This thesis describes and analyses the development of the health care system in Saudi Arabia, particularly in the period since 1970. Two major differences between Saudi Arabia and most other countries have to be isolated. First, as a result of its oil wealth, Saudi Arabia has experienced extremely rapid economic growth over the last twenty years. Second, a very strong value system, Islam, has a persuasive effect upon Saudi society, including the organization of its health care system. The Basic Needs approach, which is favoured here, defines 'economic development' a the satisfaction of certain basic material human needs. Health care is important because it is one such basic need. The principal characteristics of health and health care in poor countries are examined. Patterns of mortality and morbidity are discussed as are the different health systems, and financial and health care planning arrangements, which are to be found. Trends in mortality, morbidity and life expectancy in Saudi Arabia are then discussed, bringing together data not previously assembled. The framework of the Saudi health sector is described. For the first time, the roles of health service providers, other than the Ministry of Health itself, are comprehensively documented. Regression contributions of rising living standards and the development of the health services to improvements in health status. Although some positive results are obtained, inadequate data prevent firm conclusions from being drawn. This crucial issue is therefore pursued on a more analytical level, employing comparative evidence on the experience of other countries. The final judgement is that economic growth, rather than the expansion of the health services, is the principal explanation of better standards of health in Saudi Arabia.

Bibliography: pages 150-158. / Health care systems all over the world are in crisis. The presenting symptom is a cost spiral that is out of control. Money supply is finite, and if this problem continues the system will eventually collapse. There are a number of causes associated with the problem that are usually analysed by reduction, an approach based upon an assumption of simple linear causal relations. This study shows the problem to be the dialectic opposite, in other words these problems are all interrelated through complex causal interactions. Therefore, the health care system is a complex social system and solutions to its problems may be found in terms of the interactions in such a system. An investigation into the history of the health care system shows that the system started with a simple one on one interaction between patients and physicians. At the time of its initiation, very little empirical knowledge was available about illness. After the renaissance, this changed dramatically with a subsequent increase in the ability to diagnose, but also in the complexity to treat illness. However, modern beliefs about illness and illness processes do not reflect the complexity of this knowledge. Beliefs about both illness and knowledge contribute to the process of diagnosis (medical decision making, or problem solving). Furthermore, the expectations, wants, and needs of patients and physicians, as well as the decision environment, increases the complexity and difficulty of this decision making process. These decisions initiate treatment processes that are ultimately represented in the health care system as cost. Therefore, the patient-physician system as the simplest initial interaction is an event that ultimately affects cost. This system is not functioning efficiently at present and a system of inquiry that can improve it may make a contribution to an improved system, and therefore a saving in cost. Altering the diagnostic system from a linear into a circular process, in other words into a learning system, improves both decision making and the use of knowledge. However, an inquiring system is needed in addition that can enhance the rigour of this process. Charles West Churchman devoted a large part of his work to knowledge and the way we acquire knowledge, in other words inquiring systems. His belief is that problem solving ought to be approached in a comprehensive way in order to minimise the risk for making incorrect decisions. Furthermore, because decisions are made upon incomplete information, the solutions will be the cause of new problems. Therefore, problem solving is a never ending cycle of learning. In order to have as complete information as possible about the problem, we have to: know the history of the problem, take a broad view that includes the environment of the problem (use a systems approach), and consider all the alternative solutions to the problem. Virtually all of our knowledge is based upon underlying assumptions. In order to test the validity of the knowledge we use for inquiry and decision making, it is important to test the assumptions upon which the knowledge is based. This is valid in regard to empirical knowledge as well. Finally, according to Churchman, decision making has to be ethical. Therefore, we have to do all we can to ensure that the implementation of the decision will improve the situation, not only now, but also in the future. The application of Churchman's approach to the patient-physician interaction, assists in the synthesis of a more comprehensive world view of health care and illness. This study shows that this leads to important changes in the negative interactions identified as contributing to the health care crisis. In terms of Churchman's approach, the role of physicians can be seen as managers of illness. Their purpose is therefore to plan for the improvement of illness (the problem) in an ethical way. Such planning should include the values of patients in deciding upon appropriate treatment. It is the submission of this study that only a methodology that is able to address complex human systems, such as a systems approach, and a comprehensive philosophy of inquiry, such as that of C West Churchman is appropriate to address the current problems of the health care system.

