South Africa has a complex healthcare system. The provision and financing of health care in South Africa occur within two fundamentally different systems: the public healthcare sector and non-governmental not-for-profit organisations, on the one hand, and the private healthcare system, on the other hand. The socioeconomic status of an individual in South Africa is the primary determinant of the system through which he or she will receive access to healthcare. The healthcare services provided by the public and private sectors are perceived to be unequal. The introduction of healthcare reforms by the South African government through the National Health Insurance (NHI) aims to address these disparities. The primary objective of this study was to contribute to the successful implementation of the proposed South African NHI by identifying critical success factors that would impact such implementation. A sample of managerial representatives of the following healthcare institutions in the Nelson Mandela Bay Municipality (NMBM) was drawn: Large private hospitals groups; Eastern Cape Department of Health; Independent medical practitioners groups; South African Dental Association; Pharmacy Association of South Africa; Optometrist Association of South Africa. A total of 250 questionnaires were distributed among these institutions and approximately 233 usable questionnaires were returned (response rate 93.2 percent). A literature review was conducted to identify the various viewpoints (critical success factors, as well as positive and negative perceptions) on NHIs in other countries, as well as the proposed one in South Africa. About 43 of such viewpoints were identified. The 233 respondents were surveyed on these 43 viewpoints. The empirical results revealed the following three critical success factors for the successful implementation of the South African NHI: The projected benefits for stakeholders, with specific reference to medical aid schemes; the projected benefits to the private healthcare sector in servicing the public sector; and strategic leadership. The empirical results also showed that the healthcare managers, who serve the poor versus the affluent geographical areas of the NMBM, differ with regard to their projected success of the NHI. Finally, the study highlighted these health managers’ general perceptions about the envisaged benefits and shortcomings of the NHI.

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

一個國家要維持正常穩定的運作狀態，作全面性的有效管理，是立足於現代社會環境的必要條件。如何建立一個低風險、高水準的生活環境與社會保障（Social Security）體制，是現代社會中急切而且必要的措施。 在各項社會保障體制下，醫療保險的保障範圍最大、內容最繁複，且攸關人民健康與生命最密切，世界各國均非常重視。中共在建政之初，醫療制度由國家包攬，由於缺乏成本概念，加上管理制度不健全，造成許多醫藥資源浪費，使國家財政難以負擔。改革開放後，隨著經濟體制的轉軌，原有計劃經濟體制下的醫療保險已不合時宜，因而於1998年正式將以往之醫療保險做全新的變革，由於中國大陸地大人多，各地在醫療改革上的重點及進度不一，且實行上都未臻完善，然改革目標卻是一致的。為配合醫療保險制度的完善，中共政府除於1998年頒訂醫療保險改革措施外，複於2000年推出醫藥衛生體制改革措施與之配套，期能「在醫療保險制度改革中引入分擔機制；在醫藥衛生體制改革中引入競爭機制」。而於其醫療改革實施方式中，多處可見其參酌國外觀念與台灣全民健康保險之蹤影存在。 在連串的試點、擴充改革範圍的執行下，中國大陸一方面發展其既定之改革與配套措施，一方面也面臨許多執行上的瓶頸。然而無可否認的，隨著中國大陸加入WTO，外來醫療資源的進入，對中國大陸醫療相關產業與社會發展造成相當的刺激。中國大陸在躋身國際，走入全球化的腳步中，對於本身特殊條件造成的醫療改革缺點與障礙必須努力排除，否則其與世界的接軌，將因內部貧富不均等社會因素所造成的社會不穩定而功虧一簣。本論文在對中國大陸醫療改革措施的肯定與鼓勵之同時，亦針對轉軌中的改革政策及執行缺失提出檢討。 關鍵辭：社會保障、醫療保險、醫療改革、全民健康保險 / Overall and effective management is indispensable to a nation to assure sound and secure operation. How to set up a low risk, high level social security system is the very essential for the society today. Under all sorts of social security systems, medical insurance offers the largest coverage and most complicated contents. Such medical insurance is closely related to nationals' health and assurance of life. In People's Republic of China, the medical system was provided by the nation in package in the initial phase after it came into being. With lack in cost concept and unsound managerial systems, they have undergone critical waste in medical resources, leading to heavy burden to the nation. After People's Republic of China launched the reform and open-door policy, the economic systems have been restructured. The previous medical insurance system under planned economy no longer oriented itself to the trends. In 1998, therefore, it launched an overall reform. With vast territories and huge number of population, the medical reforms have been launched in varied highlights and paces, not satisfactorily though they have all aimed at the same objectives. The PRC government launched the medical reform in 1998 and further worked out the supporting package for the medical and health system reform in 2000 in an effort to "bring in sharing instrument in the medical insurance reform and bring in competition instrument in the medical & health system reform". In the medical reform, foreign concepts and the National Health Insurance launched in Taiwan have been significantly seen. In the series of tests and expansions. People's Republic of China has launched the established reform policies on the one hand and run into significant bottlenecks on the other. Undeniably, anyway, with foreign medical resources pouring in in the wake of the WTO admission, the business lines and society in China have undergone tremendous stimulation. In the pace of playing a pivotal role in the global village, China must try by all means to remove the stumbling blocks on the way of medical reform otherwise the significant gaps between the rich and the poor and such social problems must ruin the entire efforts. This thesis focuses on the reassessment on the shortcoming China has undergone in enforcement of the policies while approving the praiseworthy performance in the medical reform. Key words: Social security, medical insurance, medical reform, National Health Insurance

