The Program intervention is a home delivery health system developed by a multidisciplinary health team. The Programs follow up is developed according to a stratification score defined by a functional assessment. This process creates five distinguished groups, called functional groups. Elderly who refused to participate in the Program remain under usual care. This cost analysis is a partial economical evaluation as it establishes the comparison of the health care costs of the two groups of elderly: one under the intervention, grupo Bem Viver (N=627) and other under usual care, grupo Recusa (N=392). This analysis looked at the 12 months period before and after the event (either acceptance or refusal of the health care Program). Health care costs considered were consultations, tests, out of hospital medical procedures and hospitalizations during the period. The Programs costs were also included for final analysis. The two groups were analyzed within the period of comparison defining patterns in the health care costs. The health care costs were discriminated for the functional groups as well. Results show that there was a high percentage of elders with functional dependence for the intervention group, suggesting that there was a differential selection, when high risk individuals accepted the Program. For those under the Program intervention there was an increase costs for health care services as far as consultations, tests and out of hospital medical procedures. There was a decrease of the unitary costs of hospitalization. For the group which refused the intervention, it was found a discrete increase of health care costs for consultations, tests and out of hospital medical procedures. However, an important percentage of increase of hospital costs (+40.2% for hospital costs and + 34.3% for medical consultation costs at the hospital) was presented. As far as hospital care is concerned, this result was confirmed when applying a statistics of logarithmic transformation, with the usage of the inverse function. In the final analysis, when the costs of the Program itself were included, it was presented a hypothesis for the evaluation of the Bem Viver group, without the Programs intervention. In that way, a projection was presented for the group under intervention from the perspective of the group who refused the Program.

Esta tese realiza uma análise de custo de um programa de prevenção de internação hospitalar para idosos (acima de 65 anos), no ambiente da saúde suplementar. Trata-se um programa voltado para idosos considerados de risco, de acordo com um questionário que avalia a probabilidade de risco de internação hospitalar. Indivíduos de risco são convidados a participar do programa, quando se estabelecem dois grupos: um que aceita a intervenção do programa (Grupo Bem Viver) e outro que recusa (Grupo Recusa). A intervenção do programa está voltada para o acompanhamento domiciliar, com equipe multidisciplinar, que se efetiva de acordo com uma estratificação, segundo a avaliação da dependência funcional para os indivíduos. Essa estratificação funcional divide os idosos do programa em cinco grupos distintos, denominados grupos funcionais. Indivíduos que recusam a intervenção mantêm a assistência com cuidado usual. A análise de custo é uma avaliação econômica parcial que estabelece uma comparação da utilização de serviços de saúde entre os dois grupos de idosos: um sob intervenção, grupo Bem Viver, e outro em cuidado usual, grupo Recusa. Esta análise foi realizada para um período dividido em 12 meses antes do evento (intervenção ou recusa) e 12 meses após o evento. Levantou-se a utilização de serviços de saúde de acordo com os indicadores de consultas, exames, procedimentos ambulatoriais, internações e consultas hospitalares. O custo do programa foi incluído também na análise final. Comparações foram estabelecidas entre os grupos no padrão de utilização, considerando-se os períodos antes e depois do evento. Os grupos funcionais foram analisados dentro da perspectiva da utilização para os mesmos períodos. Os resultados demonstraram que o grupo com adesão tem um grande percentual de indivíduos com dependência funcional, sugerindo que existe uma seleção adversa na aceitação do programa, quando indivíduos de maior risco têm adesão. Para o grupo sob intervenção, ocorreu um aumento da utilização com os serviços de saúde no conjunto de consultas, exames e procedimentos ambulatoriais, havendo diminuição com o custo unitário das internações hospitalares e consultas hospitalares. O grupo que recusa tem discreto aumento para o conjunto de consultas, exames e procedimentos ambulatoriais e um grande percentual de aumento para as internações (+40.2%) e consultas hospitalares (34.3%). Este resultado para internações foi analisado também através da transformação logarítmica, com uso da função inversa para a base de cálculo. Nesta aplicação estatística foi confirmado esse resultado para o padrão de utilização de internações. Na análise final, que incluiu o custo do programa propriamente dito, foi apresentada uma hipótese de avaliação para o grupo Bem Viver, sem a intervenção do programa. Desta maneira, realizou-se uma projeção para a utilização do grupo Bem Viver, a partir dos percentuais atingidos pelo grupo Recusa. / This thesis is a cost analysis study of a health care program for the elderly (individuals over 65 years old) in the context of a private health care organization. The program is designed for individuals at risk of hospitalization according to a screening questionnaire. Elders at risk are invited to participate in the health care Program, when there is an outcome of two groups: one which accepts the Program (and it is called grupo Bem Viver, named after the Program) and one which refuses to participate (and it is called grupo Recusa). The Program intervention is a home delivery health system developed by a multidisciplinary health team. The Programs follow up is developed according to a stratification score defined by a functional assessment. This process creates five distinguished groups, called functional groups. Elderly who refused to participate in the Program remain under usual care. This cost analysis is a partial economical evaluation as it establishes the comparison of the health care costs of the two groups of elderly: one under the intervention, grupo Bem Viver (N=627) and other under usual care, grupo Recusa (N=392). This