Magister Scientiae (Physiotherapy) - MSc(Physio) / Introduction: A spinal cord injury is the damage to the spinal cord that alters functional independence. Two different systems of care for the management of health conditions are available in private and public care in South Africa. A better understanding of health and functioning of individuals in the two systems is crucial to help address inequality between the two systems. The aim of the study was to describe the health status and functioning of persons with traumatic spinal cord injury (TSCI) in the Western Cape province who received public-funded care compared with those in the Gauteng province who received private care. Methodology: The study entailed a cross-section comparison between a government-funded cohort in the Western Cape and a private cohort in Gauteng, two of the provinces of South Africa. Self-administered questionnaires and standardised outcome measures were used to collect the data and to ensure validity and reliability. Data were captured on Excel and then transferred to SPSS (Statistical Package for Social Sciences) for analysis. Ethical clearance to conduct the study was obtained from the Biomedical Research Ethics Committee of the University of the Western Cape.

Första linjens chefer balanserar kraven mellan överordnade och medarbetare. Speciellt problematiskt kan det bli i offentlig verksamhet där politik styr och negativa resultaträkningar präglar sjukvården. För att klara av höga krav och begränsade resurser är olika typer av stöd en viktig faktor för chefernas hållbarhet. Syftet med studien var att undersöka hur första linjens chefer upplever stöd, vilket stöd som saknas och vilken betydelse stöd har i yrkesrollen. Undersökningen bygger på kvalitativa semistrukturerade enskilda intervjuer med nio enhetschefer från två regioner. En tematisk analys gjordes för att identifiera väsentligt stöd, vilket stöd som anses vara otillräckligt och vilket stöd som är tillgodosett och betydelsen det har i yrkesrollen. Resultatet visade att stödet, framför allt från medarbetarna, ger den viktiga kraften att orka. Resultatet mynnade i slutsatsen att det finns ett behov av stöd för ledarskapsutveckling, ett behov av avlastning, en delaktighet i beslutsprocessen, regelbunden feedback och tydliga ramar och mandat.

Magister Commercii - MCom / The South African democratic government is mandated by the constitution to provide quality healthcare services to the citizens of the country. Therefore, healthcare in South Africa is considered as a basic human right. The existing healthcare system exhibits extreme inequality, which translates into inequity in health outcomes across different demographic factors. Even though quality healthcare is a basic human right, problems related to the quality of healthcare remain, which poses a major challenge for the South African government. This dissertation investigates patient perceptions of the quality of public healthcare in South Africa, using General Household Survey data (2009-2016), with the objective of determining the level and trends of patient satisfaction and complaints reported when accessing public healthcare services in South Africa and identifying the correlates of these perception. This study found that patient satisfaction with public healthcare services in South Africa has increased over time while complaints have decreased over time. This study refrains from drawing conclusion on these findings at face value, since they may be other factors that explain the observed trends. The most common complaint was long waiting time at public healthcare facilities. On average, White individuals, male household heads, individuals residing in rural areas and individuals from smaller household were more likely to report to being satisfied with healthcare services received at public healthcare facilities in South Africa. Therefore, patient satisfaction survey approach should be used in conjunction with other healthcare quality measures such as direct observation, vignettes and standardised or mystery patient.

According to the World Health Organisation (WHO) the goal of universal health coverage is to ensure that all people obtain the necessary health services without being financial limped because of the payable fees. This requires: - A strong, efficient, well-run health system; - A system for financing health services; - Access to essential medicines and technologies; and - A sufficient capacity of well-trained, motivated health workers. In an effort to compliment the abovementioned, the South African government proposed the National Health Insurance System (NHIS) to address the health inequality and to improve access to quality healthcare for its citizens. The National Department of Health (NDOH) has already consulted with several stakeholders since the launch of the NHI Green Paper in August 2011. Already 11 National Health Insurance (NHI) pilot sites have been established in the nine South African provinces to assess the feasibility, acceptability, effectiveness and affordability to engage the private healthcare sector. This study aimed to evaluate the feasibility of the NHI in South Africa as well as the way in which it could be implemented to be more acceptable to all stakeholders involved. A qualitative research approach was followed due to the nature of the study. Furthermore, an exploratory methodology was applied in order to generate hypotheses. The research design for this study included a literature review, participatory data collection, semi-structured interviews and data analysis. The study found that there is a need for NHI in South Africa. However, medical practitioners (also referred to as general practitioners or GPs further in the study) feel uncertain about the implementation progress which is unclear to them. Also evident is the, fear for loss of income should the NHI be implemented and thus the remuneration package remained a main concern for all. / MBA, North-West University, Potchefstroom Campus, 2015

