The purpose of the study is to determine what effect medicare has had on the distribution of public health care expenditures in the state of Oklahoma. The study tests that there is a significant correlation between medical vendor payments and indigency in Oklahoma or in other words that pre-medicare public health care dollars in Oklahoma were distributed to indigents.

Philosophiae Doctor - PhD / South Africa has not responded well to recommendations in national evaluation reports to address human resource challenges associated with the implementation of nutrition programmes and improved service delivery. Twenty-four years have passed since the dawning of democracy and the nutrition situation within the population has actually deteriorated, with persistently high levels of stunting in young children and the growing prevalence of overweight and obesity in all age groups. These conditions not only rob people of their potential, but they carry a high cost for the state and society as a whole. This study aimed to develop a comprehensive and empirically sound nutrition workforce development planning framework for the public health sector so that it is better equipped to address the nutrition-related burden of disease in South Africa. The study explored the provision of nutrition services in South Africa, focusing on the nutrition-specific work components of health personnel ‒ doctors, nurses, dietitians, nutritionists, health promoters and community health workers working at the primary health care level in the public health sector. Evidence-based workforce information was collected through a mixed methodology comprising: literature reviews, document reviews, analysis of scopes of practice, job descriptions, competencies, workforce surveys, key informant interviews and consensus assessments through the application of the Delphi technique. Permission was obtained to adapt and use questionnaires from an Australian workforce study. Ethical approval, permission to conduct the study and informed consent were obtained prior to the commencement of the interviews. Data was then analysed using descriptive statistics, content and thematic analysis and triangulation of all findings, followed by consensus assessments to describe the nutrition workforce and delineate the roles and functions thereof. The comprehensive planning framework that was developed was applied to the Western Cape province.

This diploma thesis aids to analyze the economic viability of public health care in the Czech Republic specifically on obstetrics. The theoretical part of the thesis deals with the definition of basic concepts in health care, describes the history of obstetrics and health care, and specific the differences between traditional market and medical market. Further work is focused on indivudual models of health systems and explore the main principles of financing the public health system and reimbursement mechanisms fot health care in the Czech Republic. In the current healthcare system are guaranteed by the wide availibility of health care in corporated liberal elements strongly decentralized system. Despite efforts to privatization and decentralization of heath care remains the most important role of the state. It is clear from the Constitution of the Czech Republic and its components -- The Charter of Fundamental Rights and Freedoms. The practical part contains the implementation of cost- analysis of direct and indirect cost of labor and spontaneous birth by Caesarean section in an examination of medical device. In the Czech Republic the level of neonatal care is high. Infant mortality is almoust minimal and our country is ranked in the direction of of the leading positions in Europe and worldwide. This part is focused on the hospitál in general, number of hospitals in the Czech Republic and limit number of births under which the hospitál should be concluded. In the Czech Republic, every year go from hospitál to home care about 400 children with weight under one kilogram and the subsequent care of the newborn is not so good. That is why the final part of my thesis devoted to the issue of premature infants and care for them.

Denna studies syfte är att belysa hur professionella som i sitt yrke möter hjälpsökande spelberoende individer uppfattar och reflekterar kring möjligheten att arbeta med hjälp och behandling av spelberoende utifrån sin organisations förutsättningar och ansvar. Studien har genomförts genom djupintervjuer med professionella inom kommun, landsting, en privat ägd behandlingsorganisation och en nationell organisation inriktade mot spelberoende i syfte att erhålla en så bred bild av spektrumet som möjligt. Resultatet från datainsamlingen har analyserats med hjälp av det organisationsteorietiska perspektivet konsekvenslogik och Meeuwisse och Swärds modell (2002) om vad som är ett socialt problem och hur det skall hanteras. I studien framkom att det idag finns omfattande nationella problem vad gäller ansvarsfördelningen av behandling för spelberoende vilket resulterar i att behandling av spelberoende inte utförs eller utförs med vissa restriktioner. En förklaring till dessa problem upplevs vara avsaknaden av en allmän och erkänd definition av spelberoende som inkluderar huruvida det ska behandlas som en psykiatrisk diagnos eller som ett beroende likt alkohol- och narkotikaberoende. / The purpose of this study is to provide information on the way professionals in Sweden encounter individuals with a gambling addiction, to show how they perceive and reflect on their ability to help and treat these individuals whilst fulfilling their responsibilities to their organization and their client. The study is based on interviews with local authorities, health care representatives, private treatment organizations and a national help organization, all of which specialize on gambling addiction. This is in order to show the full spectrum of gambling problems.  The results of the empirical data have been analyzed using two methods. The first of which is a model developed by Meeuwisse and Swärd (2002), which explains the definition and handling of a social problem. The second method utilizes the “consequences of logic” perspective within the organizational theory. The results indicate that the issue involving gambling addiction is problematic on a national level, in regard to the distribution of responsibilities. This has shown that treatment of gambling addictions is either not performed, or performed under certain restrictions. These problems can be attributed to the lack of a widely used and acknowledged definition of the term gambling addiction. This makes it difficult to judge whether the condition should be treated as a psychiatric disorder, or as an addiction not dissimilar to alcohol or narcotic addictions.

