Tesis sobre el tema "Soins de santé primaires – Aspect économique"
Crea una cita precisa en los estilos APA, MLA, Chicago, Harvard y otros
Consulte los 29 mejores tesis para su investigación sobre el tema "Soins de santé primaires – Aspect économique".
Junto a cada fuente en la lista de referencias hay un botón "Agregar a la bibliografía". Pulsa este botón, y generaremos automáticamente la referencia bibliográfica para la obra elegida en el estilo de cita que necesites: APA, MLA, Harvard, Vancouver, Chicago, etc.
También puede descargar el texto completo de la publicación académica en formato pdf y leer en línea su resumen siempre que esté disponible en los metadatos.
Explore tesis sobre una amplia variedad de disciplinas y organice su bibliografía correctamente.
Morize, Noémie. "Les coûts de l’autonomie : économistes et médecins libéraux dans les réformes expérimentales des soins primaires". Electronic Thesis or Diss., Paris, Institut d'études politiques, 2024. http://www.theses.fr/2024IEPP0009.
Texto completoIn the primary care sector in France, “Multidisciplinary Primary Care Groups,” or MSPs, have progressively been introduced to enhance care coordination between self-employed healthcare professionals. These initiatives diversify the predominantly fee-for-service-based remuneration model within primary care, by adding publicly funded add-on payments for coordination efforts. Two pilot programs launched in 2019 sought to advance these reforms further, striving to increase care professionals’ accountability by providing financial incentives for reaching common health outcome goals for their shared patient groups. These initiatives were conceived by administrative executives trained in economics and received support from self-employed general practitioners. This doctoral study aims to explore the mechanisms behind the unlikely collaboration between general practitioners, traditionally known for their autonomy, and stakeholders seeking to reform the self-employed system in primary care.Through case studies involving qualitative data collection from 2019 to 2023, including observations and approximately one hundred interviews, the study reveals a group of stakeholders including administrative economists, researchers, and self-employed health professionals, advocating for these pilot programs and open to compromises to achieve their respective goals. Administrative economists adapt their strategies to maintain their relationships with practitioners, while some general practitioners, well versed in economic principles, seek to reorganize care accordingly. However, they also assert their central position in professional relationships
Brunat, Marion. "Analyse économique de l'accessibilité des soins primaires en France : la question de l'organisation de l'offre de services de santé ambulatoires". Grenoble, 2010. http://www.theses.fr/2010GRENE008.
Texto completoThe objective of this work is to bring to bear a critical reflection on the choices of public policy in the fight against health inequalities, through the utilisation of the concept of " real possibilities for access " as applied to both preventive and curative care. In a neo-institutional economic approach, we develop an analysis of the accessibility of medical care recognising the importance of the financial aspect and integrating the structural characteristics of cane supply and professional practice. We stress the limits of the CMU-C provision in an unchanged institutional and organisational system. An econometric study of logistical regression on the bases of medical consumption in 2007 by beneficiaries of CMU-C supports the position we take. Thus we stress the need for a reflection on the benefits and ways of developing an integrated and pluri-professional supply of health services (health centres and " maisons de santé "). We make use of documentation provided by semi-directive interviews with several persons of the whole health sector. These differing forms of organisation are a fruitful avenue to explore to improve coordination, continuity and global healthcare service. Nevertheless, their development depends on internal choices of organisations to achieve an economic gain in terms of the cooperation of professionals. It depends also on the rules and perceptions pertaining to the system at the institutional level. Their emergence as structured ways of supplying primary health care as a means of reducing health inequalities depends on the development of new organisational forms of outpatient healthcare supply as well as their adequate institutional recognition
Thompson-Leduc, Philippe. "Prévalence et facteurs de risque associés au conflit décisionnel cliniquement significatif en soins primaires". Master's thesis, Université Laval, 2015. http://hdl.handle.net/20.500.11794/27540.
Texto completoClinically significant decisional conflict (CSDC) leads to poor patient outcomes. We sought to identify the prevalence of CSDC in primary care using the Decisional Conflict Scale (score ≥ 25/100) in five datasets of patients who consulted in primary care. We identified its risk factors using logistic regression analysis. Selection of variables was based on a review of the literature and on their availability in the datasets. The prevalence of CSDC in primary care varied between 10% and 31% depending on the dataset, a variation that could reflect the different types of decisions addressed. Overall, CSDC was more prevalent in males, people aged 45 and over and people living alone. Healthcare professionals should be trained in screening for CSDC in order to reduce poor patient outcomes.
Ferron, Parayre Audrey. "Le dépistage du conflit décisionnel chez les patients en soins primaires : Validation du test SURE". Thesis, Université Laval, 2013. http://www.theses.ulaval.ca/2013/29542/29542.pdf.
