Thesis advisor: Peter Gottschalk / Thesis advisor: Thomas McGuire / Thesis advisor: Donald Cox / Does managed care send expectant mothers to hospitals they would choose even if their choice of hospital was not limited? I find that Medicaid managed care patients are redirected to hospitals that enrollees of more generous insurance payers with the same personal characteristics do not go to. However, Medicare managed care enrollees do not face an increased risk of having a cesarean delivery at the hospital they attend, which is interpreted as evidence that they are redirected to high quality hospitals. / Thesis (PhD) — Boston College, 2003. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

acase@tulane.edu / 1 / Yongkang Zhang

Many of the assumptions underlying health care issues appear to be taken for granted by policy makers, when if fact they ought to be examined for their relevance to today's problems. This research attempts to do so, by analysing the non-economic issues and factors involved in the financing and provision of health care. It will be argued that policy makers commonly have a unidirectional economic perspective in both policy making and in health care system reform directives, a situation which leaves issues such as the health status of the population and of equity in resource allocation to political rhetoric, while in practice, policies deal with the issue of cost reduction. Of major importance is the moral dimension in policies dealing with health and welfare, which is clearly either forgotten or is afforded too little consideration in policy making. This is particularly relevant to the issue of rationing of health care in publicly provided health care systems. While always quietly practised by clinicians in the past, rationing is now required to be overt because demand for health care has outstripped available resources.The substance of the argument comes from the analysis of a very large literature on the broader issues affecting health care policy, such as concepts of social justice, ethics of resource allocation and the physician-patient relationship, all of winch ought to underpin policies for the mechanisms of funding and provision of health care systems.A conceptual diagram of a health care system is offered to provide a framework for the discussion of how the issues are interrelated at micro, meso and macro levels in policymaking. Examples of reforms to health care systems are taken from five OECD countries which share a common social, political and economic heritage: Australia, United Kingdom, New Zealand, Canada and the United States of America.The conclusions ++ / from this research show that theoretical incoherence pervades this most complex of policy areas, allowing the economic imperative to take precedence over the substantive health care issues.

Abstract not available

Objective: To describe the levels of ANC adequacy and factors related in 3 provinces of Vietnam: Long an, Ben tre and Quang ngai. Method: Data from three rural provinces of Vietnam collected by the Vietnam Australia Primary Health Care Project were analysed using descriptive and analytical statistical techniques including multivariate regression, multipart analysis and hierarchical techniques. A sample of 1335 eligible women was available for analysis. The Andersen Health Behaviour Model was utilised in analyses of ANC utilisation. The Donabedian Quality of Health Model was used in analyses of ANC content and overall adequacy. Results: ANC was inadequate with only 71% of women having some ANC, 51% having initial visits within the first four months, 41% having three or more visits, 35% having three or more visits with the initial visits within the first four months, 17% of women reported three quarter or more of recommended ANC procedures/advice, 12% of women had enough ANC utilisation and fair ANC content. Factors that existed prior to contact with health care providers such as external environment, predisposing and need were related to whether the women seek any ANC and to pregnancy duration at first visits. However, factors that resulted from initial contact with health care providers, such as satisfaction of women with ANC services and health care provider related characteristics, were important in the models examining total number of ANC visits, overall ANC utilisation, content of ANC reported and overall ANC adequacy. Province of residence related to all aspects of ANC adequacy. Different aspects of ANC adequacy were related to each other. Conclusion: ANC adequacy levels in Vietnam were low. To increase the proportions of women who use ANC services and attend ANC early, promotion of ANC should be targeted at women at risk. However, to improve continuation with ANC, ANC content, and overall ANC adequacy, the quality of services provided needs to be improved. To reduce the gap between provinces, priority should be given to less developed provinces. / PhD Doctorate

Doctor of Philosophy(PhD) / This thesis consists of a series of studies of new models of multidisciplinary community health care in four compartments. These compartments are acute, subacute, outpatient and maintenance care. The purpose of the individual studies is to demonstrate the benifits of munltidisciplinary community health care in delivering alternatives to current practice by replacing hospital care or improving traditional community care.

Child care stability affects child and family outcomes. Stability reflects the time dimension of a child care arrangement. Although stability does not guarantee positive outcomes, instability appears to decrease the likelihood of achieving them. Some level of stability is a necessary, although not sufficient, characteristic of care that meets children's needs. Child care stability is of special concern for children in low income families because child care impacts are greatest for these children, and current welfare policies result in more low-income children in nonparental care. This study increases understanding of child care stability through (a) an analysis of findings from stability studies over 30 years, (b) an examination of relationships of the four major stability measures, and (c) presentation of results from an analysis of the stability of subsidized child care arrangements in Oregon. The analysis of stability studies documented lack of consistency in conceptualization, measures, and methodology. These inconsistencies limit comparisons of reported stability findings and confidence in estimates of child care stability that have been reported. Examination of the four stability measures found that the three child-level measures appear to describe the same construct as they are highly correlated. The fourth stability measure is at the level of the arrangement and captures a distinctly different aspect of stability. Stability levels of subsidized arrangements in Oregon appear lower than those found in nationally representative samples but similar to levels found in populations participating in public assistance programs. About a third of children had very stable care but others had high levels of instability. Fifty percent of arrangement spells ended by 3 months, even when children were observed for 36 months. The study concludes with recommendations for future research. / Graduation date: 2005

This study aims to identify conceptions of the body, as well as "rational" treatment among primary care practitioners (PCPs) and emergency medicine practitioners (EMPs) dealing with managed care plans. I conducted ethnographic study throughout 1996, and interviewed six PCPs and four EMPs. In the course of my interviews, I discovered that EMPs' and PCPs' perceived meaning and power in regards to treatment of their patients has been increasingly resituated by the power of scientific discourse as utilized by technocrats (such as consumer, provider, and insurance organizations who formulate managed care plans). Technocrats have developed scientific measurements to monitor physicians' performances, quantifiably or scientifically. Technocrats conceptualize ideal treatment as a cost effective care. They guide PCPs to supervise ideal treatment of the managed care delivery networks, providing care without referring patients to specialists and administrating to hospitals. Consequently, PCPs' power to pursue the newly conceptualized ideal treatment influences other arenas of specialty, such as EMPs. On the other hand, EMPs develop preferred treatment which is formulated through their medical school education and clinical experiences. The preferred treatment is associated with time because EMPs have to treat acute conditions of their patients within a limited amount of time. However, EMPs sometimes cannot complete their preferred treatment because they have to send their patient back to the patients' contracted PCPs in order to save health care expenditure. Technocrats implemented the engineering concept of quality control, and the concept is incorporated into the principle of managed care plans, and preventive medicine. As a result, the managed care plan networks become like production lines of large manufacturing factories, and PCPs work as laborers to maintain the bodies of enrollees in healthy conditions. / Graduation date: 1998

Thesis (Ph. D.)--University of Chicago, Dept. of Psychology, June 1997. / Includes bibliographical references. Also available on the Internet.