The Diploma paper " The Health Care Providing System in Switzerland" describes the development, structure and typical aspects of health care providing system in Switzerland. The Diploma paper concentrates on identification of the key factors which helped Switzerland health care providing system to reach very high quality and also ensured large availability of the services. The work is divided into theoretical and practical part. Theoretical part describes Swiss Confederation and its health care providing system. The practical part offers the comparison with the system in Czech Republic. The finale part is devoted to the key factors which could be implemented into the Czech system and which would be helpful for its further development.

Student Number : 8910202A - MPH research report - School of Public Health - Faculty of Health Sciences / An increasing number of people are migrating to South African urban centers (GJMC, 2000). There are various reasons that can be attributed to this migration; including the hope of finding employment and better living conditions. Recent urban migrants find themselves faced with the basic problem of lack of shelter and, depending on the migrant’s situation, they may choose to live in indoor shacks within the city center, backyard shacks in the black townships or join the growing number of informal settlement dwellers (GJMC, 2000). The number of informal settlements continues to grow at an alarming rate in Johannesburg (CEROI, 2000). This poses unique health care challenges as well as presenting the health care system with unusual disease conditions associated with general lack of infrastructure and services (CEROI, 2000). It has been established that the proportion of HIV infected patients is higher in people living in informal settlements when compared to people living in private houses (SAHR, 2000). Thus, it is expected that more people will be presenting with HIV and AIDS related illnesses in an informal settlement health center as compared to well-developed residential areas. This study aimed at exploring the prescribing patterns of health care givers for patients attending a health center in an informal settlement as well as to determine the major disease patterns prevalent in the area. The study was carried out in Davidsonville and OR Tambo clinics as well as Bophelong and Hikhensile clinics in Ivory Park. The study covered regions five, one and two respectively according to Gauteng metropolitan services area classification (GJMC, 2000). The findings of the study will help the appropriate policy makers improve the Essential Drug List and inform public health officials in formulating strategies that may lead to health status improvement for people living in informal settlements.

This thesis address one of the most important topics for the human being; health. Specifically, the research is about the deficiencies of the health system in Mexico. This paper shows the importance, how the system works and its current situation in the country. The purpose of this research is, based on the Pareto principle (20% vs 80%), to find how to solve most problems with the least possible investment.   It was found that the common denominator in the problems was the process and flow of information of the patients; specifically, the health records. The researchers address the issue at first explaining in a deep way the health records to highlight their importance in the health care system. In order to corroborate this finding in the literature; The researchers designed an interview, which was applied to physicians from the two main health institutions in Mexico in order to collect the necessary information to develop the thesis.   Since the design of the research is qualitative; the necessary social context is given to be able to understand the analysis and the results; likewise, the authors explain in detail the methodology used.   In spite of other important factors that were found such as the lack of results despite the investment and deficiencies in the infrastructure; It was concluded that, in fact, most of the problems were derived from the problems of health records. These results are important because it gives a parameter of what must be corrected first in order to have the expected results and a better health system.

Este trabalho tomou como objeto de estudo a relação entre saúde, Estado e ética no âmbito do Sistema Único de Saúde brasileiro. Utilizando os espaços público e privado como categorias de análise, teve como objetivo verificar como a reforma do setor saúde, especificamente a legislação complementar Norma Operacional Básica de 1996 (NOB/96), que tem servido de base à reforma, e a Lei n. 9.637/98, que cria as Organizações Sociais e o Programa Nacional de Publicização, coadunam-se com o princípio ético, presente na Constituição “saúde é direito de todos e dever do Estado". A análise baseou-se na legislação do SUS. Observou-se que o direito à saúde não está garantido na reforma do setor saúde, pois a concepção de Estado presente no SUS e aquela da reforma são diferentes. A análise mostrou ainda que a atual reforma tende a privatizar a saúde tanto na forma dos Programas da Saúde da Família e do Agente Comunitário da Saúde como através da transformação dos equipamentos de saúde de maior complexidade em organizações públicas não-estatais, submetendo a assistência à saúde às leis do mercado. Esse processo faz parte da reforma liberalizante do Estado brasileiro e acompanha a crescente privatização do espaço público, na contemporaneidade, que permite que o poder político seja ocupado por agências internacionais que impõem suas normas aos Estados nacionais. / This study took as a general object the relationship among health, State and ethics under the scope of the Brazilian Health Care System (BHCS). Utilizing public and private spheres as analytical categories, it had a particular objective of verifying how the health reform - particularly the complementary legislation Basic Operational Norm/96 and the law n. 9.637/98, that creates Social Organizations and the National Publicizing Program -, is in accordance with the ethical principle of the Constitution health is a citizen right and a State duty. Analysis was based on the BHCS legislation. It was observed that the right to health is not guaranteed by the health reform, mainly because its conception of State is different from that of the Constitution. Analysis shows yet that the current reform tends to privatize health care through both the Health Family Program and Community Health Agent Program and through the transformation of high complex health services in non-state health organizations. This process is part of the Brazilian State liberalizing reform and follows closely the growing privatization of public sphere on contemporary societies, that has being allowing international agencies to occupy political power by imposing their norms to the National States.