Texto completoThis study validated the psychometric properties of a screening tool assessing decisional conflict, the SURE test, in patients with acute respiratory infection who had to make a decision about taking antibiotics or not. Using a self-administered questionnaire which was provided immediately after the medical encounter, 712 patients recruited in nine family practice teaching units related to Laval University were asked to respond to SURE and Decisional Conflict Scale (DCS) questions, the gold-standard measure of decisional conflict. The internal consistency using Kuder-Richardson 20 coefficient was 0.7, and there was a significant correlation between DCS and SURE scores (P<0.0001). Sensitivity and specificity were 94.3% (79.4-99.0) and 85.2% (82.2-87.8, respectively. This study suggests that the SURE test is appropriate to screen for decisional conflict in primary care. The validity of the test in different decisional contexts should be evaluated.
Simon, Jean-Michel. "Evaluation du médicament et économie de la santé". Dijon, 1995. http://www.theses.fr/1995DIJOE008.
Texto completoThe economic evaluation of drugs is referred to increasingly in the context of scientific and economic approaches to achieving more effective health expenditure. The first part of this thesis sets out the basis for, and methodology employed in the economic evaluation of drugs. It describes briefly its limitations and the main criticisms levelled against it, giving details of the analytical options available as well as the differences between methods. In the second part, the author examines the possible role of pharmaco-economic criteria within the regulatory mechanisms of the French pharmaceutical market. It shows that they conflict with other decision-making criteria which at the present time carry, relatively speaking, more weight. The third part examines the relevance of pharmaco-economic evaluation in a practical setting, on the basis of studies of the new active substances which appeared within the five year period 1989-1993. It points out the problems inherent in these studies examines the general characteristics of the method adopted. It draws attention to the most frequently occuring faults, examines the validity, and assesses their overall contribution
Apouey, Bénédicte. "Trois essais sur la santé, le revenu et les inégalités". Paris, EHESS, 2009. http://www.theses.fr/2009EHES0080.
Texto completoSelf-assessed health measures (SAH) play a prominent role for the analysis of health data. These data are generated by asking: « How is your health in general? » with the response categories ranging from « Very poor » to « Very good ». The thesis focuses on self-assessed health, income and inequalities. The first two papers develops new measures to quantify health polarization and income-related health polarization when the individual health variable is self-assessed health. The third paper looks at the causal effect of income on self-assessed health in Great Britain, and highlights that an exogenous income shock has no effect on self-assessed health, which can be seen as the sum of a positive effect on mental health and a negative effect on physical health
Ningada, Bobelem Gokoyo. "La demande de santé et ses déterminants en Afrique centrale". Lyon 3, 1987. http://www.theses.fr/1987LYO33004.
Texto completoLe, Corroller-Soriano Anne-Gaëlle. "Apports et limites de l'évaluation économique des innovations biomédicales : l'exemple de la thérapie cellulaire en cancérologie". Paris 2, 1999. http://www.theses.fr/1999PA020048.
Texto completoThe thesis studies how public economics tools (mainly the cost-benefit analysis) can be used for the evaluation of biomedical innovations and for the optimisation of their technological diffusion. In a first part, we discuss the main methodological questions of the application of different tools, based on the cost-benefit analysis, in the health care field, and more precisely on the field of biomedical innovations. In a second part, we present different empirical works about the economic evaluation of the peripheral blood stem cell transplantation. The pbpc transplantation is a major innovation in the field of cell therapy for the treatment of cancer. The empirical works try to illustrate the methodological questions raised in the first part. Our research programme leads to question the foundation of cost-benefit analysis and its relationship with cost-effectiveness and cost-utility analyses. The main interest of cost-effectiveness analysis and cost-utility analysis for our empirical work was to allowed early evaluations based on surrogate endpoints. Early economic evaluation can give early economic arguments that can be used in the decision making process of the adoption of an innovation. We show, with the example of pbpc transplantation that economic evaluation can interact with the diffusion of a biomedical innovation, if it is realised early in the development and diffusion process. The empirical works presented in this thesis were realised in the context of a very close collaboration with biologists and clinicians. We hope that the more general lessons coming from this experience will contribute to a reconciliation of economic analysis and medical practice
Graber, Nils. "La vacuna, une innovation cubaine : immunothérapie du cancer, essais cliniques et soins primaires aux marges de la globalisation". Thesis, Paris, EHESS, 2019. http://www.theses.fr/2019EHES0122.
