This study explores the policy options for health insurance in Thailand, considering the present structure of the country and taking account of international experiences. The development of health insurance in Thailand is analysed from the supply side i.e. health services. The problem of inefficiency and inequity in the health care system has led to the search for better alternatives for organizing and financing. This coincides with the overall growth in the country's socio-economic situation and the policy of health insurance laid down in the Sixth Five Year Health Development Plan (1987-1991). These factors provide positive conditions for establishing health insurance in Thailand. The demand for health insurance from employers who are likely to join the scheme is investigated. A survey of 200 private establishments in Thailand was conducted. This investigation provides essential national baseline data for the organization of health insurance, particularly on the health care fringe benefits provided by employers, and the methods of paying health care providers. Methods of organizing health insurance are formulated from international experience. The historical development of voluntary health insurance and its modified forms, as well as that of compulsory health insurance, are examined. The arguments for and against each form of health insurance are analysed. The study also highlights salient issues of health care reforms which attract the world's attention. International experience has shown that methods of paying providers is a major issue in providing viable health insurance. The study comprehensively analyses the advantages and disadvantages of each method of paying the doctor and the hospital under health insurance systems. Finally, it explores the policy options for the future development of national health insurance in Thailand.

This thesis relates informatics to the problems of health and medicine experienced in less developed countries. It evaluates the potential of health informatics and investigates the issues that constrain successful implementations. This serves as a basis for establishing a generic description of viable computer applications in the developing world. The thesis contains two case studies from sub-Saharan Africa. The first, undertaken in The Gambia, is based on a computer-assisted data collection system used in a longitudinal child health survey. The second, undertaken in Kenya, relates to a medical decision-aid system used in an out-patient clinic of a district hospital. In each case, an outline is given of the background to the application domain, and an analysis is made of some comparable prior systems that have been developed and evaluated. The two case studies provide interesting investigatory comparisons since both systems are used by health personnel with little computer experience, and exploit some state-of-the-art technologies despite the identified constraints that exist in developing countries. The context, system design, methods, and results of each case are described. A generalised evaluation approach is proposed and is used to summarise the case study findings. The evaluation framework employed includes components related to functional and human perspectives as well as the anticipated benefits to the health care system. The thesis concludes by suggesting some guidelines for the design and evaluation of future health information systems.

Relying on new empirical data, derived from a survey, and supplemented by an extensive study of available secondary material, this thesis represents the first attempt systematically to explore key issues regarding occupational welfare in Russia, with special reference to health care. The thesis is divided into three parts: a discussion of the problematic; an investigation of the evolution of policy; and an examination of primary and secondary empirical data. The fundamental theoretical problems of occupational welfare are approached in the light of research in the West, in the Soviet Union and in post-Soviet Russia with emphasis both on divergences and commonalities. It is argued that any endeavour to separate Soviet and Western experiences is artificial and ultimately unproductive. Rather, the analytical penetration of ideological barriers renders possible an examination of their fruitful interaction. On the basis of existing knowledge two perspectives of occupational welfare -- social policy and organisation -- are introduced. An attempt to formulate a general definition of the notion of occupational welfare is also made. The evolution of occupational welfare and in particular its health care component are examined in their context, from the Tsarist era, during the Soviet Union and through to post-Soviet times, with a concrete aim of elucidating any continuities in policy pathways. Contemporary issues are associated with the initial outcomes of health reforms in the 1990s that are indispensable for projecting the future prospects of occupational welfare. The empirical component of the thesis reports the results of fieldwork carried out in Moscow between 1995 and 1997. The brief was to explore the contemporary status of occupational welfare in Russia in the context of changing social policy aims and methods evolving in the course of the transformation. The attitudes of senior managers of industrial enterprises providing in-kind health services for their employees were investigated, as were employers' actual health responsibilities in the light of the introduction of compulsory health insurance legislation. It is argued that occupational welfare has a distinct sphere of operation and offers potential, not only for the survival of the service area but also for its further development in the evolving socio-political environment. The thesis is a first step towards a deeper analysis of occupational welfare in Russia: an audit of outstanding issues, although not exhaustive, completes the account as an aid to further discussion and research.

