<p>After the elections in 2006 there was a change of government in Sweden, when the Moderate Party with the right block took over the power from the Social democrats. The politics of the new government is more liberal than the politics of the Social democrats, which implied several changes of the Swedish social security system, in particular some important changes of the sickness benefit.</p><p>The objective of this essay has been to examinate the changes of the system, as well as the reasons for the changes, and also to compare the system in Sweden to the one in France, who has another structure.</p><p>The methods used are archive and corpus crossings in terms of collecting information from literature and websites of the social insurance offices in Sweden and in France. Further a qualitative method has been carried out in shape of an interview with the administrative official responsible of the sickness benefit at the social insurance office in Växjö.</p><p>The result has shown that there are several reasons for the changes in the Swedish system. It seems as if the most important reason is the big number of individuals on the sick-list which causes economical problems, since the employment rate is too low compared to the retired quotient of the population. The economical crises might have an influence on the changes of the systems, but not the present recession. Despite the rather big changes from a social system towards a more liberal one, the Swedish scheme has still kept its basic characteristics.</p> / <p>En 2006, la Suède a eu un changement de gouvernement. Les sociaux-démocrates ont été remplacés par l'alliance entre les partis à droite. Le nouveau gouvernement mène une politique plus libérale que les sociaux-démocrates, et ils ont introduit plusieurs changements dans le système de santé et particulièrement dans le règlement de l'indemnité journalière.</p><p>Ce mémoire a pour but d'examiner les changements dans le système, ainsi que les raisons de ces changements.</p><p>Les méthodes appliquées sont l'archive et le corpus, puisque j'ai étudié les ouvrages relatifs à la santé ainsi que les sites Internet des institutions responsables de l'indemnité journalière en Suède et en France. J'ai aussi eu un entretien avec un employé de la Caisse de Sécurité sociale à Växjö qui s'occupe particulièrement de l'indemnité journalière.</p><p>Les résultats de cette étude montrent qu'il y a plusieurs raisons à l'origine des changements dans le système suédois. Il semble que la raison la plus importante soit le nombre croissant de personnes en arrêt maladie ce qui génère des difficultés économiques, de même la proportion de la population active par rapport aux retraités est au cœur de la problématique. Enfin, les crises économiques peuvent influencer le système, mais la crise actuelle ne semble pas avoir eu une influence importante sur les changements.</p><p>Malgré les changements assez bouleversants vers un système plus libéral en Suède, qui tend à se rapprocher légèrement du système français, le système suédois reste plus social que le système français.</p>

La thèse a pour objectif d’étudier l’influence du financement des soins de santé sur la performance des systèmes de soins compte tenu des caractéristiques organisationnelles sanitaires des systèmes. Elle s’articule autour des trois objectifs suivants : 1) caractériser le financement des soins de santé à travers les différents modèles émergeant des pays à revenu élevé ; 2) apprécier la performance des systèmes de soins en établissant les divers profils apparaissant dans ces mêmes pays ; 3) examiner le lien entre le financement et la performance en tenant compte du pouvoir modérateur du contexte organisationnel des soins. Inspirée du processus de circulation de l’argent dans le système de soins, l’approche a d’abord consisté à classer les pays étudiés – par une analyse configurationnelle opérationnalisée par les analyses de correspondance multiples (ACM) et de classification hiérarchique ascendante (CHA) – dans des modèles types, chacun représentant une configuration particulière de processus de financement des soins de santé (article 1). Appliquée aux données recueillies auprès des 27 pays de l’OCDE à revenu élevé via les rapports Health Care in Transition des systèmes de santé des pays produits par le bureau Européen de l’OMS, la banque de données Eco-Santé OCDE 2007 et les statistiques de l’OMS 2008, les analyses ont révélé cinq modèles de financement. Ils se distinguent selon les fonctions de collecte de l’argent dans le système (prélèvement), de mise en commun de l’argent collecté (stockage), de la répartition de l’argent collecté et stocké (allocation) et du processus de paiement des professionnels et des établissements de santé (paiement). Les modèles ainsi développés, qui vont au-delà du processus unique de collecte de l’argent, donnent un portrait plus complet du processus de financement des soins de santé. Ils permettent ainsi une compréhension de la cohérence interne existant entre les fonctions du financement lors d’un éventuel changement de mode de financement dans un pays. Dans un deuxième temps, nous appuyant sur une conception multidimensionnelle de la performance des systèmes, nous avons classé les pays : premièrement, selon leur niveau en termes de ressources mobilisées, de services produits et de résultats de santé atteints (définissant la performance absolue) ; deuxièmement, selon les efforts qu’ils fournissent pour atteindre un niveau élevé de résultats de santé proportionnellement aux ressources mobilisées et aux services produits en termes d’efficience, d’efficacité et de productivité (définissant ainsi la performance relative) ; et troisièmement, selon les profils types de performance globale émergeant en tenant compte simultanément des niveaux de performance absolue et relative (article 2). Les analyses effectuées sur les données collectées auprès des mêmes 27 pays précédents ont dégagé quatre profils de performance qui se différencient selon leur niveau de performance multidimensionnelle et globale. Les résultats ainsi obtenus permettent d’effectuer une comparaison entre les niveaux globaux de performance des systèmes de soins. Pour terminer, afin de répondre à la question de