Thèses : « Medical policy – Europe »

1

Radin, Dagmar. « Too Ill to Find the Cure ? - Health Care Sector Success in the New Democracies of Central and Eastern Europe ». Thesis, University of North Texas, 2006. https://digital.library.unt.edu/ark:/67531/metadc5348/.

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This study examines the factors that have contributed to the success of some Central and Eastern European countries to improve their health care sector in the post communist period, while leaving others to its demise. While most literature has been focused on the political and economic transition of Eastern Europe, very little research has been done about the welfare aspects of the transition process, especially the health care sector. While the focus on political consequences and main macroeconomic reforms has shed light on many important processes, the lack of research of health care issues has lead to consequences on our ability to understand its impact on the future of the new democracies and their sustainability. This model looks at the impact of international (World Bank) and domestic institutions, corruption and public support and how they affect the ability of some countries to improve and reform their health care sector in the post-transition period.

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Kostera, Thomas. « When Europa meets Bismarck : cross-border healthcare and usages of Europe in the Austrian healthcare system ». Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209268.

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In a series of landmark rulings on patient mobility and cross-border healthcare, the European Court of Justice (ECJ) has made clear that Member States’ healthcare systems have to comply with the rules of the EU’s Internal Market when it comes to individual patient rights and the non-discrimination of healthcare providers. The rulings increased the possibilities for EU Member State citizens to get medical treatment in another Member State (“cross-border healthcare”), yet providing that under certain conditions the home Member State has to pay for these treatments in the other country. After a decade of negotiations, these rulings have been codified in a European Directive. Assuming that European integration has an impact on national welfare states and taking the example of European rules on access to cross-border healthcare, this thesis suggests analyzes the domestic impact of European integration in terms of Europeanization of the Austrian healthcare system within the context of the interplay between actors’ interests and practices on the one hand, and institutional effects on the other. European cross-border healthcare in forms of regional projects and privately or publicly organized healthcare arrangements has already become a reality in many European countries, especially in border regions. The main research questions which guides this thesis can be be put as follows: How does European integration in healthcare impact on the interests, practices and strategies of national actors that operate between national institutional constraints and European opportunities? And if national actors’ interests and strategies change, does this in turn have repercussions on the national institutional rules of healthcare governance? Given that European integration in healthcare delivery is a rather a “recent” phenomenon, and based on the assumption that actors’ strategies change more easily than national institutions, the following hypothesis is tested: Even if national healthcare actors use Europe – and hence their practices and strategies change – their interests remain largely determined by the national institutional set-up of the healthcare system. The institutional boundaries of the national healthcare system may have become porous, but for the time being they remain intact. The main findings of this study confirm the hypothesis and can be summarized as follows: Austrian actors responsible for the delivery of healthcare actively integrate various usages Europe into their existing practices of healthcare governance. These usages of Europe are more frequent at European level than at national level. Those actors who have important legal competencies, financial resources, and hence power in healthcare governance at national level, are also in a better position to use Europe effectively than those actors who lack such national resources. Limited usages of Europe at national level by corporate actors can best be accounted for by practices of consensually governing a typically Bismarckian healthcare system. None of the actors analysed, no matter how critical their stance vis-à-vis their own healthcare system might be, puts into question the legitimacy of the national healthcare system in the light of increased European competencies in regulating cross-border healthcare. Advancing European integration, mainly through the ECJ’s rulings on cross-border healthcare, might have rendered national institutional boundaries porous, but national institutions retain – at least for the time being – their power of channelling actors’ interests and of influencing corresponding practices of healthcare governance. These results invite us to further investigate which kind of healthcare governance structures are being developed at European level in parallel to those existing at national level, and to what extent Bismarckian welfare regimes might be showing resistance to institutional change induced by European integration.
Doctorat en Sciences politiques et sociales
info:eu-repo/semantics/nonPublished

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Palmedo, P. Christopher. « Equality, Trust and Universalism in Europe, Canada and the United States : Implications for Health Care Policy ». PDXScholar, 2014. https://pdxscholar.library.pdx.edu/open_access_etds/1929.