analysis looked at the 12 months period before and after the event (either acceptance or refusal of the health care Program). Health care costs considered were consultations, tests, out of hospital medical procedures and hospitalizations during the period. The Programs costs were also included for final analysis. The two groups were analyzed within the period of comparison defining patterns in the health care costs. The health care costs were discriminated for the functional groups as well. Results show that there was a high percentage of elders with functional dependence for the intervention group, suggesting that there was a differential selection, when high risk individuals accepted the Program. For those under the Program intervention there was an increase costs for health care services as far as consultations, tests and out of hospital medical procedures. There was a decrease of the unitary costs of hospitalization. For the group which refused the intervention, it was found a discrete increase of health care costs for consultations, tests and out of hospital medical procedures. However, an important percentage of increase of hospital costs (+40.2% for hospital costs and + 34.3% for medical consultation costs at the hospital) was presented. As far as hospital care is concerned, this result was confirmed when applying a statistics of logarithmic transformation, with the usage of the inverse function. In the final analysis, when the costs of the Program itself were included, it was presented a hypothesis for the evaluation of the Bem Viver group, without the Programs intervention. In that way, a projection was presented for the group under intervention from the perspective of the group who refused the Program.

This thesis acquaints the reader with specifics in health care business, it defines closely a field of influence of a medical rehabilitation and also describes a provision of health care services in the field of physiotherapy. The main goal of the thesis is to prepare basis and elaboration of the business plan for establishing of a private health care facility and an independent physiotherapeutic practise in Tachov district in the Czech Republic. The theoretical part describes the health care system in the Czech Republic, further defines medical rehabilitation and it specifies field of physiotherapy closely. At the same time in my thesis, I mentioned a theoretical basis for establishing of a company including a brief and clear instruction on how to proceed in setting up a private health care facility "step by step". In the practical part, an analysis of the internal and external environment in the area of the newly developed health care facility in Tachov district is performed. Furthermore, in this part, a SWOT analysis is processed and described, which determines the strengths, weaknesses and opportunities and threats for the new enterprise. In this part of thesis it is crucial the preparation of the business plan, which takes into account demographic data, the location of health care facility and...

Bakgrund: År 2010 infördes det fria vårdvalet i Sverige och därmed har även privata aktörer rätt att etablera sig som vårdgivare samt har också patienten rätt att själv välja mellan olika vårdgivare inom primärvården. Det övergripande målet inom primär- vården är att erbjuda vård på lika villkor för hela befolkningen och på så vis uppnå en god folkhälsa. Ett sätt att säkerställa att man som organisation arbetar i linje med sin strategi och når upp till de övergripande målen är att använda sig av prestations- mätningar och inom primärvården kan det bidra med en förbättring av effektiviteten med syftet att kunna erbjuda vård med en högre kvalitet till ett större antal patienter. Syfte: Syftet med uppsatsen är att skapa förståelse för hur privata vårdcentraler använder sig av prestationsmätningar för att nå upp till de övergripande målen om kvalitativ vård och samtidigt sina egna finansiella målsättningar samt hur de mäter och utvärderar resultaten av dessa mätningar. Metod: Uppsatsen är en intervjustudie där 11 verksamhetschefer från 11 olika privata vårdcentraler inom 6 olika regioner i Sverige inkluderas. Vidare har uppsatsen antagit en kvalitativ forskningsstrategi med semistrukturerade intervjuer. Slutsats: I uppsatsen identifieras ett antal steg som ingår i processen med att mäta och utvärdera prestationer, dessa är strategi, måtturval, mätning och utvärdering. Upplevelserna av huruvida mätningarna bidrar till kvalitativ vård skiljer sig dock åt beroende på i vilken utsträckning mätningar valts ut av respektive enhet. I frågan om finansiella målsättningar anses dock prestationsmätningar vara ett viktigt verktyg. / Background: In 2010, free choice of healthcare provider was introduced in Sweden, which means that private actors also have the right to establish themselves as health- care providers and patients have the right to choose between different healthcare providers within primary care. The overall goal within primary care is to offer healthcare on equal terms for the entire population and thereby achieve good public health. One way to ensure that an organization is working in line with its strategy and achieving its overall goals is to use performance measurements, and within primary care, this can contribute to improving efficiency with the aim of providing higher quality care to a larger number of patients. Purpose: The purpose of this essay is to create an understanding of how private healthcare providers use performance measurements to achieve the overall goals of providing high-quality care while also meeting their own financial objectives, as well as how they measure and evaluate the results of these measurements. Method: The essay is an interview study that includes 11 managers from 11 different private healthcare providers in 6 different regions in Sweden. Furthermore, the essay has adopted a qualitative research strategy using semi-structured interviews. Conclusion: The essay identifies a number of steps involved in the process of measuring and evaluating performance, which include strategy, metric selection, measurement, and evaluation. However, experiences of whether the measurements contribute to high-quality care differ depending on the extent to which metrics are chosen by each unit. In the question of financial objectives, however, performance measurements are considered an important tool.

