Magister Legum - LLM / In South Africa, there are two health systems through which health services are delivered,1 namely private and public. These two systems were inherited from the apartheid regime.2 With South Africa’s political change from a system of parliamentary sovereignty to a constitutionally supreme system in 1996, huge changes were bound to come including changes to the health sector.3 This meant the overhauling of health legislation, as the right of access to health care services became guaranteed in the Constitution of the Republic of South Africa, 1996.4 In 1997, the White Paper on the Transformation of the Health System (White Paper on Health)5 was introduced with the aim of developing a national health system.6 There has been a lot of progress made in reforming the health sector, however there are still many cracks that the national government aims to remedy through the realisation of universal health coverage (UHC).

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Thesis (LLM. (Labour Law)) -- University of Limpopo, 2013 / The South African government gazzetted the Green Paper introducing the NHI on 12 August 2012. This policy seeks to progressively realize the right of access to quality health care services for everyone. Those who cannot provide for themselves will be assisted by government at the expense of the elite. The NHI was first recommended by the Taylor Commission and it has been under the discussion since then. Since this announcement, there has been growing pressure for mandatory health insurance to be included in the development of a comprehensive social security system, as was envisaged by the Taylor Committee of Inquiry. This discussion was further debated at the 52nd conference of the African National Congress (ANC) in Polokwane in December 2007 where numerous resolutions were taken with regard to the NHI. The Freedom Charter of 1955 and also section 27 and 28 also provided some guidance.

The National Health Insurance Scheme (NHIS) in Ghana was introduced to alleviate the problem of citizens having to pay for healthcare at the point of delivery, given that many did not have the financial resources needed to do so, and as such were unable to adequately access healthcare services. The scheme is managed from the national headquarters in the capital Accra, through satellite offices located in districts right across the length and breadth of the country. It is the job of these offices to oversee the operations of the scheme within that particular district. Current literature however shows us that there is a digital divide that exists between the rural and urban areas of the country which has led to differences in the management of information within urban-based and rural-based districts. This thesis reviews the variables affecting the management of information within the scheme, and proposes an information management model to eliminate identified bottlenecks in the current information management model. The thesis begins by reviewing the theory of health insurance, information management and then finally the rural-urban digital divide. In addition to semi-structured interviews with key personnel within the scheme and observation, a survey questionnaire was also handed out to staff in nine different district schemes to obtain the raw data for this study. In identifying any issues with the current information management system, a comparative analysis was made between the current information management model and the real-world system in place to determine the changes needed to improve the current information management system in the NHIS. The changes discovered formed an input into developing the proposed information management system with the assistance of Natural Conceptual Modelling Language (NCML). The use of a mixed methodology in conducting the study, in addition to the employment of NCML was an innovation, and is the first of its kind in studying the NHIS in Ghana. This study is also the first to look at the differences in information management within the NHIS given the rural-urban digital divide.

This thesis explores the implications of democratisation on the regulation of health care providers. It examines the reforms in relation to two regulatory policies in the pharmaceutical market of the National Health Insurance (NHI) in South Korea – the separation of prescribing and dispensing (SPD) and the pharmaceutical pricing policy – conducted in two periods – the 1980s under the authoritarian regime and the 1990s under the democratised regime. The misuse and overuse of drugs had long been recognised as a problem for the NHI, and the tight regulation of the SPD and pharmaceutical pricing as potential solutions. Democratisation seems unlikely to tighten the government’s regulation of the SPD and pharmaceutical prices. On the one hand, the Korean authoritarian regime was known as being capable of conducting top-down regulation of societal groups, and democratisation as having liberalised the government-society relationship. On the other, pharmaceutical regulation is a sophisticated and detached issue, which restricts the ability of laypeople to mobilise and exert bottom-up pressure for regulation. Nevertheless, the authoritarian government failed to tighten, and even loosened these regulations, whereas the democratised government tightened them. This thesis explains this puzzle by focusing on the features of the agenda-setting process and the articulation of policy issues therein. In the 1980s, the SPD and the pharmaceutical reimbursement pricing policy were administrative issues, discussed exclusively between bureaucrats and the central associations of health care providers, which resulted in loose regulation. In contrast, in the 1990s, reform-oriented professionals and NGOs raised these issues and put them on the political agenda, which motivated the government to conduct tighter regulation. This thesis suggests some general implications of democratisation on the politics of regulation. The hierarchical and exclusive authoritarian policy network aims to realise policy goals set by ruling elites; however, for other policy issues, societal partners can utilise this network to promote their preferred policies. Democratisation, which promotes competitive elections and political rights, allows previously excluded policy actors to participate in policy-making networks. These new actors include professionals and activists who are able to understand regulatory issues and articulate them in ways that are salient to politicians and the general public, which will motivate the government to tighten the regulation governing its traditional policy partners.