This thesis aims to contribute to the debate surrounding the underlying medical, social, economic and political determinants of health status improvement. The Hashemite Kingdom of Jordan was chosen as the case study because of its exceptional performance as evidenced from various international comparative data studies. An added dimension which contributes to the benefit of studying a country like Jordan, is its status as an Arab society and a middle-income country. The processes affecting health in countries that fall in these categories have not been sufficiently assessed. The primary measure of health status used is the infant mortality rate, which had fallen to 35/1000 by 1987. A review of the theoretical literature and of previous case studies on the inter-sectoral determinants of health is presented. Economic performance, national and international politics, urbanization, housing, water and sanitation, nutrition, education, fertility and the availability of health services are examined to ascertain their relative impact on the overall health status of the Jordanian population. Particular emphasis is accorded to the way in which these factors affect Jordanian women and their roles in society and the economy. Separate sections of the study are allocated to each of the above-mentioned variables. In a separate section of the thesis, the same variables are examined for the Palestinian refugee population. The refugees comprise a significant proportion of the population and their needs are met almost entirely by UNRWA. The multi-sectoral elements which have led to the success of the Jordanian experience in health development are examined closely in the concluding chapter. These include regional and international favourable conditions, strong government commitment and a high level of awareness among the population. Policy recommendations for future health sector planning in Jordan and other Arab and middle income countries are outlined.

The vast majority of Africans living in rural areas do not have access to health insurance and policy related questions to assist health planners design and implement financially viable rural health insurance schemes have yet to be fully addressed. This thesis seeks to fill some existing gaps in the knowledge about the performance of existing schemes and methods of assessing "willingness to pay" (WTP) and financial feasibility. It begins with a review of the literature on the theory of insurance and its practice in rural areas in Sub-Saharan Africa, that contributed to the research conceptual framework and implementation. Two health insurance schemes (La Carte d'Assurance Maladie and the Abota in Burundi and Guinea Bissau), were evaluated regarding their social and financial performance in rural areas. The research instruments were household surveys, focus group discussions and health facility costing. In both schemes access to health care appeared to have improved and the findings suggested that were quality of care improved, the schemes would considerably reduce financial concerns faced by people at the time of illness. They would also raise significant revenue. In the third study country, Ghana, a study of preferred benefit options, WTP, and community rated premiums for a proposed health insurance scheme was undertaken in a rural area. In undertaking this feasibility study, the research developed a WTP instrument and used a contingent valuation approach. Eight hundred households participated in the study. Eighty percent of households said they would be willing to pay the premium required to recover 100% of the non-salary recurrent costs of providing OPD care in a local clinic and inpatient care in a hospital. The stated WTP was conditional on; a) the insurance scheme giving access to health care in which drugs and basic laboratory investigations would be available, b) health staff being professionally qualified and respectful, and c) a local solidarity association having a role in administering the participating health facilities. Econometric analysis of households' WTP for outpatient insurance cover supported the hypothesis that WTP is influenced by a) the experience of frequent difficulties in paying for health care in the past; b) the perception that adults in the household are healthier than those in other households; and c) the household head's sex, education and religion.

Achieving active participation of community members in community-based health care programmes (CBHC) is a challenging and complex task. It is also a criterion for successful programming and is promoted as a universal truth and requirement for primary health care development. Nevertheless, most CBHC programmes admit that more needs to be done to achieve satisfactory levels of community involvement. Thus, a better understanding is required as to why success in community involvement has been in most part, elusive. The thesis uses a historical perspective to examine the emergence of participation in the period prior to and during the community development era in Africa and the post-independent period in Kenya. The emergence of participation and it's progression as an international health strategy in the 1980's and 1990's within WHO, a leading international organisation promoting community involvement in health is critically examined. At the community level, people's perception and understanding of community participation and an analysis of how they participated in the case study CBHC programme provided an operational assessment of community participation. A particular focus was community contributions as a mechanism of participation. Thus, the primary aim of this thesis was to examine in rural Kenya the socio-economic and institutional support factors which can potentially enhance or limit participation of community members in rural community-based health development programmes. The main socio-economic factors examined were education, income, group membership and domestic factors such as harmony in the household and women's time. The roles of local structures and support personnel such as community health volunteers (CHVs), health committee members (HCMs) and local leaders in promoting participation were also analysed. The method used was interviews with a sample of these respondents. Based on the case study research results, the thesis draws conclusions on the factors that appear to be most significant in relation to community participation. The importance of education, group membership and regular monthly visits by CHVs were identified as particularly significant factors. A more informed understanding of these relationships will enable health planners in designing integrated programme strategies which can help promote broader community participation in health development programmes. An awareness of these factors and their inter-relationships by operational-level health staff will enable them to enhance community participation when developing and implementing community-based health care programmes.

No description available.

No description available.

No description available.

No description available.