Healthcare in the Czech Republic is currently undergoing reform changes. The aim of the thesis is to evaluate the upcoming changes in the reimbursement of health care in hospitals. To achieve the goal is used as the literature, as well as proposed legislation and the case law. The practical part of the thesis focuses on the hospitals. Emphasis is placed on the analysis of mechanisms fixed costs reimbursement of health care and reimbursement of health care by the DRG method. The potential impact of reform measures is presented on the example of an extremely costly medical care (orphan drugs). Based on the information and analysis are in the final part of the thesis describes the effects of health reform on financing health care in hospitals. At the same time also outlined a possible solution to save the cost of medical equipment in the field of medicines.

A reforma sanitária, ocorrida após a constituição de 1988, criou o Sistema Único de Saúde (SUS), descentralizando a gestão em saúde pública no Brasil e delegando mais autonomia e responsabilidade aos municípios. Esta descentralização traz inúmeros benefícios, pois aproxima a gestão das realidades locais. Os municípios são peculiares e podem apresentar dificuldades em atingir os mesmos padrões de serviços de saúde dos demais entes federados e, eventualmente, incorrer na desigualdade em saúde. Para garantir a integralidade no atendimento, as Redes Regionais de Atenção à Saúde (RRAS) articulam o sistema de maneira a satisfazer os diferentes níveis de complexidade. Procurou-se nesta pesquisa encontrar padrões espaciais destoantes na distribuição de recursos de saúde no estado de São Paulo, de maneira a caracterizar eventuais desigualdades em saúde. Os dados foram analisados por RRAS e por aglomerados de munícipios de atributos similares. Os resultados indicam diferenças regionais nos vários aspectos pesquisados, sobretudo na cobertura por equipes de saúde da família, no acesso aos serviços de saúde e na oferta e ocupação de leitos. Estas diferenças variam conforme se dista da capital do estado e estão associadas à renda e à presença da saúde suplementar. / The health care reformulation, which started after the constitution of 1988, created the Unified Health Care System (SUS), decentralizing the management of public health care in Brazil and delegating more autonomy and responsibility to counties.This decentralization brings numerous benefits because it approaches the county management to local area realities. Counties have different features and may have difficulties achieving the same health care standards of other federative entities and possibly create health care inequalities. To ensure comprehensiveness in health care, the Regional Health Care Networks (RRAS) articulate the system in order to provide the different levels of complexity. It is aimed in this research to find dissonant spatial patterns in health care resources distribution in the state of São Paulo, in order to characterize any inequalities. The data was analyzed by the RRAS and clusters of counties of similar attributes. Results indicate regional differences in several aspects of the research, mostly in family health care teams coverage, access to health care services and availability and bed occupancy rate. These differences vary according to how distant from the state capital the county is and are associated with income and health insurance attendance.