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A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and generalized trust are positively associated with universalism is only partially true. Equality is positively associated (B = .301, p < .001), while generalized trust is negatively associated with universalism (B = -.052, p < .001). Not only do Americans show lower levels of support for income equality and universalism than Europeans, but the effect of being American holds even after controlling for socio-demographic and religious variables (B = .044, p < .01). When the model tests the association of equality and trust on universalism in each region, it explains approximately 17 percent of the variance of universalism for the United States, and approximately 13 percent in Europe and Canada.

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Beckhoven, Ellen van. « Decline and regeneration : policy responses to processes of change in post-WWII urban neighbourhoods / ». Utrecht : Koninklijk Nederlands Aardrijkskundig Genootschap : Universiteit Utrecht, Faculteit Geowetenschappen, 2006. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=016413115&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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Nickel, Christiane. « Insider und Outsider bei der Osterweiterung der europäischen Währungsunion / ». Frankfurt : Lang, 2002. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=009495992&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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Iosifides, Petros. « Media concentration policy in the European Union and the public interest ». Thesis, University of Westminster, 1996. https://westminsterresearch.westminster.ac.uk/item/948x9/media-concentration-policy-in-the-european-union-and-the-public-interest.

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Stewart, Emma J. « The European Union and conflict prevention : policy evolution and outcome / ». Münster : LIT, 2006. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=014648755&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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Cheiladaki, Maria. « Supranational institutions, path dependence and EU policy development : the cases of student and patient mobility ». Thesis, University of Sussex, 2011. http://sro.sussex.ac.uk/id/eprint/7582/.

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The purpose of the present study is, by employing the methods of process-tracing and pattern-matching, to compare the policy-processes with regards to the cases of student and patient mobility. While the case-study approach to EU policy-making from a comparative perspective was introduced in the late 1970s, so far there has not been a study, which compares the cases of student and patient mobility. This gap in the academic literature is important in order to examine what conclusions can be drawn from such a comparison and as a result their consistency with previous theoretical work. In particular, and in contrast to current theoretical themes in the field of European studies and in the policy studies literature more generally, both of which stress policy change as opposed to policy stability, the comparison stresses the latter due to the interests of the most powerful member-states, that is, France, Germany and Britain. The role of interests is manifested with the adoption of the Erasmus Programme and of the European Health Insurance Card, which do not concern the free movement of students and patients. Through a synthesis between liberal intergovernmentalism and the concept of path-dependence it has been possible to create a model in order to explain why those particular policies were chosen when the alternative of free movement was also available. This interest-based account comes in direct opposition with those studies which stress the role of ideas in the policy-process but it also emphasizes the role played by the supranational institutions more specifically the Commission and the court.

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Costache, Andreea Madalina. « De-regulation of european media policy (2000-2014) The debate on media governance and media pluralism in the EU ». Doctoral thesis, Universitat Autònoma de Barcelona, 2014. http://hdl.handle.net/10803/284884.

