M.Com. (South African & International Taxation) / The tax system in South Africa makes provision for everyday South African citizens to contribute to a greater or lesser extent towards health care funding in South Africa. However, as a result of the high unemployment rate, a large gap exists between tax contributors and non-tax contributors. This raises the question of whether it is fair that the burden to fund the proposed National Health Insurance (NHI) initiative in South Africa is borne by the small percentage of current tax contributors. The purpose of this research was to provide a taxation perspective on the different funding models and financing options available to the South African government for consideration in developing the NHI implementation strategy. The study evaluated the four traditional health care models used worldwide and assessed existing health care systems in selected first and third world countries in order to contribute towards the development of the proposed NHI system in South Africa. The health care models used by France, The United States, The United Kingdom, Brazil and Spain were evaluated in order to achieve an understanding of the funding approaches followed by these countries. It was found that although it is inevitable that South African tax contributors will have to be more heavily taxed in order to fund the NHI, as there are only limited possibilities for distributing the tax burden evenly. The main stumbling block in finding an equitable funding solution is the fact that there is a large disparity in South African income tax contributors.

Health insurance stands at the center of global debates on how nations can ensure equitable access to health care, especially for countries like Vietnam whose integration into the global economy has boosted economic development but intensified social inequality. When health insurance is promoted to low- to middle-income country contexts by development agencies such as the World Health Organization and the World Bank, what embedded cultural values accompany this? How do locally specific historical, political, and ethical concepts for managing vulnerability and uncertainty shape public understanding of insurance? To date, empirical research on health insurance’s impact has tended to examine its relation to health outcomes, service utilization patterns, or health care delivery rather than its cultural effects. As health insurance initiatives have expanded to at least 27 countries within the last decade, the universality of insurance’s value to local populations cannot be assumed. This ethnographic research investigates the cultural mediators and effects as a factor for understanding public responses to health insurance. It documents how this financial technology is transforming knowledge about how to care and manage health vulnerability. With the support of international organizations, the Vietnamese government began its universal health insurance enrollment campaign in 2015. State officials, however, identify the “Vietnamese habit” of purchasing insurance only when ill as both a technical and cultural problem to achieving universal coverage. To better understand this process, I investigated how strategies to “change the mindset of citizens” were deployed by state media and personnel, and then actively resisted, incorporated, or transformed by community members. The study took place in Vinh Long Province, an agricultural area in the Mekong Delta with one of the highest uninsured rates in the country. I conducted twelve months of ethnographic research, including 60 semi-structured interviews with community members, health insurance professionals, and health care professionals; and extended participant observation in government health facilities, insurance offices, and the homes of community members. The study analyzes the social consequences of new health insurance initiatives, the temporality of care, everyday dimensions of health care uncertainty, and their relevance to concerns within medical anthropology. I demonstrate how Vietnam’s insurance reform affected the terms through which people understood their social relations and risk subjectivities. By detailing the dynamic processes of a health insurance campaign aimed at changing health behaviors, the research reveals how financial policies are not value neutral. Rather, they reshape local moral worlds, social relations, and practices for managing uncertainty in late socialist Vietnam.

從世界各國實施社會性健康保險的經驗來看，醫療費用上漲是共同面臨的難題。本論文從道德危險的角度探討醫療服務需求面及供給面的濫用與浪費，針對部分負擔與支付制度抑制道德危險的效果，分析世界主要國家制度改革的的成效，以供我國實施全民健保的參考。 從文獻探討中可以知道：消費者會因自付價格下降，引發需求面的道德危險；而基於消費者無知及資訊不對稱之特性，醫療服務供給者會誘發道德危險。面對道德危險，實施醫療費用部分負擔可抑制醫療利用，其中以定率負擔制最能發揮功能。而具有正面誘因的支付制度，能鼓勵醫院及醫師增進醫療提供之成本控制、效率及公平性，其中，以論病例計酬制最具這些功能。 由本文實證研究的結果可看出，要有效抑制道德危險，應該注意以下幾點： 1.高部分負擔不一定對抑制道德危險有效，在商業醫療保險普及下，反而會增加低收入者的負擔。 2.為避免改革只收到短期的效果，必須同時在支付制度及部分負擔上做持續性的改革。 3.健康照護制度中的成員，本身對政策之配合度也是影響制度改革能否收到成效的重要因素。 4.影響醫療利用的因素錯綜複雜，仍有許多部分負擔及支付制度以外的因素在影響醫療資源的使用，在實施制度改革時，應同時也把其他因素納入考慮中。

