Bakgrund: Den privata vårdsektorn är en sektor som karaktäriseras av stark tillväxt. Behovet av vård kommer alltid att finnas och i takt med att människan lever längre ökar även trycket på vården. Den privata vårdsektorn har skapat en debatt i samhället där man ifrågasätter att offentliga medel går till vinster i privata vårdföretag. Därav är det av allmänt intresse att analysera vårdföretagens ekonomiska utveckling och risk. Syfte: Att utreda vilka finansiella strategier privata vårdföretag tillämpar och om de byggt upp tillräcklig finansiell styrka (kapitalstruktur) för en långsiktig utveckling. Metod: Uppsatsen bygger på en kvantitativ metod där information baseras på årsredovisningar under en 10-årsperiod. Utifrån den finansiella informationen beräknas nyckeltal för att beskriva företagens kapitalstruktur och prestation. Därefter görs en ingående analys av resultat- och balansräkning för respektive företag. Uppsatsen använder sig av hävstångsformeln som huvudsakligt analysverktyg för att analysera om företagen vinstmaximerar eller om de har en mer långsiktig finansiell strategi för att uppnå finansiell styrka. Resultat, slutsatser: Genom vår analys av vårdföretagens rörelserisk har utredningen funnit att en rimlig balans mellan rörelserisk och finansiella styrka uppnås vid en soliditet på 40 % som är genomsnittet för bolag på Stockholmsbörsen. De små vårdbolagen (som är den dominerande företagsformen) uppnår mer än väl balans mellan rörelserisk och finansiell styrka. Deras soliditet uppgår i regel till ca 50 %. Företagen har hög lönsamhet och som finansiell strategi väljer de att inte vinstmaximera genom att belåna sig och utnyttja hävstångseffekten. Tre av de marknadsledande företagen har en dålig lönsamhet och en soliditet som är betydligt lägre än börsgenomsnittet. Den låga soliditeten kompenseras helt eller delvis av att företagen har starka ägare med möjlighet att tillföra kapital via aktieägartillskott och nyemissioner vid behov. Den fjärde av de marknadsledande större vårdföretagen har hög lönsamhet och högre soliditet än börsgenomsnittet. Även detta företag väljer att liksom de mindre vårdföretagen att inte belåna sig och utnyttja hävstångseffekten för att maximera vinster. / Background: The private health sector is a sector that is characterized by growth. The need for care will always be, and as the human lives longer it will also increase the pressure on health care. The private health sector has created a debate in the community in which the dividends allocation is being questioned. Hence, it is of general interest to analyze healthcare companies' financial performance and risk. Purpose: To investigate the financial strategies that private health care companies apply and if they have built up sufficient financial strength (capital structure) for long term development. Methodology: The essay is based on a quantitative method where information is based on annual reports over a 10-year period. Based on the financial information financial ratios are calculated to describe firms' capital structure and performance. Thereafter, a detailed analysis of the income statement and balance sheet is made for each company. The essay uses effects of leverage as the main analytical tool for analyzing how firms maximize profits or if they have a more long-term financial strategy. Conclusion: Through our analysis of healthcare companies operating risk, the investigation found that a reasonable balance between business risk and financial strength is achieved at an equity ratio of 40 % which is an average for companies on the Stockholm stock exchange. The small healthcare company (which is the dominant company form) achieve a balance between business risk and financial strength. Their equity ratio is usually around 50 %. Companies have high profitability and as financial strategy they choose not to maximize profits by leveraging themselves and use the effects of leverage. Three of the market leaders have a poor performance and a solvency that is significantly lower than the market average. Their strong owners compensate the low equity ratio with the ability to provide capital through shareholder contributions and new issues as necessary. The fourth of the leading major healthcare companies have high profitability and higher solvency than the market average. This company also chooses to, like the smaller healthcare companies not to use leverage and use the effect of leverage to maximize their profit.

