The primary goals of the National Health Planning and Resources Development Act (P.L. 93-641) of 1974 were to (1) contain health care costs and (2) increase the accessibility and quality of health services. Certificate of need (CON) regulation is one attempt to constrain health care costs by limiting the supply of certain medical care facilities. With respect to the nursing home industry, prospective nursing home owners/operators are required to demonstrate that a "need" exists for more nursing home beds. Some States also imposed a construction moratorium that prevented any expansion of existing facilities or construction of new facilities regardless of whether or not a "need" existed. These CON/moratorium programs impose a supply side constraint that creates a potential barrier to entry and in the presence of excess demand may cause a nursing home bed shortage for those residents covered by Medicaid. Even though the Federal CON requirement lapsed in 1986, forty-two St ates and the District of Columbia continue to have a CON, a construction moratorium, or both for nursing home facilities. Yet maintaining these regulations comes with a cost.This paper investigates if differences exist in the quality of care and the access to care between nursing homes in those States without CON and/or construction moratorium and those States that still have such policies. Using data for the years 1991 through 2003 for all freestanding Medicaid-/Medicare-certified nursing home facilities in the United States and employing state and facility fixed effects models we find that Medicaid-eligible residents in those states without CON and/or construction moratorium policies have more access to a nursing home bed than those individuals in states with these policies. With respect to quality of care the results are mixed depending on the measure of quality that is employed. With the risk of becoming a nursing home resident at the age of 65 at 44 percent and at the age of 8 5 at 53 percent (Spillman and Lubitz 2002) coupled with the aging of the current population, the areas of quality of care and access to care remain important policy issues in the nursing home industry.

Magister Scientiae - MSc (Pharmacy Administration and Policy Regulation) / Aim: The purpose of this research was to assess the validity of pharmacoeconomic evaluation in Egypt three years after the guideline was issued and analyse challenges and opportunities for improvement. Objectives: To conduct a literature review of pricing, medicine reimbursement, and pharmacoeconomic evaluation. Examine, in conjunction with relevant stakeholders, the progress of the pharmacoeconomic evaluation. To present examples of pharmacoeconomic evaluation deployment. To propose recommendations on how to optimize the pharmacoeconomic implementation. Methods: A literature review and a qualitative research method that was conducted using a semi-structured interview with stakeholders of the reimbursement process in Egypt. In addition, examples were analysed to determine the impact of pharmacoeconomic methods on medicine reimbursement in Egypt. Results: The Egyptian Pharmacoeconomic Evaluation Unit was established in 2013, it supports various reimbursement decisions, especially for new technologies. The unit evaluations depended mainly on the available international data. However, fragmentation of the health care system in Egypt is a major obstacle to progress. The guidelines are still non-compulsory for implementation, and accordingly some reimbursement committees do not consider its evaluation in its decision making. Conclusion and Recommendations: The pharmacoeconomic evaluation has demonstrated a good start in Egypt. To gain the full benefit of pharmacoeconomic evaluation, authorities need to consider reducing the complexity of health care system, setting clear strategies, building capabilities to improve pharmacoeconomic awareness; endorsing risk sharing strategy and building a proper health related information system along with creation of full Health Technology Assessment program. The above-mentioned recommendations could be associated together under the Universal Health Coverage road map that Egypt committed to achieve by 2030.

The purpose of this thesis is to analyse legal provisions on business trips and the related issue of reimbursement of travel expenses. The reason why I have chosen this topic is extraordinary popularity of this institute in practice and an interest to establish to which travel expenses an employee sent on a business trip is entitled. The thesis is composed of five chapters. The first - introductory chapter defines key terms used later in the thesis: e.g. an employment relationship and its alteration, agreements on work performed outside an employment relationship, a business trip (abroad), transfer to another place, temporary assignment etc. The second chapter analyses the reimbursement of travel expenses generally. The travel expenses are defined, the role of the conditions of a business trip is explained and a possibility to stipulate the reimbursement of travel expenses is examined also with respect to the agreements on work performed outside an employment relationship. The third chapter reviews the types of travel expenses in detail. In accordance with the Labour Code (hereinafter the "LC") it distinguishes between travel expenses reimbursed by an employer who is not stated in Section 109 Paragraph 3 of the LC and who is stated in this provision. Furthermore, it differentiates between the...