Masters in Public Administration - MPA / The public health sector over the years had been under constant criticism for the lack of or substandard service delivery. The post1994 democratic era was accompanied by slogans such as ‘a better life for all ’. These slogans in part stem from the Constitution of the Republic of South Africa, 1996. The Constitution, chapter two, in its discussion on the Bill of Rights states that everyone has the right to quality health care services. The critics argue that the fundamental r right enshrined with in the Constitution in as far as it pertains to healthcare has been violated. The state introduced various interventions, such as human resource capacity development t programs, to turn the dismal state of public health care around. This research focused on the impact and the relevance of the human resource development within the public health sector. The following research question had been formulated to guide the research; is skills development within the state undertaken for compliance sake or is it a focused interventionist approach aimed at improving the skills set of staff to perform effectively and efficiently? The research was qualitative in nature and the case methodology was used. In this regard Tygerberg hospital was used as the case study. A number of findings emanated from the data collection process, amongst other, that the skills development is not workplace specific but rather undertaken for compliance sake. Furthermore, that no individual staff development plans exist. The end result is that the skills development intervention aimed at improving the staff capacity and the state of health service generally is not making any meaningful impact. The major recommendation is that a health audit must be done, which must inform the development of the hospital staff skills development plan. This in turn must be used to develop individual staff f development plans. This alignment of development plans from provincial level to hospitals and then to the individual will result in a more focussed skills intervention and ultimately an improved public health sector.

Magister Artium - MA / There is a widely held assumption that immigrants have difficulties in accessing public health care services in South Africa. This assumption derives from the experiences of some immigrants in accessing public health care services at some public health care facilities which are all required by law and policy to provide such services. The main aim of the study was to investigate the experiences of Zimbabwean immigrants in accessing public health care services at some public clinics and hospitals in Cape Town. Foucault’s theory on power was used to unpack the experiences of Zimbabwean immigrants at these public health care centers. Zimbabwean immigrant participants were all purposively sampled for the study and medical personnel were randomly sampled. The Zimbabwean immigrants sampled had used public health care facilities in Cape Town. Semi-structured interviews were used to collect data from the Zimbabwean immigrants which were qualitatively analysed using content analysis. Questionnaires were also used to collect data from both the Zimbabwean immigrants and medical personnel and subsequently open-ended questions from the questionnaires were also analysed using content analysis and closed questions were analysed using the Micro-soft excel package of data assessment and statistically presented using pie, bar and line graphs. Themes that were recurring from the semi-structured interviews and responses from questionnaires suggested that immigrants in their experiences at public health care facilities encountered barriers that included communication problems, negative attitudes and xenophobia from medical staff, policy and practice problems and preferential treatment offered to citizens over non-citizens. Recommendations of what needs to be done to reduce barriers to health care for immigrants were made to all involved in the provision of health care. The study contributed to our understanding of barriers that immigrants encounter in accessing public health care in South Africa as well as the role of citizens in this process.