Texto completoSince its emergence in the 1980s, the Cuban biotechnology industry has developed pharmaceuticals designed to both export and integration into the national health system. Among innovative projects, cancer immunotherapy stands as one of the main areas. This domain of cancer therapy attempts to act upon immunological mechanisms to destroy or contain the tumour. Since 2010, some of these treatments have been made accessible for a wide-spread use in the country through the implementation of clinical trials expanded to primary health centres, called polyclinics, where notably general practitioners are working. The aim of this intervention is to transform (advanced) cancer into a chronic disease. It is an unprecedented intervention. At the international level, where immunotherapy also stands as a cutting-edge oncology treatment, these new drugs are only available at the hospital level, and wide access is threatened due to high prices. Combining ethnography with the study of collaborative networks, this work explores the innovation process in the development of cancer immunotherapy in Cuba, in its attempts to conciliate industrial policies and public health goals. The use of the local term vacuna is part of an examination of epistemic specificity as well as of the multiple understanding of cancer immunotherapy among industrial researchers, oncologists and primary healthcare professionals. The vacuna is taking shape through practices embedded within public institutions, which attempt to constantly conciliate conflicting dimensions, between economic and public health goals, biomedicine and primary care, respect of global norms and attention to local particularities, which is a source of multiple and modular innovations, likely to circulate among both global South and global North
Donnat, Marianne. "Espaces pastoral, médical et sanitaire : le recours aux soins en zone sahélienne : le cas des communautés arabes Juhayna et dazagara du Bahr-el-Ghazal, au Tchad". Montpellier 3, 2006. http://www.theses.fr/2006MON30028.
Texto completoIs the health care system which is available today in the Sahel adapted to the needs of nomadic people? The current use of health facilities by pastoral people reveals specific choices and strategies that are analyzed here with the tools of Health Geography. The study shows the assets but also the disconnections between the pastoral space, the health supply space and the health demand space, with the case-studies among arabic and dazagara communities in western Chad. It suggests practical solutions to encourage a health policy that takes more nomadic people needs into account
Lagasnerie, Grégoire de. "Trois essais en économie de la santé sur la régulation de la demande de soins de ville s'appuyant sur la méthode de micro-simulation". Paris, EHESS, 2013. http://www.theses.fr/2013EHES0093.
Texto completoThis thesis sheds light on various issues in health economics (reimbursement system of care, sensitivity of the demand for health care prices , prediction of the dynamics of care expenses ) through the technique of micro -simulation. This thesis is composed of three articles. The first two articles of this thesis contribute to improved understanding of the mechanism related to the regulation of health care demand through the reimbursement system. The last article analyzes the evolution of the demand for care in the medium and long term. The first article focuses on the analysis in term of equity and hedging of reform of the reimbursement system of healthcare services in France. The second article examines the implications for health insurance and the insured of changes in consumption behavior of insured following a reform of the reimbursement system of cafe in France. The third article, from the study of different methods of projections in the economic literature analyzes the dynamic of outpatient healthcare expenditure related to the ageing population
Lamiraud, Karine. "Méthodes d'évaluation de l'utilité du patient : une analyse économique et économétrique du comportement d'observance dans un essai clinique". Paris, EHESS, 2004. http://www.theses.fr/2004EHES0141.
Texto completoThis work offers an indirect measure of patient welfare based on observed individual choices. We argue that adherence behavior toward medication is a true choice made by the patient and reveals subjective valuations of particular therapies. We write a simple theoretical model of adherence behavior, that reflects the patient trade-off between perceived costs and observed regimen efficacy. Extending previous studies of the welfare benefits from innovation or product differentiation, we perform the estimation within a discrete choice framework. The econometric analysis focuses on identifying patient and drug characteristics associated with non adherence while controlling for the impact of adherence on health status. It is implemented through a panel non linear simultaneous two-equation system on clinical trial data in HIV disease. Both our theoretical and empirical results suggest that a lower adherence reveals that the cost benefit ratio is bigger
Piovesan, David. "Les restructurations des cliniques privées : adaptations, évolution ou métamorphose?" Lyon 3, 2003. http://www.theses.fr/2003LYO33021.
Texto completoMeynet, Robert. "Micro-économie de l'infection nosocomiale". Lyon 3, 1987. http://www.theses.fr/1987LYO33020.