Scientific developments in genetics receive great public and political attention. However, genetic tests as medical innovations need to travel from the laboratory to the individual patient in order to fulfil the goal that makes the science so attractive. A medical innovation has to pass through the institutions of diverse health care systems. This thesis compares how the structures of two very different health care systems in Europe (Germany and the UK) foster or hinder the diffusion of genetic technologies. It presents a detailed analysis of the institutional pathways involved in order to discuss whether and in which way the kind of medical innovation that genetic testing represents is accommodated. The case study used for analysing the passage of a genetic test in both countries is diagnostic testing for Maturity Onset Diabetes of the Young (MODY). This example has the idiosyncratic dimension that it had strong support by scientists and government when the UK Government prioritized genetics in health policy. However, MODY testing was chosen for this study because MODY is a ‘simple’ monogenetic test, and it is one of the few at present that are both reliable and lead to altered treatment with a better quality of life for the patient. MODY represents, according to the current state of genomic knowledge, a prime example of what genetics is likely to deliver at best over the coming decades. In brief, the comparison of the pathways MODY travelled and the degree to which it reached patients successfully shows that both systems are not optimally set up to exploit what MODY genetic testing has to offer, but that the vertical structure and centralization in the UK system fit the needs of genetic medical innovations better than the horizontal, diversified and market oriented structures dominating the German health care system.

<p>The present development of the demography of elderly people in the western world will generate a shortage of caregiver’s for elderly people in the near future. There are major risk that the lack of qualified caregivers will result in deterioration in the quality of elderly care. One possible </p><p>solution is the use of modern information and communication technology (ICT) to enable staff to work more efficiently. However, if ICT system is introduced into the elderly care it must done in a way which is acceptable from a humane perspective while at the same time increasing the efficiency of the personal that working in elderly care centers. This thesis investigates the </p><p>technical feasibility of using a wireless mesh network for a social alarm system, in the elderly care. The System as such is not intended to replace the staff at an elderly care center but instead is intended to reduce staff workloads while providing more time for elderly care.</p>

Little research has examined the role traditional health care systems play today among Native populations. The present research examined the role these systems play among the urban Native population of Saskatoon, Saskatchewan. The research was conducted at the Westside Community Clinic, located in the downtown core area of Saskatoon. This area of the city has previously been identified as having a high concentration of Native people. The present study represented one component of a much larger project which examined both Native and non-Native utlization patterns of the Western health care system at the Westside clinic. An interview schedule was used to gather data, with a total of 103 Native and 50 non-Native interviews being conducted. Since no sampling frame exists for the Native population of Saskatoon, an availability sampling technique was used. "Native" was defined in this study as status Indian, non-status Indian and Metis.<p> It was discovered that traditional health care systems play an important role in the health care of this population, with the use of these systems being quite extensive. It was determined that the variable of language was a somewhat useful predictor of the utilization of traditional health care systems, although language retention (the ability to speak a Native language) was found to be more important than the frequency with which a Native language was spoken. It was also discovered that use of traditional health care systems was not found only among older respondents, but rather was generalized among the respondents. The economic variables of income and education levels were also found to be related to utilization of traditional health care systems, with those respondents with higher income and education levels reporting greater use of these systems. Use of traditional health care systems was not found to be restricted to respondents with Indian status; rather, use was generalized among status Indian, non-status Indian and Metis respondents.<p>Respondents who utilized traditional health care systems also fully utilized the Western health care system. Further, use of traditional health care systems was not found to be related to difficulty respondents may have encountered in using the Western health care system, such as language or economic problems, or experiences of racism, although such problems were found to exist. Clearly, respondents did not turn to traditional health care systems because of difficulties in utilizing the Western health care system. Rather, traditional health care systems were used to supplement the Western health care system. It was further found that the majority of the respondents in the study desired access to traditional medicines and healers within the city of Saskatoon-and, again, this finding was not confined to any sub-group (I.e. older respondents) of the study but was generalized. The extent to which this access is presently available is questioned, and this could represent an important unmet health need of this population.

Little research has examined the role traditional health care systems play today among Native populations. The present research examined the role these systems play among the urban Native population of Saskatoon, Saskatchewan. The research was conducted at the Westside Community Clinic, located in the downtown core area of Saskatoon. This area of the city has previously been identified as having a high concentration of Native people. The present study represented one component of a much larger project which examined both Native and non-Native utlization patterns of the Western health care system at the Westside clinic. An interview schedule was used to gather data, with a total of 103 Native and 50 non-Native interviews being conducted. Since no sampling frame exists for the Native population of Saskatoon, an availability sampling technique was used. "Native" was defined in this study as status Indian, non-status Indian and Metis.<p> It was discovered that traditional health care systems play an important role in the health care of this population, with the use of these systems being quite extensive. It was determined that the variable of language was a somewhat useful predictor of the utilization of traditional health care systems, although language retention (the ability to speak a Native language) was found to be more important than the frequency with which a Native language was spoken. It was also discovered that use of traditional health care systems was not found only among older respondents, but rather was generalized among the respondents. The economic variables of income and education levels were also found to be related to utilization of traditional health care systems, with those respondents with higher income and education levels reporting greater use of these systems. Use of traditional health care systems was not found to be restricted to respondents with Indian status; rather, use was generalized among status Indian, non-status Indian and Metis respondents.<p>Respondents who utilized traditional health care systems also fully utilized the Western health care system. Further, use of traditional health care systems was not found to be related to difficulty respondents may have encountered in using the Western health care system, such as language or economic problems, or experiences of racism, although such problems were found to exist. Clearly, respondents did not turn to traditional health care systems because of difficulties in utilizing the Western health care system. Rather, traditional health care systems were used to supplement the Western health care system. It was further found that the majority of the respondents in the study desired access to traditional medicines and healers within the city of Saskatoon-and, again, this finding was not confined to any sub-group (I.e. older respondents) of the study but was generalized. The extent to which this access is presently available is questioned, and this could represent an important unmet health need of this population.