A modern democratic nation is responsible to taking care its people¡¦s basic needs. This is not only the essential reason for the existence of a nation, but also its responsibility and obligation. The right to life is an important issue in international treaties and constitutions of variable nations. People are entitled to claim care from their countries to maintain a reasonable living standard. Countries are obliged to safeguard its people¡¦s right to life through legislation, to provide basic living needs which meet human nature dignity. A nation has many obligations include the maintaining of individual health, ensuring sound environment, social relief and social insurance. Financial operation is a key issue in managing a nation. Therefore, in fulfilling the obligations, a nation must consider its financial affordability seriously so as not to deteriorate its finance for overly taking care of its people. Due to rapid aging of population and low fertility, Japan implemented Long Term Care Insurance in 2000; however, many a relative legal issue was encountered while conducting such system. For instance, for the purposes of convenience and efficiency in collecting premiums, a special levy is applied to 90% of No. 1 insurees whose age were over 65, the premiums were pre-deducted from their perpetual pensions, which may cause the qualms about trenching on the capability of people to maintain a lowest living standards and the abuse of the power of administrative decision. Eyed on financial consideration, Japanese government carried out the Law for Long Term Care Insurance, refuses its service to those whose premiums were over due, and suppresses the accessibility for the poor. The group that was supposed to be taken care of by the government is totally neglected while the middle class taking advantages from the system and waste more public fund. This is completely opposite to the objectives of the long term care system legislation. This also caused the disputes that the right to life regulated in the article 25 of Japanese Constitution is violated by administrative power. Our nation is confronted with population aging and low fertility as well lately. The total fertility rate has declined to 0.895, which is the lowest in the world. In the aging society, the long term care need of the elders and the disabled, and related heavy financial burdens are already far beyond the capacities of individuals or families and become a ¡§Social Risk.¡¨ Such a risk will need a coercive risk managing technique enforced by the nation, to organize a social insurance structure so as to share the risk and reduce individuals¡¦ burdens. Our government is engaging in planning a long term care system. The flaws of Japan¡¦s Law for Long Term Care Insurance, both in legislation and enforcement, can be valuable lessons for us. This essay discussed the legalization of the long term care system of our nation, reviewed its jurisprudence and raised integrated long term care concept. Some suggestions concerned with operation subject, insurance objects and financial plans were provided in hope with a comprehensive guideline on policy making, legislation and enforcement and system construction can be established.

To set ¡§Electronic Government¡¨ into action becomes common practice all over the world. The aims of ¡§Electronic Government¡¨ are to link all government agencies, citizens and information through networking and to establish real time and interaction system services. It improves government operational procedures, promotes service efficiency and quality. There are ¡§Government to Government¡¨, ¡§Government to Business¡¨ & ¡§Government to Citizens¡¨ according to the applications of electronic business. To implement the Government to Government program, The government has deployed a¡§Electronic Gateway Information System¡¨and an E-government Common Platform Guideline to integrate interdepartmental information and simplify related operating processes. There are many important influences to lessen the need for redundant copies of official documents and to improve the efficiency of administrative procedures. The study takes Bureau of National Health Insurance Kao-ping Branch, which practice National Health Insurance in Taiwan as an example to research interdepartmental information sharing and services. That includes its performance, benefits, influential factors, and difficulties of implementation to try to seek the key problems and propose some suggestions for implementation of ¡§Electronic Gateway Information System¡¨. For examples establishing the interdepartmental integrated association, improving the system quality, protection personal detail security, etc.