Texto completoThis work has been realized in lyon which is the second largest hospital structure in france in two departments of abdominal surgery for one year and in prospective. 15,4 per cent of the sick have been infected and the cost of this infection amounts to 16. 994 french francs on average per patient 1978, that is an 80 per cent rate of increase (37. 138 20. 144) for infected sick patients as compared with non infected ones. The microeconomic infection cost includes not only invoiced postoperative hospital cost (stay, examinations, medical treatment) but also the post hospital cost, valued from the studied medical consumption angle during the six months after coming out of hospital (new hospital admissions, care, examinations, pharmacy, convalescence home). Another type of non invoiced post operative medical hospital cost valued from a difference in intensity of care between infected sick patients and non infected sick ones : this type of cost comes in addition to invoiced cost. The invoiced social cost worked out from wages paid completes the microeconomical infection cost notion. In relation to previously published international studies, this work presents a particularity in the approach of invoiced medical postoperative hospital cost and non invoiced medical postoperative cost
Schneider-Bunner, Claude. "Economie et justice sociale : l'organisation et la régulation des systèmes de santé face à l'équité". Dijon, 1996. http://www.theses.fr/1996DIJOE008.
Texto completoSince the early seventies health economics and social justice studies have developed in parallel, but the overlap between these two fields is a relatively under-explored area of research, despite-or perhaps precisely because of-the fact that from the outset one of the foremost aims of european health care system has been to guarantee equal access to health care. Furthermore, under the pressure of economic difficulties, the issue of equity in health care systems arises with a new intensity. What concepts of equity for health and health care can be envisaged, taking the contemporary theories of justice as a starting point? Three standpoints are distinguished: a rawlsian standpoint is added to the traditional dichotomy between egalitarian and liberal theories. The interpretation of these theories for health and for health care leads to a framework for analysis adapted to the evaluation of health systems. (part one). Which of these conceptions are encountered, implicitly or explicitly, in the european health care systems, in their various mods of organization and regulation? The search of a better knowledge of this basic dimension of health care systems aims at assessing the mecanisms that influence equity and at clarifying the possible alternatives. (second part)
Guthmuller, Sophie. "L'accès aux soins des populations modestes en France : études micro-économétriques des comportements de recours à la complémentaire santé et aux soins". Thesis, Paris 9, 2013. http://www.theses.fr/2013PA090052.
Texto completoThe purpose of this research is to study the financial access to complementary health insurance (CHI) and to health care of low-income populations in France. We are particularly interested in evaluating a subsidized health insurance program (ACS) introduced to encourage households whose resources are just above the free means-tested complementary health insurance program (CMUC), to purchase a CHI plan. In implementing a randomized experiment and in using a sample of eligible households for these programs, we are able to enhance the knowledge base on three issues: (i) Understanding and reducing the ACS non-take-up. (ii) The take-up of CHI plan and the health care use of low-income populations. (iii) The existence of a CMUC threshold effect. Results of this thesis provide some important tracks to improve the effectiveness of these programs and more generally that of future public policies aiming to improve equity in access to health care
Nkwenkeu, Sylvain F. "Evaluation des politiques publiques de santé : une analyse économique appliquée au Cameroun". Thesis, Grenoble, 2014. http://www.theses.fr/2014GRENE006/document.
Texto completoIn Cameroon, the sequence of reforms in the health sector has reinforced an ideological wavering between two opposing currents: a socio-universal that promotes equity, and a neoliberal, which militates for greater economic efficiency of existing systems. Articulating two concerns which are, the worsening of health inequalities as consequence of policy choices made on the efficacy of services without taking into account factors that support the demand, and the form of organization of the health system arising from an imperfect translation of major international principles, this thesis aims to contributing to a critical reflection on the process, the implementation and the results produced by these health policies. To determine Cameroonian specificity, we inscribe them in a triple theoretical field. The neo-institutionalist approach, mobilize to grasp the importance of the economic history and its influence on the evolution of the health system, which allows understanding the conditions for policy change. The “referentials” approach to policy analysis in order to apprehend the foundations of the new public policy, including the understanding of how interests and ideas are formatted by institutions. An effort to illuminate the policy game is undertaken to appraise the mediation of political entrepreneurs, thereby testing empirically the “top-down hypothesis”. Finally, the theories of justice help to argue for the existence of an imbalance between health supply and demand which undermines health outcomes, and reinforces the conflict efficacy versus equity. Indeed, our work aims to provide some answers to three main questions: (i) Why (triggers) and how (dynamic) health public policies are influenced in their construction and implementation by economic policies? (ii) What are the outcomes of induced changes by the global referential (macroeconomic framework) on sectoral referential that requires a more equitable distribution and access to health services? (iii) What lessons can we learn from the knowledge of the interrelationships between the dynamics of poverty reduction and the persistence of inaccessibility to health care in order to improve the evaluation of public policies? From a number of quantitative and qualitative indicators, the robustness of the new policy is questioned following prospects regarding health distribution and accessibility. Therefore, we emphasize the difficulty of the public policy to achieve satisfactory results both in terms of efficacy or equity due to the institutional and organizational system in which it is designed and implemented. Three epistemic communities acting on a nonstructural basis are identified and analyzed through a robust qualitative material that enables us to grasp the existence of a paradigmatic conflict emerged from how different groups are positioning themselves and interpret reality in order to put in coherence the sectorial referential and the global market-based one which appears to be rather spontaneous and mandatory. Statistical and econometric works to measure more precisely the inequalities and determinants of access and use of health services by the population supports the idea of a widening of inequalities by the health policies maintained by strong regressive mechanisms. The analysis of the determinants of occurrence of catastrophic health expenditures also confirms this. We mobilize thereafter an additional material to assess the allocative efficiency and efficacy of public spending on health as well as their impact on the use of services and benefits revealed from their use
Perraudin, Clémence. "Analyse économique et évaluation des pratiques du pharmacien d'officine : Application au dépistage d'une maladie chronique : Le syndrome d'apnées du sommeil". Phd thesis, Université Paris Sud - Paris XI, 2013. http://tel.archives-ouvertes.fr/tel-01003945.