Background: Warfarin is an anticoagulant that is used for the prophylactic and therapeutic treatment for a wide range of thrombo-embolic disorders. The prescribing and monitoring of warfarin therapy is challenging due to the fact that warfarin exhibits numerous interactions with other drugs and a variety of factors that influence the dosing of warfarin. Objective: The general objective of this study was to investigate the prevalence of drugs prescribed with warfarin that may have a potential drug-drug interaction (DDI) with warfarin. Methods: This was a cross-sectional, observational or qualitative study that was conducted on medicine claims data of a pharmaceutical benefit management company for patients receiving warfarin therapy for a six year period, ranging from 1 January 2005 to 31 December 2010. Drug products that were co-prescribed with warfarin were also identified from the medicine claims database. The total number of prescriptions for all drug products during the study period were analysed and compared to the warfarin dataset. This was done by means of the SAS 9.1® computer package (SAS Institute, 2004). The total number of prescriptions and medicine items claimed from the database during the study period were respectively 49 523 818 and 118 305 941. Potential DDls between warfarin and coprescribed drugs were identified and classified according to a clinically significant rating. The clinically significance ratings of potential DDls are described in three degrees of severity, identified as major, moderate and minor (Tatro, 2011 :xiv). Results: The database consisted of 427 238 warfarin prescriptions and 427 744 warfarin medicine items, which represented 0.9% of the total number of prescriptions and 0.4% of total number of medicine items. The total number of patients who claimed warfarin prescriptions through the database represented 0.9% (n=68 575) of the total number of patients who claimed prescriptions in the total database (2005-2010). General practitioners prescribed the highest frequency of warfarin medicine items, representing 58.3% (n=249 202) of the total number prescribed. The age group that claimed the highest frequency of warfarin prescriptions (n=327 592, 76.6%) and the highest frequency of warfarin medicine items (n=327 984, 76.7%) was age group 4 (consisting of patients 59 years and older). The distribution between females and males regarding warfarin prescriptions claimed (n=205 999, 48.2%; n=221 117, 51.8%) and warfarin medicine items claimed (n=206 232, 48.2%; n=221 390, 51.8%) were almost equal. General practitioners prescribed the highest average PDD (7.01 mg ± 9.86 mg) of warfarin medicine items. Paediatric cardiologists prescribed the lowest average PDD (4.61 mg ± 1.29 mg) of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDD between general practitioners and paediatric cardiologists. The average PDD of warfarin medicine items between females (6.60 mg ± 9.06 mg) and males (6.74 mg± 8.41 mg) was almost equal. The age group who was prescribed the highest average PDD was age group 2 (consisting of patients 20 years to 39 years old) (7.42 mg± 7.42 mg). Age group 4 (consisting of patients 59 years and older) (6.50 mg± 8.90 mg) was prescribed the lowest average PDD of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDDs of warfarin medicine items between these two age groups. The results revealed that drugs with a significance rating (SR) of 1 (n=155 066, 43.3%), 2 (n=30128, 8.4%), 4 (n=137144, 38.3%), and 5 (n=36144, 10.1%) were co-prescribed with warfarin in the six year study period. The five drugs that was co-prescribed with warfarin most frequently was aspirin (n=48 903, 13.6%), thyroxine (n=33 954, 9.5%), amiodarone (n=25 056, 7.0%), simvastatin (n=19 070, 5.3%) and celecoxib (n=10 794, 3.0%). These five drugs have a SR of 1. Conclusions: This study showed that the top five drugs most frequently prescribed with warfarin are aspirin, thyroxine, amiodarone, simvastatin and celecoxib. These drugs can potentially interact with warfarin. The potential interactions of these drugs are rated with a significance rating of 1. This concludes that drugs that can potentially cause life threatening effects and permanent damage are commonly co-prescribed with warfarin. Clinical data concerning the INR or PT must be obtained in order to evaluate whether or not warfarin therapy is changed when a potentially interacting drug is co-prescribed. The age of the patients as well as the duration of warfarin treatment should also be obtained in order to assess whether warfarin treatment is changed with the progression of age. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2013