savoir quel mode – ou quels modes – de financement générerait de meilleurs résultats de performance, et ce, dans quel contexte organisationnel de soins, une analyse plus fine des relations entre le financement et la performance (tous définis comme précédemment) compte tenu des caractéristiques organisationnelles sanitaires a été réalisée (article 3). Les résultats montrent qu’il n’existe presque aucune relation directe entre le financement et la performance. Toutefois, lorsque le financement interagit avec le contexte organisationnel sanitaire pour appréhender le niveau de performance des systèmes, des relations pertinentes et révélatrices apparaissent. Ainsi, certains modes de financement semblent plus attrayants que d’autres en termes de performance dans des contextes organisationnels sanitaires différents. Les résultats permettent ainsi à tous les acteurs du système de comprendre qu’il n’existe qu’une influence indirecte du financement de la santé sur la performance des systèmes de soins due à l’interaction du financement avec le contexte organisationnel sanitaire. L’une des originalités de cette thèse tient au fait que très peu de travaux ont tenté d’opérationnaliser de façon multidimensionnelle les concepts de financement et de performance avant d’analyser les associations susceptibles d’exister entre eux. En outre, alors que la pertinence de la prise en compte des caractéristiques du contexte organisationnel dans la mise en place des réformes des systèmes de soins est au coeur des préoccupations, ce travail est l’un des premiers à analyser l’influence de l’interaction entre le financement et le contexte organisationnel sanitaire sur la performance des systèmes de soins. / The aim of this thesis is to investigate the influence of health care financing on the performance of health care systems when organizational characteristics of health care system contexts are taken into consideration. It focuses on the following three objectives: 1) to characterize health care financing across the various models emerging in high-income countries; 2) to assess the performance of these health care systems by identifying the different profiles seen in these countries; and 3) to examine the relationship between health care financing and system performance, taking into account the moderating influence of the organizational context of health care. Inspired by the revenue flow process in health care systems, the approach adopted consisted in first classifying the countries studied – using configurational analysis operationalized through multiple components analysis (MCA) and ascending hierarchical classification (AHC) – into typical models, each representing a particular configuration of health care financing processes (article 1). Analysis of data collected on 27 high-income OECD countries from the Health Care in Transition reports produced by the WHO Regional Office for Europe, the 2007 Éco-Santé OCDE database and the 2008 WHO statistics revealed five financing models. These models differ among themselves in terms of the functions of collecting money (collection), pooling the collected funds (pooling), distributing the collected and pooled funds (allocation) and paying the professionals and health care establishments (payment). The models thus developed, which extend beyond the simple process of collecting money, provide a more complete picture of the health care financing process. As such, they enable a better understanding of the internal coherence that exists among the four health care financing functions that will impact any change in a country’s health care financing system. Next, based on a multidimensional conception of health care system performance, we classified the same 27 countries according to three parameters: (1) their levels of resources mobilized, health care services provided and health outcomes achieved (absolute performance); (2) the efforts they invested to achieve higher levels of health outcomes in proportion to resources mobilized and health care services provided, in terms of efficiency, efficacy and productivity (relative performance); and (3) the overall performance profiles that emerged when absolute performance and relative performance were combined (article 2). The analyses we carried out on the data collected for these 27 countries produced four profiles that were differentiated in their multidimensional and overall performance. The results thus obtained allow us to compare overall health care system performance among high-income countries. Finally, to answer the question of what financing modalities would generate the best performance, and in what types of health care organizational contexts, we carried out an in-depth analysis of the relations between health care financing and health care system performance (as defined above), taking into account the organizational characteristics of the health care contexts (article 3). The analysis revealed almost no direct relations between health care financing and health care performance. However, when we looked at interactions between financing and health care organizational contexts to capture the level of system performance, some relevant relations emerged. Thus, in terms of performance, some health care financing modalities would appear to be more appealing than others, depending on the organizational characteristics of the health care context. These results can help health care system stakeholders to understand that there is only an indirect relationship between financing and system performance, due to the interaction between health care financing and the organizational characteristics of health care contexts. One original aspect of this thesis lies in the fact that very few studies have attempted to operationalize the concepts of health care system financing and performance using multidimensional approaches before analyzing any relationships that might exist between them. Furthermore, despite the relevance of taking into account the organizational characteristics of health care contexts in health system reforms, this thesis is the one of the first to analyze the impact of the interaction between health care financing and organizational contexts on health care system performance.

