AFRIKAANS : Die doel van die navorsing was om vas te stel watter metodes Marlene van Niekerk in haar roman Agaat gebruik om die karakters en hulle omstandighede deur middel van verwysings na musiek te teken. Die verhandeling begin met ’n oorsig oor die interdissiplinêre studiegebied van verwysing na musiek in die letterkunde. Op hierdie terrein het onder andere Fuller, Losseff, Scher en Weliver belangrike rolle gespeel. Die wyse waarop uitsprake van onder andere Bakhtin, Barthes, Blanchot, Eco, Kristeva en Van Wyk Louw op die gebied van verwysing, en dus op Van Niekerk se Agaat, van toepassing gemaak kan word, is ondersoek. Deur ’n onderhoud met Van Niekerk is daar meer oor haar houding oor musiek en verwysings daarna in Agaat uitgevind. Sy voel sterk dat die gebeure en musiekverwysings in Agaat nie op haar as persoon van toepassing gemaak moet word nie. Tog is daar baie van die musiek waarna verwys word wat vir haar ook baie betekenisvol is. Sy luister baie na musiek en gebruik dit as ’n stimuleringsmiddel, maar ook om haar in toom te hou sodat sy nie te “maklik” skryf nie. Van Niekerk beskik oor ’n goeie kennis van musiek en van die repertorium en kan dus ’n wye verskeidenheid verwysings maak na musiekterminologie, musiekinstrumente, musiekmaak, Suid-Afrikaanse kultuur waarin musiek ’n deurslaggewende rol speel, FAK- en Afrikaanse volksliedere, psalms, gesange en hallelujaliedere, ander ligte liedere, en komposisies uit die repertorium van klassieke musiek. Daar word in Agaat ook verskuilde, vertaalde aanhalings van versreëls uit getoonsette gedigte uit die Duitse kunsliedrepertorium ingesluit. In laasgenoemde geval (gedigte getoonset deur Brahms, Mahler, Schubert en Schumann) word die woordteks op ’n komplekse manier geïntegreer. Van Niekerk sluit die woordteks van godsdienstige en volksliedere byna uitsluitlik in om ironiese kommentaar op gebeure te lewer. Dit is selde dat hierdie tekste in hulle gebruiklike omgewing aangewend word. Die intertekstuele integrasie van musiekverwysings in Agaat kan as ’n baie groot prestasie beskou word. ENGLISH : The aim of the research was to establish the methods used by Marlene van Niekerk in her novel Agaat (the Afrikaans version) to paint the characters and their circumstances by means of references to music. The dissertation starts with an overview of the interdisciplinary field of music references in literature. In this area Fuller, Losseff, Scher and Weliver (amongst others) have played a major role. The ways in which pronouncements by (amongst others) Bakhtin, Barthes, Blanchot, Eco, Kristeva and Van Wyk Louw can be applied to the field of references, and therefore to Van Niekerk’s Agaat, were investigated. In an interview with Van Niekerk, her views on music and references to music were clarified. She feels strongly that the events and references to music in Agaat should not be equated to her own life. Nevertheless, much of the music referred to is also significant to Van Niekerk. She listens to music much, using it as a stimulus, but also to keep her in check so that she does not fall into “easy” writing. Van Niekerk possesses a sound knowledge of music and of the repertoire. She can therefore make a variety of references to music terminology, music instruments, music making, South African culture in which music plays a decisive role, Afrikaans folk songs and songs from the FAK song album, psalms and hymns, popular songs, and compositions from the repertoire of classical music. Concealed, translated quotations of lines from German poems set to music as art songs are also included in Agaat. In these cases (poems set to music by Brahms, Mahler, Schubert and Schumann) the word text is incorporated in a complex manner. Van Niekerk includes the word texts of religious and folk songs nearly exclusively in order to comment on events in an ironic way. These texts are seldom presented in their proper circumstances. The intertextual integration of music references in Agaat can be regarded as a great achievement. Copyright / Dissertation (MA)--University of Pretoria, 2009. / Afrikaans / unrestricted

The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.