Texto completoRochut, Julie. "Health care supply, payment system and medical practice : evidence from obstetric practice". Paris, EHESS, 2010. http://www.theses.fr/2010EHES0017.
Texto completoA significant share of deliveries are performed by Cesarian section (C-section) in Europe and j many developed and developing countries. The aims of this thesis are to highlight the non medical, especially economic and financial, incentives that expIain the use of C-section, as well as the medical consequences of C-section on women's health, in regard with other factors of obstetrical care quality such as hospital concentration. Our analysis focus on two countries, France and Switzerland. In the first part of the thesis, we show the influence of two non medical factors on to C-section use, namely the hospital payment system and the obstetricians behaviour, especially their demand for leisure. We show payment system and the number of obstetricians have an impact on C-section use and that the rise of C-section rate between 2003 and 2006 is mainly caused by changes in hospitals and patients features. Yet, it can show that obstetricians change their coding practises to justify the use of certain practice. Using Shelton Brown III identification strategy, we found a potential impact of obstetricians leisure preference on the use of C-section, demand for leisure has a significant impact on the resort to emergency C-section. The second part of the thesis deals with obstetric care quality , using swiss and french data to study the impact of C-section on the patients' probability of having an obstetric complication and the influence of concentration between hospitals on the quality of obstetric care. We find there are risks entailed by C-section on obstetric complications. We find that hospital concentration has a negative impact on obstetric care quality
Gottfried, Fabrice. "Vers un outil d'aide à la décision en ingénierie territoriale appliqué à la géolocalisation de centres de santé". Thesis, Strasbourg, 2019. http://www.theses.fr/2019STRAH012.
Texto completoEveryone knows that our western societies are getting older. Our elderly use also a lot of health care where costs go up and up year after year. Thus, health managers have to face conflicting challenges : how to offer top health protection for all at a reasonable cost for each of us and at an acceptable cost for our local health authorities. A health management that is too rigorous limited to the sole expenditure may undermine intergenerational solidarity by sacrificing the most vulnerable populations. In this way of mind, our aid decision tool could help health managers and politics find alternative solutions to restore some equity, in our case health care accessibility, to ensure sustainable social justice, the cement of all advanced societies. We have tested our tool with 2 territories having very different geographical and demographic characteristics : the densely populated Bas-Rhin region located in the Eastern part of France and the less densely populated region of Estrie located in the South-eastern Province of Quebec (Canada). Our tool may only be part of the solution to these health care costs mentioned above but, its utility and originality are also easily transferable to other possible organizational environments
Schieber, Anne-Cécile. "Étude de la relation patient-médecin généraliste : quel éclairage sur les inégalités sociales de santé ? : analyse des données épidémiologiques et des productions interdisciplinaires issues du projet INTERMEDE". Toulouse 3, 2014. http://thesesups.ups-tlse.fr/2418/.
Texto completoThe work produced in this dissertation aims to understand mechanisms' communication at play during the interaction between a patient and his - or her - general practitioner (GP) which could contribute to social inequalities in health. It uses the qualitative and quantitative data of the project INTERMEDE. The epidemiological analysis reveal the influence of the gender concordance/discordance between patients and GPs on their disagreement on the advice given during the consultation, and the role played by a social distance perceived by the physician on their disagreement on patients' perceived health status. The interdisciplinary analysis have been conducted within an innovate methodology inspired from the Delphi technique. It led to a core of shared knowledge, revealing the convergence of different disciplinary approaches
Zidi, Najoua. "Études économiques sur les inégalités sociales de santé". Electronic Thesis or Diss., Paris 8, 2019. http://www.theses.fr/2019PA080053.
