>Magister Scientiae - MSc / Health is considered as a sensitive marker of the sustainable development of a population. In Central America and Caribbean (CAC) region, the majority of countries are considered middle-income economies with significant inequalities mainly between the different types of health coverage and health expenditure.The main objective of the dissertation is to identify a possible relationship between universal health coverage and health investment in the main health and some sociodemographic determinants defined by the WHO/PAHO from 2009 to 2018. Additional characterizations of current types of health coverage, investment in health and the main health and socio-demographic indicators of the region were made.

Master of Public Health - MPH / The World Health Organisation estimates that more than 50% of medicines are inappropriately used globally. The situation is worst in developing countries such as Nigeria, where irrational prescribing practices account for wastage of resources, catastrophic medicines costs and poor access to health services. In 2005, the Social Health Insurance Programme was launched as a financially sustainable model to achieve cost effective and affordable health care services including medicines. This study investigated prescribing practices and availability of medicines in the Social Health Insurance Programme in accredited public sector secondary hospitals in the Federal Capital Territory, Nigeria.Methodology:The study is a descriptive, cross-sectional and retrospective survey of prescriptions of insured outpatients in the Federal Capital Territory, Nigeria. Four hospitals were selected by stratification of thirteen (13) public secondary hospitals in the territory into urban/peri-urban areas, followed by random selection of two hospitals from each stratum.A total of seven hundred and twenty (720) retrospective prescription encounters of insured outpatients were systematically selected from encounters between July 2009 and June 2010 at the selected facilities. Data on prescribing practices and the extent to which prescribed medicines were provided were assessed with the use of modified WHO/INRUD indicators. Descriptive statistics were generated with Epi-info (version 3.4.3) and SPSS (version 17.0)Results: Out of the seven hundred and twenty (720) prescriptions that were assessed analgesics/NSAID, antibiotics, antimalarials and haematinics/vitamins collectively accounted for 67.4% of the medicines prescribed.A comparison of the results with WHO/Derived reference values showed that average number of medicines prescribed per prescription (3.5 ±1, p<0.001) and the rate of antibiotic prescribing (53.7%, p=0.009) were higher than the WHO recommended ranges of (1.6-1.8) and (20.0- 25.4%) respectively.The use of generic names in prescribing (50.9%, p<0.0009) and medicines prescribed from the Essential Medicine List (74.2%, p=0.05) were considerably lower than the standard (100%) However, the rate of injection prescribing (12.49%, p=0.4) was within the recommended range (10.1–17.0%).The study also found that 85.1%, (p=0.001) of prescribed medicines were dispensed, while 93.4% (p=0.256) of essential medicines were dispensed which was lower than the recommended standard (100%). Overall, only 58%,(p<0.0001) of patients had all prescribed medicines completely dispensed and this was significantly lower than the desired standard (100%.) in social health insurance programmes.Conclusions:The findings of this study show trends toward irrational prescribing practices as characterized by poly-pharmacy, overuse of antibiotics, sub-optimal generic prescribing, as well as poor adherence to the use of NHIS-Essential Medicine List. There was sub-optimal provision of prescribed medicines. These are potential threats to the scheme‟s goal of universal access to health care in the year 2015. Pragmatic multi-component interventions are recommended to promote rational prescribing and improve equity in access to essential medicines.

Background: Irresponsible self-medication is a problem for health systems in developing countries. We aimed to estimate the frequency of self-medication and associated factors in users of drugstores and pharmacies in Peru. Methods: We performed a secondary data analysis of the 2015 National Survey on User Satisfaction of Health Services (ENSUSALUD), a two-stage probabilistic sample of all regions of Peru. Non self-medication (NSM), responsible self-medication (RSM) and irresponsible self-medication (ISM) were defined as the outcome categories. Demographic, social, cultural and health system variables were included as covariates. We calculated relative prevalence ratios (RPR) with their 95% confidence intervals (95%CI) using crude and adjusted multinomial logistic regression models for complex samples with NSM as the referent category. Results: 2582 participants were included. The average age was 41.4 years and the frequencies of NSM, RSM and ISM were 25.2%, 23.8% and 51.0%; respectively. The factors associated with RSM were male gender (RPR: 1.35; 95%CI: 1.06-1.72), being between 40 and 59 years old (RPR: 0.53; 95%IC: 0.39-0.72), being 60 or older (RPR: 0.39; 95%IC: 0.25-0.59), not having health insurance (RPR: 1.89; 95%CI: 1.31-2.71) and living in the Highlands region (RPR: 2.27; 95%CI: 1.23-4.21). The factors associated with ISM were male gender (RPR: 1.41; 95%CI: 1.16-1.72), being between 40 and 59 years old (RPR: 0.68; 95%IC: 0.53-0.88), being 60 or older (RPR: 0.65; 95%IC: 0.48-0.88) and not having health insurance (RPR: 2.03; 95%CI: 1.46-2.83). Conclusion: Around half of the population practiced ISM, which was associated with demographic and health system factors. These outcomes are the preliminary evidence that could contribute to the development of health policies in Peru. / Revisión por pares