Health care concerns everybody. Man{\crq}s right to health care is one of the fundamental human rights. There is no ideal health care system as yet, and states reform their health care systems and the ways of their funding. The reform of the health care system has been conducted in this country for a long time. No minister, however, has introduced more substantial changes and interferences in the present system than the Health Minister MUDr. Tomáš Julínek. This reform is known to citizens especially because of the introduction of fees for health treatment. However, the reform reaches farther. Further steps of the reform propose changes in the public health insurance, providing health care and in education, science and research. The transformation of the health care system of the Czech Republic has not completely resolved and finished a number of matters. Finishing these matters is braked by disputes in the political representation. This thesis is focused on finding out the understanding and attitudes of physicians towards the present reform of the health care system. To collect data, I used the questionnaire method. Its data were collected between January and March 2009. The return rate of questionnaires reached 84 per cent. The set of respondents consisted of physicians from the Vysočina Region in the districts of Havlíčkův Brod and Jihlava. The objective of my thesis was to find out the attitudes of physicians towards the present reform of the health care system. The objective of my thesis was fulfilled. I verified the following hypotheses by my research: Hypothesis 1: Opinions of self-employed physicians are different from those in employment relationship. Hypothesis 2: Differences in physicians{\crq} opinions are also dependent on their specialisations. Both hypotheses were confirmed in most aspects. I suppose that my research has brought new information concerning the opinions of physicians of the Czech health care system and of the changes going on in it. A number of things changed while this diploma thesis was being written, and the reform of the health care system did not proceed in the way it had been planned. I think that despite this the research results are useful and may be used as a basis for further research in this field, and thus enlarge information concerning this subject.

The purpose of this study was to investigate and describe the experience of infertility of African women, men and family member. It is hoped that this description will contribute to a deeper understanding of the psychosocial difficulties involved in the area of infertility and ofthe ways in which people respond to the situation of infertility. A qualitative research approach was used, and in particular social constructivist-interpretive research and feminist research approaches. The sample consisted of39 participants: 19 women, 10 men, and 10 family members faced with infertility. The research orientation was field-based, concerned with collecting data using the technique of in-depth semi-structured interviews. Each participant was interviewed individually. The interviews were recorded on tape, transcribed in their full length and translated into English. Data were analysed on the basis of the interpretive feminist approach. Analysis of individual cases and crosscase analysis were employed. The findings suggested a contextual definition of infertility, for example, for some, having had an ectopic pregnancy or a miscarriage meant that they did not fit into the definition of infertility. The findings revealed that for many African women and men, blood ties still defined the family and the persona. Thus, failure to have a blood child resulted in courtship and marital break up, extramarital relationships, polygamy, and divorce and remarriage. Infertility had serious psychosocial consequences for both the infertile individuals and their families. Participants experienced repeated periods of existential crisis, which began at different points for different participants. Analysis of gender differences indicated similarities in the experience of the crisis, but differences in terms of expression and ways of responding to the crisis. Family dynamics within the context of infertility were coloured by ambivalent feelings, resentment, insensitivity, and miscommunication, but also affection, and social support. Traditional and modern medical health systems offered the possibility of finding explanations and treatment, but there was further strain from the negative experiences with the health care system. The findings in this study suggested the need for policy reformulation, for psychosocial intervention as part of the treatment plan, and for future research on the outcome of using various coping strategies. / Psychology / D. Phil. (Psychology)