Les paiements informels (PI) sont des sommes d’argent supportées par les patients, ou exigées indument par le personnel sanitaire, à l’occasion d’une prestation de soins qui est pourtant censée être prise en charge. Dans les systèmes de soins publics des pays en développement (PED), ces paiements constituent une pratique courante. Puisque ces systèmes de santé sont souvent réputés pour être peu efficients, nous proposons dans cette étude une analyse des possibles liens entre le versement de PI et l’efficience d’un système de santé. Dans la première partie de ce travail, nous mettons en évidence une corrélation négative entre les PI et l’efficience du système de soins : à des taux élevés de PI sont typiquement associées de faibles performances sanitaires. Nous expliquons qu’il est par conséquent légitime de penser qu’une réduction des niveaux de PI entrainerait une amélioration des prestations fournies ou/et une réduction des dépenses sanitaires. Dès lors, il semble pertinent d’examiner les motifs qui poussent les patients et le personnel sanitaire à s’adonner à des paiements informels. Nous explorons cette voie en partant d’une analyse coût-bénéfice. Pour cette dernière, quatre déterminants majeurs de la conduite de l’agent seront identifiés au cours de cette analyse : le salaire, les conditions physiques de travail, la responsabilité légale et les normes sociales. Partant du postulat que l’agent ne changera d’attitude que si un comportement intègre lui procure au moins autant de satisfaction qu’un comportement opportuniste (corrompu), nous déduisons de cela quelques pistes susceptibles de réduire le versement de PI. / Informal payments (IP) are sums of money paid voluntarily by patients, or unduly demanded by medical staff, for the provision of care that is supposed to be already financed. In the public healthcare systems of developing countries (DC), these payments are a common practice. Since these healthcare systems are often considered to be inefficient, we propose in this study an analysis of the possible links between the payment of IP and the efficiency of a healthcare system.In the first part of this work, we highlight a negative correlation between IPs and the efficiency of the healthcare system: high levels of IP are typically associated with poor health outcomes. We explain that it is therefore legitimate to think that a reduction in IP levels would improve the services provided or / and a reduction in health expenditure.If one wishes to reduce IPs, it seems relevant to examine the reasons that push patients and health personnel to indulge in informal payments. In the second part of this work, we explore this path from a cost-benefit analysis. Hence, four major determinants of the agent's behavior are identified: wages, physical working conditions, legal accountability and social norms. Starting from the premise that the agent will change his attitude only if a behavior of integrity gives him at least as much satisfaction as a corrupted behavior , we deduce from this some strategies likely to reduce IPs.

One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed. / In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance. / This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.

Introduction/ Objectives: Stroke, the third leading cause of death in Canada, is projected to rise in the next 20 years as the population ages and obesity rates increase. Family caregivers fulfill pertinent roles in providing support for family members who have survived a stroke, from onset to re-integration into the community. However, the transition from rehabilitation to home is a crucial transition for both the stroke survivor and family caregiver. As the stroke survivor transitions home from a rehabilitation facility, family caregivers provide different types of support, including assistance with navigating the stroke rehabilitation system. They also are a constant source of support for the stroke survivor providing them with continuity during the transition. In this exploratory study we examined family caregivers’ perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity care and complex adaptive systems were used to examine the transition home from hospital or stroke rehabilitation facility, and in some cases back to hospital. Methodology: Family caregivers (n=14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient’s discharge from a stroke rehabilitation facility. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed content analysis was used to explore the perceptions of family caregivers as they reflected on the transitions home. The theories of continuity of care and complex adaptive systems were used to interpret their experiences. Results/Conclusions: During the transition home from a rehabilitation facility, family caregivers are a constant source of support, providing the stroke survivor with continuity. Emergent themes highlight the importance of the caregiving role, and barriers and facilitators that impact the role, and influence continuity of care. Also, supports and services in the community were limited or did not meet the specific needs of the family caregiver. The acknowledgment of the unique attributes of each case will ensure supports and services are tailored to the family caregiver’s needs. Mitigation of systemic barriers would also decrease complexity experienced at the micro-level in the stroke rehabilitation system, and better support the family caregiver during the transition home from a stroke rehabilitation facility.

South Korea has been evaluated as having the weakest primary care system. In South Korea, the health care delivery system is concentrated too heavily in the private sector. Increased concern on keeping one’s health and reducing the burden of health care costs led community members to gather and form health care co-operatives. Currently, 19 health care co-operatives have been established through residents’ participation and even more are preparing to be incorporated. As a nonprofit organization, a health care co-operative is a voluntarily established co-operative organization that tries to solve health, medical, and life problems in communities. This report examines how these health care co-operatives work in the health care system, whether they can be effective alternatives to a future health care system in South Korea, and finally the report provides recommendations. Given the fact that the nation already has national health insurance, health care co-operatives in South Korea mainly operate several clinics by focusing more on managing chronic diseases and increasing access to care, rather than developing affordable health care insurance or lobbying in policy sectors as they do in other countries. Health care co-operatives’ motivation is to keep people healthy; hence, they put a great deal of effort into delivering primary care and helping patients deal with chronic diseases. Health care co-operatives are encouraging because of their democratic structure. Health care co-operatives emphasize the idea that the owners of the health care co-operatives are in fact the members. The overall satisfaction of users in the current health care cooperatives is moderately high. Taking the lessons from the examples of health co-operatives in other countries, health care co-operatives should be able to function as a good complementary to the health care system. / text