The present development of the demography of elderly people in the western world will generate a shortage of caregiver’s for elderly people in the near future. There are major risk that the lack of qualified caregivers will result in deterioration in the quality of elderly care. One possible solution is the use of modern information and communication technology (ICT) to enable staff to work more efficiently. However, if ICT system is introduced into the elderly care it must done in a way which is acceptable from a humane perspective while at the same time increasing the efficiency of the personal that working in elderly care centers. This thesis investigates the technical feasibility of using a wireless mesh network for a social alarm system, in the elderly care. The System as such is not intended to replace the staff at an elderly care center but instead is intended to reduce staff workloads while providing more time for elderly care.

Includes bibliographical references / Integration is an important emerging health systems issue, which has relevance to different health programmes. Improving prevention of mother-to-child transmission of HIV (PMTCT) programs in South Africa would reduce preventable maternal and infant morbidity and mortality, assist with achieving Millennium Development Goals 4 and 5, and help in the response to the WHO call for the elimination of MTCT, the new international PMTCT goal. Integrating PMTCT care into routine maternal and child health programmes has been recommended as a way to optimize PMTCT care. The Part B literature review in this dissertation examines the reasons why PMTCT programmes need to engage with integration as an issue, challenges to implementing integrated programmes, followed by a discussion of the benefits and lessons to consider in planning integrated PMTCT programmes. Theoretical concepts and frameworks such as Atun's framework, complexity, Theory of Change and innovation in health systems are discussed, as they have key relevance to the research findings. Lessons about implementing health system changes can be learned from programmes which have done so successfully. Using Case Study methodology, the process of developing the fully integrated longitudinal clinic at McCord Hospital is described in Part C, and reflections on the experience of providing integrated care are captured through qualitative interviews with the staff. Recommendations regarding innovation and change within complex systems are made, emphasizing the need to understand contexts which are receptive to change and the importance of leadership in managing change.

Yes / There is increasing recognition among policymakers that health systems are no longer fit for purpose. Our hospital-centred systems, originally created to deal with communicable disease epidemics, are now faced with the challenge of delivering care to the exponentially increasing number of people living with (typically multiple)≈non-communicable disorders (NCDs). Global economic stagnation has also contributed to the pressures facing health systems – such that there is an imperative to develop new models of care.

This dissertation addresses resource allocation problems that occur in both public and private health care settings with the objective of characterizing the tradeoffs that occur when simultaneously incorporating multiple objectives and developing methods to address these tradeoffs. We examine three resource allocation problems (i) strategic allocation of financial resources and limited staffing capacity for the mobile delivery of health care within African countries, (ii) real-time allocation of hospital beds to internal patient requests, and (iii) development of patient redirection policies in response to limited bed availability in units within a system of hospitals. For each problem we define models, each with a different methodology, and utilize the models to develop allocation strategies that account for multiple competing objectives and examine the performance of the strategies with computational studies. In Chapter 2, we model African health care delivery systems utilizing a mixed-integer program (MIP) which accounts for financial and personnel constraints as well as infrastructure quality. We characterize tradeoffs in effectiveness, efficiency, and equity resulting from four allocation strategies with computational experiments representing the variety of spatial patterns that occur throughout the continent. The main contributions include (i) the development of a model that incorporates spatial and infrastructure characteristics and allows for a study of equity in the delivery of care, rather than access to care, and (ii) the characterization of tradeoffs in the three objectives under a variety of settings. In Chapter 3, we model the real-time assignment of bed requests to available beds as a queueing system and a Markov decision process (MDP). Through the development of bed assignment algorithms and simulation experiments, we illustrate the value of implementing strategic bed assignment practices which balance the bed management objectives of timeliness and appropriateness of assignments. The main contributions of this section include (i) the development of new bed assignment algorithms which use stochastic optimization techniques and outperform algorithms which mimic processes currently used in practice and (ii) the definition of a model and methods for the control of a large complex system that includes flexible units, multiple patient types, and type-dependent routing. In Chapter 4, we model the impact of a patient redirection policy in a hospital unit as a Markov chain. Assuming preferences for patient redirection are aligned with costs, we examine the impact of incremental changes to redirection policies on the probability of the unit being completely occupied, the long-run average utilization, and the long-run average cost of redirection. The main contributions of this chapter include (i) the introduction of a model of patient redirection with multiple patient thresholds and patient preference constraints and (ii) the definition of necessary conditions for an optimal patient redirection policy that minimizes the average cost of redirection.