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The masters’s final work is written in Lithuania and consist of 80 pages, 20 Figures, 14 Tables, 38 References, 4 Appendixes. Research object: health insurance system in Lithuania. Research subject: health insurance. Research aim: to evaluate the system of health insurance in Lithuania and to present it’s development in perspective. Objectives: to analyze the theoretical aspects of health insurance and development of health insurance system in Lithuania, to fulfill the analysis of the accumulation of the income of Compulsory Health Insurance Fund Budget and distribution of the already accumulative finance, to define the factors determining the variations of income and expense; to provide the recommendations for the development of health insurance system in Lithuania. Research methods: analysis and synthesis of literature, logical analysis and synthesis, vertical analysis, methods of graphic modeling and forecast calculations. After studying the legislations of the Republic of Lithuania, scientific research works by various authors on the subject of health insurance in Lithuania, the analysis and evaluation of health insurance system as well as recommendations for the development of health insurance system were performed.

Magistro studijų baigiamasis darbas, 76 puslapių, 21 paveikslo, 2 lentelių, 68 literatūros šaltinių, 12 priedų, lietuvių kalba. Tyrimo objektas – Lietuvos privalomojo sveikatos draudimo sistemos finansavimas. Tyrimo dalykas – privalomasis sveikatos draudimas. Darbo tikslas – atlikus Lietuvos privalomojo sveikatos draudimo sistemos finansavimo analizę, nustatyti finansavimo problemas ir pateikti pasiūlymus jo tobulinimui. Uždaviniai: išnagrinėti sveikatos draudimo teorinius aspektus, sukurti Lietuvos privalomojo sveikatos draudimo sistemos finansavimo įvertinimo metodiką, įvertinti Lietuvos privalomojo sveikatos draudimo finansavimo modelį, atskleisti sveikatos draudimo sistemos privalumus ir trūkumus, indentifikuoti privalomojo sveikatos draudimo sistemos finansavimo problemas, ištirti ir įvertinti veiksnius labiausiai įtakojančius Privalomojo sveikatos draudimo fondo biudžetą, pateikti sveikatos draudimo sistemos finansavimo tobulinimo galimybes. Iškeltai problemai tirti ir rezultatams gauti naudoti šie tyrimo metodai: specialiosios literatūros bendrieji moksliniai tyrimo metodai – literatūros analizė ir sintezė, sisteminė analizė, loginė analizė ir sintezė, loginio ir grafinio modeliavimo metodai, daugiafaktorinė regresinė analizė, prognoziniai skaičiavimai. Nagrinėjant Lietuvos autorių mokslinius straipsnius, periodinę spaudą, užsienio autorių mokslinius darbus apie sveikatos draudimo sistemą, atlikta Lietuvos privalomojo sveikatos draudimo sistemos finansavimo analizė... [toliau žr. visą tekstą] / The research project is written in Lithuanian language and comprises of 76 pages, 21 figures, 2 tables, 68 references, 12 appendices. Research object: financing of Lithuanian compulsory health insurance system. Research subject: compulsory health insurance. Research aim: to evaluate the financing system of compulsory health insurance in Lithuania and to define the problems and opportunity of improvement. Objectives: to analyse the theoretical aspects of health insurance, create methodology of financing evaluation of Lithuanian compulsory health insurance system, evaluate model of financing of Lithuanian compulsory health insurance system, show advantages and disadvantages of health insurance system, identify problems of financing of compulsory health insurance system, analyse and evaluate factors significantly effecting compulsory health insurance fund budget, provide the recommendations for the improvement of financing of Lithuanian compulsory health insurance system. For solving problems and research results the following research methods were used: general scientific research methods of special literature - analysis and synthesis of literature, systemic analysis, logical analysis and synthesis, methods of graphic and logical modelling, multifactor regression analysis, forecast calculations. During the research of scientific articles by Lithuanian authors, periodic printings, scientific works by foreign authors about health insurance system, analysis of financing of... [to full text]

