A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management Johannesburg, 2011 / Introduction: South Africa is currently facing a quadruple burden of diseases: poverty related conditions, emerging chronic diseases, injuries and HIV/AIDS. Increasing burden of these diseases is having a detrimental impact on service delivery particularly in rural areas, where the majority of the population are dependent on public health system. Although numerous epidemiological studies had been done in the past to determine the prevalence of these conditions, only a few studies have attempted to quantify the effect of these diseases on health facilities such as admission rate, bed occupancy rate and resource utilisation. More data is required to develop a better understanding of their impact and to guide development of appropriate response strategies. Aim of the study: To `analyse trends of admissions and resource utilisation in adult medical wards of a rural district hospital in South Africa. Methodology: This was a descriptive cross-sectional, retrospective study involving an analysis of data from adult medical wards in the George Masebe Hospital (a district hospital in Limpopo Province) for six months in 2009. Results: The study found average number of admissions per month was 148, their length of stay varied from one day to more than a year. Their median age was 44 years. They were black, had no medical aid and unemployed and the majority of them were dependent on social welfare grant. The most common health problems diagnosed amongst the medical admissions were HIV related conditions such as gastro-enteritis, pneumonia, AIDS and tuberculosis as well as other chronic diseases such as diabetes mellitus. A striking discovery was the high incidence of mental illness amongst the admissions. The majority of them were discharged home. The crude death rate was 190 per 1000 admissions and the main cause of death was HIV related conditions. The average direct expenditure per month was R 1,040,579. The expenditure for salaries was the main expenditure (54%) followed by Allied health services (29%). The average expenditure per patient was R 7,039 (R 7,548 for female patients and R 6454 for male patients). v Conclusion: This was the first study on admission trends resource utilisation in this Hospital and in the Limpopo Province. The evidence from this study would hopefully steer the re-organisation of some of the Hospital services, more especially the establishment of a step-down ward facility within the Hospital. This study has recognised that the increased number of admissions in rural district hospitals often result from double burden of infectious and chronic diseases. More studies on the subject are needed to identify their impact on resource utilisation at these hospitals.

Thesis (M.H.S.A.)--University of Michigan, 1980.

Thesis (M.H.S.A.)--University of Michigan, 1980.

Research report submitted to the Faculty of Health Sciences, University of the Witswatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management / Background: Use of drugs in maternity unit plays a major role in maternal health service delivery. Therefore, drug use during pregnancy requires close monitoring which includes prescription of appropriate medication to their diagnosis, correct doses, and adequate period of time. Drugs are also one of the major cost drivers in health facilities. Although maternal health services are receiving increasing attention in South Africa, very few systematic studies have been done to analyze this important component (prescribing patterns and costs of drugs) of maternal health care services in a district hospital setting. Aims: The overall aim of the study is to assess the drugs utilized in a maternity ward at Pretoria West District Hospital (A district hospital in the Tshwane District in the Gauteng Province) and the factors that might influence its use and their cost over a period of one year. Methodology: Cross-section study design was used. Retrospective review of hospital records was undertaken for 2087 maternal patient deliveries during one year study period (01 January to December 2009) and no primary data was collected. Data was extracted for variables used in the study (quantity and cost of drug used, profile of patients). The study commenced after obtaining necessary approval from the Gauteng Department of Health and Social Development and University of the 2 Witwatersrand “Human Research Ethics Committee (Medical)’. Results: The study found that all the patients were prescribed iron supplements. The second most commonly prescribed drugs are uterotonics. Besides these two items other prescription drugs were prescribed to 7% of patients. Postnatal contraceptives were seldom used. The most commonly used antibiotic was Ceftriaxone. Bezylpenicillin was prescribed only for one RPR positive patient during one month. Only 13% HIV positive received antiretrovirals which is too low as compared to number of mothers delivered. The study found underprescription of anti-hypertensive drugs. Low use of parenteral analgesics signifies that probably patients were not given adequate pain relief during labour and this policy should be reviewed. The quantity of biological vaccines (BCG and oral polio) was prescribed routinely for all the newborn babies. However, the antiretrovirals (Zidovudine and Nevirapine syrups) were prescribed for fewer newborn babies (n= 51), in comparison to total number of babies born to a HIV positive mothers (n=266) and of concern. Total cost for the drugs used during one year study period was R 113,664.56. The average costs per mother and newborn babies were R 39.40 and R 15.08 respectively. Routine availability of affordable and effective drugs is one of the key indicators of quality health. The study showed that affordable and effective drugs were readily available in the Unit. Conclusion: This is probably the first study that documented the use of drugs in the maternity unit in a district hospital. Further prospective study would be able to provide more information in this important subject.

Health care reimbursement is changing, and hospitals are finding it difficult to receive payment due to insurers' denial of services already rendered to patients. A denial can be considered an underpayment by the insurer to the hospital. Using a Six Sigma approach, a large hospital system in the southeast United States found that individual hospitals were not focused strictly on denials, but other tasks as well. Hospital administrators conducted a literature review and found that centralizing denials management team has improved reimbursement outcomes elsewhere. Therefore, the hospital system implemented a centralized denials unit to focus on overturning insurer denials while the patient was still hospitalized. The purpose of the project was to develop an evaluation plan to determine whether the pilot centralized denials management unit could overturn an additional 5% or more of the concurrent denials compared with the current individual hospital-based denials management approach. The quantitative evaluation plan will guide review of data collected from one organization to determine payer trends on the types of denials received and reasons for the denials. Understanding the pattern of denials is expected to uncover opportunities for denials coordinators in the dedicated centralized management unit to challenge payers based on contract language or medical necessity. If the centralized denials management unit is shown to reduce denials, it will be considered for expansion corporate wide. The social change expected through a successful denials management unit program is that the hospitals in the system will recover payment for services rendered and will be able to continue to provide quality care in the communities they serve.

Thesis (Ph.D.)--University of Minnesota, 1998. / Includes bibliographical references (leaves 115-119). Also available on the World Wide Web as a PDF file.

Thesis (M.H.A.)--University of Michigan, 1967.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.A.)--University of Michigan, 1967.