Suchergebnisse

Includes bibliographical references. ; In this thesis, equality is considered as the absence of differences in utilization among individuals of different socioeconomic status while equity is taken to mean that individuals in equal need of health care should use the same amount of care, irrespective of their socioeconomic status. Using the above definitions, this thesis, examines equity/inequality in the utilization of public health care in Zambia. Concentration curves, concentration indices and horizontal equity indices were used for this purpose. This thesis focuses specifically on public health care that is subsidized by the Government. It is anticipated that the findings of this thesis will broaden the knowledge base on health care utilization inequities in Africa.

"Die deutschen Lehrbücher für Gesundheitsökonomie basieren mehr oder weniger auf dem Menschenbild des homo oeconomicus. Dieses grundlegende Paradigma der neoklassischen Ökonomie ist entweder trivial in dem Sinn, dass die Menschen immer versuchen, das Beste aus einer jeden Situation zu machen, oder sie hat nur sehr begrenzte empirische Evidenz, wie man anhand Mark Paulys 'moral hazard'-Postulat zeigen kann. Es besagt, dass die öffentliche Finanzierung von Gesundheitsdiensten falsche Anreize setzt, weil die Nutzer versuchen würden, mehr Leistungen als erforderlich zu bekommen. Diese systematische Überkonsumtion medizinischer Leistungen könne nur durch Zuzahlungen bzw. Franchise-Systeme beschränkt werden. Eigentlich unterstellt Pauly, dass medizinische Behandlungen ein reines Vergnügen sind, von dem man gar nicht genug haben kann - eine äußerst unrealistische Annahme. Zuzahlungen haben nur dann eine rationale Wirkung auf die Inanspruchnahme von medizinischen Leistungen, wenn die Patienten eine wirkliche Wahl haben, etwa im Festbetragssystem für Arzneimittel. Aber wenn es so wenige Belege für die Rationalität von Zuzahlungen gibt, weshalb war dann dieses Instrument in jedem Kostendämpfungsgesetz der letzten 30 Jahre in Deutschland enthalten? Die Gesundheits- und Sozialpolitik wird in Deutschland von einer hoch ideologischen Debatte über Lohnkosten und deren Wirkung auf Deutschlands Stellung im globalen Wettbewerb dominiert. Krankenkassenbeiträge werden als Lohnnebenkosten definiert und für die hohe Arbeitslosigkeit verantwortlich gemacht. Leistungskürzungen in der Gesundheitsversorgung sollen ein Impuls für wirtschaftliches Wachstum und Beschäftigung sein. Es gibt keine belastbaren Belege für diese Behauptung, aber sie beherrscht die veröffentlichte Meinung. Ein anderes Paradigma der neoklassischen Ökonomie ist die umfassende Nützlichkeit des Wettbewerbs. Jedoch gibt es zwei verschiedenen Denkschulen, deren Protagonisten Walter Eucken und F.A. von Hayek sind. Während Eucken der freien Marktwirtschaft eine suizidale Tendenz zum Monopolismus unterstellt und deshalb für einen regulierten Wettbewerb plädiert, nimmt Hayek eine dogmatische Haltung zum freien Markt ein und weist jede politische Einflussnahme ab. Diese unterschiedlichen Grundsätze bestimmen auch heute noch die deutsche Debatte über den Wettbewerb in der gesetzlichen Krankenversicherung. Es ist evident, dass ein solches System nur mit einem Risikostrukturausgleich vernünftig funktionieren kann. Andernfalls entstünde ein total verzerrter Wettbewerb zu Lasten jener Krankenkassen, die chronisch Kranke und sozial Schwache versichern." (Autorenreferat)