In my thesis, I deal with the issue of perception of health insurance companies in the South Bohemian Region. That is, how South Bohemian citizens perceive health insurance companies and whether they are satisfied with the services that health insurance companies provide. In the theoretical part, I present basic information about public health insurance system in the Czech Republic. I mention the history of health insurance evolution, its systems, and principles of its operation. I also deal with legislature which is the cornerstone of this system. Most of the laws were passed in the 1990?s when the Czech Republic began to develop the current version of health insurance. Since its inception, these laws have been amended several times. Public health insurance system in our country is based on the Bismarck model, which is based on the existence of multiple health insurance companies and contractual relationships between health insurance companies and health care facilities. Furthermore, the theoretical part refers about health insurance companies as such, whose activities are governed by Act No. 551/1991 Coll., on the General Health Insurance Company, and Act No. 280/1992 Coll., on departmental, professional, occupational and other health insurance companies. The practical part describes the results of my research focused on the aforementioned issue of perception of health insurance companies in the South Bohemian Region. The results have been obtained through quantitative analysis. The method of questioning, the technique of questionnaires, was used. In this research, two of three assumed hypotheses have been confirmed. The research shows that health insurance clients in the South Bohemian Region are satisfied with local and time availability of their health insurance company subsidiaries. Furthermore, the research carried out shows that citizens respect the opinion of their general practitioners on the selection of their health insurance company. In contrast, what good (preventive) programs health insurance companies offer is not crucial for citizens when selecting a health insurance company. The knowledge gained can form the basis for further research, but it can also serve to health insurance companies themselves to improve their services. The issue of health care and health insurance companies is still a topic of current concern, both in the political field and for the general public.

After the elections in 2006 there was a change of government in Sweden, when the Moderate Party with the right block took over the power from the Social democrats. The politics of the new government is more liberal than the politics of the Social democrats, which implied several changes of the Swedish social security system, in particular some important changes of the sickness benefit. The objective of this essay has been to examinate the changes of the system, as well as the reasons for the changes, and also to compare the system in Sweden to the one in France, who has another structure. The methods used are archive and corpus crossings in terms of collecting information from literature and websites of the social insurance offices in Sweden and in France. Further a qualitative method has been carried out in shape of an interview with the administrative official responsible of the sickness benefit at the social insurance office in Växjö. The result has shown that there are several reasons for the changes in the Swedish system. It seems as if the most important reason is the big number of individuals on the sick-list which causes economical problems, since the employment rate is too low compared to the retired quotient of the population. The economical crises might have an influence on the changes of the systems, but not the present recession. Despite the rather big changes from a social system towards a more liberal one, the Swedish scheme has still kept its basic characteristics. / En 2006, la Suède a eu un changement de gouvernement. Les sociaux-démocrates ont été remplacés par l'alliance entre les partis à droite. Le nouveau gouvernement mène une politique plus libérale que les sociaux-démocrates, et ils ont introduit plusieurs changements dans le système de santé et particulièrement dans le règlement de l'indemnité journalière. Ce mémoire a pour but d'examiner les changements dans le système, ainsi que les raisons de ces changements. Les méthodes appliquées sont l'archive et le corpus, puisque j'ai étudié les ouvrages relatifs à la santé ainsi que les sites Internet des institutions responsables de l'indemnité journalière en Suède et en France. J'ai aussi eu un entretien avec un employé de la Caisse de Sécurité sociale à Växjö qui s'occupe particulièrement de l'indemnité journalière. Les résultats de cette étude montrent qu'il y a plusieurs raisons à l'origine des changements dans le système suédois. Il semble que la raison la plus importante soit le nombre croissant de personnes en arrêt maladie ce qui génère des difficultés économiques, de même la proportion de la population active par rapport aux retraités est au cœur de la problématique. Enfin, les crises économiques peuvent influencer le système, mais la crise actuelle ne semble pas avoir eu une influence importante sur les changements. Malgré les changements assez bouleversants vers un système plus libéral en Suède, qui tend à se rapprocher légèrement du système français, le système suédois reste plus social que le système français.