Thesis (LLM ( Labour law)) --University of Limpopo, 2013 / Refer to document

Given the general poor state of health care and the devastating effect of user fee, the National Health Insurance Scheme (NHIS) was instituted as a health financing policy with the main purpose to ensure universal access for all Nigerians. However, since NHIS became operational in 2005, only members of scheme are able to access health care both in the public and in private sectors, representing about 3% of Nigerian population. The thesis therefore examines the design and implementation policy of NHIS in Oyo state, Nigeria. Key design issues conceptual framework guides the analysis of data. The framework identifies three health interrelated financing functions namely revenue collection, risk pooling and purchasing. Data was collected from the NHIS officials, employees of the Health Maintenance Organisations (HMOs) and the Health Care Providers (HCPs) using key informant interview. In addition, in-depth interview and semi structure questionnaire were used to gather data from the enrolees and the nonenrolees. Empirical findings show that NHIS is fragmented given the existence of several programmes. In addition, there is no risk pooling neither redistribution of funds in the scheme. Revenue generated through contributions from the enrolees was not sufficient to fund health care services received by the beneficiaries because of the small percentage of the Nigerian population that the scheme covers. Further findings indicate that enrolled federal civil servants have not commenced monthly contribution to the NHIS. They pay 10% as co-pay in every consultation while federal government as an employer subsidised by 90%. Majority (76.8%) of the respondents agreed that they were financially protected from catastrophic spending. However, the overall benefit package was rated moderate because of exclusion of some priority and essential health care needs. Although above half (57%) of the respondents concurred that HMOs are accessible, in the overall, (47.6%) of the respondents were not satisfied with their services. In the case of the HCPs, majority (61.9%) of the respondents claimed that there is no excessive waiting time for consultation. Furthermore, (64.3%) rated their interpersonal relationship with the HCPs to be good. However, more than half of the respondents (54%) disagreed on availability of prescribed drugs in NHIS accredited health facilities. For the nonenrolees, findings show that most of the respondents (72.9%) were willing to enrol, but significant proportion (47.5%) indicated financial constraint as impediment to enrolment. / Sociology / D. Phil. (Sociology)

綜觀世界社會福利進步之國家，一方面致力於促進經濟成長，提高國民所得，一方面則積極推展社會保險，以兼顧社會福利及安全，俾使經建成果為全民共享。我國憲法明文規定社會安全為基本國策之一，而社會安全重心首推全民健康保險，故推行全民健康保險是政府責無旁貸任務，而其成效之良窳，端賴其是否妥善規劃。就現今實施全民健康保險，，規劃仍有未盡周詳之處，因而不僅易招致民怨，製造徵納雙方無謂困擾，更違反政府謀求全體國民最大福祉之目標，因此為鞏固全民健康保險實施基礎，以確保其千秋大業，更須針對全民健康保險制度之疏失予以檢討改善。 　　本研究係針對全民健康保險規劃未盡周延之處，分析問題之所在，繼而集思廣益去蕪存菁以尋求問題之改善方法，茲將研究結果歸納如下︰ 　　一、為謀求全體國民最大福祉，追求社會公平正義，全民健康保險法無職業受扶養親屬規定應與所得稅制無職業受扶養親屬二者作一銜接與配合。 　　二、為避免全民健康保險予擾所得稅制之機能，維持實質所得稅制免稅額（扶養親屬寬減額）與保險費扣除額不變，應將所得稅制下免稅額、保險費扣除額予以調整反映之。 　　三、鑒於投保金額分級，以每一等級之上限為投保金額，產生非預期性逆所得重分配現象，違反社會公平正義，宜將投保金額予以修正。 　　四、全民健康保險保險費徵收基礎，因被保險人身份產生差異，考量公平原則、所得重分配效果、行政效率及費率影響，故將標準予以調整。 　　五、眷屬投保金額反映以被保險人投保金額設算眷屬經濟能力之特質，若被保險人僅具扶養之名，不具扶養之實，為求眷屬保費負擔公平及合理性，宜尋求適當投保金額。 　　為使全民健康保險成為我國社會保險之中流砥柱，對保障全體國民身心健康，維護社會安全，貢獻良多，應秉持促進全體國民最大福祉原則，將全民健康保險法規定之不合理地方，考慮與所得稅制相關規定銜接與配合，並參酌專家學者意見，國外實施社會保險國家之經驗，以解決全民健康保險制度未盡周延之處。

The purpose of this study is to find existing circumstances in our country and a elder long-term care system of preventing transitions. Through the existing social insurance, for example: health insurance, national pension, labor insurance and the elderly welfare legal in our country, to compare with the other social countries, I hope to use the research analysis to find the problems of policies or legislated process that we need to prevent before the elder long-term care insurance started. Through the generalize analysis and history development of elder long-term care in many countries, use the Constitution and the Administrative Law to examine what Council of Grand Justices about Social Insurance interpretation and compare with the official policy offered by our government. I expect to avoid making mistakes and dispute like before and establishing the elder long-term care system which relieving burdens. After the analysis, I found that all of the advanced countries are almost confronting by problems like aging of population and the birthrate has been decreasing, and also confronting lack of care members and long-term care needed huge monetary payment issues. The key core of all the problems is whether it has enough money to the whole social welfare countries to be successful. Social welfare in democratic countries also face election activities carrying on social welfare politics. Ignoring national finance situations and majority political men were merely thinking off-the-shelf votes. It is priority for elder¡¦s policy but ignores the generation justice issues. Let me worry about whether descendant whom need care, not these elders, are there generations conflict being happened? In my opinion, to solve these problems is strengthening family function. If the whole social and nation wants to be stable, it is important to strengthen the family function. Therefore, the elder long-term care should be considered main family basis, in addition to ought to maintain the elder long-term care system and dualism and co-operate with National Health Insurance to work in coordination. The other elder social insurances have to adjust to unity, includes all kinds of old-age pensions similar nouns. Finally, it should be a definite principle and laws, and decrease indefinite concepts of law and reduce administrative discretion rights regarding pay items, thus it will protect people¡¦s rights instead of incurring damage beyond that could bring supervisory mechanism functions into full play after that.

South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.