Background: Access to adequate health services that is of acceptable quality is important in the move towards universal health coverage. However, previous studies have revealed inequities in health care utilisation in the favour of the rich. Further, those with the greatest need for health services are not getting a fair share. In Zambia, though equity in access is extolled in government documents, there is evidence suggesting that those needing health services are not receiving their fair share. This study seeks therefore, to assess if socioeconomic related inequalities/inequities in public health service utilisation in Zambia still persist. Methods: The 2010 nationally representative Zambia Living Conditions and Monitoring Survey data are used. Inequality is assessed using concentration curves and concentrations indices while inequity is assessed using a horizontal equity index: an index of inequity across socioeconomic status groups, based on standardizing health service utilisation for health care need. Public health services considered include public health post visits, public clinic visits, public hospital visits and total public facility visits. Results: There is evidence of pro-poor inequality in public primary health care utilisation but a pro-rich inequality in hospital visits. The concentration indices for public health post visits and public clinic visits are −0.28 and −0.09 respectively while that of public hospitals is 0.06. After controlling for need, the pro-poor distribution is maintained at primary facilities and with a pro-rich distribution at hospitals. The horizontal equity indices for health post and clinic are estimated at −0.23 and −0.04 respectively while that of public hospitals is estimated at 0.11. A pro-rich inequity is observed when all the public facilities are combined (horizontal equity index = 0.01) though statistically insignificant. Conclusion: The results of the paper point to areas of focus in ensuring equitable access to health services especially for the poor and needy. This includes strengthening primary facilities that serve the poor and reducing access barriers to ensure that health care utilisation at higher-level facilities is distributed in accordance with need for it. These initiatives may well reduce the observed inequities and accelerate the move towards universal health coverage in Zambia.

Intro -- Acknowledgements -- Contents -- Abbreviations -- Chapter 1: Introduction -- Formal Public Health Care Structure and the Pandemic -- Where Lies the Deficiency? -- The Health Care Activities of Non-Covid-19 Nature -- The Inept Handling of Public Health Resources -- Inept Handling in Maharashtra -- Health Care Infrastructure at the Periphery and Covid-19 -- When the Governments Function Well and People Cooperate -- Inept Handling of Data -- The Challenge of Urban Prevalence -- The Illegitimate Scare of Rising Covid-19 Numbers -- The Good Statistics -- The Covid-19 and Public Health Measures -- Migrant Workers as a Health Issue -- How Serious Was the Spread After Migration? -- Migrant Labor-Whose Failure Is It? -- Failure of Employers and House Owners -- Was It Failure of the Central Government? -- Engineered Migrations -- Deaths During Migration -- Herd Immunity -- A Good Measure to Meet the High Covid-19 Patient Load -- Non-Health Care Decisions and Actions -- The Heroes of the Struggle -- Down Side of Dealing with Doctors and Paramedics -- The AYUSH Ministry Contribution -- References -- Chapter 2: Philosophical and Social Basis of Reorganization -- Background Changes over Last 30 Years -- Health Thinking: 70 Years Sans New Ideas -- Some Philosophical Considerations: The Hegelian Idea -- How Humans Deal with Obsolescence in General -- Limitations within Health Thinking -- Consequent Failure of Primary Care -- Need for a Philosophical Basis for Reorganization -- The Health Theorists and the Indian Scenario -- Reorganization: What It Does and Does Not Mean? -- Criteria for the Four Rs -- Structural Reforms and the Four Rs -- The Social Basis of the Context of Reorganization -- The Population Shifts -- Will Smart City Idea Help? -- Pervasive, Iniquitous Modern Medicine: Will it Help? -- Will the Public-Private Partnership (PPP) Help?.

