Critics of user charges for government primary health care have focussed on the deterrent effect these charges might have on the poor, but there is little convincing empirical evidence that supports or contradicts these claims. The main research aims were to assess the equity effects of user charges for curative PHC services on households in 2 rural districts of Sierra Leone, a country that has suffered severe economic hardship in the last decade. Secondary objectives were to assess the feasibility of using objective means-testing to identify patients for exemption, and to recoimiend a simple methodology for acquiring the same information for local, operational purposes. A survey of 1156 households was carried out in the dry post-harvest season, and covered a range of household economic factors in addition to the actions taken in response to all reported illness episodes. A followup survey was made the following rainy season to assess seasonal effects. Supplementary information was obtained through focus groups and case studies. The data were analyzed within the framework of a conceptual model which assumed that preferences, access, and ability to pay were the main factors (or groups of factors) that determined which of several medical and non-medical treatment options would be used. Multiple regression models were used to assess the effects of each group of factors. The main findings were that, while wealthier households used cheap market drugs and expensive medical treatment options more than the poor, there was little difference in use of medium-priced PHC treatment. Household wealth and income factors correlated weakly with amounts actually paid for treatment. The immediate availability of money in the household appeared to be the economic factor most affecting utilization, with wealthier households nearly as likely = to have the amounts needed for PHC treatment on hand as poorer ones. Distance was a much more important determinant of choice of treatment than was income or assets, as were certain preference factors. However, the poor spent a much higher proportion of household income on treatment than the wealthy, so a way of limiting total expenditures for the poor would be more important than limiting their deterrence. Several readily-ascertained household factors correlated well with household income, but means-testing was concluded to be an inefficient way to accomplish the objective of selectively limiting expenditures unless incorporated into a prepayment scheme.

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In Taiwan, the environment of medical treatment is changing drastically. In fact, business competition among hospitals in an agricultural county is obviously increasing today. It is a crucial challenge for a new and large-scale hospital to survive in an agricultural county at a location without good traffic network and high resident population. For some people who are living in agricultural counties, even though the economical predicament in buying health insurance and taking medical treatment has been alleviated due to execution of the national health insurance system, but obstruction on the way to taking medical treatment is still existing for lack of medical resource, traffic convenience and others. Additionally, the patient-transfer policy among medical treatment providers does not go to practice and effect very well. Therefore, what tactics drawn up to enhance the accessibility of medical service to patients are very important to the business management of a hospital in an agricultural county. The purpose and works in this thesis research are as follows: (1) To analyze the factors that influence the accessibility of hospital to the residents and to draw up the tactics that might be effective to enhance the accessibility. (2) To analyze the factors that influences the accessibility of medical service to the patients in hospital and to draw up the tactics that might be effective to enhance the accessibility. (3) To evaluate the effectiveness of the related tactics in business management of some selected hospitals, then to confirm what are good and effective tactics. In this research, Chung-Kang memorial hospital in Chia-Yi branch, abbreviated to CKCY hereafter, was selected as a major study object. Effectiveness of four tactics that are adopted and brought to practice by CKCY was evaluated. These tactics are improvement on traffic convenience, taking benefit from tactical cooperation, popularization by providing circulating medical service and efficiency enhancement by introducing electronic business (e-business) operation. In order to evaluate effectiveness of the tactics objectively, two hospitals were also selected as study objects for comparison with CKCY. The information and data from interview with key managers and answers of the designed questionnaires that were sent to some related employees in these hospitals are used as base to evaluate effectiveness of the tactics. Based on the analysis and evaluation done in this research, the conclusions are drawn up as follows: (1) Regarding the improvement of traffic convenience, the more faraway the town, the more obviously effective the tactic. Both the shuttle bus service provided by the hospital and the prompt assistance from volunteers in the hospital are more effective to increase the number of patients than the elongation of public bus lines. (2) Regarding the tactical alliance for regional isolation, the proper radial distance of the hospital-centered region for cooperating with other hospitals is around 30 kilometers. However, it is better to ally with hospitals located in neighboring counties. Within the short distance region, it would be helpful for hospitals to take tactic cooperation in vertically integrating the medical treatment resources via division of the medical care with different hospitals on different diseases, for example, acute or chronic diseases. In the horizontal integration, it would be helpful for hospitals to set up outpatient service centers in the allied hospitals. (3) Patient satisfaction to the circulating medical service for rural communities is very high and the ratio of return patients in the outpatient service is also very high. Therefore, the circulating medical service is worth taking into practice more actively. (4) Merits of electronic business (e-business) operation in the hospital comparing with traditional operation are confirmed and listed as follows: <1>Simplifying operation procedures <2>Reducing waiting time for patients to get medical treatment <3> Improving the accessibility of medical service and patient satisfaction <4> Ensuring the correctness and integrity of hospital operation <5>Saving labor cost of hospital operation.