許多公共政策的的實施雖以提升社會福利為出發點, 但往往造成了扭曲 勞動市場的現象。為了瞭解實施公共政策對勞動市場會產生多大的衝擊, 在 本論文中, 我們以台灣為對象, 分別探討兩項公共政策對勞動市場的效果。首 先我們探討全民健康保險制度的實施對勞動市場均衡工資與工時的影響。台 灣自1995年起推行全民健保, 以透過收取健保費的方式來籌措經費。但由於 員工及雇主所負擔的健保費為員工薪資的比例, 如同對員工課徵了一筆薪資 稅, 加上健保費與健保福利兩者在制度中並沒有任何關聯, 因此, 在這樣的機制之下, 我們認為全民健保的實施對勞動市場將可能形成負面衝擊。我們的 實證結果發現, 全民健保的實施的確會使勞動市場均衡工時下降, 但對均衡 工資率的效果則不顯著。其次, 本論文探討勞動保護法令的實施對勞動市場 流動的影響。台灣於1984年實施勞動基準法。由於勞基法是台灣第一套全面 性的勞動法規, 在勞基法實施後, 勞工在就業上受到許多保障, 但相對的, 卻提高了雇主的解雇成本。雇主很可能為了因應較高的解雇成本而減少解雇數 量, 且在雇用新進員工時也變得相對保守, 使勞動市場的流動將會因此降低, 進而可能造成生產力下降等的社會成本。我們的實證結果顯示, 勞基法的實 施會使勞動市場流動下降。而且, 當勞動檢查越嚴格時, 勞動市場流動亦下 降得更嚴重。 / The original purpose of most labor market policies is to enhance social welfare of a specific group of individuals and sustain a fair social relationship. However, the labor market may be distorted by the introduction of these public policies. In this thesis we examine the labor market effects of two public policies in Taiwan. Firstly, we investigates the impacts of national health insurance on the labor market. Taiwan's national health insurance is financed by premiums, which are proportional to an employee's salary. These premiums may introduce distortions to the labor market. Based on repeated cross-sections of individual data we find that, on average, private sector employees' work hours declined relative to their public sector counterparts, while their relative wage rates were almost unchanged with the introduction of national health insurance. Secondly, we investigates the effects of employment protection legislation on the rates of worker flows, job reallocation, and churning flows. Our study’s empirical identification takes advantage of the natural experiment created by Taiwan's enactment of Labor Standards Law, which substantially increases the costs of firing an employee, in 1984 and the subsequent measures of the law’s enforcement. Moreover, our identification also exploits the fact that in Taiwan the stringency of Labor Standards Law’s provisions and the intensity of the law's enforcement vary with establishment size. Our analysis is based on monthly data at the establishment level for the period 1983–1995. We find that Taiwan’s Labor Standards Law and its enforcement measures dampen worker and job turnover rates for medium-sized and large establishments, and the dampening effects vary with establishment size.