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Esta tesis doctoral analiza el caso de la regulación del pluralismo de los medios de comunicación a nivel de las instituciones de la Unión Europea. El objetivo principal es examinar si hay una evolución en el cambio de políticas de medios de la UE desde la estricta regulación gubernamental a un enfoque de gobernanza suave con respecto a la protección del pluralismo desde el 2000 hasta el 2014. En la primera parte se desarrolla el marco teórico, basado en dos conceptos teóricos: el pluralismo de los medios y la gobernanza suave. En este sentido, este estudio argumenta que el pluralismo de los medios de comunicación se puede proteger mejor si la regulación gubernamental a nivel de los Estados Miembros se complementa con medidas de regulación suave en el ámbito de la UE, teniendo en cuenta las circunstancias de la limitación de competencias de la Comisión Europea. En la segunda parte se analizan las acciones de política de medios de comunicación a nivel de la UE. Aquí se hace una distinción entre las acciones políticas e iniciativas para la protección del pluralismo de los medios de comunicación avanzadas por las instituciones de la UE como el Parlamento Europeo, El Consejo de Europa, organizaciones de la sociedad civil y los de la Comisión Europea. Las iniciativas gubernamentales, estrategias y argumentos y la regulación suave hacia la protección del pluralismo de medios, procedentes de todos los actores de la política de medios se discuten. De este modo, se puede evaluar si la Comisión Europea se aleja más del tema del pluralismo de medios o cierra la brecha hacia las iniciativas de los Estados Miembros para complementar estas iniciativas con iniciativas de la regulación suave a nivel de la UE.
This PhD dissertation analyses the case of the regulation of media pluralism at the European Union’s institutions level. The main objective is to examine if there is an evolution on the EU media policy change from strict-government regulation to a soft-governance approach regarding the protection of pluralism from 2000 to 2014. In the first part the theoretical framework is developed, based on two theoretical concepts: media pluralism and soft-governance. In this regard, this study argues that media pluralism can be better protected if the statutory governance at national level of Member States is complemented with soft-regulatory measures at the EU level, considering the circumstances of the European Commission limitation of competences. In the second part are analyzed the media policy actions at the EU level. A distinction is made here between the policy actions and initiatives for the protection of media pluralism advanced by the EU institutions like European Parliament, the Council of Europe, civil society organizations and the ones of the European Commission. The hard-regulatory initiatives, strategies and arguments and soft-regulatory ones towards the protection of media pluralism, coming from all the media policy actors, are discussed. In this way, it can be assessed if the European Commission is distancing further more from the subject of media pluralism or is bridging the gap towards the initiatives of the Member States to complement these initiatives with soft-regulatory initiatives at the EU level.

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Schreiner, Patrick. « Staat und Sprache in Europa : nationalstaatliche Einsprachigkeit und die Mehrsprachenpolitik der Europäischen Union / ». Frankfurt am Main [u.a.] : Lang, 2006. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=014628095&line_number=0004&func_code=DB_RECORDS&service_type=MEDIA.

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Ades, Moraes Felipe. « Evaluation of the disparities in trastuzumab approval, reimbursement and uptake across the 27 European Union Member States (EU-27) ». Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209132.

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Introduction: The European Union (EU) is a political and economic confederation

composed by 27 member states (EU-27). The EU implemented several standardizations in laws,

justice and home affairs and shares the consensus that health care should be regulated by the

state. A high level of human protection should be ensured in all its member states. European

health systems are funded and managed by each national government and for historical

reasons health policy and health expenditure are not homogeneous.

Whereas cancer incidence is dependent on factors such as population age, life-style and

genetic predisposition, cancer mortality in general is dependent on the efficacy of health

systems in providing cancer prevention, efficient screening methods and treatments.

Around 20% of the breast cancers show amplification/overexpression of HER2 that is

associated with a more aggressive disease and worse clinical outcome. By targeting the HER2

receptor trastuzumab has significantly improved overall survival and changed the natural

course of this disease.

Objectives: This study aims to evaluate (1) the association of health expenditure with

breast cancer outcome, (2) to explore to which degree the differences in breast cancer survival

are related to the speed of uptake of trastuzumab and its determinants and (3) to evaluate the

real usage of trastuzumab and its relation to breast cancer survival in the EU.

Results: Breast cancer survival was found strongly correlated with health expenditure. A

clear cutoff divides Western and Eastern Europe in that regard, with western countries showing

higher health expenditure and higher breast cancer survival than Eastern Europe. Trastuzumab

reimbursement was faster in Western European countries, a factor associated with higher

health expenditure and better health policy performance. Trastuzumab uptake is increasing all

over Europe in the last 12 years, however it is still being under used in Eastern countries while

in Western Europe the uptake is sufficient to treat virtually all patients in need of the drug.

Conclusion: Important discrepancies in breast cancer survival exist in the EU. Western

Europe has higher breast cancer survival and higher health expenditure than Eastern Europe.

This can be partially explained by the faster approval and increased uptake of trastuzumab in

Western countries. Higher health expenditure and better health policy performance were

factors linked to faster reimbursement and uptake of trastuzumab.
Doctorat en sciences médicales
info:eu-repo/semantics/nonPublished

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Pelletier, Christine. « Application des techniques d'aide à la décision à la planification sanitaire régionale ». Phd thesis, Université Joseph Fourier (Grenoble), 1999. http://tel.archives-ouvertes.fr/tel-00004845.