Obtaining a patient’s informed consent to treatment is an expected component of clinical interactions. The notion that a person as an autonomous being has a right to decide whether or not to consent to medical treatment from an informed basis has its origins in both law and ethical theory. In this research I investigate the issue of informed consent from two overall perspectives. The first concerns its basis in ethical theories of autonomy and its interpretation by the law and by health professional guidelines. The second involves an empirical examination of its occurrence within the communicative interaction between a physiotherapist and their patient, and its interpretation by the physiotherapist. I use qualitative research methods involving analysis of individual audio-taped treatment encounters in private physiotherapy practice and interviews with the treating physiotherapist. A central tenet of this study is that the translation of both legal and ethical criteria into the context of the clinical encounter requires a process of negotiation and communicative interaction between the patient and health professional. This research seeks to understand this process, and the factors that influence it in the specific context of physiotherapists and the private practice clinical encounter. (For complete abstract open document)

During the last decade a considerable number of statutes were adapted in South Africa pertaining to the medical treatment of children. Following international norms regarding this matter, South African law also prescribes a minimum age of consent for children seeking medical treatment without the parent’s or guardian’s consent. The long awaited Children’s Act revolutionised child law in South Africa in that it is a piece of legislation touching on a wide spectrum of issues which impact on children’s lives. Before the Children’s Act, matters regarding children were found in scattered fragments in a number of Acts and were not always focused on the child. The Act was hailed by children’s rights activists and generally welcomed. However, as with all legislation, the Act is not without its shortcoming and there are several areas which are vulnerable to criticism. In any communication or transfer of information, the manner in which the message or information is constructed will influence the ultimate decision. The Act does not address the manner or mode in which information is conveyed to the child. For instance, it does not address the predisposition that the medical practitioner consulting the child may have, nor does it require an impartial medical practitioner to assist the child in his/her assessment and decision in the matter. In this regard, the caution offered by Du Preez may be applicable, that “if the effective meaning of the information predominates over the conceptual meaning thereof, the listener/ reader will fail to make a proper judgement of what is being said.” 1 Section 129 does not contain any guidelines or provisions on how a medical practitioner should test whether a child has the mental capacity to understand the information regarding the proposed treatment. The study will report on the results of a consultation with a counselling and educational psychologist to determine which tests or methods could be used by medical practitioners to evaluate the maturity of child patients and the implications this could have on the child and his/her medical treatment. The prerequisites as set out in the new Children’s Act will be examined and the possible problems which might occur will be discussed. Copyright / Dissertation (LLM)--University of Pretoria, 2012. / Private Law / unrestricted

