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In being philosophically based this thesis is concerned with understanding the human condition with particular reference to matters of meaning and how these find expression in systems of government and social policy. This study is based on the premise that concepts determine how the world is viewed and people use a variety of conceptual schemes to answer different classes of questions. Scientific endeavour is based in a scheme that enables questions about the material world to be answered. It cannot however answer classes of questions related to many features of human lives as its methods necessitate the development and use of abstractions and generalisations that are ill-equipped by design to determine what is important to people and what motivates and satisfies them. Therefore, the reality of any particular individual or group cannot be adequately understood in scientific terms. The thesis examines the scientific conceptual framework and minimalist abstractions of the medical model and the quasi-scientific conceptual frameworks of economics and identifies their conceptual limits. It shows that if the medical model is assumed to provide a complete representation of realities in health and is uncritically used as the basis of medical practice it has the potential to overlook the patient as a person and distance medical practice from its social roots which can lead to adverse outcomes for both clinical practice and medicine itself. It also observes that the economic scheme has conceptual limits that create their own distorted representations of reality. A similar dislocation in the meaning of people�s lives occurs when abstractions are made by adopting concepts from other schemes based in science, such as the medical model, without any awareness of their conceptual limits. Further distortions occur when these other accounts are turned into economic ones. Not only is the patient as a person overlooked, so is the patient as an entity. In light of these observations the thesis examines health reforms that have taken place in New Zealand, whereby the economic scheme has been given dominance in the development of public policy and set the parameters for rationality and what can acceptably be said. It shows that in not recognising features of meaning these parameters have led to health sector reforms that have had unintended and adverse consequences for clinical practice, as shown in the particular case of reforms of maternity services. Furthermore these reforms have severed the health sector from its social roots and moral frameworks and created barriers between it and government so that health sector problems that cannot be understood using economic parameters cannot be addressed in forums where public policy is developed.

The objective of this thesis is to examine the nature of health care system change in the Czech Republic and Hungary after the collapse of communism. In order to do so, the thesis focuses mainly on Europeanization and New Institutionalism as competing approaches in explaining domestic changes in Central and Eastern European Countries. While doing so, first this study tries to explore whether Europeanization is one of the main determinants in the transition process of the health care systems of the Czech Republic and Hungary and discusses the EU-level policies, laws and regulations related to the health care sector. Second, the study looks through the historical legacy and path dependency theories as branches of the New Institutionalist approaches to investigate the transition of the health care systems of case countries. The review of the related literature and empirical case studies exhibit that the transformation process of the health care systems of the Czech Republic and Hungary were possibly affected by many factors and it would be misleading to attribute all consequences to only one determinant. In this respect, the main argument is that the Europeanization effect is weak compared to the New Institutionalism approach in explaining the transition process of health care systems of Hungary and the Czech Republic / however, there are strong opportunities for EU institutions to shape the future contours v of health care systems and public health programs in Hungary and the Czech Republic.

This paper considers the adoption of Health Information Technology (HIT) by physician clinics with ten or fewer physicians. The paper considers the theoretical economics literature on technology adoption for a new technology and has a place in the empirical tests of these models. The two major hypotheses tested in the paper are that the probability of adopting HIT increases with the number of physicians working at the clinic and if the clinic is part of a chain of clinics, and that it also increases with increased competition at the market level measured by the number of clinics per 10,000 residents in a county. To test these hypotheses, the paper first estimates a baseline logit model followed by three hazard rate models. In each case, clinic size is found to have positive though not significant effect on the probability of adoption (in the logit model) or to decrease the predicted time to adoption for the clinic (in the hazard rate models), being in a chain of clinics is found to have a strong positive and significant on the probability of adoption, and increased competition is found to have a positive though not significant effect on the probability of adoption.

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University of Macau / Faculty of Social Sciences / Department of Economics

The Austrian mental health care system has been characterized by reform initiatives since the 1970s. The reform strategies can be summarized under the term 'community mental health care'. The thesis focuses on an analysis of the reform (context) and the related challenges for mental health care financing with respect to its interdependencies with service provision in the process of change. In a qualitative research process, firstly, reform documents and transcripts of qualitative interviews have been analyzed via a discourse-analytical approach. Secondly, secondary data on mental health care financing in Austria and in western European countries have been collected. An analytical framework was, finally, applied to analyze the interrelations between mental health care financing and reform discourse with respect to its impact on the micro-level and on the macro-level of the mental health care system. The results show that the reform discourse reflects broader welfare state transformation processes. Yet, financing issues have hardly been addressed in reform discussions. Nevertheless, discursive elements are either explicitly or implicitly associated with financing issues or are even linked to specific financing models. A central impact from the restructuring processes on the micro-level is an increasing (financial) responsibility for people who are affected by a mental disorder and/or their relatives. On the macro-level, the processes of change are related to decreasing (financial) responsibility for the sector 'state' while responsibility for the sectors 'family' and 'voluntary/community' is rising. The international development shows similar characteristics. The thesis finishes with some recommendations for developing an alternative financing model and provides a guideline for a comprehensive discussion of alternative mental health care financing approaches. (author´s abstract)

Whereas the traditional rhetorical practices of memory and delivery were directly connected to the body of the speaker, I argue that when communication is embodied on digital networks, the processes underlying memory and delivery—the coordination of individual and text and the use of embodied affordances to present a text, respectively— are expressed in different ways. Resonance, or the act of bringing two structures into coordination with each other, and switching, or the act of making connections between two networks, fulfill the role of memory in digital networks, coordinating the actions of different networks. Similarly, the protocol, or the technical and cultural rules of networks, and the program, or the emergent behavior, of a network must be taken into account by writers who wish to achieve rhetorical ends. Using three case studies of network formation on the microblogging service Twitter, I show how the acts of resonance and switching, along with the protocol and program of these networks, influence network formation, the types of communication generated by networks, and how those networks are received by outsiders. / text

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The eighteenth century was a period ripe with challenges for hospitals in France. Denounced as ineffective, inefficient and even inhumane institutions, hospitals found themselves at the centre of a growing debate over the administration of health care and welfare. Although dismissing the hospital's traditional role as a refuge for the poor, the indigent and the sick, many reformers believed that this institution still could play a valuable social role. Thus, while contemporaries lashed out against the large, "abuse-ridden," hopitaux generaux and hotels-Dieu , small hospitals were seen in a more favourable light. For the growing number of contemporaries who argued that hospitalisation should be reserved exclusively for the sick, hospitals containing a small number of beds were promoted as better disposed and better equipped to meeting the health-care needs of the community. At the same time, contemporaries began calling for the decentralization of health care and welfare services. Instead of focusing these services in large regional poor-relief institutions, reformers argued that the poor and the sick would be better served by receiving assistance in their own community, either in small parish hospitals, or within their own home (secours a domicile). / This dissertation examines how hospitals and hospital services in the late eighteenth-century generalite of Rouen responded to this growing hospital reform movement. It shows that many of the policies adopted by the region's hospital administrators reflected the contents of the larger "national" debate on health care and welfare reform. More importantly, the military was behind many of the changes affecting hospital services in this region During the eighteenth century, military hospitals became a model to emulate towards making the "reformed" hospital a reality. However, imposing military-style health standards on the region's civilian hospitals proved to be a complicated process, one that often involved a great deal of negotiation and compromise.