The health sector is today facing many challenges, requiring a need for capabilities in managing innovations. At Karolinska University Hospital in Sweden, the management of some of the innovations has been centralized to the Innovation Center. The Innovation Center can be involved in all phases of an innovation process, but have identified difficulties to deal with innovations that have already been successfully implemented. Further implementation of these innovations to other hospital units, creates benefits for more patients and care givers, and is therefore of high importance. Therefore, managing innovations also includes making sure that successfully implemented innovations are spread to other clinics in the hospital, a phenomenon hereby called dissemination of innovations. Studies show that many innovations, even though they are successfully implemented at one location, disseminate slowly, or not at all. In fact, two out of three implementation efforts in the health care sector fail due to various barriers. The purpose of this master thesis is therefore to explore how dissemination of innovations can be facilitated at university hospitals in public health care systems. By dissemination we refer to the intentional spreading of innovations to other hospital units, or repeated implementations following the initial implementation target. Therefore, dissemination is targeted by studying the dynamics of implementation processes through the following research question: How do organizational factors affect the implementation of innovations at public university hospitals? By organizational factors we mean general areas that can be influenced by central management functions, such as: funding, leadership and culture.   The research question has been studied qualitatively through a literature study, a contextual study and three case studies. The cases consist of three innovation projects managed by the Innovation Center that have undergone some sort of dissemination. The empirical data has been collected through semi-structured interviews with both administrative and clinical staff. The data has been structured and analyzed using a theoretical framework developed from findings in previous research. In accordance to previous research, our results indicate that various organizational factors affect the dissemination of innovations. For instance, the complex and unstandardized way of getting funding to dissemination projects are impeding the process. Also, it needs to be clearly established who is to assume responsibility of an innovation, both during its initial implementation process as well as its dissemination. Resistance from clinicians may also function as a barrier and is caused by, for instance, a lack of information about the innovation or bad experiences from earlier failed projects. Additionally, if innovations do not meet identified and prioritized needs at the clinic, or if it is not properly adapted to local conditions and requirements, this may also impede the implementation. To properly involve clinicians is therefore of high significance in order to enable a successful implementation. Finally, rigid structures affect implementation negatively. These are built up by, for instance: extensive use of, and sometimes contradicting, policies and regulations; high administrative requirements as well as an organizational structure that separates medical disciplines. This inertia, together with sparse time allocated for innovation activities among the clinics, leads to difficulties when implementing and disseminating innovations in the hospital.

Migrant women are often omitted within the migrant discourse/research, with that in mind, the research study brings to the fore migrant women's experiences when accessing public health care services within underdeveloped communities. The study explored Zimbabwean migrant women's experiences in accessing public health care services in Makhado, a small town based in Limpopo, South Africa which has only two public health care services namely, Louis Trichardt Memorial Hospital and Louis Trichardt clinic. To conduct this study, ethical clearance was obtained in November 2018 from the Department of Sociology at the University of Cape Town. The qualitative research method was adopted in collecting the data. The study conducted in-depth interviews with five Zimbabwean migrant women who had made use of the two public health care services in Makhado. Field notes, diary entry, an impromptu focus group were used to collect the study data. The sample for the study was purposively selected. The study worked with a total of twelve participants, in-depth interviews with five Zimbabwean women, and a focus group with seven health care workers. The collected data was manually transcribed and was analyzed using the framework analysis. Main themes and sub-themes were extracted from the transcribed interview scripts. The study revealed that migrants accessing the two hospitals in Makhado faced challenges such as language barriers, discrimination, and adverse health personnel attitudes based on the patient's citizenship status. Furthermore, the challenges that nurses are faced within their workplace, which include lack of resources, absenteeism, long working hours and overcrowded public health care services within their workplace contributed towards their negative attitude in assisting patients. As a result, migrants bore the challenges faced by the nurses within the public health care services. Therefore, the migrants reverted to having other alternatives such as traditional healers, churches, connections with nurses working in the hospitals, private hospitals and over the counter medication. However, participants underscored that in order for betterment within the public health care services, the following measures ought to be implemented, these include the introduction of independent centres, an increase of mobile clinics, increased number of interpreters, better working environment for the health personnel within the public health care facilities and intensive education training of the health personnel around the awareness migrant issues when accessing public health care services. Foucault's (1980) theory on power and knowledge, played a significant role in understanding the operational systems of public health care services. It also assisted in understanding how public health care services function, to exclude and control migrant patients, through the introduction of fees and required documentation to access public health care services.