On coping with the¡§hospital-based self-management＂ project implemented by the National Health Insurance in Taiwan-----A case study of an Armed Forces Hospital The global budget payment system has been implemented in Taiwan＇s National Health Insurance (NHI) for dental care, Chinese medicine and basic western medicine since 1998, and for Western medicine hospital since 2002. The purpose of this payment system is to control the toal medical expenditure by a fixed annual budget. However, it used in Westewrn medical hospital is so complicated that the fulfillment of this new system will create a new competetion era for the hospitals if without associated set of measures, its complexity is far beyond our detection. The Bureau of NHI therefore carry out variable kinds of mamagement protocols such as ¡§global budgeting system by different area＂,¡§hospital-based self-management＂, and ¡§hospital in pursuit of excellence＂, so that each branch of NHI Bureau will own a fixed amount of budget and negotiate the separate amount with the hospitals. The military hospitals are facing a critical environment; the public budget and personnels of the hospital sponsored by the National Defense Department is decreasing; and the NHI has implemented the global budgeting system which will condense the growth rate of each hospital. The thesis is focusing on the study hospital＇s model of strategic management, establishing a criteria-monitoring system in the hospital in order to analyze the details of the operating performance , when negotiating the growth rate with the Burear of NHI, which is the most important part of the plan for hospital in persuit of excellence, will find out the abnormalities and the solutions for that iii problem. The result of this study showing the management information system in a hospital will provide immediate data, analyze it and help the superintendent make decisions. It is quite critical in such a competitive environment, the information system was proved to be effective and the hospital can achieve the vision of sustainable operationOn coping with the¡§hospital-based self-management＂ project implemented by the National Health Insurance in Taiwan-----A case study of an Armed Forces Hospital The global budget payment system has been implemented in Taiwan＇s National Health Insurance (NHI) for dental care, Chinese medicine and basic western medicine since 1998, and for Western medicine hospital since 2002. The purpose of this payment system is to control the toal medical expenditure by a fixed annual budget. However, it used in Westewrn medical hospital is so complicated that the fulfillment of this new system will create a new competetion era for the hospitals if without associated set of measures, its complexity is far beyond our detection. The Bureau of NHI therefore carry out variable kinds of mamagement protocols such as ¡§global budgeting system by different area＂,¡§hospital-based self-management＂, and ¡§hospital in pursuit of excellence＂, so that each branch of NHI Bureau will own a fixed amount of budget and negotiate the separate amount with the hospitals. The military hospitals are facing a critical environment; the public budget and personnels of the hospital sponsored by the National Defense Department is decreasing; and the NHI has implemented the global budgeting system which will condense the growth rate of each hospital. The thesis is focusing on the study hospital＇s model of strategic management, establishing a criteria-monitoring system in the hospital in order to analyze the details of the operating performance , when negotiating the growth rate with the Burear of NHI, which is the most important part of the plan for hospital in persuit of excellence, will find out the abnormalities and the solutions for that iii problem. The result of this study showing the management information system in a hospital will provide immediate data, analyze it and help the superintendent make decisions. It is quite critical in such a competitive environment, the information system was proved to be effective and the hospital can achieve the vision of sustainable operation

From the implementation of National Health Insurance on March 1, 1995 in Taiwan, the public has obtained it¡¦s benefit, and it¡¦s really a blessing for Taiwanese. Following the implementation of National Health Insurance Policy, the public began having demands for National Pension due to the aging of society from 1993. As a result the authorities including the Ministry of the Interior which is in charge of National Pension, the Council of Agriculture which plans Farmer Pension, and the Council of Labor Affairs which proposes reforming Labor Pension Payment all show their attitude to take charge then positively frame each kind of pension systems. In fact, the coming of National Pension which is a blessing for the public could be the shackles to future generations. Blessing or shackles, it all depends on whether the formation of National Pension is for the public¡¦s benefit or only for the political intention. Is it for the people¡¦s lifetime protection and peaceful old age or only to make good the commitment made during the campaign? Is it a long-term, integral and foresighted consideration about people¡¦s demand or merely a short-term, sectional and realistic payback? With the basis of economic development to measure the long-term burdens and take improving financial affairs as an important condition, or, there is only one-year budget thus the local government have to raise funds and rely on central government subsidies? National Pension and National Health Insurance are both the nation¡¦s social security business, in order to benefit the public and not to recommit the same error of the current insurance systems, the authorities and other related groups should find out people¡¦s true demands and consider whether the people could afford the insurance premium but also take advantage of other countries¡¦ experience as consultation. This article is to probe into the achievement of National Pension implementation in Japan¡Xan orient country which has similar cultural background and family social formations with Taiwan.¡Xand to understand the background, current status, and the achievement of the implementation then take their strong points as an example to us. The Taiwan government planned to carry out National Pension in 2000, which is a significant social welfare policy after the implementation of National Health Insurance; unfortunately it doesn¡¦t come into effect even to this day due to the political rivalries and the substitution of political party. National Pension is a kind of compulsory savings scheme; it¡¦s a kind of insurance program and also a project of wealth redistribution. Furthermore, National Pension can be taken as the rearrangement of economic resources to regulate individual¡¦s wealth and income in the society, the arrangement of pension system would influence the management of whole economic system. The performance of pension has its dual purpose, the positive is to undertake the horizontal integration to have a healthy aged pension system; the passive is to grasp the opportunity to keep political power and electoral factors from causing the allowance or welfare systems become disordered. Lastly, to compare the main difference of pension implementation and the feasibility analysis after performance between Taiwan and Japan. Whether the pension can be put into practice or not depends on if we can achieve the most effective resources allocation of social resources, then we can see the economic benefits of pension system.

