Master-Arbeit Univ. St. Gallen, 2006.

This policy/planning thesis takes the format of a hypothetical study done for the Senior Assistant Deputy Minister in the B.C. Ministry of Health. The Ministry had shown interest in restructuring as a means of setting some boundaries on an open-ended medical care system in order to reduce expenditures for health care services. Because the clients' specific interest was in the American health maintenance organization (HMO) model, the study was concerned with the feasibility of introducing this model into the health care structures of B.C. The problem situation of increasing expenditures for health care services in B.C. was described and relevant systems involved in the situation were identified as: the Ministry of Health, the medical profession and hospitals. The unique perspectives of each system were described so their implications for the feasibility of an HMO model could be assessed. The HMO model, in the American context, was analyzed according to its generic elements and variant characteristics. In addition, the policy process of developing and implementing the HMO strategy was described. The HMO was found to be a highly complex organization that integrates financial mechanisms and service delivery. Evidence reviewed about its performance indicated that HMOs are a less expensive means of providing care than fee for service practice, that hospitalization rates range from 20 to 40% lower and are the primary source of HMO cost saving and that enrollees probably receive comparable quality care. The publicly funded health insurance system presents a primary obstacle to adopting this model to a Canadian setting because of weakened financial incentives for competition. The principles upheld by the program also hamper enrolling a fixed population which is a basic HMO element. To implement an HMO model in B.C., considerable restructuring of financial systems would be necessary to redirect funds to an HMO so that it could be at financial risk for providing hospital and medical services to an enrolled population. In reviewing some policy options, it was apparent that an HMO model would be most easily adapted to B.C. within the context of publicly funded competition in medical care practice. However, there did not appear to be sufficient support from relevant constituencies for such a comprehensive approach. But a consensus was evident in support of an HMO pilot project in order to assess more fully feasibility problems, to build support for the concept and to evaluate its effectiveness. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

The major purpose of this study was to develop an Adaptation Model for emergency departments in urban and suburban Health Maintenance Organizations. Questions explored which provided data for the Model were: 1) are there significant differences in the demographic, sociologic, and decision-making characteristics of clients seeking services in emergency rooms and after-hour clinics?, and 2) are there significant differences in perceptions of access-related problems and stated preferences for personal physicians among clients seeking such services? A pilot study was completed, critiqued, and analyzed. Final research instruments were developed for adults and children. Questionnaires were completed by 1,031 clients in an urban and suburban facility of the Kaiser-Permanente Medical Care Program in Portland, Oregon. Data analysis was completed using the Statistical Package for the Social Sciences sub-program FREQUENCIES, CROSSTABULATION, AND DISCRIMINANT. Major findings of this study were: 1) no significant differences existed in the demographic and sociologic characteristics of clients, 2) significant differences were found in perceived problems of access, in decision-making characteristics, and in preferences for personal physicians. Significant items were: 1) convenience of the facility location, 2) immediacy and availability of care, 3) contact prior to arrival, 4) instruction by "nurse" to seek care, 5) clients reporting they did not have a personal physician, and 6) repeated use of the emergency department during the previous year. Different profiles of decision-making characteristics of urban and suburban clients resulted from the analyses. The overall pattern of care for children varied less between urban and suburban settings than did the pattern of care for adults. Findings were discussed in terms of the traditional model of emergency department care. Conflicts arising from system "controls" provided the basis for suggesting changes incorporated into the Adaptation Model. The basic premise for the Adaptation Model advances the point at which triage occurs, eliminates conflicts of control, and thus modifies both consumer behavior and the emergency department system. / Graduation date: 1982

No description available.

Bachelor-Arbeit Univ. St. Gallen, 2007.

Thesis (Ph. D.)--University OF MICHIGAN.

Thesis (Ph. D.)--University OF MICHIGAN.

Thesis (Ph. D.)--University of Michigan, 1997. / Includes bibliographical references.

Thesis (D.P.H.)--University of Michigan, 2004. / Includes bibliographical references.