The purpose of this study was to investigate the health service delivery by private health sector and develop guidelines to enhance provision of health service so as to increase their contribution in the country’s health system. Interviews with 1112 participants were conducted in phase I. Descriptive statistics, chi square tests and logistic regression analysis were used for analysis. Private health facilities (30.5%) were providing healthcare services in their own buildings that were constructed for that purpose while others work in a rented houses built for residence or others. Some facilities (11.7%) received loan services from financial institutions in the region. A significant association was found between obtaining loan and owning building for healthcare services delivery (x2=13.99, p<0.001). Private health facilities were mainly engaged in profit driven and curative services while their participation in the promotive and preventive services like FP, ANC HIV test, TB and malaria prevention and control was not minimal. Majority, 247 (96.5%) provide services for extended hours out of normal working time such as evening, weekends and holidays. Physicians, more than other professionals were found practicing part time work (dual practice). Service consumers of the private health sector were urban dwellers 417 (71.6%) and 165 (28.4%) rural residents. Nearly three-fourth (73.0%) of study participants had a history of multiple visits to both public and private health facilities for current medical condition. Median payment of patients in a single visit including diagnosis and medicine was 860 birr ($30.85) (IQR = 993 ($35.62). Only 2.1% have paid through insurance services while others through out of pocket payments. Price of services delivered in private health facilities were set mainly by owners’ will (91.4%) while others with established team. Satisfaction on the fairness of prices to services obtained from each facility were reported by 63.1% service consumers. Those patients without any companion (AOR=1.83, 95% CI=1.16-2.91) and no history of visit to other facilities (AOR=1.97, 95% CI=1.24-3.12) were more likely to be satisfied than those coming with companions and those with history of visit. In addition, as age of consumers increase, satisfaction to services prices tend to decline (AOR=0.97, 95% CI=0.96-0.99). Uncomplimentary regulatory system to private health facilities, lack of training and continuing education for health professionals, unavailability of enough health workforce in the market and shortage of supplies to private facilities were among main gaps disclosed. Based on findings, five guidelines were developed to enhance health services delivery in the private health sector, namely, increase facilitation for financial access to actors in the sector, increase facilitation to access regular updating trainings and continuing education for healthcare workers, enhance and scale up the capability of existing association in the private health sector, strengthen and support working for extended hours to promote user friendly services and accessibility of healthcare services for the poor through community based health insurance and exemption. Therefore, these recommendations to help enhance the private health sector for better performance and contribution. / Health Studies / D.Lit.Phil (Health Studies

The main aim of the study was to determine the prescribing patterns of antibiotics with an emphasis on fluoroquinolones in the private health sector of South Africa. The empirical study followed a quantitative, descriptive, observational method using retrospective, longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2005 to 31 December 2012. Penicillins, cephalosporins, carbapenems, aminoglycosides, chloramphenicol, fluoroquinolones, macrolides, tetracyclines, sulphonamides and trimethoprim were considered in the study. A total of 5 155 262 (44.8%) patients received at least one antibiotic prescription out of the total number of registered beneficiaries included in the database. The average number of antibiotic prescriptions per patient per year ranged from 2.22 ± 1.89 (95% CI 2.22-2.22) in 2005 to 1.98 ± 1.62 (95% CI 1.98-1.99) in 2012. The number of antibiotics per prescription per year remained fairly constant at 1.05 ± 0.19 (95% CI 1.05-1.05) in 2005 to 1.06 ± 0.21 (95% CI 1.06-1.06) in 2012. The prevalence of patients receiving antibiotic prescriptions decreased from 46.1% (n = 789 247) in 2005 to 38.2% (n = 480 159) in 2012. Antibiotics were mostly prescribed for females (54.9%, n = 2 831 686) and in patients aged 0 to 18 years (26.5%, n = 1 366 824) and least in patients above 65 years (9.5%, n = 490 496). The prevalence of patients receiving antibiotic prescriptions was highest in Gauteng (41.9%, n = 2 159 360) and lowest in the Northern Cape (1.7%, n = 87 720). Antibiotics were mostly prescribed during the winter period. Penicillins were the most prescribed antibiotics (43%) and carbapenem the least (0.1%) out of the total number of antibiotics claimed. No practically significant association was found between antibiotic prescribing and gender, age, province and season. A total of 1 983 622 prescriptions for fluoroquinolones were claimed in patients older than 18 years. The average number of fluoroquinolone prescriptions per patient per year ranged from 1.45 ± 0.92 (95% CI 1.44-1.45) in 2005 to 1.31 ± 0.71 (95% CI 1.31-1.32) in 2012. The highest prevalence of fluoroquinolone prescribing was observed in females (64.1%, n = 850 253) and in patients between 45 and 65 years (38.6%, n = 511 542). The total fluoroquinolone use by the study population decreased from 2.85 DID in 2005 to 2.41 DID in 2012. Norfloxacin was the only first-generation fluoroquinolone prescribed. The second-generation fluoroquinolones accounted for more than 50% of the total DID, with ciprofloxacin being the most used active ingredient in this generation. Moxifloxacin was the most prescribed third-generation fluoroquinolone; its use ranging from 0.51 DID in 2005 to 0.44 DID in 2012. Between 2005 and 2012, a total of 57 325 prescriptions for fluoroquinolones were claimed by patients 18 years and younger. The prevalence of patients receiving fluoroquinolone prescriptions decreased from 3.6% (n = 8 329) in 2005 to 2.9% (n = 3 310) in 2012. Fluoroquinolones were mostly prescribed to females and in patients between 12 and 18 years. In all age groups, prescribing was mainly done by general medical practitioners. Ciprofloxacin was the most prescribed fluoroquinolone, followed by levofloxacin. In conclusion, this study established estimates on the prevalence of antibiotic prescribing covering an eight-year period. Secondly, baseline estimates for fluoroquinolone prescribing in adults using the ATC/DDD methodology were determined. Fluoroquinolone prescribing patterns in children and adolescents were determined, with specific reference to the comparison between the prescribed daily and recommended daily dosages in the different age groups and by prescribers’ specialties. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

The main aim of the study was to determine the prescribing patterns of antibiotics with an emphasis on fluoroquinolones in the private health sector of South Africa. The empirical study followed a quantitative, descriptive, observational method using retrospective, longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2005 to 31 December 2012. Penicillins, cephalosporins, carbapenems, aminoglycosides, chloramphenicol, fluoroquinolones, macrolides, tetracyclines, sulphonamides and trimethoprim were considered in the study. A total of 5 155 262 (44.8%) patients received at least one antibiotic prescription out of the total number of registered beneficiaries included in the database. The average number of antibiotic prescriptions per patient per year ranged from 2.22 ± 1.89 (95% CI 2.22-2.22) in 2005 to 1.98 ± 1.62 (95% CI 1.98-1.99) in 2012. The number of antibiotics per prescription per year remained fairly constant at 1.05 ± 0.19 (95% CI 1.05-1.05) in 2005 to 1.06 ± 0.21 (95% CI 1.06-1.06) in 2012. The prevalence of patients receiving antibiotic prescriptions decreased from 46.1% (n = 789 247) in 2005 to 38.2% (n = 480 159) in 2012. Antibiotics were mostly prescribed for females (54.9%, n = 2 831 686) and in patients aged 0 to 18 years (26.5%, n = 1 366 824) and least in patients above 65 years (9.5%, n = 490 496). The prevalence of patients receiving antibiotic prescriptions was highest in Gauteng (41.9%, n = 2 159 360) and lowest in the Northern Cape (1.7%, n = 87 720). Antibiotics were mostly prescribed during the winter period. Penicillins were the most prescribed antibiotics (43%) and carbapenem the least (0.1%) out of the total number of antibiotics claimed. No practically significant association was found between antibiotic prescribing and gender, age, province and season. A total of 1 983 622 prescriptions for fluoroquinolones were claimed in patients older than 18 years. The average number of fluoroquinolone prescriptions per patient per year ranged from 1.45 ± 0.92 (95% CI 1.44-1.45) in 2005 to 1.31 ± 0.71 (95% CI 1.31-1.32) in 2012. The highest prevalence of fluoroquinolone prescribing was observed in females (64.1%, n = 850 253) and in patients between 45 and 65 years (38.6%, n = 511 542). The total fluoroquinolone use by the study population decreased from 2.85 DID in 2005 to 2.41 DID in 2012. Norfloxacin was the only first-generation fluoroquinolone prescribed. The second-generation fluoroquinolones accounted for more than 50% of the total DID, with ciprofloxacin being the most used active ingredient in this generation. Moxifloxacin was the most prescribed third-generation fluoroquinolone; its use ranging from 0.51 DID in 2005 to 0.44 DID in 2012. Between 2005 and 2012, a total of 57 325 prescriptions for fluoroquinolones were claimed by patients 18 years and younger. The prevalence of patients receiving fluoroquinolone prescriptions decreased from 3.6% (n = 8 329) in 2005 to 2.9% (n = 3 310) in 2012. Fluoroquinolones were mostly prescribed to females and in patients between 12 and 18 years. In all age groups, prescribing was mainly done by general medical practitioners. Ciprofloxacin was the most prescribed fluoroquinolone, followed by levofloxacin. In conclusion, this study established estimates on the prevalence of antibiotic prescribing covering an eight-year period. Secondly, baseline estimates for fluoroquinolone prescribing in adults using the ATC/DDD methodology were determined. Fluoroquinolone prescribing patterns in children and adolescents were determined, with specific reference to the comparison between the prescribed daily and recommended daily dosages in the different age groups and by prescribers’ specialties. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