BACKGROUND AND OBJECTIVES: Standard meta-analysis compares two treatments whereas network meta-analysis compares multiple treatments. In light of the increasing number of treatments available, we have seen a shift from using standard meta-analysis towards using network meta-analyses to support regulatory and reimbursement decisions. This thesis (composed of nine separate papers) applied network meta-analysis to a series of real world problems which simultaneously addressed many of these methodological issues while also supporting healthcare decision making. METHODS: In the first chapter, background information on network meta-analysis and outline the rationale for each of the subsequent chapters is provided. In Chapter 2, an applied example is presented where we use FDA Public Summary documents to populate a network meta-analysis of antithrombotic therapies for atrial fibrillation. In Chapter 3, the advantages and disadvantages of rapid network meta-analysis using ClinicalTrials.gov are investigated by re-doing Chapter 3 but only using data available in ClinicalTrials.gov and examining concordance. In Chapter 4, the application of network meta-analysis when events are rare are investigated using an illustrative example investigating the risk of serious infection in biologics. In Chapter 5, the application of network meta-analysis to a complex network – triptans for migraine – are presented where there are a large number of studies and treatments. In Chapter 6 a network meta-analysis which assesses both a benefit and harm and integrates findings using a benefit harm methodology is presented. In Chapter 7, methods to incorporate non-randomized studies into network meta-analysis are investigated using data on riskof myocardial infarction derived from the Mini-Sentinel distributed data network. FINDINGS AND CONCLUSION: Pragmatic research around methodological areas in network meta-analysis were conducted to address real world problems for decision makers. It is my hope that this thesis and the approaches used in this thesis for the application of network meta-analysis will be disseminated to enhance research capacity in conducting network meta-analysis in Canada.

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Costs of civil proceedings Abstract The diploma thesis addresses the issue of costs of civil proceedings. The aim of the thesis is to provide a basic introduction to the issue of the costs of the proceedings and subsequently, on the basis of the knowledge gained in this way, to examine aspects that the legislation on the costs of civil proceedings. The diploma thesis also contains a short comparison of selected differences between Czech and Slovak legislation on the costs of civil proceedings. The first chapter defines the specific costs of civil proceedings. The chapter is divided into 7 sub-chapters, which deal in more detail with the individual costs of civil proceedings, as they are stated in the provision of Section 137 of the Czech Civil Procedure Code. The costs of civil proceedings are the costs incurred in the connection with legal proceedings as a result of the application of the subjective right of the party. An essential factor of the costs of civil proceedings is also a matter of effectiveness. The first chapter is focused mostly on the legislation of the court fees and the reward for legal representation. Chapters 2 and 3 cover the issue of payment and reimbursement of costs of civil proceedings. In the chapter on payment of costs of civil proceedings, the author deals, among other things,...

12. Abstract Costs of civil proceedings with concentration in petty cases This diploma thesis focuses on costs of civil trial proceedings. Although costs of proceedings are often perceived as a secondary topic, their reimbursement may commonly represent a very problematic issue for a party to a case. Costs of proceedings are incurred by both parties to a case or involved parties and the state. The thesis describes different principles that are applied to decision-making about reimbursement of the costs of proceedings with regard to their origin and the type of proceedings. After a general introduction to the costs of proceedings issues I pay attention to different types of costs of proceedings. In the second chapter I deal in more detail with the representation fee, which is usually the largest expense of the party to the case. Further I explain the terms of payment and reimbursement of the costs of proceedings. I also study an institute of moderation law that enables the court in certain conditions to disallow the reimbursement of the costs fully or partially. The core of my thesis is the reimbursement of the costs in petty cases. The whole chapter is devoted to the term of petty case because of controversial issues of one instance appeal and the limits of boundaries that set petty cases. Minor cases which...

The purpose of my thesis is to point out the increase of the amount of the petty cases, to analyze its reasons, to describe the development of the relevant legislation and case law and to deal with some main legal arguments related to the issue of the reimbursement of the costs of proceedings in petty cases. The reason for my research is mainly its topicality and rapid evolution in a few past years. The boom of the mass claim recovery realized by the specialized "debt companies" was the reason of the legislative amendments and led to the ground-breaking decisions of the Constitutional Court, which resulted in the repeal of the regulation No. 484/2000 Coll. The thesis is composed of the introduction, four chapters and conclusion. The introduction is focused on the reasons of my choice of the topic and on the definition of the specific kind of petty cases my thesis is related to. Chapter Two provides the general overview of the institute of reimbursement of costs of proceeings, examines the varieties of the costs of proceedings, explicates the general principles the reimbursement of costs of proceedings is based on, explores the remedies and deals with the reimbursement of costs of enforcement proceedings. Chapter Three describes the growing amount of the petty cases, analyzes its reasons and reviews...

The Issue of Reimbursement and Price Regulation of Medicinal Products during Provision of Health Services This master thesis deals with the price and reimbursement regulation of medicinal products in the Czech Republic and with selected problematic aspects of this field. The thesis describes and analyzes the issue in broader, especially economic, contexts and aims to give the reader a comprehensive view of the subject. The work itself is divided into nine chapters. The introductory chapter outlines the issue of prices of medicinal products in general and outlines healthcare reforms that have attempted to focus more or less successfully on problematic aspects of the field. The following chapter is devoted to explaining the terms that are key or somehow unclear to health or pharmaceutical law. The third chapter deals with an economic approach to regulation and aims to explain to readers why regulation by state authorities in modern society is in some cases important and in some cases even necessary. There are also described and explained the tools of regulation and at the conclusion of the chapter the economic approach is directly reflected in the situation of the market of medicinal products in the territory of the Czech Republic. The following chapter characterizes the actual entry of a particular...