<p>This thesis examines the problems related to IT in the Swedish healthcare system, specifically the drug searching part of the electronic healthcare systems used in Sweden. The question formulation is divided into two questions: What parameters and functions are of greatest importance when performing a search on drugs, and how should these be presented in a graphical user interface? Thus the purpose is to answer these questions through developing a design concept, in the form of a prototype, which describes how a drug search can be carried out.</p><p>The entry point is a central quality checked drug database that is managed and owned by Swedish county councils and regions. The problem is attacked through user-centered methods where interviews of physicians and developers, in conjunction with observations, are used to give an overview of the problem area as well as to specify a requirements specification for the prototype that this thesis aims to develop. The thesis result is a requirements specification in combination with a prototype that exemplifies how drug searching can be performed, the prototype is based the requirements gathered from the interviews with the user group of physicians.</p> / <p>Den här uppsatsen behandlar problematiken kring IT i vården och mer specifikt läkemedelssökningar i vårddokumentationssystem. Frågeställningen är uppdelad i två frågor: Vilka parametrar och funktioner är av störst vikt vid en sökning på läkemedel samt, hur bör dessa presenteras i det grafiska gränssnittet? Syftet är därav att besvara dessa frågor genom ett designkoncept, i form av en prototyp, som beskriver hur en läkemedelssökning kan gå till.</p><p>Ingångspunkten är en centralt kvalitetssäkrad läkemedelsdatabas som förvaltas av en organisation som ägs av Sveriges landsting och regioner. Problemet angrips med hjälp av användarcentrerade metoder där intervjuer av läkare och utvecklare används, tillsammans med observationer, för att ge en bild av problemområdet samt för att ställa upp krav på den prototyp som denna uppsats ämnar framta. Uppsatsens resultat är en kravspecifikation i kombination med en prototyp för hur läkemedelssökning kan gå till baserat på krav extraherade ur intervjuer med en användargrupp bestående av läkare.</p>

Submitted by Flavio Rogério Villar Silva (flavio.silva@me.com) on 2018-07-04T16:46:43Z No. of bitstreams: 1 TA FINAL.pdf: 1527931 bytes, checksum: 5fbbeced3509b6dd05af1c437a6c2665 (MD5) / Rejected by Simone de Andrade Lopes Pires (simone.lopes@fgv.br), reason: Boa Tarde Flavio, Por favor, falta alteração de duas coisas: CAPA: você colocou como SÃO PAULO - SP. Excluir o "-SP" FOLHA DE APROVAÇÃO: ajustar a linha de assinatura. Faça as alterações o submeta novamente o trabalho na biblioteca digital. Atenciosamente, SIMONE DE A LOPES SRA on 2018-07-04T17:22:38Z (GMT) / Submitted by Flavio Rogério Villar Silva (flavio.silva@me.com) on 2018-07-06T13:23:45Z No. of bitstreams: 1 ABNT Rev PDF.pdf: 1951169 bytes, checksum: 485e2bf86d0dea863a0d8fab24495c6d (MD5) / Approved for entry into archive by Simone de Andrade Lopes Pires (simone.lopes@fgv.br) on 2018-07-06T14:32:04Z (GMT) No. of bitstreams: 1 ABNT Rev PDF.pdf: 1951169 bytes, checksum: 485e2bf86d0dea863a0d8fab24495c6d (MD5) / Approved for entry into archive by Suzane Guimarães (suzane.guimaraes@fgv.br) on 2018-07-06T14:57:10Z (GMT) No. of bitstreams: 1 ABNT Rev PDF.pdf: 1951169 bytes, checksum: 485e2bf86d0dea863a0d8fab24495c6d (MD5) / Made available in DSpace on 2018-07-06T14:57:10Z (GMT). No. of bitstreams: 1 ABNT Rev PDF.pdf: 1951169 bytes, checksum: 485e2bf86d0dea863a0d8fab24495c6d (MD5) Previous issue date: 2018-05-22 / É notório a retomada do modelo assistencial à saúde centrado na Atenção Primária nos diversos sistemas de saúde, sejam eles públicos ou privados. Este estudo busca, fundamentalmente, analisar a viabilidade financeira de um projeto dessa natureza em uma cooperativa de trabalho médico, através de um Plano de Negócios. A introdução e a revisão bibliográfica, evidenciam a qualidade dos serviços prestados e dos resultados alcançados sob a lógica desse modelo. Por outro lado, são escassos na literatura médica dados relacionados ao custo que se impõe a partir da sua implantação. Quanto a metodologia, o Plano de Negócios parte de premissas e dados provenientes da experiência já percorrida por esses sistemas de saúde ao reconstruírem o sistema pelo nível de complexidade. Importante ressaltar