Background: Warfarin is an anticoagulant that is used for the prophylactic and therapeutic treatment for a wide range of thrombo-embolic disorders. The prescribing and monitoring of warfarin therapy is challenging due to the fact that warfarin exhibits numerous interactions with other drugs and a variety of factors that influence the dosing of warfarin. Objective: The general objective of this study was to investigate the prevalence of drugs prescribed with warfarin that may have a potential drug-drug interaction (DDI) with warfarin. Methods: This was a cross-sectional, observational or qualitative study that was conducted on medicine claims data of a pharmaceutical benefit management company for patients receiving warfarin therapy for a six year period, ranging from 1 January 2005 to 31 December 2010. Drug products that were co-prescribed with warfarin were also identified from the medicine claims database. The total number of prescriptions for all drug products during the study period were analysed and compared to the warfarin dataset. This was done by means of the SAS 9.1® computer package (SAS Institute, 2004). The total number of prescriptions and medicine items claimed from the database during the study period were respectively 49 523 818 and 118 305 941. Potential DDls between warfarin and coprescribed drugs were identified and classified according to a clinically significant rating. The clinically significance ratings of potential DDls are described in three degrees of severity, identified as major, moderate and minor (Tatro, 2011 :xiv). Results: The database consisted of 427 238 warfarin prescriptions and 427 744 warfarin medicine items, which represented 0.9% of the total number of prescriptions and 0.4% of total number of medicine items. The total number of patients who claimed warfarin prescriptions through the database represented 0.9% (n=68 575) of the total number of patients who claimed prescriptions in the total database (2005-2010). General practitioners prescribed the highest frequency of warfarin medicine items, representing 58.3% (n=249 202) of the total number prescribed. The age group that claimed the highest frequency of warfarin prescriptions (n=327 592, 76.6%) and the highest frequency of warfarin medicine items (n=327 984, 76.7%) was age group 4 (consisting of patients 59 years and older). The distribution between females and males regarding warfarin prescriptions claimed (n=205 999, 48.2%; n=221 117, 51.8%) and warfarin medicine items claimed (n=206 232, 48.2%; n=221 390, 51.8%) were almost equal. General practitioners prescribed the highest average PDD (7.01 mg ± 9.86 mg) of warfarin medicine items. Paediatric cardiologists prescribed the lowest average PDD (4.61 mg ± 1.29 mg) of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDD between general practitioners and paediatric cardiologists. The average PDD of warfarin medicine items between females (6.60 mg ± 9.06 mg) and males (6.74 mg± 8.41 mg) was almost equal. The age group who was prescribed the highest average PDD was age group 2 (consisting of patients 20 years to 39 years old) (7.42 mg± 7.42 mg). Age group 4 (consisting of patients 59 years and older) (6.50 mg± 8.90 mg) was prescribed the lowest average PDD of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDDs of warfarin medicine items between these two age groups. The results revealed that drugs with a significance rating (SR) of 1 (n=155 066, 43.3%), 2 (n=30128, 8.4%), 4 (n=137144, 38.3%), and 5 (n=36144, 10.1%) were co-prescribed with warfarin in the six year study period. The five drugs that was co-prescribed with warfarin most frequently was aspirin (n=48 903, 13.6%), thyroxine (n=33 954, 9.5%), amiodarone (n=25 056, 7.0%), simvastatin (n=19 070, 5.3%) and celecoxib (n=10 794, 3.0%). These five drugs have a SR of 1. Conclusions: This study showed that the top five drugs most frequently prescribed with warfarin are aspirin, thyroxine, amiodarone, simvastatin and celecoxib. These drugs can potentially interact with warfarin. The potential interactions of these drugs are rated with a significance rating of 1. This concludes that drugs that can potentially cause life threatening effects and permanent damage are commonly co-prescribed with warfarin. Clinical data concerning the INR or PT must be obtained in order to evaluate whether or not warfarin therapy is changed when a potentially interacting drug is co-prescribed. The age of the patients as well as the duration of warfarin treatment should also be obtained in order to assess whether warfarin treatment is changed with the progression of age. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2013