According to the World Health Organisation (WHO) the goal of universal health coverage is to ensure that all people obtain the necessary health services without being financial limped because of the payable fees. This requires: - A strong, efficient, well-run health system; - A system for financing health services; - Access to essential medicines and technologies; and - A sufficient capacity of well-trained, motivated health workers. In an effort to compliment the abovementioned, the South African government proposed the National Health Insurance System (NHIS) to address the health inequality and to improve access to quality healthcare for its citizens. The National Department of Health (NDOH) has already consulted with several stakeholders since the launch of the NHI Green Paper in August 2011. Already 11 National Health Insurance (NHI) pilot sites have been established in the nine South African provinces to assess the feasibility, acceptability, effectiveness and affordability to engage the private healthcare sector. This study aimed to evaluate the feasibility of the NHI in South Africa as well as the way in which it could be implemented to be more acceptable to all stakeholders involved. A qualitative research approach was followed due to the nature of the study. Furthermore, an exploratory methodology was applied in order to generate hypotheses. The research design for this study included a literature review, participatory data collection, semi-structured interviews and data analysis. The study found that there is a need for NHI in South Africa. However, medical practitioners (also referred to as general practitioners or GPs further in the study) feel uncertain about the implementation progress which is unclear to them. Also evident is the, fear for loss of income should the NHI be implemented and thus the remuneration package remained a main concern for all. / MBA, North-West University, Potchefstroom Campus, 2015

Användandet av innovationsmodeller inom vårdsektorn studerades, med anledning av den innovationsmodell Sveriges Kommuner och Landsting nyligen tagit fram. Offentlig sektor har i litteraturgenomgångar inte tagits upp som positiva exempel på innovativ verksamhet, men det finns mycket litteratur som visar på hur systematiserade och byråkratiska de organisationerna är. Därför är det av intresse att undersöka hur en systematiserad organisation angriper innovationsarbete med hjälp av verktyg och modeller. Genom semistrukturerade intervjuer samlades data in från fem representanter inom den offentliga vårdsektorn (från två olika kommuner och landsting), och resultaten visade på att valet och användningssättet av innovationsmodeller skiljde sig mellan respondenterna. Vissa respondenter använde redan existerande modeller, medan andra skapade egna. Vidare visade resultatet att den modell Sveriges Kommuner och Landsting tagit fram ej användes av någon respondent, och endast två kände till att modellen fanns. Studien avslutas med en diskussion gällande innovationsmodellers nivå av generalisering respektive specialisering, samt förslag på en möjlig revidering av modellen Sveriges Kommuner och Landsting tagit fram, för att på så vis sprida vetskapen om den. / The use of models for innovation within the public healthcare sector were studied, due to the fact that the public agency The Swedish Association of Local Authorities and Regions, SALAR, recently developed and launched a model for innovation. The public sector has not been the focal point in any of the literature about innovative organizations, but there is no shortage of literature regarding that of bureaucracy and the systematization of work processes in the public sector. That is why the authors find it interesting to study how a systemized organization set about working innovatively using instruments and models. Through the use of semi-structured interviews with five representatives from the public healthcare sector, data was collected and the results showed that the choice and use of innovative models differed between the respondents. Some respondents used models that already exist, while others constructed their own. The results also showed that neither one of the respondents used the model created by SALAR, and only two of them had pre-existing knowledge of the model. The study is concluded with a discussion about the degree of generalization/specialization in innovative models, and a suggestion for a possible revision of SALAR’s model in order to create wider knowledge of it.

This study applies statistical models to mood in patients with bipolar disorder. Three analyses of telemonitored mood data are reported, each corresponding to a journal paper by the author. The first analysis reveals that patients whose sleep varies in quality tend to return mood ratings more sporadically than those with less variable sleep quality. The second analysis finds that forecasting depression with weekly data is not feasible using weekly mood ratings. A third analysis shows that depression time series cannot be distinguished from their linear surrogates, and that nonlinear forecasting methods are no more accurate than linear methods in forecasting mood. An additional contribution is the development of a new k-nearest neighbour forecasting algorithm which is evaluated on the mood data and other time series. Further work is proposed on more frequently sampled data and on system identification. Finally, it is suggested that observational data should be combined with models of brain function, and that more work is needed on theoretical explanations for mental illnesses.

