Please read the abstract in the front of this document. / Dissertation (MMed)--University of Pretoria, 2004. / School of Health Systems and Public Health (SHSPH) / Unrestricted

Data were analyzed from the 1998-2004 Uniform Data System (UDS) to identify trends and predictors of financial performance (costs, productivity, and overall financial health) for health centers (HCs). Several differences were noted regarding revenues, self-sufficiency, service offerings, and urban/rural setting. Urban centers with larger numbers of clients, centers that treated high numbers of patients with chronic diseases, and centers with large numbers of prenatal care users were the most fiscally sound. Positive financial performance can be targeted through strategies that generate positive revenue, strive to decrease costs, and target services that are in demand.

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Despite a call by researchers for estimates of the treatment clinical and cost effectiveness for relational problems, very little has been done to answer this call. The present study is an examination of actual treatment costs and recidivism rates for patients treated for a relational problem (either in individual or conjoint therapy sessions) in the CIGNA network. Despite the fact that this study compares treatment provider cost-effectiveness for treating relational problems, analyses do not control for average amounts paid by provider license type. Policymakers and third-party payers may use such clinical-effectiveness and cost-effectiveness data to make decisions regarding treatment of relational problems and funding allocation. The present study is also the first to compare the costs of couples therapy versus family therapy for relational problems.

Recently the direction of consumer mental health care in the United States has shifted in terms of its approach to recovery. In this sense recovery is not thought to be a complete amelioration of symptoms, but rather the acquisition of meaningful relationships, independent living, and fulfilling work. In response to these changes, the Utah division of the National Alliance for the Mentally Ill (NAMI-Utah) conducted consumer focus groups for the purpose of developing a tool to monitor this new conceptualization of recovery. The focus groups generated 10 recovery indicators based on recovery as the Substance Abuse and Mental Health Services Administration have defined it. This study explored initial psychometric reliability and validity estimates for these recovery indicators and their ability to track changes in recovery over time. In addition, the study also explored the relationship between distress reduction and recovery both concurrently and over time.

This dissertation examined how complexity theory might offer insight into the behavior of a population of large-scale networked organizational groups. Academic medical centers (AMCs), a large-scale social and policy system that plays a key role in the education of physicians, the conduct of research, and the provision of specialized clinical care, were chosen as an example to demonstrate the enhanced understanding that can be obtained from the application of complexity theory. Graphical and nonlinear mathematical tools were chosen to place this research study in contrast to studies that metaphorically apply the concepts of complexity theory to social systems. Complexity science suggests that AMCs will demonstrate both nonlinearity and the emergence of patterned behaviors characteristic of self-organization in complex adaptive systems. Changes in the fiscal environment of AMCs, influenced by federal policy and the health care delivery market, were hypothesized to be among the factors that mediated changes in AMCs' activities and organizational relationships during a twenty-year period. The collection and examination of multiple indicators within the framework of a study model allowed development of a rich description of the AMC system and identification of patterned behaviors. Graphical analysis was used to identify underlying periodic and chaotic attractors in the AMC system. A logistic equation was used to confirm the presence of nonlinearity. The presence of nonlinearity and the emergence of patterned behavior within schools in different managed care market groups suggested that it is appropriate to treat the population of AMCs as a complex adaptive system. The results of this research study also showed that AMCs have responded to the rise of managed care in the health care delivery marketplace by leveraging their institutional strengths. Identification of nonlinear properties offers a new perspective for understanding the behavior of a population of networked organizations, the management of large-scale systems, strategic planning, and policy formulation. Until researchers and managers recognize the coexistence of nonlinear and linear processes in social systems, they will make decisions on the basis of incomplete information. / Ph. D.

This thesis examines several recent transformations in the United States health care system and their effects on the role of physicians. Technology, specialization, ancillary health care workers, for-profit hospitals and managed care corporations have all expanded throughout the health care industry. These changes have resulted in an increase in bureaucratic, capitalist and corporate influences over the system. As a result of the increasing costs of medical practice, the corporatization of health care is occurring in which physicians must not only rely on corporations for access to the capital that they need, but also relinquish some of their power to the corporations. McKinlay and Arches (1985) assert that these changes have led to the proletarianization of the physician. Health maintenance organizations (HMOs) and other forms of managed care companies continue to grow throughout the United States. Therefore, physicians, who have historically dominated the health care system, no longer have the autonomy that they once had. To measure physicians' attitudes toward these changes, The Managed Care in the New River Valley survey was conducted. The findings show that although managed care is not as strong as it is in other parts of the country, physicians still believe that their control of health care is declining. The importance of managed care companies and other third party influences will continue to increase in the future, as they further extend to areas such as the New River Valley. / Master of Science

This thesis argues for providing spiritual care in primary care for Massachusetts persons with disabilities having Medicare and Medicaid as their primary insurers. It outlines an advocacy strategy to (1) increase awareness of the importance of spiritual care as key to primary care, (2) get buy-in for spiritual care as an optional primary care service to Medicaid beneficiaries needing nonmedical supports and services to live in the community due to mental health diagnosis or physical disability, and (3) put forward a statutory or regulatory proposal requiring One Care plans to provide certified peer chaplains as a covered service starting 2023.