The researcher used the integration of both qualitative and quantitative approaches. The respondents were drawn from three district, one regional, one academic and two private hospitals. Data was collected by means of questionnaires. The open-ended questions in the questionnaire allowed the respondents to respond in their own words (“etic” description). This enhanced the organisation and reduction of the relevant data for analysis as well as the validity and trustworthiness of the study. The study revealed that even though most of the South African government health policies were very advanced and among the best in the world, some crucial policies appeared to have encountered problems with implementation, from conflicting ideologies and opinions from hospital management, different unions, professional associations, the provincial government, the South African Nursing Council (SANC) and patients. Too many groups appeared to have discussed nurses‟ issues with government and made decisions for nurses, leaving nurses disillusioned. The majority of the respondents attributed this to poor representation at government level. Furthermore, some decisions, resolutions and strategies agreed upon between the unions and bargaining councils appeared to have worked against nurses, further dividing RNs and failing to accomplish the intended purpose. Although most of the respondents had hoped that the Occupational Specific Dispensation (OSD) for nurses would address chronic low salaries for all nurses in the PHS, it favoured certain specialty qualifications (which were based on the description of post-basic courses in R212 and R48, which were not clearly delineated). In addition, RNs were not informed about the meaning and implications of the OSD prior to implementation. The study thus found an information gap between government and RNs at the production level, which appeared not to be with the government and the nurses, but in between. Most importantly, nurses seemed to be represented more by unions to government and bargaining councils, as opposed to nurses, while most of the respondents did not favour the division of nurses between professional associations and unions. Decisions in the PHS appeared to have been dominated by leaders who had no experience with pragmatic issues of health care services (HCS), particularly at the operational level, and the dynamics of the nursing profession. The study therefore concluded that, if the right people (nurses, doctors and systems) were put in place, and nurses were represented by nurses at government level, bargaining councils and parliament, discontent among RNs in the PHS could be reduced significantly. Existing strategies were found to deal with the symptoms and not the root cause of discontent among RNs in the PHS. / Health Studies / D. Litt. et Phil. (Health Studies)

The researcher used the integration of both qualitative and quantitative approaches. The respondents were drawn from three district, one regional, one academic and two private hospitals. Data was collected by means of questionnaires. The open-ended questions in the questionnaire allowed the respondents to respond in their own words (“etic” description). This enhanced the organisation and reduction of the relevant data for analysis as well as the validity and trustworthiness of the study. The study revealed that even though most of the South African government health policies were very advanced and among the best in the world, some crucial policies appeared to have encountered problems with implementation, from conflicting ideologies and opinions from hospital management, different unions, professional associations, the provincial government, the South African Nursing Council (SANC) and patients. Too many groups appeared to have discussed nurses‟ issues with government and made decisions for nurses, leaving nurses disillusioned. The majority of the respondents attributed this to poor representation at government level. Furthermore, some decisions, resolutions and strategies agreed upon between the unions and bargaining councils appeared to have worked against nurses, further dividing RNs and failing to accomplish the intended purpose. Although most of the respondents had hoped that the Occupational Specific Dispensation (OSD) for nurses would address chronic low salaries for all nurses in the PHS, it favoured certain specialty qualifications (which were based on the description of post-basic courses in R212 and R48, which were not clearly delineated). In addition, RNs were not informed about the meaning and implications of the OSD prior to implementation. The study thus found an information gap between government and RNs at the production level, which appeared not to be with the government and the nurses, but in between. Most importantly, nurses seemed to be represented more by unions to government and bargaining councils, as opposed to nurses, while most of the respondents did not favour the division of nurses between professional associations and unions. Decisions in the PHS appeared to have been dominated by leaders who had no experience with pragmatic issues of health care services (HCS), particularly at the operational level, and the dynamics of the nursing profession. The study therefore concluded that, if the right people (nurses, doctors and systems) were put in place, and nurses were represented by nurses at government level, bargaining councils and parliament, discontent among RNs in the PHS could be reduced significantly. Existing strategies were found to deal with the symptoms and not the root cause of discontent among RNs in the PHS. / Health Studies / D. Litt. et Phil. (Health Studies)