The background variables, GDP per capita, marketization, industrialization and urbanization are used to control different levels of development across provinces. The role of the state is measured in the following ways. First, financial capacity, administrative capacity and coercive capacity are used to measure the role of state capacity in BMI extension. The study examines whether there is a difference in choosing different agencies to collect social insurance premiums: one is local taxation agency and the other is social insurance agency. Third, the performance of BMI is measured through the deposit rates of BMI funding which reflects governments' ability to manage the BMI program. In the current policy, employers are charged largely the social insurance fees. So their willingness and capabilities to pay will affect BMI coverage. The study investigates two kinds of employers: loss making State-Owned-Enterprises (SOE hereafter) and Foreign Invested Enterprises (FIE hereafter). On the employee's part, the percent of informal employment in total urban employment is used to measure the effect of adverse employment conditions on BMI coverage. Trade union density is used to estimate the labor organization strength. / The complicated process of extending coverage is related to three major stakeholders: state, employers and employees. These three stake-holders influence BMI progress. Also, the background factors (such as the economic growth) should be taken into account for the regional variations in development level. Since BMI is a typical social policy field, this study reviews major theories about social policy development: logic of industrialism, power resource theory and state-centered approach and so on. These theories help organize pieces of phenomena into a unified framework and testable hypotheses are also derived. / The contributions of this study can be twofold. First, from the theoretical aspect, this research tests several welfare state development theories using Chinese data. In this way, it does not only expand the scope conditions of theories, but also improves our understanding of the social policy development in China, an outlier of traditional western democracies. Second, this study tests some controversial issues on BMI development and the research findings provide knowledge support for the policy practice in the real world. / The low coverage of social health insurance is one of the causes of the problems in Chinese health care system which is criticized for the rising health cost, large share of out-of-pocket payments and health inequality issue. The Basic Medical Insurance for Urban Employees (BMI hereafter) was chosen as the subject of my investigation. It was established in 1998 for the working population and till now it has not achieved universal coverage yet. The Basic Medical Insurance for Urban Residents (BMI-R hereafter) was started in 2007 and it is still in pilot stage, therefore data are still inadequate. In rural areas, the New Cooperative Medical Scheme (NCMS hereafter) achieved almost full coverage in 2008. Thus extending coverage is not issue at concern for NCMS. Besides, the NCMS data at province level are quite limited. Considering the stages of policy development and data access, BMI-R and NCMS are not included in this study. / The proportion of winning lawsuit in labor disputes is used to measure the function of labor protection system. This study adopts the panel method. Data is ranging from the year 1999 to 2005 and the unit of analysis is province/year. They were collected from various official statistics and constructed into a panel database which can trace the development of BMI from its origin to most recent situation. / The research question is what are the determinants of BMI's coverage? It is originated from some puzzling observations: the NCMS achieved full coverage in four years and it is a voluntary participation insurance program. On the contrary, why the mandatory BMI did not reach universal coverage after almost ten years' development? Besides, the progress of BMI across different provinces varied greatly. Given the policy designing and starting points are rather similar, how can we explain these variations? / The research yields several interesting results. First, the roles of financial capacity and administrative capacity in BMI development are supported by data, especially the social insurance agency. Second, results show that using local taxation to collect social insurance premiums has better effects in extending coverage than the alternative approach. This result will give an end to the decade-long debate on choice of social insurance premiums collection agencies. Third, the deposit rates of BMI funding are negatively related with BMI coverage. It implies that governments should improve the performance of BMI so as to attract more people to enroll in this program. Fourth, the union density in the private sector is positively related with BMI coverage. This result disagrees with the conventional wisdom that the Chinese trade unions are useless. It implies that strengthening the organization of employees (even through the official channel) can protect the rights of employees in some degree. / 劉軍強. / Adviser: Cheek-Kie Wong. / Source: Dissertation Abstracts International, Volume: 73-03, Section: A, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (p. 198-222) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Liu Junqiang.