A dissertation presented to the Faculty of Health, Durban University of Technology, for the Masters Degree in Technology: Chiropractic, 2009. / Background: The International Classification of Diseases (ICD) provides codes to classify diseases in such a manner, that every health condition is assigned to a unique category. Some of the most common diagnoses made by chiropractors are not included in the ICD-10 coding system, as it is mainly medically orientated and does not accommodate these diagnoses. This can potentially lead to reimbursement problems for chiropractors in future and create confusion for medical aid schemes as to what conditions chiropractors actually diagnose and treat. Aim: To determine the level of compliancy of chiropractors, in South Africa, to the ICD-10 coding procedure and the factors that may influence the use of correct ICD-10 codes. As well as to determine whether the ICD-10 diagnoses chiropractors commonly submit to the medical aid schemes, reflect the actual diagnoses made in practice. Method: The study was a retrospective survey of a quantitative nature. A self-administered questionnaire was e-mailed and posted to 380 chiropractors, practicing in South Africa. The electronic questionnaires were sent out four times at two week intervals for the duration of eight weeks; and the postal questionnaires sent once. A response rate of 16.5% (n = 63) was achieved. Raw data was received from the divisional manager of the coding unit of Discovery Health (Pty) Ltd. in the form of an excel spreadsheet containing the most common ICD-10 diagnoses made by chiropractors in South Africa, for the period June 2006 to July 2007, who had submitted claims to the Medical Scheme. The spreadsheet also contained depersonalised compliance statistics of chiropractors to the ICD-10 system from July 2006 to October 2008. SPSS version 15 was used for descriptive statistical data analysis (SPSS Inc., Chicago, Ill, USA). Results: The age range of the 63 participants who responded to the questionnaire was 26 to 79 years, with an average of 41 years. The majority of the participants were male (74.6%, n = 47). KwaZulu-Natal had 25 participants (39.6%), Gauteng 17 (26.9%), Western Cape 12 (19%), Eastern Cape four (6.3%), Free State and Mpumalanga two (3.1%) each and North West one (1.5%). The mean knowledge score for ICD-10 coding was 43.5%, suggesting a relatively low level of knowledge. The total percentage of mistakes for electronic claims was higher for both the primary and unlisted claims (3.93% and 2.18%), than for manual claims iv (1.57% and 1.59%). The total percentage of mistakes was low but increased marginally each year for both primary claims (1.43% in 2006; 1.99% in 2007; 2.33% in 2008) and unlisted claims (0% in 2006; 2.61% in 2007; 3.07% in 2008). CASA members were more likely to be aware of assistance offered, in terms of ICD-10 coding through the medical schemes and the association (p = 0.131), than non-members. There was a non-significant trend towards participants who had been on an ICD-10 coding course (47.6%; n = 30), having a greater knowledge of the ICD-10 coding procedures (p = 0.147). Their knowledge was almost 10% higher than those who had not been on a course (52.4%; n = 33). Most participants (38.1%; n = 24) did not use additional cause codes when treating cases of musculoskeletal trauma, nor did they use multiple codes (38.7%; n = 24) when treating more than one condition in the same patient. Nearly 70% of participants (n = 44) used the M99 code in order to code for vertebral subluxation and the majority (79.4%; n = 50) believed the definition of subluxation used in ICD-10 coding to be the same as that which chiropractors use to define subluxation. According to the medical aid data, the top five diagnoses made by chiropractors from 2006 to 2007 were: Low back pain, lumbar region, M54.56 (8996 claims); Cervicalgia, M54.22 (6390 claims); Subluxation complex, cervical region, M99.11 (2895 claims); Other dorsalgia, multiple sites in spine, M54.80 (1524 claims) and Subluxation complex, sacral region, M99.14 (1293 claims). According to the questionnaire data, the top five diagnoses (Table 4.24) were: Lumbar facet syndrome, M54.56 (25%); Lumbar facet syndrome, M99.13 (23.3%); Cervical facet syndrome, M99.11 (21.7%); Cervicogenic headache, G44.2 (20%) and Cervicalgia, M54.22 (20%). Conclusion: The sample of South African chiropractors were fairly compliant to the ICD-10 coding system. Although the two sets of data (i.e. from the medical aid scheme and the questionnaire) regarding the diagnoses that chiropractors make on a daily basis correlate well with each other, there is no consensus in the profession as to which codes to use for chiropractic specific diagnoses. These chiropractic specific diagnoses (e.g. facet syndrome) are however, the most common diagnoses made by chiropractors in private practice. Many respondents indicated that because of this they sometimes use codes that they know will not be rejected, even if it is the incorrect code. For more complicated codes, the majority of respondents indicated that they did not know how to or were not interested in submitting the correct codes to comply with the level of specificity required by the medical aid schemes. The challenge is to make practitioners aware of the advantages of correct coding for the profession.