From 2002, Bureau of National Health Insurance attempted to solve the problem that the average time that a doctor uses to diagnose a sickness is to short by Global Budget System. However, in 2007, Micheal Porter argued that the average time that a doctor uses to diagnose a sickness is only three minutes. Therefore, Bureau of National Health Insurance is failed to solve this problem. In this research, we find that the time that a doctor uses to diagnose a sickness is not decided by doctors but sickness. However, the target that Bureau of National Health Insurance wants to influence is doctors. Besides, although Bureau of National Health Insurance wants to influence doctors, the people who are real influenced are operators. As the result, the average time that a doctor uses to diagnose a sickness is still short and Global Budget System lets operators not only fire inferior doctors hardly but also less invite better doctors to help. Thus, it causes sickness rights and interests damage. Besides, we try to find the high leverage solution to solve this problem. We consider three ways, including limiting doctors` patient, increasing price and helping doctors to improve their skill. After studying, we find that only helping doctors to improve their skill would not cause any side effect.

The Department of Health (DOH) has embarked on a noble initiative to address the disproportionate distribution of resources and spending within the public and private healthcare sectors. Social Health Insurance (SHI) has thus been mooted as the vehicle to obtain a more equitable healthcare dispensation. This thesis explores the state of preparedness of the DOH, for the implementation of SHI. Ten aspects of health have been identified which will assist in determining if sufficient reforms have been implemented to facilitate the successful implementation of SHI. The prospective mechanism of financing of SHI is compared to the highly acclaimed model employed by the Australian Department of Health. Two research methodologies have been utilized viz. the case study approach and semi structured interviews, to provide comprehensive data. This enabled the researcher to adequately answer the research question. The responses from the respondents on the 10 aspects of healthcare have been arranged into themes to facilitate a greater understanding of the issues being highlighted. Established strategic management instruments have been utilized to analyze the data obtained and evaluate the preparedness of the DOH for the implementation of SHI. Following the data analysis, recommendations are proposed that would facilitate the successful implementation of SHI, thereby promoting its viability and sustainability in providing quality healthcare to all who call South Africa home. / Thesis (MBA)--University of KwaZulu-Natal, 2006.

Health and safety is of the utmost importance for any company or institution to be successful. There is quite a negative perception regarding the health and safety of rural hospitals and clinics. Rural hospitals are most of the time overcrowded due the large amount of patients that has no medical aid, thus increases the risk for health and safety issues. Patients sit in long queues for hours to receive medical attention and their medication and are therefore exposed to all kinds of diseases, which is a high risk for these patients’s health. The employees working in these rural areas are also exposed to life-threatening diseases on a daily basis and have a good chance of being infected. Employees leave the public sector because of these unsafe working conditions and find themselves either working in the private sector or may even immigrate to foreign countries for better and safer working conditions. During this research done, there were a few shortcomings identified for the management to improvement on and to ensure a safe working environment. There are quite a lot of negativities surrounding the patients and employees in these rural hospitals, because patients get raped by nurses, babies get stolen from maternity wards, doctors are attacked by patients and much more horrific incidents happening in these hospitals. Cultural differences are also a main concern for management, because there are a lot of different races working together in the same department and not everyone has the same beliefs and ways in doing tasks. These cultural differences may lead to clashes amongst employees and result in a negative working environment. This quantitative research was done in selected rural hospitals, due to cost and time consumption. Only 80 employees (doctors, nurses and pharmacists) participated in the research done and the research was not an in-depth research, but enough evidence was compiled to make the necessary assumptions that all is not well in the public sector. With the new National Health Insurance (NHI) to be implemented from 2012, there may a lot of changes in the rural hospitals for the better. Hospitals all over the country are being upgraded and the working conditions are being attended to by the government which may attract more health professional to rural hospitals and clinics. / Thesis (MBA)--North-West University, Potchefstroom Campus, 2012