No health care professional in Canada should be without a clear understanding of the Canadian health care system! Health and Health Care Delivery in Canada, 2nd Edition explores the nation's basic approach to health, wellness, and illness. Set entirely within a Canadian context, this text includes coverage of individual and population health, the role of federal agencies and provincial governments, health care funding, and current issues and future trends in health care. Written by experienced educator and nurse practitioner, Valerie Thompson, this textbook is ideal for all students beginning a career in health care. Clear, easy-to-understand approach to health care in Canada begins with an overview of health, wellness, and illness and proceeds through the fundamentals of the Canadian health care system, such as population health, ethical and legal issues, health care funding and principles, practice settings, and changing trends. Learning Outcomes outline the knowledge that you should gain in each chapter. Key Terms open each chapter and include page references for definitions. Student-friendly learning aids include summary tables and boxes, photographs, figures, and illustrations. Review questions at the end of every chapter test your comprehension of the material. Case examples provide real-world scenarios related to the chapter content. In The News boxes highlight landmark case law, research developments, emerging health issues, and ethical challenges. Thinking It Through questions ask you to critically consider key aspects of health and health care delivery. NEW! Coverage of issues and trends includes expanded information on mental health issues, aboriginal health, privatization, use of electronic health records, and interprofessional health care practice.

This volume deals with the reorganizing of health care delivery systems: problems of managed care and other models of health care delivery. Issues of how to best organize a health care delivery system are not new, but the amount of interest in this topic in the US (as well as in other countries) has grown in recent decades. Reorganizing health care delivery systems is a concern of many systems of the world, and this volume contains some papers from countries other than the US, although the majority of the papers do relate issues to the US health care delivery system. While most papers relate to structural and organizational factors, the impact of individual patients is not neglected. The volume contains 11 papers, organized into four sections. The sections cover managed care issues and organizational features, special groups of patients and health issues, lessons from other countries, and broader policy concerns and health insurance reform. This book addresses important themes in medical sociology, with papers that range from those with an explicit policy point of view to narrower papers on more specific issues in health care delivery. It aims to contribute to improving our understanding of these issues and provides a sociological focus for the exploration of them. This should make the volume essential reading for medical sociologists and other social scientists studying health care delivery issues. The information should be also helpful to health services researchers, policy analysts and public health researchers.

It is commonly opined that decentralisation through Panchayati Raj Institutions (PRIs) can help in creating greater accountability in the Indian healthcare system. Health decentralisation is specially meant for peoples' participation, increased transparency and a higher degree of accountability to provide comprehensive and quality health services at the grassroots level. The National Rural Health Mission (NRHM) visualises the provision of decentralised healthcare at the grassroots level. However, this scheme has some lacunas in reaching the needy, especially in the rural parts of India because of an ineffective and non-participatory role of PRIs in decision making. This has been ascribed to a malfunction in creating healthcare awareness and making the procedures complicated and chaotic for the local Panchayats. The article is based on the Indian Council of Medical Research-funded study in the state of Karnataka. It seeks to find out how PRIs are managing the public healthcare system and its success and failure through a qualitative study. The study has shown that some amount of caution is needed in devolving requisite powers to the PRIs within the NRHM. The coordination between Public Health Institute officials and those of PRIs is completely absent and most of the PRI members do not even know about various health schemes.

Der Verfasser grenzt zunächst das Netzwerkkonzept gegen das eng mit diesem verwandte Konzept 'soziale Unterstützung' ab. Er charakterisiert im folgenden soziale Netzwerke als Vermittlungs- und Beratungsinstanzen. In diesem Sinne stehen sie als soziale Ressourcen vermittelnd zwischen den persönlichen (Persönlichkeitsmerkmale, Fähigkeiten) und den institutionellen Ressourcen (Einrichtungen des Gesundheitsversorgungssystems). Soziale Netzwerke können Ansatzpunkte für direkte und indirekte Interventionen zur Stärkung und Mobilisierung vorhandener oder zum Aufbau neuer Unterstützungspotentiale sein. Der Verfasser stellt exemplarisch Vernetzungsformen bei der Förderung der Selbsthilfe und der Selbstorganisation gegenseitiger Hilfe sowie im professionellen und informellen Gesundheitssystem zur Optimierung der gesundheitlichen Versorgung vor. (ICE2)