Despite already having the most expensive healthcare system in the world, the U.S. is facing rapidly rising costs, a growing population not covered by health insurance, and outcomes that are no better, and frequently worse, than those seen in the majority of developed nations with universal healthcare. Popular justifications of keeping the state out of healthcare appeal to protecting individual liberty; those who assert that there is a universal right to healthcare usually fail to address this claim. This paper describes the kinds of obligations in healthcare that are consistent with, if not demanded by, theories of justice that emphasize liberty. I give three different perspectives on liberty, and compare their relationship with healthcare obligations. First, I examine a plausible account of liberty, based on the condition of equal freedom, given by Immanuel Kant and Arthur Ripstein, and show how this account necessitates a system of universal public healthcare. Second, I grant the specifically libertarian approach to liberty through inviolable self-ownership, which seeks to limit the abilities of the state – using a reasonable interpretation of the Lockean proviso, as given by left-libertarians such as Peter Vallentyne, Hillel Steiner, and Michael Otsuka, this approach undoubtedly brings about increased equality in a society, which would have positive implications for healthcare access. Third, I grant furthermore the right-libertarian limited reading of the proviso, and demonstrate that even with Robert Nozick’s unhindered rules for property ownership, right-libertarianism properly understood obligates the state to act in many important aspects of healthcare.

The health system in Abu Dhabi has undergone a series of far reaching reforms during the past six years, yet in spite of the structural transformations, public confidence in the performance of this vital sector is still skeptical at best and employee engagement is still low. The thesis was underpinned by the aim to reveal the challenges in public health system reform outside the context of western administration. This thesis is an attempt to analyse the intricate, multidimensional concept of organisational culture within the complex structure of public healthcare sector in a fast growing economy like Abu Dhabi. Managing organisational culture is increasingly viewed as an essential part of health system reform. Organisational culture in health care organisations has gained increased consideration as an important factor that affects health systems reform and influences the quality of health care. The research project aims to explore the context of health system reform in Abu Dhabi and to understand the organisational culture of the different constituents of its public healthcare sector. Using a multi-method investigation combining both qualitative and quantitative approaches using the Competing Values Framework as conceptual framework, this research aims to provide a critical assessment of organisational culture in healthcare sector in Abu Dhabi. Semi-structured interviews were conducted in the regulator, operator, and three public hospitals prior to the use of a survey instrument based on the Organisational Culture Assessment Instrument (OCAI). The data analysis revealed that the prevailing cultural model of the Abu Dhabi public sector organisations was concurrently governed by hierarchy and market cultures while the presence of clan and adhocracy models was relatively limited. Interesting variations in assessment of clan culture were found between UAE nationals and other nationality clusters. The findings also revealed a desired cultural shift manifested by a higher emphasis on clan and adhocracy cultures and a lower emphasis on hierarchy and market culture. Those results confirm the presence of two opposing or competing cultural dimensions clan/adhocracy vs. hierarchy/market. This research makes a considerable contribution to the sparse empirical studies in health system reforms and organisational culture in the Arab Gulf states, and proposes important explanations and possible solutions to the salient challenges facing the health system in Abu Dhabi.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The aim of this dissertation is to explain how elective surgery patients choose between the public and private hospital sectors in the United Kingdom, and to analyze government policy changes which affect this choice. First the choice between the public and private sectors is modeled for the case where there is no private insurance available. The model takes into account the different rationing mechanisms used by National Health Service (NHS) and private hospitals to allocate surgery among patients. Private hospitals charge a price and ration on the basis of willingness to pay , while NHS hospitals , which face budget limits, ration on the basis of clinical need and require patients to wait for surgery. Consequently, a patient's choice of sector depends on her income and her level of clinical need. A simulation model is used to compare the efficiency and equity of two policy measures designed to raise the number of people receiving elective surgery : an increase in NHS funding and a subsidy to the price of private surgery. The subsidy is shown to be more efficient and the NHS funding increase more equitable. Within the same framework an expected utility model of the demand for private health insurance is developed. Two cases are analyzed: the case where individuals have no information about their future need for elective surgery and the case where they have partial information. In each case it is shown that for a given insurance premium there is a threshold level of income above which people buy insurance. It is also shown by simulation that in each case the insurance company can set a premium that allows it to break even. Finally the two models are combined. This enables the efficiency and equity of an increase in NHS funding, a subsidy to private care and a subsidy to private insurance to be compared in a situation where some private patients have insurance to cover the cost of their surgery. The NHS funding increase is shown to be most equitable , and depending on the definition of efficiency chosen, one of the two subsidies is most efficient. / 2999-01-01