Tesi sul tema "Soins médicaux – Coût – Pakistan"
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Rizvi, Syeda Anam Fatima. "Dépenses et financement de la santé ; une perspective de déterminants macroéconomiques et de microfinancement pour les pays en développement (Un cas du Pakistan)". Electronic Thesis or Diss., Université Clermont Auvergne (2021-...), 2023. http://www.theses.fr/2023UCFA0157.
Testo completoHealth expenditures across the globe are rising; therapeutic health services have increased as well as becoming expensive. Life expectancy in developed economies have increased more as compared to the developing countries, however developed economies have ensured adequate health financing mechanisms as compared to developing countries case. Developed economies have developed health financing models through risk pooling i.e. insurance mechanism and developing health markets where as developing economies are still grappling with the quest of adequately financing their health spending needs. But still incidence of Out-of-Pocket Health expenditures are the major source and these at times also become catastrophic for the families which have an unexpected health emergency.In this thesis we have empirically estimated the macro determinants for health expenditures across countries. Every country has its unique health sector circumstances, these differences may be in the existence of health markets, insurance options, economic growth and above all the institutional quality which defines the overall governance structure of health sector. Income ,education, technology, and aging population are generic drivers for higher health expense on the other hand. Our results have shown that these variables significantly affect overall need of health expenditures.These are however macro level determinants and in order to understand the basic empirical underpinnings of the health financing needs one has to delve into micro level studies. One of the major query in this regards for developing countries like Pakistan is to see the determinants for the out of pocket health expenditures. These OOP health expenditures often become catastrophic and may result in making households welfare damaged permanently. Because these OOP are managed by selling productive assets or by reducing the essential expenditures such as education and other amenities. However, one needs to understand the causes for such catastrophic expenditures to be able to propose evidence-based policy proposals. Our findings provide that theory of change where we see that for Pakistan; the households's education, age, type of employment and region are major covariates which drives the families into further poverty by virtue of a health shock to one of the family member, and if it is the household head which is also the single earner of the family then without intervention of the government it becomes impossible to become stable again.Lastly, one question which puzzles the policy makers that rationality suggests that individuals are risk averse. Hence in a health outcome climate where risk of catastrophic expenditures probability is very high one should cover the risk by opting for health insurance, however the data does not reflect this picture. This may be because of an underdeveloped health insurance market in countries like Pakistan, but there can also be behavioral attributes besides low-income levels which may result in such insurance purchase decisions. Therefore, a good research query would be to evaluate the determinants of health insurance purchase decisions. Because this can lead us to propose a policy framework which ensures that majority of population's health risk is covered through health insurance system. Our results have identified that age, province, family size, education, internet usage and wealth are significant variables. Since we could not cover the health insurance markets from a primary data perspective hence this can be a limitation of the study
Chauvin, Pauline. "Evaluating health expenditures with cost-effectiveness analysis : foundations, methods and application to colorectal cancer mass screening". Rennes 1, 2011. http://www.theses.fr/2011REN1G011.
Testo completoThe on-going growth of medical expenditures in most countries has strengthened the interest for economic evaluations of health care programmes. This thesis questions the extent to which and how Cost-Effectiveness Analysis (CEA) can be used to evaluate health care expenditures. CEA is defined as the methodological approach valuing consequences of allocation of resources with non-monetary units. More specifically, it is used to assess alternative mass screening strategies for Colorectal Cancer (CRC) in France. Even though CEA is currently the reference in health care assessment, its theoretical foundations are not definitely settled. In the first part of this thesis, three potential normative frameworks for CEA are considered, namely welfare economics, the capability and extra-welfarist approaches. Then in a second part, the methodology enabling to properly use CEA is examined. Eventually, two CEAs are implemented to assess alternative mass screening strategies for CRC in France. The potential contribution of Computed Tomography Colonography (CTC) to CRC mass screening is considered. A Markov model is elaborated in order to compare CTC with guaiac and immunological fecal occult blood tests. The first test is currently used in France for the mass screening campaigns while the second one is likely to replace it
Cabon, Sébastien. "La disposition à payer comme mesure des préférences individuelles dans le secteur de la santé". Lyon 1, 2000. http://www.theses.fr/2000LYO10040.
Testo completoSamios, Stefanos. "Détermination de critères pour l'allocation de ressources dans le secteur hospitalier : le cas de la Grèce". Paris 9, 1988. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=1988PA090032.
Testo completoHealth expenditures increase radically all over the world, since the early 70ies. Among them, those concerning hospital services often represent more than half of the total. Greece cannot escape that rule : especially after the new national health system (E. S. Y. ) With its significant financing needs was established, the traditional financing procedures of the Greek public hospitals via direct subventions by the ministry of social services is again under question, as it does not allow control of the exploding expenses. This is the reason why the Greek administration has invented the term "rationalization", referring to the allocation of resources of the hospital sector. An embarrassing question appears: "how to do it»? This is exactly the context that our study is referring to in an attempt to elaborate resources-allocation-criteria under the point of view of "rationalization"
Grimaud, Jérôme Paul. "Évaluation médico-économique de la prise en charge initiale des patients atteints de sclérose en plaques". Lyon 1, 2005. http://www.theses.fr/2005LYO10108.
Testo completoTraoré, Sory. "Estimations non-paramétriques de coût médical et d'incidences d'événements cliniques : application à l'évaluation médico-économique d'un dépistage pré-thérapeutique des toxicités du 5-fluorouracile". Angers, 2010. http://tel.archives-ouvertes.fr/tel-00967957/fr/.
