<p> This research examines the physical operations of a health care sector called long term care facilities. Long term care refers to organizations that provide onsite nursing care for people with long-term illnesses, elderly people who need continuous medical supervision, or for those in long-term rehabilitation programs. Most specifically, this research looks at the performance of the physical buildings (i.e. facilities) and how this performance impacts the external environment. Using secondary data from the organization Practice Greenhealth, this study addresses the following two research questions. </p><p> 1. What is the combined current state of environmental performance at the long term care facilities that have applied for a Practice Greenhealth award? </p><p> 2. What are the proposed environmental key performance indicators for the long term care sector? </p><p> Based on this research, a model is suggested for future researchers interested in the environmental performance of long term care facilities. The model suggests six drivers for improving environmental performance in long term care; (1) maintain compliance with environmental regulations, (2) reduce costs, (3) meet expectations of parent organization, (4) increase market competitiveness, (5) engage stakeholders, and (6) improve patient outcomes. Four environmental improvement categories are then established; (1) waste, (2) energy, (3) water, and (4) engagement initiatives, along with each categories&rsquo; associated indicators. Finally, this study develops a concise environmental performance survey that could be used by any long term care facility looking to make improvements to its environmental performance over time.</p><p>

Background This thesis explores processes involved in stakeholders’ attempts to secure sustainability of three short-term funded community health initiatives known as healthy living centres (HLCs). The overall aim was to identify and examine development of sustainability strategies in Scottish HLC organisations. In contrast to retrospective accounts examining influences on extent of sustainability little is known about how this concept is considered by organisations approaching the end of funding. Organisational development theorising has focused on organisational change, with no attention given to sustainability processes in short-term funded organisations. Building on a concurrent longitudinal evaluation of a larger sample of HLCs, the temporal nature of this PhD study offered scope to explore development of, influences on and changes to stakeholders’ sustainability strategies over time. Methods The study used a qualitative evaluation methodology. A case study approach framed the HLCs, permitting comparison between sites. An ethnographic approach using observations and in-depth interviews was employed. Interviews were undertaken with stakeholders (comprising managers, staff, partners and board members) from each HLC. Managers were interviewed on several occasions. Latterly, interviews were undertaken with respondents holding policy, practice and funding posts. A thematic analysis, informed by grounded theory, was carried out. This used a constant comparative methodology to understand the data against the backdrop of the PhD study aims and wider literature. Findings Findings examine stakeholders’ accounts of the impact of a range of issues on HLC sustainability strategies. These are located in the context of health and community sector restructuring. Especially challenging were: efforts to secure local partners and further lottery funding; consideration of new funding criteria and models of service delivery; and limitations in demonstrating effectiveness. Addressing such challenges, managers’ strategic positioning signified attempts to influence HLCs’ fit within local health structures. Stakeholders’ accounts highlighted attempts to secure continuation of HLCs’ original identity; ensuring continued accessibility of Centres to local communities; and, seeking continuation of developmental methods of work. External respondents’ perspectives illuminated how policy-driven changes restricted system-wide attention to HLC sustainability. Latterly, Government-provided funding offered a short-term fix, enabling continuation of attempts to secure sustainability. Conclusions and implications This study offers new perspectives on the temporal exploration of sustainability of shortterm funded health initiatives. Analysis of stakeholders’ accounts over time provides insight into the effects of restructuring and ways in which system-wide flux impacted on influences known to enhance the likelihood of sustainability. Recommendations address programme design and wider responsibilities of health system actors in positioning and considering a future for such organisations after short-term funding ends.

