Impact of demographic changes on healthcare expenditures in the Czech Republic Abstract This work aims to analyse the influence of demographic changes on public healthcare expenditures in the Czech Republic. The first part displays particular factors having effect on healthcare expenditures with a special focus on demographic characteristics. In spite of the fact that the expenditure level seems to be mainly affected by the economic output of particular states and new technology development, while the influence of demographic fluctuation is of minor effect so far, this situation is likely to change. The next part presents the health care expenditures evolution in the Czech Republic from the beginning of the nineties. The data sources confirm that these expenditures keep growing just the same way as in other states in the world. The last part defines and quantifies the foreseen scenarios of the above mentioned health care expenditures depending upon demographic evolution. The results of those scenarios are being compared with other analysis results focusing on analyzing the influence of ageing process and health condition fluctuations on expenditure levels in the Czech Republic as well as in other EU countries. Keywords: population ageing, health care, costs of dying, health, new technologies, healthcare...

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-11-26T14:53:23Z No. of bitstreams: 1 Josevane Aparecida Barbosa Domingos.pdf: 936906 bytes, checksum: 1c24cff04754caf66233afb1657e9254 (MD5) / Made available in DSpace on 2018-11-26T14:53:23Z (GMT). No. of bitstreams: 1 Josevane Aparecida Barbosa Domingos.pdf: 936906 bytes, checksum: 1c24cff04754caf66233afb1657e9254 (MD5) Previous issue date: 2018-08-20 / The fragmentation of the network and the lack of communication of the health services lead users to a pilgrimage for health care, yet when the beneficiaries feel secure in a service, in many cases it is not able to meet all the demands that the health-disease process requires. Thinking about cancer patients, these are perhaps the ones most dependent on holistic care and an interconnected network. The objective of this study was to study the network restructuring of a supplementary health care provider, who has been implementing vertical structure in the oncological health service offered. The qualitative and quantitative approaches were adopted and the method was a single case study. In the qualitative approach, structured interviews were carried out, elaborated by a construct based on assumptions and in the theoretical reference with the managers directly involved in the vertical structure implementation. For the evaluation of the data and compilation of the results we used the content analysis, where grouping the questions by similarity categories were created. Since the health care provider has a wide network of providers in the city of São Paulo, who attend cancer patients, and requests for chemotherapy demand from these various providers and each provider practices a different value for similar care, not always contemplating all the needs of the patients, in the quantitative approach was carried out a survey of the chemotherapy requests from December 2017 to February 2018 for patients with breast and prostate cancer and compared the value of chemotherapy in network of providers and in own service. This comparison was analyzed with the help of microsoft® excel software for windows 2007. The results obtained demonstrate that the infusion of chemotherapy in service for treatment of breast and prostate cancer can be 17% and 7%, respectively, cheaper than the same service offered in an outsourced network, and that the implementation of the vertical structure in health provides a greater integration among the professionals involved, greater care responsibility and provides knowledge exchange which strengthens the service provided. / A fragmentação da rede e a falta de comunicação dos serviços de saúde levam usuários a uma peregrinação por atendimento de saúde, ainda assim, quando os beneficiários se sentem seguros em um serviço, por muitas vezes esse não é capaz de suprir todas as demandas que o processo saúde-doença exige. Pensando em pacientes oncológicos, esses sejam talvez, os que mais dependem de um cuidado holístico e de uma rede interligada. O objetivo deste trabalho foi estudar a reestruturação de rede de uma operadora de saúde suplementar, que vem implementando estrutura vertical no serviço oncológico de saúde oferecido. Foram adotadas as abordagens - qualitativa e quantitativa - e o método, um estudo de caso único. Na abordagem qualitativa foram realizadas entrevistas estruturadas, elaboradas por um construto baseado em pressupostos e no referencial teórico com os gestores diretamente envolvidos na implantação da estrutura vertical. Para a avaliação dos dados e compilação dos resultados foi utilizada a análise de conteúdo, onde agrupando as perguntas por semelhança foram criadas categorias. Uma vez que a operadora de saúde possui uma rede de prestadores ampla na cidade de São Paulo, que atendem pacientes oncológicos, e as solicitações de quimioterapia demandam desses diversos prestadores e cada prestador pratica um valor diferente para atendimento assemelhado, nem sempre contemplando todas as necessidades dos pacientes, na abordagem quantitativa foi realizado levantamento das solicitações de quimioterapia de dezembro de 2017 a fevereiro de 2018 para pacientes com câncer de mama e próstata e comparado o valor da quimioterapia em rede de prestadores e em serviço próprio. Esse comparativo foi analisado com o auxílio do software microsoft® Excel para Windows 2007. Os resultados obtidos demonstram que a infusão de quimioterápicos em serviço próprio para tratamento de câncer de mama e próstata pode ser 17% e 7% respectivamente mais barato que o mesmo serviço oferecido em rede terceirizada, e que a implantação da estrutura vertical em saúde proporciona uma maior integração entre os profissionais envolvidos, maior responsabilidade assistencial e propicia a troca de conhecimentos, o que fortalece o serviço prestado.