The main focus of the thesis is the multilayered view of regional hospitals on their contractual relationship with health insurance companies. The thesis draws information from two case studies of regional hospitals in Central Bohemia. These case studies have allowed me to map the whole process of establishing a contractual relationship with health insurance companies from the first contact to the final conclusion of the contract for a particular year. Through mapping the process I have identified a number of problematic areas that are encountered when concluding contracts. Thesis has also concentrated on the establishment and content of the payment regulation which, to a large extent, determines the final form of the contractual relationship. One of the goals of the thesis is the identification of key problems stemming from the parameters of the contractual relationship and payment mechanism. These problems are analyzed on the level of hospitals, individual specialized units, and in relation to the provision of health care to patients.

The National Health Act aims to protect the health care users and workers by ensuring that their work environments are protected against injuries. Practice environment is described as a physical, social and psychological characteristic of a work setting in which policies, procedures and systems are designed so that employees can meet the organisational objectives and achieve personal satisfaction in their work environment. The aim of the study was to describe and analyze characteristics of the practice environment of nurses. A quantitative descriptive study was conducted in a public hospital in Gauteng Province. Practice Environment Scale-Nursing Working Index (PES-NWI) questionnaires were distributed to 207 nurses who were proportionately stratified. Data was analysed using the SPSS version 25. Findings identified gaps of the current characteristics of the practice environment and developed strategies that will assist managers to enhance practice environment. There was alignment and correlation between the means, standard deviation and the frequencies which were drawn from the findings. The overall Cronbach’s alpha was 89% which confirmed the internal consistency of the instrument. The majority of the variables demonstrated statistical significance which had a p value of 0.001. In conclusion, practice environment affects all health care professionals although the study only analyzed the practice environment of nurses. / Health Studies / M. P. H.

Text in English / Interactive health communication between the health-care professional (HCP) and patient relationship for diabetes health-care positively contributes to patient-centred care. Hence individual patient concerns are addressed and catered for in the medical system. The purpose of this study was to analyse in-depth how HCP-patient relationships and HCP-HCP teamwork dynamics positively contribute to effective diabetes patient care and treatment adherence. Different health communication models and theories were reviewed and a conceptual framework was developed from the literature. A qualitative case study approach was used to collect data at Stanger Hospital’s diabetes clinic. Data was collected using three different methods, namely in-depth interviews with HCPs and patients individually, observations conducted at the clinic analysing both the HCPs and patients, and finally, documentation that emerged as a third data collection method where patient files and diabetes educational material were analysed at the clinic. Triangulation by means of the three methods ensured that reliable, valid and credible data was collected in the field. Diabetes health-care and treatment management are affected by the social context/social system which includes family and culture. These social factors are acknowledged as core in the literature. However, a single comprehensive health communication model did not exist solely in this regard. The data indicated that at the Stanger Hospital’s diabetes clinic, patient-centred (individual tailor-made treatment plans) care was only implemented after patients had defaulted treatment for reasons linked to their social circumstances. The findings of the study indicate that teamwork was favoured in the HCP-HCP relationship at the diabetes clinic, and that this made a positive contribution to effective diabetes patient care. HCPs were overburdened at the clinic since patient numbers were high and there were staff shortages. The patients’ empirical data indicated that interactive communication positively contributed to their medical concerns being catered for at the diabetes clinic, but this tended to occur only after non-adherence. Patients required care and support from HCPs in order to learn to accept diabetes and manage their illness. / Sociology / D. Litt. et Phil. (Sociology)