Thesis (MBA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: This thesis researches World Class Manufacturing Techniques (WCMT) and their applicability in a Non-Production Environment such as an inbound call centre in the financial services sector. These WCMT involve a set of innovative techniques and principles, which are applied by foremost manufacturing companies. These techniques however, are not sacred and one always needs to refer back to the objectives of World Class Manufacturing, namely to (a) Eliminate waste, (b) Improve quality, (c) Shorten lead times, (d) Reduce costs, and (e) Improve morale and seek other improvements. The importance lies in attaining the objectives in the context of the necessary manufacturing tasks. Companies applying these techniques demonstrate significant productivity gains, production synergies, reduced rework and more reliable on-time delivery. In the highly competitive global market, these offer a competitive advantage for such companies. A critical and essential element of a company's strategic vision is a clearly defined and healthy competitive advantage. It is imperative that a company's vision is clearly aligned to its business objectives and goals. The WCMT is a tool that aligns the business vision and strategic objectives to realize its competitive advantage. By aligning the vision to its competitive advantage, it is crucial that the company challenge its existing production processes and the way in which it operates. Existing production processes need to be continuously reviewed and adjusted where necessary to sustain the competitive advantage. This paper is a practical example of how a non-production organisation can apply these WCMT to sustain its competitive advantage. The WCMT such as Theory of Constraints (TOC), Just in Time (JIT) and Total Quality Management (TQM) are discussed and applied in the inbound call centre of a medical aid administration company. In a relatively short time span, some remarkable sustainable productivity improvements were achieved. This would imply that these WCMT could be applied in traditional non-production environments. / AFRIKAANSE OPSOMMING: Hierdie navorsings werkstuk ondersoek Wêreld Klas Vervaardigings Tegnieke (WCMT) en die moontlike toepassing daarvan in 'n nie-vervaardigings omgewing, soos 'n inbeldienssentrum in die finansiële dienste sektor. Hierdie WCMT omsluit 'n groep innoverende tegnieke wat huidiglik aangewend en toegepas word in die meeste vervaardigings ondernemings. Hierdie tegnieke is nie beperk nie en verwys altyd terug na die doelstellings van WCMT naamlik (a) Vermindering van afval, (b) Verbetering van kwaliteit, (c) Verkorting van wag periodes, (d) Verlaging van kostes, en (e) Verbeterende personeel moraal en die voortdurende soeke na ander verbeteringe. Die belangrikheid van WCMT lê in die bereiking van hierdie bogenoemde doelwitte binne die konteks van die noodsaaklike vervaardigings metodes. Ondernemings wat hierdie tegnieke toepas vind groot produksiekapasiteit verbeteringe, produksie sinergie, 'n verlaging in die oordoen van foutiewe werk en ondervind ook grotendeels meer gereelde op-tyd aflewering. In die hoogs kompeterende globale mark bied die WCMT die broodnodige mededingende voordeel aan hierdie ondernemings. Die kritieke en belangrike bestanddeel van 'n onderneming se strategie en visie is die onderneming se vermoë om 'n deeglike en gesonde mededingende voordeel bo sy mededingers te hê. Dit is van kardinale belang dat die onderneming se visie behoorlik in lyn is met die onderneming se strategiese doelwitte. Hierdie WCMT is 'n instrument wat die onderneming kan aanwend ten einde sy visie en strategiese doelwitte, asook sy kompeterende voordeel, te bereik. Dit is krities belangrik dat 'n onderneming se visie en sy kompeterende doelwitte gesinkroniseer en gelykgestel is en verder dat die onderneming ook sy huidige produksie prosesse herevalueer, asook die manier waarop die onderneming opereer. Huidige produksie prosesse moet voortdurend geherevalueer en aangepas word waar nodig, ten einde die onderneming se voortdurende kompeterende voordeel te behou. Hierdie navorsings stuk is 'n voorbeeld van die praktiese toepassing van WGMT en hoe hierdie tegnieke 'n onderneming behulpsaam kan wees ten einde sy kompeterende voordeel te behou. Die WGMT soos die Teorie van Beperkings (TOC), Net Betyds (JIT) en Totale Kwaliteit Beheer (TQM) word deeglik ondersoek en bespreek. Die navorser ondersoek voorts die moontlikheid om hierdie tegnieke toe te pas in 'n in beldienssentrum by 'n administrateur van mediese fondse. In 'n relatiewe kort periode het die navorser noemenswaardige en voortdurende produksie verbetering teweeg gebring deur die toepassing van WGMT. Die navorser het afgelei dat hierdie WGMT nie net beperk is tot die vervaardigings sektor nie, maar dat dit ook in die nie-vervaardigings sektor doeltreffend aangewend kan word.

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