The Department of Health executed the contract with Tri-Service General Hospital on January 2, 2003, consigning the latter to render Penghu medical treatment services with the newly built ¡§Penghu Medical Care Building of Department of Health¡¨. Under the consignment, the Tri-Service General Hospital will launch an overall integration of the medical care resources of the current Penghu Hospital of Armed Forces and Penghu Hospital of Department of Health. Starting from July 1, 2006, Tri-Service General Hospital, Penghu Branch has officially come into being, bringing in human resources of the Tri-Service General Hospital, creating the medical treatment facitities in Penghu area easily accessible to upgrade the professional medical treatment services in Pengh area, enabling the local community people of Penghu area to enjoy diverse local welfare in medical services. In Penghu County, with limited medical care resources, other than the efforts to help patients release from suffering and reduce the rate of patients being arranged for medical treatment beyond Penghu area, the efforts to upgrade the quality of medical treatment services have gradually become the major goals in the consigned management. The present study aims at the concept mode of ¡§Service Quality Model, PZB¡¨ offered by Parasuraman, Zeithaml&Berry(1988) as the very ground, taking the two local service oriented public hospitals, i.e., ¡§Penghu Branch of Tri-Service General Hospital¡¨ and ¡§Penghu Hospital of Department of Health¡¨ as the target of survey, to probe into the levels of satisfaction on hospital quality of services felt by the hospital department heads, medical care service crew, patients and patients¡¦ families. The study further analizes to make sure whether the hospital department heads, medical care service crew, patients and patients¡¦ families show difference in the level of satisfaction. As indicated by the findings yielded by the present study, the two public hospitals show shortfalls in quality of services which call for immediate improvement. Penghu Hospital of Department of Health takes advantage of the geographical benefits, easy access to transportation, the close connection with the local patients and public praise and should team closely up with Penghu Branch of Tri-Service General Hospital. Penghu Branch of Tri-Service General Hospital attempts to localize the three messions in medical teratment, education and research. The doctors of the two hospitals should participate in various seminars to co-share the resources, strengthen the professional know-how to upgrade the quality of medical treatment services. The management administrator should make the department heads and medical service crew feel of how important the quality of services is. The present study may help better satisfy the needs of patients and their familities in the perspective of a consumer. The upgrade of quality of medical treatment services is a pivotal part of the public affairs on offshore island areas. The administrator should offer prominent systematic strategies in systematic services to take firm command of the quality of services and technological advantages. Only through such efforts can those hospitals create sound image and public praise in medical treatment in Penghu area to assure sustained survival and existence. On the grounds of the results yielded by the present study, the thesis, finally offers proposals for betterment to Penghu Branch of Tri-Service General Hospital and Penghu Hospital of Department of Health in terms of quality of services. Such proposals will function as handy reference to the government authorities and the subsequent researchers regarding medical treatment in Penghu area.

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This thesis explores the argument that inherent in medical treatment interventions for chronic hepatitis C, there are certain implicit ontological assumptions about the relationship between the body, disease, and society. Focusing primarily on biomedical practices, it is argued that these assumptions might have a profound effect on the world-views of patients undergoing them. This in turn, might have far-reaching sociological implications. Using a methodology specifically developed for the purpose of explicating the ontological assumptions inherent in medical treatment, the visual and narrative texts produced by thirteen hepatitis C positive participants are examined. A deconstructive analytical approach is then applied to these texts as they relate to the treatment interventions pursued by participants. An exploration of the way participants engage with, negotiate, and/or resist the discourses and assumptions inherent in biomedicine, traditional Chinese medicine, and to some extent naturopathy, is conducted. Two broad ways in which the participants visualise the relationship between disease and their bodies, relating to treatment undertaken, are identified. The possible social implications of these are then suggested. The first, and predominant view, is aligned with biomedicine. The relationship between disease and the body is antagonistic in this view. It is suggested that this way of seeing might naturalise xenophobic attitudes and perpetuate social conflict. The marginal view is related to non-biomedical treatments for hepatitis C. The relationship in this case is the result of a negotiated accommodation with the disease. It is suggested that such a view might allow for non-resistant social tolerance of that which is perceived of as new and different. This qualitative study contributes to the body of knowledge in the field of the sociology of health and illness in two ways: Firstly, it proposes a methodology that may be taken up or adapted for future sociological research, and secondly, it suggests something of the social and political nature of treatment decisions made by people living with chronic hepatitis C.

Försvarsmaktens sjukvårdsorganisation var under det kalla kriget och invasionsförsvarets dagar anpassad och dimensionerad för att kunna omhänderta tusentals skadade per dygn. Sedan 1990-talet har Försvarsmaktens inriktning fokuserat på internationella insatser. I kombination med förändringar inom det medicinska området, hotbilder, skadepanorama och folkopinionen har detta lett till nya förmågor inom den militära sjukvården. Sedan en tid har Försvarsmaktens inriktning ändrats till ett mer nationellt fokus. Vad har då hänt med sjukvårdsförmågorna? Denna uppsats använder sig av Moshe Kress teorier presenterade i boken ”Operational Logistics - The Art and Science of Sustaining Military Operations” för att göra en analys av de förmågor Försvarsmaktens insatsorganisation har idag. Kress teorier används även för att analysera vilka förmågor som krävs för att uppnå en lägsta acceptabel sjukvårdsnivå på Medical Treatment and Evacuation och vilka förmågor som bör ingå i Försvarsmaktens framtida insatsorganisation. I uppsatsen konstateras att den framtida insatsorganisationen bör innehålla förmågor för Damage Control, både sett ur ett operationellt perspektiv och ur ett medicinskt perspektiv.

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