研究動機與問題：本研究最主要的目的希望能夠將最易被大家忽略的健保醫療檢驗資源使用問題，從實務面上探討，並指認出有效使用醫療檢驗資源的關鍵因素，針對這些因素與措施進行評估，歸納出具體明確可行的方向，提供主管機關做為費用管控的參考，為我國健保永續經營貢獻一份力量。 本研究根據研究動機與目的，設定三個研究問題：1.影響醫師有效的使用醫療檢驗資源的因素有哪些？2.藉由桃園縣執業醫師的看法了解有效使用醫療檢驗資源關鍵因素為何？3.不同執業院所、服務科別、職別的醫師對有效的使用醫療檢驗資源看法是否有差異？ 研究資料與方法：以文獻回顧法、問卷調查法、深度訪談法蒐集資料及驗證資料；研究過程分三個階段進行，第一階段為背景資料與文獻資料的蒐集，瞭解醫療檢驗資源使用現況與問題，並透過訪談實務界菁英驗證文獻與補充資料不足；第二階段依文獻分析與彙整內容設計問卷與訪談大綱；第三階段將回收的問卷編碼、整理後以Excel/2003版與SPSS for window12.0版套裝軟體進行資料分析；深度訪談資料透過內容分析法予以歸納整理分析。獲得研究答案，達成研究目的。 研究結果與建議：量化研究部分，本研究共分送488份問卷，回收318份，回收率為65.1％。並以卡方檢定樣本與母群體並無差異，可代表母群體。質化研究部分，深度訪談三位年資10年以上實務界菁英，建構本研究實務上的概念。歸納研究結果：醫療檢驗資源有效使用的關鍵影響因素有「醫療風險」、「病人就醫行為」與「照護之連續性」3項。根據研究結果，為有效使用醫療檢驗資源，必需減少醫療風險、規範病人就醫行為與進行照護流程改造。 / Background:The purpose of this research is to find out the influencing factors related to the usage of resources for medical examinations under the Taiwanese National Health Insurance (NHI). From the practical point of view, this research focuses on, the first, defining the efficient use of medical test and then finding out the critical factors effecting the efficient usage from medial practitioners’ viewpoints in Taoyuan County, Taiwan. It is expected to provide advisory values to improve the global budget system of NHI. Research Questions: 1.What are the factors influencing doctors to utilize medical examination efficiently? 2.What are the certified medical doctors of Taoyuan County thinking about these factors? 3.Concerning the above factors, do there exist systematic differences among medical doctors from different hospitals, rank of medical doctors and fields of profession? Methods: In this study, author utilizes literature review, questionnaires, and in-depth interview. The survey was divided into three stages. First, related information was collected to clarify the problems of medical examination usage in present situation from both interviewing medical practitioners and literature review. In the 2nd stage, a general questionnaire was designed to administrate to selected medical doctors in Taoyuan County in mid-2008. The last stage was data coding and analyzing by using Excel/2003 and SPSS for Windows. The return rate was 65% (318/488) and there is no difference between population and sample after consistency test. Results and Suggestions The results show that the key factors of efficient medical examination usage are medical risk-aversion of doctors, clinical shopping of patients, and the need to medical care continuity. These exist a greater viewpoint differences between different level of hospital than different ranks or specialties of doctors. These results will lead the author to suggest that the Bureau of NHI needs to promote adequate mediation mechanism to reduce medical risk, to promote inter-hospital patient information sharing system, and to improve the logistic of continuity care.