Background: In Vietnam, problems of high out-of-pocket payments for health, leading to catastrophic health expenditure and resulting impoverishment for vulnerable groups, has been at focus in the past decades. Since the beginning of the 1990’s, the Vietnamese government has launched a series of social health insurance reforms to increase prepayment in the health sector and thereby better protect the population from the financial consequences of health problems. Objective: The objective of this thesis is to contribute to the discussion in Vietnam on how large the problems of catastrophic health expenditure are in the population as a whole and in a special subgroup; the elderly households, and to assess important aspects on health insurance as a means to reduce the problems. Methods: Catastrophic health expenditure has been estimated, using an established and common method, from two different data sources; the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in the Bavi district, and Vietnam Household Living Standards Survey (VHLSS) 2010. Results from two cross-sectional analyses and a panel study have been compared, to gain information on whether the estimates of catastrophic health spending may be overestimated when using cross-sectional data. Then, the size of the problem for one group, the elderly households; hypothesized to be particularly vulnerable in this context, has been estimated. The question of to what extent a health insurance reform; the Health Care Funds for the Poor (HCFP), has offered protection for the insured against health spending is being assessed in another study over the period 2001 – 2007, using propensity score matching. The value that households attach to health insurance has also been explored through a willingness to pay (WTP) study. Results: Comparing results from two cross-sectional studies with a panel study over a full year in which the respondents were interviewed once every month, the estimates of catastrophic spending vary largely. The monthly estimates in the panels study are half as large as the cross-sectional estimates; the latter also having a recall period of one month. Among the elderly households, catastrophic health spending and impoverishment are found to be problems three times as large as for the whole population. However, household health care expenditure as a percentage of total household expenditure was affected by the HCFP, and significantly reduced for the insured. In the study of household WTP for health insurance, it was iiifound that households attach a low value to this insurance form; WTP being only half of household health expenditure. Conclusions: Cross-sectional studies of catastrophic spending with a monthly recall period are likely to be affected by recall bias leading to overestimations through respondents including expenditure in the period preceding the recall period. However, such problems should not deter researchers form studying this phenomenon. If using the same method, estimates of catastrophic spending and impoverishment can be compared between different groups – as for the elderly households – and over time; e.g. studying the protective capacity of health insurance. It should be used more, not less. The VHLSS rounds offer the Vietnamese a possibility to regularly study this. The HCFP were found to be partly protective but important problems remain to be solved, e.g. the fact that people are reluctant to use their health insurance because of e.g. quality problems and possible discrimination of the insured. The findings of a low WTP for health insurance may be another reflection of this.

The 2009 reform of China’s health care system attempts to lower the burden of medical costs and provide universal access to health care. This thesis focuses on a particular access and equity gap within the health care system that faced by internal migrants, and explores the potential value of a legally enforceable and justiciable right to health care in the Chinese context to address such gaps. Despite recent advances in the health care reform, lack of a framework of health care rights could be a limiting factor to current health care initiatives which are falling short of their promises of universality in some way. In the long run, establishment of such framework could be a direction that deserves further research.

The 2009 reform of China’s health care system attempts to lower the burden of medical costs and provide universal access to health care. This thesis focuses on a particular access and equity gap within the health care system that faced by internal migrants, and explores the potential value of a legally enforceable and justiciable right to health care in the Chinese context to address such gaps. Despite recent advances in the health care reform, lack of a framework of health care rights could be a limiting factor to current health care initiatives which are falling short of their promises of universality in some way. In the long run, establishment of such framework could be a direction that deserves further research.

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1984. / Bibliography: leaves 109-114. / Microfiche. / xii, 114 leaves, bound ill. 29 cm

Thesis (Ph. D.)--University of Sydney, 2005. / Title from title screen (viewed 20 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Sociology and Social Policy, Faculty of Arts. Degree awarded 2005; thesis submitted 2004. Includes bibliographical references. Also available in print form.