Texto completoThis dissertation addresses social inequalities in health by attempting to identify the main determinants of social inequalities in health. The purpose of this research is to examine the impact of health systems and their reforms on social inequality in health, with an emphasis on a deeper understanding of the ways and mechanisms by which socio-economic factors reduce or increase health inequalities. The aim is to understand social inequalities in health and identify their main determinants, whether in Tunisia or by comparing Tunisia with other countries.Based on a review of the literature on the determinants of social inequalities in health, we propose a conceptual analysis of the links between health and socio-economic status, including the income of individuals and countries by studying the impact of the latter on the health status of a population. It is thus proposed to explore the relationship between income inequality, social inequality and disparities in health status in the context of the emergence of social inequalities in health (SSI). According to the definitions of social determinants, health inequality must be considered from a perspective of systematic analysis referring to the most explicitly cited and proven socio-economic theories in the health economics literature. A conceptual framework on methods for measuring social inequalities in health was proposed to discuss approaches to decomposing inequalities in health care consumption, in particular with the concentration index as a measure that has so far been little explored. This made it possible to assess health inequalities, make a judgment on the inequity of health care distribution, and highlight the relevance of this measure in this area.Among the aspects of health inequality, several determinants support disparities in the demand for health services that are linked to both economic situations and health systems. Many theoretical approaches argue that inequality in access to care is linked to the characteristics and norms of health systems that lead to conditions of inequity in financial access to care and the use of the resources and services of these systems. This has been a motivation for successive and ongoing reforms in several countries around the world in the areas of health financing and health insurance. These reforms have also sought to improve the performance of health systems. Thus, in this thesis, we have tried to measure the levels of efficiency and equity in the Tunisian health system, by studying the factors that cause health inequalities in Tunisia and the reform of health insurance as well as the determinants of its development as a means of financing health care. We then presented an evaluation of the reform of the Caisse Nationale d'Assurance Maladie (CNAM) in 2007, examined its impact on access to healthcare and analysed their motivations and consequences. A conceptual framework for health system performance evaluation is presented to discuss methods for measuring and estimating the level of technical and economic efficiency, including the DEA method
Jacquemet, Nicolas. "Essais d'économie appliquée sur l'intervention d'une tierce partie dans la relation d'agence". Phd thesis, Université Lumière - Lyon II, 2005. http://pastel.archives-ouvertes.fr/pastel-00001785.
Texto completoJacquemet, Nicolas. "Essais d'économie appliquée sur l'intervention d'une tierce partie dans la relation d'agence". Phd thesis, Lyon 2, 2005. http://theses.univ-lyon2.fr/documents/lyon2/2005/jacquemet_n.
Texto completoAgency theory has provided a deep understanding of the conditions under which incentives manage to reconcile the diverging interests experienced by the principal and the agent. The essays presented in this thesis evaluate the empirical relevance of those results when a third party interacts with the primary contract. We focus on three archetypal situations: corruption behavior, the practice patterns of physicians and the demand for underground work. First, corruption refers to situations in which two contracts are at stake: a delegation contract between a Principal and an Agent and a corruption pact concluded between this Agent and a third player, called Briber. We first provide a survey of both empirical and theoretical recent literature on corruption, highlighting how corruption behavior results from the properties of each of those two contracts. We thereafter show that the Agent faces a conflict in reciprocities due to those two contradictory agreements. The resulting delegation effect, supported by observed behavior in our three-players experimental game, could account for the deterrence effect of wage on corruption. Second, the supply of health care is governed by contradictory objectives: patients are mainly worried about the quality (health) provided whereas containing health care cost is the primary goal of health care administrators. We provide further understanding into the ability of incentives to account for those two contradictory objectives. To this matter, our theoretical and econometric analysis is aimed at evaluating how a new mixed compensation scheme, introduced in Québec in 1999, has affected physicians practice patterns. The labour supply of physicians is described both by the extensive margins (total hours of work, number of services delivered) and the intensive margin (time devoted to each patient). Free switching is shown to be an essential feature of the reform, since it implements screening between physicians on the basis of their preferences regarding work practice. Last, the demand for underground work departs from previously analysed illegal behavior due to the benefit of illegality depending upon competitors' behavior. We set up a theoretical model linking the individual demand for underground work to this feature, with specific emphasis on the potential deterrence effect of denunciation. We first show that competition leads to the rather intuitive Bertrand curse: evasion occurs at the only equilibrium although it opens the door for a price war that cancels out the benefit of illegality. We next turn to the conditions under which an industry can sustain collusive evasion, a strategy where evasion benefits are recovered thanks to a collusive pricing behavior. Denunciation is shown to help firms in supporting this strategy at equilibrium, hence fostering underground work. Our empirical evidence supports those results. This leads to strong support against adding denunciation to actual deterrence policies. Overall, those three applications highlight the central role played by the interests of the three players involved, respectively: divergent, convergent but contradictory and divergent but helped by a mechanism of reconciliation
Gabarro, Céline. "L’attribution de l’aide médicale d’Etat (AME) par les agents de l’Assurance maladie : entre soupçon de fraude, figures de l’étranger et injonctions gestionnaires". Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCC167/document.