全民健保自開辦以來，財務一直存在入不敷出之隱憂，醫療院所頻頻呼籲健保的給付不足，將造成經營困難。除此之外，醫師人口逐年增長、診所成本入不敷出、人口老化迅速及新醫療設備之引進及各政策之影響下，本研究想瞭解在競爭及不確定的環境中，診所應如何以創新經營。本研究導入資料採礦之觀點，將商業智慧用於眼科診所之案例，利用忠誠度分析、流失度分析、獲利貢獻度分析、就診時段分析，想瞭解診所客戶之特性並且針對其習性及特點，並加上SWOT分析，清楚瞭解診所內部之優缺點及外部的機會與威脅，作好準備以謀取事業的永續發展。忠誠度分析之結果發現，其特點為家庭來診人數最多，性別比例較其他集群平均，案類分佈則以一般案類為主，年齡層為22歲以下及35歲以上居多；而在獲利貢獻度中，高利潤收入之地區分佈為竹北市、新竹市明湖路、福德街等；在流失度分析當中，研究發現客戶群在22歲以下，案類為一般案類，且兩人看診家庭的流失比例最高；最後就診時段分析當中，發現所有病例之地區時段、看診日分析看診人數除星期四外，皆以早上時段為最多。資料採礦是很好的輔助工具，將商業智慧應用於診所之經營上，可依照不同的分析集群搭配不同的行銷策略，增加競爭力，規畫創新之營運模式，以追求更好的發展。 / Since its start, expenditure exceeding income has always been a hidden concern in the finance of the National Health Insurance (NHI). Medical clinics have repeatedly said insufficient payment from the NHI will result in difficulty in their management. Moreover, other factors are affecting the clinics, namely, the growing number of doctors statewide, the income shortage of running a clinic, the rapidly aging population, the introduction of new medical equipment, and the various new policies. This paper intends to explore some innovative management plans for the clinics in a competitive and uncertain environment. Business intelligence is applied in the case study of an eye clinic. The analysis of client the degree of loyalty, run off, profit contribution, and visiting time help understand client habits and characteristics. A SWOT analysis further helps the clinic clearly understand its own strength and weakness, and the opportunities and threats from outside. Thus it can better prepare itself for a long term business. The analysis of client the degree of loyalty shows the following: most of the clients are family members; there is an even male/female ratio while in other categories it is not so; most medical cases are general cases; most of the clients aged under 22 or above 35. The analysis of the degree of profit contribution reveals that the districts related to higher profit are Zhubei City, and Minghu Road and Fude Road of Hsinchu City. In the analysis of The degree of run offs, it is found that most of them are under 22, most medical cases are general cases, and most of the clients are two people from a same family. Lastly, in terms of visiting time, analysis shows that most of the clients, regardless of their residential areas, visit in the morning except on Thursday. Business intelligence is an helpful tool. According to the analysis a clinic can match different client groups with different marketing policies, enhance it competitive edge, plan for an innovative management model, and pursue a better development.

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

全民健康保險自實施以來，透過危險分擔與社會互助的原則，降低了民眾就醫時的財務障礙，進而促進了全體國民的健康。可是由於收入成長減緩與支出不斷增加的情形，使得這個制度目前已面臨嚴重的財務危機，然而在目前政治與經濟環境的雙重影響之下，健保收入已無法有效增加，因此努力控制醫療費用支出，便成為當務之急。但是全民健康保險是一項社會福利政策，不能因為控制醫療費用而降低了醫療品質。如何將醫療資源有效分配，以便減少醫療資源浪費、維持醫療品質並減輕醫療費用的支出，便需依賴一個良好的審查制度。 然而對於醫療費用的審查，不管在設計、分析、控管乃至評估上，都是知識密集的工作，而且審查的過程還必須藉由專業審查者的參與始能完成，因此如何善用資訊科技予以適當之輔助，便成為醫務管理上一個非常重要的議題。 本研究使用健保局北區分局感冒等疾病之就醫資料作為樣本，在分析過國內外對醫療費用審查的建議方式後，嘗試設計一個新的自動化審查機制，並發展一套以資料發掘為基礎的自動化審查雛型系統，希望能在醫療院所申報的記錄中找出共同的規則，並利用這些規則自動將有問題的資料篩選出來，幫助健保局與專業審查者將焦點集中在有問題的資料上，以便能更有效率的進行審查的工作。 本研究所得到的結果，經健保局人員與專業審查醫師檢視後，認為確實可行，除了證明資料發掘技術可以有效地應用在醫療費用審查，並帶來可觀的效益之外，還達到有效降低審查人力、提昇審查效率的目的。而對於這種自動篩選出異常的審查方式，應如何實際加以應用，本研究也提出了具體的建議架構及實施步驟，供健保局在未來建立自動化審查制度時的參考依據。