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La planification sanitaire régionale consiste à répartir dans l'espace régional les ressources sanitaires rares (équipement lourd, personnel, ...) entre différentes structures sanitaires existantes ou non, afin d'"optimiser" la réponse aux besoins en soins de la population régionale. Cette répartition s'effectue dans un contexte décisionnel multidimensionnel, dont les dimensions médicale, économique et celles relatives à l'aménagement du territoire. Depuis une quarantaine d'années, la recherche de méthodes rationnelles applicables à la planification sanitaire a permis l'investigation de nombreuses voies de modélisation, et la proposition de méthodes variées. Malgré leur multitude, aucune d'entre elles n'a acquis de légitimité auprès des planificateurs. Trois motifs expliquent ce phénomène: le caractère restrictif de la définition donnée au système de santé, la complexité des techniques mathématiques utilisée, souvent obscures pour les non initiés, et le rôle passif réservé au planificateur. Le travail présenté dans ce mémoire propose la formalisation d'un outil interactif d'aide à la planification sanitaire. Cette formalisation s'appuie sur une approche globale du système de santé, à partir de laquelle nous avons établit une définition de la planification sanitaire. A l'issue de cette formalisation, nous proposons un outil HERO qui lie un Système d'Information Géographique (SIG) avec un outil de résolution multiobjectif. Via le SIG, l'outil informe le planificateur sur l'état de santé de la population ainsi que sur les mécanismes de production et de consommation de soins. L'outil de résolution multiobjectif assiste ce dernier dans l'élaboration d'un plan en lui fournissant un moyen d'évaluation de la pertinence de ses choix dans la répartition spatiale des ressources. Le fonctionnement de HERO est illustré sur un exemple utilisant des données du Bas-Rhin (France).

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GRANGE, Aline. « Au-delà des traités communautaires ? : l'européanisation des politiques sanitaires et sociales des drogues : diffusion et apprentissage autour de la notion de réduction des risques en France, en Italie et aux Pays-Bas ». Doctoral thesis, 2004. http://hdl.handle.net/1814/5128.

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Defence date: 2 February 2004
Examining board: Prof. Martin Rhodes, IUE (directeur de thèse) ; Prof. Adrienne Héritier, IUE/RSCAS ; Prof. Henri Bergeron, CNRS (Paris), Observatoire européen des drogues et des toxicomanies (Lisbonne) ; Prof. Renaud Dorandeu, Institut d'Etudes Politiques, Univ. R. Schuman (Strasbourg)
PDF of thesis uploaded from the Library digitised archive of EUI PhD theses completed between 2013 and 2017

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SMISMANS, Stijn. « Functional participation in European occupational health and safety policy : democratic nightmare or additional source of legitimacy ? » Doctoral thesis, 2002. http://hdl.handle.net/1814/4787.

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Defence date: 14 January 2002
Examining Board: Prof. G. de Búrca (EUI Law Department), co-supervisor ; Prof. R. Dehousse (Institut d'Etudes Politiques, Paris/ former EUI Law Department), supervisor ; Judge K. Lenaerts (Court of First Instance/ and Katholieke Universiteit Leuven) ; Prof. P.C. Schmitter (EUI Department of Political and Social Sciences)
PDF of thesis uploaded from the Library digitised archive of EUI PhD theses completed between 2013 and 2017

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STAVROULAKI, Theodosia. « Integrating healthcare quality concerns into a competition law analysis : mission impossible ? » Doctoral thesis, 2017. http://hdl.handle.net/1814/49704.