Made available in DSpace on 2016-03-15T19:34:25Z (GMT). No. of bitstreams: 1 Guilherme Guimaraes Coam.pdf: 1212998 bytes, checksum: 00923316eb8e03504303c42cdc605f1e (MD5) Previous issue date: 2015-08-13 / Universidade Presbiteriana Mackenzie / The Federal Constitution, in the article 196, states that health is everyone s right and duty of the State . In recent years, the said Constitutional device has been analyzed in isolation, with total disregard for all other constitutional and legal provisions on the matter, including the rest of the article 196 of the precept itself. Thus, despise up all legal and constitutional limits for granting health benefits, adopting the understanding that any kind of provision in health should be granted to any citizen who seeks the judiciary, regardless of public policies, appropriations budget, or any legal limits. The Judicial Activism has been exacerbated with court decisions clearly go against the constitutional principles and the ordinary law. In this thesis, we intend to explore the concept of universal coverage in health, in an attempt to demonstrate that the Constitution allows the ordinary legislator and public administrator, to impose legal limits on health benefits that the state must pay. / A Constituição Federal, no início do artigo 196, estabelece que saúde é direito de todos e dever do Estado . Nos últimos anos, o referido dispositivo Constitucional vem sendo analisado de forma isolada, com total desprezo por todas as demais disposições constitucionais e legais referentes à matéria, inclusive o restante do próprio preceito do artigo 196. Com isso, desprezam-se todos os limites jurídico-constitucionais à concessão de prestações em saúde, com adoção do entendimento de que qualquer espécie de prestação em saúde deverá ser concedida a qualquer cidadão que procure o Poder Judiciário, independentemente de políticas públicas, de dotações orçamentárias ou de quaisquer limites jurídicos. O ativismo judicial vem sendo exacerbado, com decisões judiciais claramente contrárias a princípios constitucionais e à lei ordinária. Pretende-se, na presente dissertação, explorar o conceito de universalidade da cobertura em saúde, na tentativa de demonstrar que a Constituição Federal permite, ao legislador ordinário e ao administrador público, a imposição de limites jurídicos às prestações de saúde que o Estado deve custear.

BACKGROUND: The barriers in accessing healthcare for gay, lesbian and bisexuals individuals are not well explored. These challenges as well as a lack of knowledge concerning this understudied group has prompted the Institute of Medicine to create a research agenda to build a foundational understanding of gay, lesbian and bisexual health and the barriers they encounter.1 the primary aim of this study will be to compare the differences in health care access and utilization between gay/lesbian, bisexual and heterosexual individuals using a large, nationally representative dataset of the U.S. population. METHODS: Data from 2001 to 2012 from the National Health and Nutrition Examination Survey was pooled. Using logistic regression, we calculated the unadjusted and adjusted odds ratios of having health insurance, having a routine place and seeing a provider at least one in the past year. RESULTS: We found that gay men were more likely to have health insurance coverage (ORadj:2.13 95%CI: 1.15,3.92), while bisexual men were at a small disadvantage in having health insurance coverage (ORadj:0.82 95%CI: 0.46,1.46). Bisexual men were more likely to have received health care in the past 12 months (ORadj:3.11 95%CI: 1.74,5.55). Lesbian women were less likely to have health insurance coverage (ORadj-lesbian:0.58 95%CI: 0.34,0.97). CONCLUSION: This study contributed to the limited knowledge on understanding the health care access and utilization among gay, lesbian and bisexual individuals, which was classified as a high priority by the Institute of Medicine. Expanding health insurance coverage through the Affordable Care Act and Universal Partnership Coverage may reduce the disparities among gay, lesbian and bisexual individuals.

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)