This research investigated physician and emergency room use among representative samples of children in the Dallas metropolitan area (N = 1606) and among patients who used Children's Medical Center of Dallas' First Care services (N = 612). Through telephone interviewing, caregivers to children under fifteen years of age were asked about an array of health service use behaviors, social-psychological issues related to acquiring health care for their children, and demographic characteristics as outlined by the Andersen & Newman model of health care service use. Children's use of physician services is best predicted by whether or not they have medical insurance, their level of income, and whether or not they have medical homes. Although having commercial managed care and fee-for-service Medicaid insurance consistently predicted increased physician use, neither independently reduced reliance on emergency rooms for non-emergent care. Managed care insurance and Medicaid did, however, significantly improve the odds that children would have medical homes, which significantly decreased emergency room use for non-emergent care. Further, increasing physician use and reducing reliance on hospital emergency rooms for non-emergent care will require ensuring that children have medical homeseither private physicians or community health centersat which they can readily and consistently receive sick and well care. Although some ethnic differences were observed, few of the broad array of factors in the Behavioral Model significantly predicted either physician or emergency room use. Moreover, educational levels and health beliefs rarely, and if significant negligibly, influenced physician and emergency room use. Health policy for children would best be served by focusing on programs that facilitate parent's ability to secure health insurance for their children and allocating children to medical homes where they can readily and consistently access sick and well care.

Cette thèse traite des inégalités sociales en matière de comportements de santé tels que les modes de vie liés à la santé (spécifiquement, l’obésité et la consommation d’alcool) et l’utilisation des services de santé, dans plusieurs pays de l’OCDE. Ce travail repose sur une approche micro-Économétrique et utilise un grand nombre de bases de données nationales. Les objectifs de cette thèse sont de: (1) comparer les inégalités sociales de comportements de santé entre des pays ayant des caractéristiques différentes, (2) apporter un éclairage à la compréhension des disparités sociales des comportements de santé, et enfin (3) examiner comment l’auto-Déclaration peut affecter l’évaluation des comportements de santé, et donc affecter la mesure des inégalités. / This thesis deals with social inequalities in health-Related behaviours such as lifestyle risk factors for health (precisely, obesity and alcohol consumption) and the utilisation of health care services, in a number of OECD countries. This work relies on an applied micro-Economics approach, using several national health survey data. This thesis aims to (a) compare social inequalities in health-Related behaviours across countries with different settings; (b) shed light on the understanding of social disparities in health-Related behaviours; and (c) examine how self-Reporting may affect the rating of behavioural risk-Factors, and therefore affect the measurement of social inequalities.

Children are often referred to as the 'hidden' generation, a powerless group who in infancy and childhood depend on their parents and families/whanau to ensure they receive everything in life required to enable them to grow into healthy young people and adults. Some are more disadvantaged than others due to the socioeconomic circumstances they grow up in. This can have lasting effects on their health in childhood with associated impacts later in life. In New Zealand the populations of children most disadvantaged are those from Maori, Pacific and other low income families/whanau. The disparities that exist between children from these populations and other groups whilst lessening, is still significant. The purpose of this study was to explore with Maori, Pacific and low income parents and caregivers why they choose to 'seek' health services for their children, or not as the case may be. Patterns of use are established early in life therefore it is important to understand children's health care use. The literature suggests that children's access to health care is influenced by predisposing factors such as their socioeconomic status, ethnicity, the availability of services, choice of providers, availability of school–based health services, outreach services, relationships between the community and health service providers and having a regular source of primary health care. A qualitative exploratory design was the methodology chosen for this research. A modified 'community as partner' model (Anderson, 2008) formed the conceptual framework for the research. Sixteen Maori, Pacific and Pakeha parents and caregivers participated in three focus groups to discuss their perceptions of children's access to health care. Thematic analysis was used to identify codes, categories, themes and sub themes from the data. The New Zealand Child Health Strategy (Ministry of Health, 1998) was used as a model to inform the discussion. The main themes were: reality of life, visibility, knowing you, knowing me and kids come first. The findings suggest that relationships with primary health care providers, the cost of health care for children over five years, awareness of services and a need to prioritise children's needs, enable or prevent children's access to health care. Decisions made regarding further service provision for children will be enhanced by health providers and practitioners having a clearer understanding of the enablers and barriers to access and the factors that influence parental choice of services.