Texto completoIn this dissertation, we address the issue of healthcare access for undocumented immigrants through the study of State Medical Aid (referred to as AME – Aide Médicale d’Etat) – a healthcare coverage specifically dedicated to them. Based on an ethnographic study carried out on both sides of the counter at Health Insurance Offices (referred to as CPAM - caisses primaires d’Assurance maladie), we question the impact of an increasingly managerial approach to healthcare and of CPAM occupational mutations on AME attribution. We show how a rhetoric of suspicion developed in this administration, towards foreigners in particular. Event though this rhetoric is institutionalized, we shall see how it can also be individually reappropriated, in a context where the meaning of labor is strongly called into question, and where professional identities are undermined. While all agents share a common discourse on the fight against social fraud, they nevertheless use this logic in different ways. As a result, agents may distinctively promote a managerial expertise, a social expertise, or a system gatekeeper expertise. Finally, this dissertation shows how the use of a suspicion rhetoric does not necessarily produce a rigorist reading of AME, even if the latter dominates. On the contrary, it may also call on a social or managerial perspective – given the specificity of AME and its separate processing – that may facilitate healthcare access for undocumented immigrants
Drapeau, Maude y Maude Drapeau. "Impacts macroéconomiques des changements démographiques : une approche avec générations imbriquées". Master's thesis, Université Laval, 2014. http://hdl.handle.net/20.500.11794/25082.
Texto completoTableau d’honneur de la Faculté des études supérieures et postdoctorales, 2013-2014.
Ce mémoire présente un modèle macroéconomique pouvant servir d’outil pour l’analyse des impacts macroéconomiques du vieillissement de la population québécoise. Le point de départ est le modèle à générations imbriquées de Gertler (1999), dans lequel deux catégories d’agents consommateurs interagissent : les travailleurs et les retraités. Chacun fait face à des contingences individuelles, notamment le passage d’un état de travailleur à celui de retraité puis, au décès. Notre étude enrichit le modèle de Gertler en ajoutant un deuxième bien au panier de consommation, à l’aide d’une fonction d’utilité à élasticité de substitution constante entre les deux types de biens. Ce deuxième bien représente la consommation de soins de santé et le modèle est étalonné de manière à ce que le poids accordé à cette composante de l’utilité augmente au cours du cycle de vie du ménage. La solution dynamique du modèle est simulée et permet d’évaluer la trajectoire de différentes variables macroéconomiques comme le PIB, les dépenses publiques, le taux d’intérêt et les salaires, à la suite d’un choc démographique.
Ce mémoire présente un modèle macroéconomique pouvant servir d’outil pour l’analyse des impacts macroéconomiques du vieillissement de la population québécoise. Le point de départ est le modèle à générations imbriquées de Gertler (1999), dans lequel deux catégories d’agents consommateurs interagissent : les travailleurs et les retraités. Chacun fait face à des contingences individuelles, notamment le passage d’un état de travailleur à celui de retraité puis, au décès. Notre étude enrichit le modèle de Gertler en ajoutant un deuxième bien au panier de consommation, à l’aide d’une fonction d’utilité à élasticité de substitution constante entre les deux types de biens. Ce deuxième bien représente la consommation de soins de santé et le modèle est étalonné de manière à ce que le poids accordé à cette composante de l’utilité augmente au cours du cycle de vie du ménage. La solution dynamique du modèle est simulée et permet d’évaluer la trajectoire de différentes variables macroéconomiques comme le PIB, les dépenses publiques, le taux d’intérêt et les salaires, à la suite d’un choc démographique.
Romanens, Jean-Louis. "Permanences, mutations et renouveau du service public hospitalier". Thesis, Montpellier 1, 2014. http://www.theses.fr/2014MON10007/document.