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Defence date: 22 December 2017
Examining Board: Professor Giorgio Monti, European University Institute (Supervisor); Professor Hans-Wolfgang Micklitz, European University Institute; Dr. Okeoghene Odudu, University of Cambridge; Professor Daniel Sokol, Levin College of Law, University of Florida
Healthcare markets have started being created in Europe. Indeed, some European countries, such as the UK and the Netherlands, have started adopting the choice and competition model for healthcare delivery. Taking as a starting point that as health systems in Europe move towards market driven healthcare delivery, the application of competition law in these systems will increase, the goal of this doctoral thesis is (a) to identify some of the competition problems that may be raised in light of the reality that especially in hospital and medical markets the pursuit of competition and the pursuit of essential dimensions of healthcare quality may inevitably clash (b) to demonstrate that competition authorities would be unable to address some of these competition problems if they did not pose and address a fundamental question first: how should we define and assess quality in healthcare? How should we take healthcare quality into account in the context of a competition analysis? In delving into these questions, this doctoral thesis explores how the notion of healthcare quality is defined from antitrust, health policy and medicine perspectives and identifies three different models under which competition authorities may actually assess how a specific anticompetitive agreement or hospital merger may impact on healthcare quality. These are: (a) the US market approach under which competition authorities may define quality in healthcare strictly as choice, variety, competition and innovation (b) the European approach under which competition authorities may extend the notion of consumer welfare in healthcare so that it encompasses not only the notions of efficiency, choice and innovation, but also the wider objectives and values European health systems in fact pursue (c) the UK model under which competition authorities may cooperate with health authorities when they assess the impact of a specific transaction on healthcare quality. The thesis identifies the main merits and shortcomings of these models and emphasizes that what is crucial for the adoption of a holistic approach to healthcare quality is not only the model under which healthcare quality is actually integrated into a competition analysis but also competition authorities’ commitment to protect all dimensions of this notion.
Chapter IV ‘Integrating healthcare quality concerns into the US hospital merger cases : a mission impossible’ of the PhD thesis draws upon an earlier version published as an article 'Integrating healthcare quality concerns into the US hospital merger cases : a mission impossible' (2016) in the journal 'World competition'

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Leutgert, Brooke. « Disentangling the roots of public support for European integration : exploring the effect of EU policy / ». 2007. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=018700018&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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OLESEN, Jeppe Dørup. « Adapting the welfare state : privatisation in health care in Denmark, England and Sweden ». Doctoral thesis, 2010. http://hdl.handle.net/1814/14504.

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Defence date: 12 June 2010
Examining Board: Jens Blom-Hansen (Aarhus Univ), Pepper Culpepper (EUI), Bo Rothstein (Univ. Gothenborg), Sven Steinmo (EUI) (Supervisor)
First made available online on 8 April 2019
This dissertation deals with the following question: In the past decades some of the countries most dedicated to the universal public welfare state have privatised many of their welfare service provisions. Why is this so? The dissertation takes a close look at privatisation policies in health care in Denmark, Sweden and England in order to figure out how and why the private health care sector has expanded rapidly in recent years. Health care services in Denmark, Sweden and England provide good examples of welfare state service privatisation because these three countries have spent decades building up universal public health care systems that offer free and equal access to all citizens - and these programmes are very popular. In this dissertation I find that the most common explanations for welfare state reform fail to explain these changes: Privatisation policies are not the result of partisan politics, instead they are supported by Social Democratic / Labour parties and in some cases the unions as well. Privatisation is not the result of pressures for fiscal retrenchment; in fact, public health care funding has increased in all three countries over the past decade. Neither is privatisation the straight forward result of new right wing ideas. Certainly, new ideas play a role in this change, but it is difficult to sustain the argument that ideas alone have been the cause of privatisation in these three health care systems. Finally, it has been debated whether privatisation is the result of pressure from EU legislation. This explanation does not hold either for the basic reason of timing. The policies leading to privatisation in Denmark, England and Sweden were all implemented before the European debate over health care services started. Instead, I suggest that privatisation in health care in Denmark, Sweden and England can best be understood as the product of policy makers puzzling over important policy problems (Heclo, 1972). I call this an adaptive process. In this analysis I show that privatisation is the result of several interconnected attempts to adapt health care systems to a changing context. By taking a long historical view of the changes in health care systems, it becomes evident that the changes towards privatisation do not occur overnight or as a result of a ‘punctuated equilibrium’. Rather, the increasing privatisation in health care is the accumulated effect of several small step policy changes, which, over time, result in rising levels of privatisation. Some scholars have suggested that neo-liberal policies, such as privatisation of service provision, will ultimately lead to the end of the welfare state. In this study, I come to a different conclusion. Rather than undermine the welfare state, privatisation in health care may help the welfare state survive. Privatisation can be seen as a way of adapting welfare state services to a changing political context.

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Thèses sur le sujet « Medical policy – Europe »

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