que, embora previsto desde a criação do Sistema Único de Saúde, a implementação da atenção primária se deu sem a devida importância aos atributos que organizam o modelo em todas as instâncias da esfera pública. Isso deve ser considerado pois os resultados obtidos durante a implementação tendem a ser bastante positivos no curto prazo, fruto da prioridade aos outros níveis de complexidade, especialmente à atenção terciária. Evidencia o estudo, que a ferramenta gerencial se mostra adequada no que se refere ao objetivo do trabalho e seus resultados sinalizam que o modelo é viável financeiramente e tende, paulatinamente, a incrementar seus resultados no médio e longo prazo trazendo assim, vantagem competitiva ao nosso negócio. / It is notorious that the health care model focused on primary health care in the various health systems is resumed, whether public or private. This study seeks, fundamentally, to analyze the financial viability of such a project in a medical work cooperative, through a Business Plan. The introduction and the bibliographic review show the quality of the services provided and the results achieved under the logic of this model. On the other hand, there are few data in the medical literature related to the cost that is imposed from its implantation. As for the methodology, the Business Plan starts from premises and data from the experience already covered by these health systems when reconstructing the system by the level of complexity. It is important to note that, although it was foreseen since the creation of the Unified Health System, the implementation of primary care was given without due importance to the attributes that organize the model in all instances of the public sphere. This should be considered because the results obtained during implementation tend to be quite positive in the short term, due to the priority given to other levels of complexity, especially to tertiary care. The study shows that the managerial tool is adequate in terms of the objective of the work and its results indicate that the model is financially viable, tends gradually to increase its results in the medium and long term and bring a competitive advantage to our business, as well.

This thesis examines the problems related to IT in the Swedish healthcare system, specifically the drug searching part of the electronic healthcare systems used in Sweden. The question formulation is divided into two questions: What parameters and functions are of greatest importance when performing a search on drugs, and how should these be presented in a graphical user interface? Thus the purpose is to answer these questions through developing a design concept, in the form of a prototype, which describes how a drug search can be carried out. The entry point is a central quality checked drug database that is managed and owned by Swedish county councils and regions. The problem is attacked through user-centered methods where interviews of physicians and developers, in conjunction with observations, are used to give an overview of the problem area as well as to specify a requirements specification for the prototype that this thesis aims to develop. The thesis result is a requirements specification in combination with a prototype that exemplifies how drug searching can be performed, the prototype is based the requirements gathered from the interviews with the user group of physicians. / Den här uppsatsen behandlar problematiken kring IT i vården och mer specifikt läkemedelssökningar i vårddokumentationssystem. Frågeställningen är uppdelad i två frågor: Vilka parametrar och funktioner är av störst vikt vid en sökning på läkemedel samt, hur bör dessa presenteras i det grafiska gränssnittet? Syftet är därav att besvara dessa frågor genom ett designkoncept, i form av en prototyp, som beskriver hur en läkemedelssökning kan gå till. Ingångspunkten är en centralt kvalitetssäkrad läkemedelsdatabas som förvaltas av en organisation som ägs av Sveriges landsting och regioner. Problemet angrips med hjälp av användarcentrerade metoder där intervjuer av läkare och utvecklare används, tillsammans med observationer, för att ge en bild av problemområdet samt för att ställa upp krav på den prototyp som denna uppsats ämnar framta. Uppsatsens resultat är en kravspecifikation i kombination med en prototyp för hur läkemedelssökning kan gå till baserat på krav extraherade ur intervjuer med en användargrupp bestående av läkare.