Texto completoPermanencies, mutations and revival of hospital public utilities : The legislative corpus initiated on July, 21st, 2009, by the law reforming the hospital and relative to the patients, health and territories, put a new legal paradigm concerning the hospital public utilities. So we have questioned this concept, its constraints, its permanencies but also mutations and apparent revival. The concept of a public hospital service, may be the first public service created in our history, emerged from a slow maturation, based on that rule: ''serve the other one'', canonically appeared during the Orleans Council, 511. Since one thousand and five hundred years, it has often mutate but has kept this mental content, on which transplanted the hospital experiment. Two new mutations were developed during the last decade. In a formal legal break-off, distinguishing public services missions opened to any health actor, and the public utilities' guaranties of equality, continuity, mutability, the public utilities originating from hospital, leaving its organicity, built for itself a euro-compatibility. In return, mainly supported by the French hospital and its nine million hospitalizations a year, it shaped the concept of general economic interest service of the European Union. Through another mutation of its autonomous management, it has found the ethic of a new synergy between systemic medical quality and economic management grounded on activeness. However, it weighs on its future, other imperatives. On one hand, the cooperations between establishments require their elevation into a public utilities mission rank. And a management of the user's representatives and the various hospital staff must be integrated to the strategy. On the other hand, the heavy current stakes in public health, worsening the social deficits, paralyzed by the corporatism and sanitary powerlessness, would quickly require a personalized coverage in health routes of chronic diseases, and of populations in social dislocation. The rise of a territory health public utilities mission opened to any health actor whose legislation we propose, would contribute to the inter-professional coordination and the relevance of the health system. In continuation, we propose legislative and organizational modalities of creation of specific entities by the health establishments, in territories of exception agreed with the Regional Health Agency (Agence Régionale de Santé). It would be a matter of Inter professional hospital poles of health (PHIS) on ambulatory medicine of prevention, therapeutic education, organic care, mental care, reeducation and rehabilitation follow-up. Health centers included into health poles, they would allow restoring population accessibilities adapted to each territory, bettering the town-hospital relationship, and a research-teaching valuing the general medicine. In its society and for the citizen, the public hospital utilities have to stay the experiment of future
Soilly, Anne-Laure. "Evaluation économique de la prématurité : une première année de vie aux enjeux majeurs : le cas de la France". Thesis, Dijon, 2016. http://www.theses.fr/2016DIJOE003/document.
Texto completoThis thesis focuses on a first economic assessment of prematurity in France. Prematurity is defined as occurring before 37 weeks of gestation. It is increasing in France and worldwide. If the issues of public health are already well identified, medical care and collective choices concerning prematurity matters also involve significant economic challenges. The first part of this thesis attempts to present the public health issues of prematurity and highlights the remaining efforts required to provide prevention in France. It then considers economic issues on the use of socially fairer resources dedicated to perinatal health in a context where current health expenditure is rising. Assessment of the collective burden of care for preterm infants is necessary and envisaged by a Cost-Of-Illness study. Finally it presents a framework where ethical and economic considerations are complementary. The second part addresses the methodology and results of the study. The study assesses the hospital and non-hospital direct costs for preterm and term births, in the first year of life, from health insurance point of view. It is based on an extraction of data from the National Heal Insurance Inter-Regime Information System. The results of the study highlight in particular the level of average costs associated with extreme prematurity (before 32 weeks) and demonstrate an inverse and significant relationship between average costs and the gestational age (GA) at birth. This economic study invites awareness of the policy makers about the need to provide financial and human resources to anticipate and prevent critical situations associated with prematurity
Lamontagne, Erik. "The economic analysis of the AIDS response and its determinants among sexual and gender minority". Thesis, Aix-Marseille, 2021. http://theses.univ-amu.fr.lama.univ-amu.fr/211220_LAMONTAGNE_906coigum240yxx699ovkzw401sgt_TH.pdf.
Texto completoHuman immunodeficiency virus (HIV) is one of the leading causes of death in low- and middle-income countries.On June 8, 2021, the United Nations adopted the Political Declaration on Ending Inequality and Ending AIDS by 2030. Nevertheless, the need for prevention and treatment in many of the most affected countries far exceed their ability to pay. In addition, AIDS mainly affects most-at-risk population groups. This thesis shows that the benefits of this massive investment by the international community to end the AIDS epidemic by 2030 exceed 6 for every 1 invested. While this is an attractive investment, achieving the global 95-95-95 HIV target is far from certain, especially for sexual and gender minorities who are up to 26 times more likely to acquire HIV.The economic models used in this research identify three main factors that impede the achievement of the targets. First, stigma and discrimination are the main barrier to accessing HIV services. Second, too little emphasis is placed on the role of mental health in vulnerability to HIV infection. Finally, it demonstrates that inequalities undermine HIV response efforts by reducing the uptake of HIV testing.The findings of this thesis encourage policy makers to consider the importance to address inequality, mental health and homophobia in order to ending AIDS