This thesis focuses on the protection of the patient’s privacy in health care in Sweden. It is crucially important that the patient has confidence in the health care and that patient data are kept secret from other persons and authorities. A patient who is unsure about secrecy and confidentiality may choose not to provide data that could prove necessary for health care personnel to arrive at an accurate diagnosis. Some individuals might even avoid seeking medical help from fear that data may be spread to outsiders. Inadequate protection of sensitive data may lead to the confidence of citizens in health care eventually eroding or vanishing completely. Protection of patient privacy is thus of fundamental importance in this area. In the area of health care, the intention of the legislator is that the regulations regarding secrecy in public health care and confidentiality in private health care will guarantee protection of patient privacy. Secrecy in public health care is regulated mainly in Chapter 25, Section 1 of the Swedish Public Access to Information and Secrecy Act (2009:400). In private health care, confidentiality is regulated mainly in Chapter 6, Section 12, first paragraph, and Section 16 of the Swedish Act on Patient Safety (2010:659). The overall purpose of the thesis is to examine and analyse the legislator’s intentions and the juridical construction regarding the rules of secrecy and confidentiality, from the perspective of patient privacy. The starting point of the thesis is that the patient’s privacy should be strongly protected. One of the main conclusions is that the legal construction cannot be considered to be in accordance with the legislator’s intention that the regulation of patient privacy protection should constitute a strong protection for the patient’s privacy, be comprehensible, clear and easy to apply for health care personnel, as well as being the same in both public and private health care.

Magistro baigiamajame darbe išanalizuoti LR egzistuojančių viešų ir privačių sveikatos priežiūros įstaigų veiklos skirtumai bei jų sąveiką. Ištirti tokie viešųjų ir privačių sveikatos priežiūros sektorių aspektai: sveikatos priežiūros sektoriai patys savaime, šių įstaigų institucinis išsidėstymas, teisinis reglamentavimas, finansavimas, konkurencingumas, prieinamumas pacientui. Pirmojoje darbo dalyje yra aptarta Lietuvos nacionalinės sveikatos sistema, kaip turinti vienyti viešąsias ir privačiąsias sveikatos priežiūros įstaigas, aptarta jos bendroji charakteristika. Antrojoje dalyje išsamiai išnagrinėtos, suklasifikuotos sveikatos priežiūros įstaigos, aptarta jų priklausomybė viena nuo kitos. Trečiojoje darbo dalyje kaip atskiros grupės išskirtos privačios ir viešosios sveikatos priežiūros: aptarta jų sąveika, pagrindiniai skirtumai, pamatiniai teisinio reglamentavimo ypatumai. Paskutinė ketvirta lyginamoji darbo dalis leido surasti tuos taškus, per kuriuos viešasis sveikatos priežiūros sektorius galėtų bendradarbiauti su privačiu. Palyginta šių sektorių finansavimo bazė, surasta papildoma alternatyva papildomojo sveikatos draudimo pavidalu. Kadangi sveiktos priežiūros sektoriuje centrinė figūra vis tik turi būti pacientas, pateiktas ir jo požiūris į privatų ir viešąjį sveikatos priežiūros sektorius, šių sektorių vertinimas. / The distinction and interface of health care institutions of Lithuania Republic are analyzed in this final master’s work Such public ant private health care institutions aspects are analyzed: health care institutions by themselves, deployment of these institutions, their legal regulation, sponsorship, competitive ability, accessibility for the patients. The first part of the work is concerned about national health care system of Lithuania, which must unify public and private health care institutions. The common characteristics of this system are discussed. The second part thoroughly reveals and classifies health care institutions; knock about their dependence on each other. In the third part as separate groups are divided private and public health care institutions: their interaction, main differences and basic legal regulation principles are discussed. The last fourth comparative part enabled to find those points, which could help for private health care sector to collaborate with public one. The comparison of financial basis of those sectors, allowed to found an additional assurance alternative. Since the patient is the central figure in a health care sector, his attitude towards the private and public health care institutions, and those sectors valuation is represented.

Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014