Research on social inequalities has a very long tradition in sociological research, and discussion of the impact of social inequalities on health and health care delivery has long been one of the more important topics covered by medical sociologists. The research presented in this volume varies in its coverage and its approach to issues of social inequality in health and health care delivery. This volume includes both theoretical and quantitative papers, and deals with complex understandings of macro system issues, the impact of the patient and individual factors on health and health care and the impact of the provider and interaction between providers and patients. The first section focuses on macro system issues and includes both theoretical approaches to the topic and quantitative approaches. The second section includes articles with a greater focus on patient characteristics. These articles vary greatly in their coverage, with some focusing on the US as a whole, and others on specific sections of the US or subgroups within the population such as African American women or the elderly. The third section focuses on providers and issues of social inequality and health care delivery. These papers examine issues of gender, race and poverty as examples of sources of inequality in modern societies. In contrast to the second section these papers pay more attention to individual factors and the focus of the chapters is on aspects of health care providers. Research on providers of care is another long, important research tradition within medical sociology. Social Inequalities, Health and Health Care Delivery should be useful reading for medical sociologists and people working in other social science disciplines studying health-related issues. The volume also provides information for health services researchers, policy analysts and public health researchers.

Intro -- INTEGRATED HEALTH CARE DELIVERY -- NOTICE TO THE READER -- CONTENTS -- PREFACE -- A BRIEF DESCRIPTION OF THE LIMITATIONS OF THE CURRENT HEALTH CARE SYSTEM IN THE UNITED STATES, AND A PROGRAM RESPONSE TO THE COMPLEX ISSUES OF MANY INDIVIDUALS WHO ARE CONFRONTED WITH MULTIPLE, CHRONIC CONDITIONS -- ABSTRACT -- INTRODUCTION -- LITERATURE REVIEW -- THE INTERGRATED HEALTH ADVOCACY PROGRAM -- The Primary Advocate -- The Psychosocial Advocate -- The Medical Advocate -- The Advocacy Team -- The IHAP Participants -- Materials -- DESCRIPTIVE AND STATISTICAL RESULTS -- Descriptives -- Statistical Results -- CONCLUSION -- REFERENCES -- A COMPARISON OF INTEGRATED DUAL DIAGNOSIS TREATMENT SERVICE DELIVERY MODELS ON FIDELITY AND CLIENT OUTCOMES AT 1- AND 2-YEAR FOLLOW-UPS -- ABSTRACT -- INTRODUCTION -- METHOD -- RESULTS -- DISCUSSION -- CONCLUSION -- ACKNOWLEDGMENT -- REFERENCES -- OPERATING ROOM COSTS AND RESOURCE UTILIZATION IN LUMBAR FUSION WITH INSTRUMENTATION PROCEDURES: INTEGRATED DELIVERY SYSTEM IS IMPLICATED -- ABSTRACT -- INTRODUCTION -- MATERIALS AND METHODS -- Sample and Data Sources -- Statistical Analysis -- RESULTS -- CONCLUSION -- REFERENCES -- SOCIAL CAPITAL AND PARTNERSHIP OPPORTUNITIES: MANAGEMENT IMPLICATION IN INTEGRATED HEALTHCARE NETWORKS -- ABSTRACT -- INTEGRATED HEALTH NETWORKS -- MANAGERIAL ISSUES FOR HEALTH CARE NETWORK MANAGEMENT -- WHAT WE FOCUS ON ARE SOCIAL CAPITALS: THE ROLE OF SOCIAL CAPITAL IN THE MANAGEMENT OF INTEGRATED HEALTH NETWORKS -- EXAMPLE OF TAIWAN'S PRIMARY COMMUNITY CARE NETWORK (PCCN) DEMONSTRATION PROJECT: CONCEPTUALIZATION AND MEASURES OF SOCIAL CAPITAL -- Unique Characteristics in Taiwan's Healthcare Industry -- Backgrounds of the Health Reform for PCCNs in Taiwan -- Structures and Responsibilities for PCCNs in Taiwan.