Cette thèse étudie les politiques d’aide aux personnes âgées dépendantes à domicile menées au Japon, afin d’en tirer des enseignements pour la France. Nous développons notre étude à travers trois axes : i) l’analyse des différences entre le systèmes japonais et français dans l’organisation de l’aide publique et dans l’aide réellement perçue par les personnes en perte d’autonomie, ii) l’examen des barrières potentielles à l’accès aux aides publiques au Japon, iii) l’étude des conséquences de l’aide informelle sur l’emploi des femmes seniors au Japon. Dans cette perspective, nous avons effectué deux études qualitatives comparant les politiques japonaises et françaises, puis deux études micro-économétriques des comportements individuels et familiaux de prise en charge dans le contexte japonais. Ce travail met ainsi en exergue les spécificités des politiques menées dans les deux pays, et souligne les avantages et les faiblesses du modèle japonais. / This thesis focuses on the long term home care policies conducted in Japan, in order to draw lessons for France. Our analysis is developped through three topics : i) the analysis of the differences between the Japanese and the French systems in the public care organisation and in the care received by the elderly, ii) the examination of potential barriers to access to public elderly care in Japan; iii) the study of the impact of informal care on the labor participation of Japanese middle-aged women. In this regard, we carried two qualitatives studies comparing Japanese and French policies, and two microeconometrics studies of individual and family behaviour of caring in Japan. This study outlines the specificities of the policies conducted in both countries, and highlights the strenghts and weakness of the Japanese model.

This Ph.D. thesis discusses the evolution and current situation regarding availability of healthcare for third countries migrants in the Czech Republic. In terms of methodology, the author has chosen a qualitative approach. The research design is a historical case study. The thesis uses a combination of "desk research" and empirical survey based on 56 in-depth interviews with migrants, healthcare providers and experts who come into contact with migrants during the course of their work. Based on the approach of historical institutionalism, the author is explaining policy of migrants' health insurance evolution in Czech Republic since 1993 till today. The author identifies the key events and the roles of particular actors within the observed "sub- system" of public policy. From the viewpoint of migrants and healthcare providers, the thesis also presents how the current institutionalised set-up of migrants' health policy transfers into the real access to healthcare for migrants. It also identifies the main barriers to health care accessibility and the consequences of possible health care unavailability. Key words: migrants, health care availability, health insurance, historical institutionalism, barriers to health care access

Bakgrund: Covid-19-pandemin har påverkat hela samhället och inskränkningar har varit tvunget att göras för alla medborgare. Restriktioner kring sociala kontakter har förändrat livssituationen för individer med särskilda behov av assistans och vårdinsatser, som exempelvis för barn som har funktionshinder och deras familjer. Syfte: Syftet med studien är att undersöka hur föräldrar till barn med funktionsnedsättning har upplevt sin livssituation och de gällande restriktionerna under den pågående Covid-19-pandemin, i relation till olika samhällsorgan såsom habilitering, sjukvård och skola. Metod: Studien är en kvalitativ intervjustudie som bygger på data från sju föräldrar. Materialet har analyserats med tematisk analys. Resultat: Viktiga aspekter som framkommer ur denna studie är faktorer som minskad eller inställd assistans/avlastning och vård samt att föräldrarna ofta behövt ha barnen hemma från skola och förskola, vilket upplevts som påfrestande. Föräldrarna har upplevt sjukhus och korttidsboenden säkrare att besöka eftersom de anser att de har anpassat sig bra efter restriktionerna, skolmiljön har inte känts lika säker då skolan inte upplevs förebygga smittorisk lika bra. Digitala lösningar har ersatt många fysiska träffar, vilket föräldrarna överlag upplevt fungera bra samt önskar mer av i fortsättningen. Slutsats: Föräldrar till barn med funktionsnedsättning har levt med hög press under Covid-19-pandemin, de har tappat en stor del av de avlastande verksamheterna vilken ger dem utrymme till bland annat ett eget arbetsliv och återhämtning i vardagen. Digitaliserade möten och undervisning har varit av stor vikt under perioden. / Background: The whole community has been affected by the COVID-19-pandemic. The limitation of physical interactions has changed the conditions for assistance services and healthcare. It has especially affected those with special needs, like children with disabilities and their parents.  Aim: The aim of the study was to examine parents of children with disabilities and how they experienced their life-situation during the COVID-19-pandemic. The interaction with different community authorities like habilitation services, healthcare and schools was the main target. Methods: The study was a qualitative study with inductive approach. Seven parents were included. Thematic analysis was used to analyse the material.   Results: Parents reported that habilitation services and health care appointments have been decreased or cancelled during the pandemic. In addition, they report that schools often have called them with short notice to fetch their sick kids, which has been stressful for the parents. The parents felt safe at the short-term accommodations and at the healthcare facilities due to their adjustments against the restrictions. The parents felt the school situation as less safe since school staff were less strict with adjustments against the virus. However, several physical meetings were replaced with digital solutions, which worked well and was much appreciated by the parents. Conclusion: Parents of children with disabilities seemed to have a tough time during the COVID-19-pandemic. Their situation at work and time spent on recreation was negatively affected as they spent more time on childcare. Digital teaching and online meetings have been very important during the pandemic.

