Suchergebnisse

Mortality caused by non-communicable diseases has been extremely high in Hungary, which can largely be attributed to not performed preventive examinations (PEs) at the level of primary health care (PHC). Both structures and financial incentives are lacking, which could support the provision of legally defined PEs. A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs. A sample of 4320 adults representative for Hungary by age and gender was surveyed. Twelve PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not performed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund. The rate of service use varied between 16.7 and 70.2%. There was no correlation between the unit price of examinations and service use (r = 0.356; p = 0.267). The rate of not performed PEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million euros saved by not paying for PEs, the largest share was not spent on those in the lowest educational category. New preventive services offered in the reoriented PHC model program include systematic and scheduled health examination health promotion programs at community settings, risk assessment followed by individual or group care, and/or referral and chronic care. The Model Programme has created a pressure for collaborative work, consultation, and engagement at each level, from the GPs and health mediators up to the decision-making level. It channeled the population into preventive health services shown by the fact that more than 80% of ...

In many countries market-oriented health care reforms are high on the political agenda. The purpose of these reforms is to make resource allocation in health care more efficient, more innovative and more responsive to the consumers' preferences. The Netherlands is no exception in this respect. The Dutch health care reform shows close similarities with the reforms in, for instance, Belgium (Kesenne, 1996), Germany (Graf von der Schulenburg, 1994; Files and Murray, 1995), Switzerland (Beck and Zweifel, 1996), Israel (Chinitz, 1994) and the U.S. (Newhouse, 1994). A common element of these reforms is that the consumers may choose among competing health insurers or health plans, which are largely financed through premium-replacing capitation payments.

Abstract
The case for competition in health-care markets rests on economic models in which providers seek to maximize profits. However, little is known regarding how public health-care providers, who might not have a profit motive, react to increased competition from private providers. This study considers the heterogeneous effects of a primary health-care reform in a Swedish region that considerably loosened entry restrictions and increased patients' freedom of choice, thus enabling increased competition. Our difference-in-differences analysis contrasts local markets that were affected by both entry and choice with local monopoly markets, which were unaffected by the reforms. Using detailed administrative data on all visits to public health centers in 2008–2011, we find that providers in markets with increasing competition registered more diagnoses in an administrative database, thus increasing their reimbursement per patient. Although the economic significance of the effect is small, the result suggests that public providers are indeed sensitive to competition.

Under capitation health scheme, a member freely selects a health facility from which to seek health services. There is no restriction of the number of times a member seeks health services from the facility within the contract period. This has affected delivery of health service under capitation contracting. This paper documents a quantitative analysis of the effect of health seeking behaviour on effective delivery of health services. Since human behaviour is assumed to be a natural phenomena, a philosophical view of positivism w?s ?dopted in this research. Accordingly, a scientific approach was used to deduce the influence of health seeking behaviour on the metrics of effectiveness. Out of 1152 health facilities accredited to offer primary healthcare in Kenya, data was collected from a sample of 297 health units using closed ended questionnaires. Logit regression analysis on the data revealed that congestion in out-patient department had a negative effect on quality of health services delivered but a positive effect on accessibility and affordability of the services. Increased frequency of consultation had a negative effect on all the three measures of effectiveness; quality, accessibility and affordability of health service delivery. Corresponding odds ratios were 0.173, 1.105 and 1.295 respectively.

Dans le cadre de cette journée d'étude consacrée à la sortie au spectacle, j'ai décidé de focaliser mon attention plus particulièrement sur les représentations exceptionnelles données par l'Opéra de Paris à la fin de l'Ancien Régime. Sont considérées comme exceptionnelles deux types de représentations : celles dont le déroulement ordinaire est modifié par un élément particulier - présence de spectateurs exceptionnels par exemple - et celles qui sont programmées dans un but particulier - cas des capitations, des galas et des gratis - et qui sortent donc des normes traditionnelles d'une représentation d'Opéra.

Dans le cadre de cette journée d'étude consacrée à la sortie au spectacle, j'ai décidé de focaliser mon attention plus particulièrement sur les représentations exceptionnelles données par l'Opéra de Paris à la fin de l'Ancien Régime. Sont considérées comme exceptionnelles deux types de représentations : celles dont le déroulement ordinaire est modifié par un élément particulier - présence de spectateurs exceptionnels par exemple - et celles qui sont programmées dans un but particulier - cas des capitations, des galas et des gratis - et qui sortent donc des normes traditionnelles d'une représentation d'Opéra.

Dans le cadre de cette journée d'étude consacrée à la sortie au spectacle, j'ai décidé de focaliser mon attention plus particulièrement sur les représentations exceptionnelles données par l'Opéra de Paris à la fin de l'Ancien Régime. Sont considérées comme exceptionnelles deux types de représentations : celles dont le déroulement ordinaire est modifié par un élément particulier - présence de spectateurs exceptionnels par exemple - et celles qui sont programmées dans un but particulier - cas des capitations, des galas et des gratis - et qui sortent donc des normes traditionnelles d'une représentation d'Opéra.