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.

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.