Practice managers are facing challenging expectations when deploying a managed-care paradigm. The problem addressed in this study was a gap in knowledge regarding practice managers' decision-making strategies that affect, or could be perceived to affect, a climate of excellence with business and client relationships, primary health care, physicians, and patients in a managed-care paradigm. The purpose of the qualitative exploratory study was to explore practice managers' decision-making strategies affecting primary health care, physicians, and patients. Guided by Simon's ideology of decision-making strategies in a management environment, the overarching research question and 3 subquestions centered on how practice managers delineate their decision-making strategies and how those strategies affect primary health care, physicians, and patients. To close the gap in knowledge, the study included (a) a homogeneous purposive sampling of 14 practice managers (n = 2, pilot study; n = 12, main study) as research participants; (b) face-to-face interviews with semistructured, open-ended questions to collect data; and (c) in vivo and pattern coding during data analysis. The study results indicated a need for change agents, interactions, partnerships, and accountability in a managed-care paradigm. Managing health care is complex and practice managers will continue to be challenged. Alliances between practice managers and stakeholders are recommended to meet those challenging expectations. As a result, positive social changes may be observed in improved access to primary health care, better health care treatments, and collaborative interactions in a managed-care paradigm.

Medical tourism is a relatively recent global economic and political phenomenon which has assumed increasing importance for developing countries, particularly in Asia. It has been slower to develop within the context of the tourism industry in English-speaking Caribbean countries but there is evidence that the tourism policy makers in the region perceive medical tourism as a potentially lucrative niche market. However, while the potential of medical tourism has seemingly been embraced by the region's political directorate, there has been limited discussion of the extent to which this market niche can realistically provide competitive advantage for the region. The argument of this conceptual paper is that the English-speaking Caribbean cannot hope to compete successfully in the global medical tourism market with many developing world destinations in Asia, or even with other Caribbean countries such as Cuba, on factors such as low cost, staff expertise, medical technological capability, investment in healthcare facilities or even in terms of the natural resources of sun, sea and sand. Rather, in order to achieve competitive advantage the countries of the region should, on the one hand, identify and develop their unique resources and competences as they relate to medical tourism, while, on the other hand, they should exploit the demand of the postmodern tourist for authentic experiences. Both these supply and demand side issues, it is argued, can be addressed through the development of a medical tourism product that utilises the region's indigenous herbal remedies. [PUBLICATION ABSTRACT]; Medical tourism is a relatively recent global economic and political phenomenon which has assumed increasing importance for developing countries, particularly in Asia. It has been slower to develop within the context of the tourism industry in English-speaking Caribbean countries but there is evidence that the tourism policy makers in the region perceive medical tourism as a potentially lucrative niche market. However, while the potential of medical tourism has seemingly been embraced by the region's political directorate, there has been limited discussion of the extent to which this market niche can realistically provide competitive advantage for the region. The argument of this conceptual paper is that the English-speaking Caribbean cannot hope to compete successfully in the global medical tourism market with many developing world destinations in Asia, or even with other Caribbean countries such as Cuba, on factors such as low cost, staff expertise, medical technological capability, investment in healthcare facilities or even in terms of the natural resources of sun, sea and sand. Rather, in order to achieve competitive advantage the countries of the region should, on the one hand, identify and develop their unique resources and competences as they relate to medical tourism, while, on the other hand, they should exploit the demand of the postmodern tourist for authentic experiences. Both these supply and demand side issues, it is argued, can be addressed through the development of a medical tourism product that utilises the region's indigenous herbal remedies. Reprinted by permission of Carfax Publishing, Taylor & Francis Ltd.

This study aimed to understand subjective cognitive decline (SCD) and functional difficulties in older age cohorts with depressive symptoms, using one scoping review and two empirical studies. We implemented the six steps of Arksey and O'Malley's procedure for the scoping review. We used the population, concept, and context (PCC) inclusion and exclusion criteria in the literature search across MEDLINE via Ebscohost, PubMed, and PsycINFO for articles published on ADL/IADL indicators of SCD in older adults with depressive symptoms and that published in English language journals from January 2011 to November 2021. The two empirical studies used the 2019 wave of the Behavioral Risk Factor Surveillance Survey dataset of older adults aged 65 and ≥ 80 from the Centers for Disease Control and Prevention. We used multiple regression and the bias-corrected percentile bootstrap with 5000 samples using standard path-analytic approaches for the moderated mediation for the two empirical studies. Findings supported that instrumental activities of daily living (IADLs) presented more difficulties for older adults with SCD than the basic activities of daily living (B-ADLs), given that IADLs require more cognitive capabilities than B-ADLs. Environmental factors like healthcare access and subjective functional difficulties predicted SCD by mentally unhealthy day (MUD) mediation and age cohort moderation. The middle age cohort (70–74) had the most pronounced effects of the MUDs mediation in the relationship between healthcare access and IADLs in older adults with SCD. The younger-old (65–69) showed more substantial MUD mediation effects in the relationship between subjective functional difficulties and SCD. Worse SCD was associated with being Asians, female older adults, and at lower education years and income levels. Findings profiled SCD indicators in daily living activities across age cohorts and the mentally unhealthy days presentation. We extend the chronic stress theory predictions on accentuated emotional vulnerability from increased functional difficulties, compounding SCD.

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