The final thesis analyzes funding of Czech healthcare system in 2015 and shows its sustainability in future years in order to answer the question, what is the impact of the abolition of regulatory fees, which were introduced in 2008, subsequently in 2014 and cancelled in 2015. Many demographic changes, specifically age structure of the nation, occurred over recent decades in the Czech Republic. This fact caused disproportionate changes on the expenditure side and the revenue side of the health system. The state tried to balance this disparity with short-introduced charges, but those were abolished due to the political pressure. The final thesis assesses the appropriateness of this measure. The theoretical part explains the healthcare system in the Czech Republic and all its entities, explains different approaches to the concept of health and issues of regulatory charges. The practical part is devoted to analysis of statistical data. There is the state of health care through the last of the statistics and demographic prognosis described. Following part talks about the issues of charges in a broader context of health care. There are also global trends and the biggest problems that the Czech Republic faces in that direction defined. The conclusion evaluates the role and effectiveness of regulatory charges and the impact of their abolition, offers possible solutions or recommendations, which are formulated on the basis of evaluated data. The final thesis concludes that regulatory charges are suitable complement to the overall reform, but this arrangement is not capable of comprehensively addressing current and possible future problems by itself.

Background – The sustainability of the health system requires the development of cost reduction strategies and effectiveness in serviçe provide. The formulation of effective planning is only possible through studies analyzing the profile of the assisted population for allocating resources strategically. Objective - Assess the value chain associated to hospitalization due to Acute Coronary Syndrome in Private Health System. Methods and Results - A transversal, documental study, using quantitative approach was done in a private hospital and in a health insurance company. Individuals admitted due to acute coronary syndrome in the years 2013 and 2014 in the researched hospital that had not been treated in another health unit or didn’t die were included in this study. The GRACE score version 2.0 was calculated and the invoices with all the hospitalization costs, discriminated in six taxonomies. The relation between the costs and GRACE score was obtained through Kruskal Wallis test, considering significant differences smaller than p<0.05. Sixty-four patients were included, most of which were female, mean age 67.3± 14,2 years exhibiting mainly unstable angina and low GRACE score. The mean cost per patient with acute coronary syndrome was R$ 31.199,38 and the median hospital stay was 5.0 days, influencing the costs (p: 0,041). There was no statistical significance between the costs and the GRACE score (p: 0,170), the cost variability in the same GRACE score was high and the taxonomy that most affected the costs were the non standard materials. Conclusion - The identified mean cost per patient was R$ 31.199,38, there was no statistical relation between the GRACE score and the costs, with large variations in the same GRACE score. The taxonomic category that most impacted the costs were the non standard material. / Fundamento – A sustentabilidade do sistema de saúde impõe a elaboração de estratégias de redução de custos e eficácia na prestação de serviço, para isso a criação do planejamento eficaz só é possível por meio de estudos que analisem o perfil da população assistida para a alocação de recursos de forma estratégica. Objetivo - Analisar a cadeia de custos com a hospitalização por Síndrome Coronariana Aguda no âmbito da Saúde Suplementar. Métodos e Resultados- Estudo transversal, documental, com abordagem quantitativa, realizado em hospital privado e operadora de plano de saúde. Foram incluídos indivíduos admitidos com síndrome coronariana aguda nos anos 2013 e 2014 no referido hospital, que não tivessem sido atendidos em outra unidade de saúde na vigência do episódio e que não evoluíram ao óbito. Foi calculado o escore GRACE versão 2.0 e obtidas faturas com todos os custos hospitalares, discriminadas em seis categorias taxonômicas. A relação entre os custos e níveis do escore GRACE foi obtida por meio do teste de Kruskal Wallis, considerando significativas diferenças inferiores a p<0,05. Foram incluídos 64 pacientes, maioria mulheres, com idade média de 67,3± 14,2 anos que apresentaram principalmente angina instável e escore de risco baixo. O custo médio por paciente com síndrome coronariana aguda foi R$ R$ 31.199,38 e a mediana de permanência hospitalar de 5.0 dias, a qual influenciou nos custos (p: 0,041). Não houve relação de significância estatística entre os custos e o escore GRACE (p: 0,170), a variabilidade dos custos em um mesmo escore de risco GRACE foi alta e a categoria taxonômica que mais impactou na fatura foram órteses/próteses/materais especiais. Conclusão: Foi identificado um custo médio de R$ 31.199,38 por paciente, não houve relação estatística entre o escore GRACE e os custos, inclusive houve grande variação de custos em um mesmo escore e a categoria taxonômica que mais impactou financeiramente foram órteses/próteses/materiais especias.