<p>The development and provision of equitable and acceptable standard of health services to all segments of the population has been the major objective of the 1993 Ethiopian National health policy. However, community based studies on satisfaction with public health care facilities reveal that the majority of the population are not satisfied with the services provided predominantly as a result of the long waiting times. Studies done on private health facilities on the contrary reveal that patients are satisfied with the service delivered within short waiting times in these clinics. Even though the speculated waiting time is thought to be long among the public health care facilities and short in private clinics, the actual waiting and service times have not been measured and compared. Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of &ldquo / acceptable&rdquo / waiting time among the providers and clients. Materials and methods: A cross sectional observational study using quantitative techniques was carried out amongst patients and staff at selected public and private health care facilities in Gondar District. Stratified sampling method was used to select facilities. All patients visiting the selected facilities and all staff who provided service to patients on the day of the study were included in the time-delimited sample. Data was collected by research assistants and health workers from all patients attending the health care facility by registering the arrival and departure time of each patient to the facility and to each service point on a patient flow card. Then data was cleaned and captured by a specific Waiting and Service Time database. Descriptive statistics was done on waiting and service times for each facility and this was summarized for each public and private health facility by using tables and graphs. Finally a comparison was made for private and public health facilities by using Wilcoxon-mann-whitney non parametric tests.</p>

Statistik visar att ungefär en fjärdedel av chefer inom offentlig sektor lämnar sin befattning inom två år samt 40 procent inom fyra år. Det föreligger ett ekonomiskt problem då personalomsättning är kostsamt på flertalet sätt. Stressnivån som första linjens chefer upplever påverkar det psykiska välbefinnandet och påvisar därmed att det föreligger ett psykosocialt problem. Det är av allmän kännedom att första linjens chefer upplever svårigheter med att balansera krav från chefer och ledning med krav från medarbetare. Tidigare forskning påvisar att kontroll och stöd är viktiga faktorer för att upprätthålla en psykosocial arbetsmiljö. Karasek och Theorell utvecklade krav-kontroll-stödmodellen under 1970-talet och modellen har främst tillämpats i stressforskning. Uppsatsens syfte är att öka förståelsen till vilken inverkan krav, kontroll och stöd har på första linjens chefers beslut att lämna sin befattning inom offentlig sjukvård. Studien baseras på sex stycken kvalitativa, semi-strukturerade intervjuer med första linjens chefer. Intervjufrågorna utgår från krav-kontroll-stödmodellen och det insamlade intervjumaterialet har analyserats samt tolkats utifrån en kvalitativ innehållsanalys. Uppsatsens resultat visar att endast två av sex första linjens chefer haft funderingar på att lämna sin chefsposition. Respondenterna har påvisat betydelsen av andra faktorer utöver krav, kontroll och stöd såsom utvecklingsmöjligheter och att finna en balans mellan arbetsliv och privatliv. Samtliga respondenter hävdar dock att krav, kontroll och stöd är viktiga för deras roll som första linjens chef. Flertalet upplever höga krav i arbetslivet, hög kontroll över arbetssituationen samt stöd i arbetsliv såväl som privatliv. Utifrån intervjumaterialet kan vi konstatera att upplevt stöd i privatlivet är av större betydelse än stöd i arbetslivet. / Statistics has shown that a quarter of managers within the public sector resign within two years and 40 percent within four years. This has caused an economic social problem, since employee turnover is expensive in multiple ways. In addition, a psycho social problem has risen due to the stress first line managers experience, which has affected their health. In general, first line managers struggle to find a balance between demands from management department and demands from employees. Furthermore, previous research has shown the importance of having control and feeling support when maintaining a healthy work environment. Karasek and Theorell created the demand-control-support-model in the 1970’s which has mainly been used in studies of stress and stress related diseases. The aim of the study is to investigate the impact demand, control and support have for first line managers’ decision to leave their manager position within public health care. The study is based on six qualitative semi-structured interviews with first line managers. The interview questions are based on the demand-control-support model whereupon the material was analyzed by using a qualitative content analysis. The result shows only two of six participants have considered leaving their manager position within public health care. The participants highlight the importance of experiencing demand, having control and feeling support in their roles as first line managers. They also emphasize other essential variables such as having the opportunity to develop both personally and in work life, and to balance work life and private life. The investigated variables are thus important and the majority of first line managers perceive a high level of demands, high control and support in work life as well as in private life. Based on the interviews, we can confirm perceiving support in private life is of greater value than feeling support in work life.