Testo completoThis thesis deals with non parametric estimation methods of medical cost and of incidences of clinical events that generate it. Such statistical analysis methods already exist but they are sometimes misused due to the bias induced by the data when encountering censorship, recurence of interest events, and competitive risks. The choice of a correct statistical method of estimation is generally an issue within such a context. In a first part, we have studied the statistical methods that are usually used but none was defined at a sufficient general level to take into account all the classical situations. So, in a second time, we have developped a "multi-state" framewok of non parametric approaches allowing to estimate both the medical cost and the incidences of the events that generate it when in presence of all these situations. The properties of the estimators, in terms of bias and asymptotic behavior have been then studied. Finally, all the methods that were studied and developped have been applied to a real case: the medical and economical evaluation of the pre-treatment screening of the toxicities for the 5-fluorouracile that has been set up by the research teams of the Laboratoire d'Oncopharmacologie and INSERM U892 of the Centre Paul Papin d'Angers. This study has showed that this pre-treatment screening could lead to a significant reduction of the major and lethal toxicities which takes place during the first two cycles of the treatment that uses the 5-FU. Moreover, the supplementary cost that it induces could be significantly inferior to the cost of the toxicities that it helps to avoid, whatever type of economical study is considered
Mouity, Nzoumba Joseph Gildas. "La modélisation des coûts à l'hôpital". Rennes 1, 2010. http://www.theses.fr/2010REN1G009.
Testo completoLejeune, Catherine. "Analyse coût-efficacité du dépistage de masse du cancer colorectal en France : utilisation d'un modèle de simulation". Dijon, 2003. http://www.theses.fr/2003DIJOMU04.
Testo completoFantino, Bruno. "Un méta-modèle de l'évaluation en médecine : applications à la chirurgie ambulatoire et à l'ostéoporose post-ménopausique". Lyon 1, 1994. http://www.theses.fr/1994LYO19006.
Testo completoLoiseau, Pierre. "La maîtrise des dépenses de santé confrontée à la responsabilité médicale, aux Etats-Unis comme en France". Perpignan, 2003. http://www.theses.fr/2003PERP0498.
Testo completoIn France, health cost control is now tracing american managed care. The point is to change physician conduct, still threatened by medical liability : normalized health care don't line up medical science, global health care don't cope with an individual decision fitted to the patient. Medical liability, however, influence health cost ; third payor liability makes failure predictible, defensive medecine makes failure persistent. Decriminalizing unwilling fault during complex deeds can be supported by a damage insurance, paid by social security through physician contribution : medical art and cost control would blend together
Lafarge, Hervé. "Économie de la discipline médicale : essai sur la dynamique économique du système de production de soins". Paris 9, 1989. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=1989PA090015.
Testo completoThe growth of health spending is mostly attributed to the impact of scientific progress on a field which society would keep outside any form of control. The present work is an attempt at making more explicit the nature of the economic dynamics at work in the health care sector from an analysis of physicians'specific micro-economic behaviour. In the first section after a reminder of the inadequacy of the habitual concepts of economics for the study of the sector, we propose an analysis of the medical cursus as a controlling body for health care activities which generate a type of specific behaviour we propose to call "specialisation disciplinee". The second section describes the economics evolution of the health care sector since the late fifties and shows hour this evolution results from a confrontation of the dynamics specific to the sector (which combines the logic of the market with that of "specialisation disciplinee", in proportion that vary according to institutions) with the market which is the main provider of funds to the sector
Attal-Valière, Martine. "Régulation de l'équipement lourd et démarche qualité". Paris 9, 1996. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=1996PA090068.
Testo completoThe different ways of diffusing imaging technologies didn't always occur following identical models. As far as the conventional radiology and ultrasound were concerned, the diffusion was done in a free and competitive manner. Through on the contrary, for material called "expensive health technologies (EHT)" represented by computed tomography, MRI and digitalized radiology, the public authorities have established a form of administrative regulation, related to a specific plan: a sanitary card. Within the frame of this sanitary card, the use of EHT, is subjected to ministerial and prefectural authorization. This planification is based on machine indexes the number of inhabitants, purely quantitative indexes. It has limited the number of machines installed, the object being to limit the number of exams practiced and therefore health expenses. Modern enterprises have (for 15 years) installed quality system. They have proved that they were a means of extremely performant management. The quality systems is based both upon the assessment and referential represented by the standards. By this work, we propose to show how the installation of this quality system could permit to improve significantly this type of administrative regulation, basing it on the performance and the quality of organization rather than on purely quantitative information’s, and at the same time, limiting the costs of non-quality in the broad sense and could become a general guarantee of quality health care
Bardey, David. "Assurance maladie et concurrence". Besançon, 2001. http://www.theses.fr/2001BESA0003.
Testo completoIn several countries, market mechanisms are used to manage health risk. The purpose of this thesis is to analyse the arguments which tend in favour of such mechanisms whereas the debate on public intervention in health insurance sector is still opened. . .
Schilling, Laurent. "La dynamique de longue durée du système de soins : une approche par la théorie de la régulation". Montpellier 1, 1995. http://www.theses.fr/1995MON10035.
Testo completoLaveix, Cyril. "Centre d'Albret : cellule d'accueil pour démunis : évaluation du coût médicamenteux". Bordeaux 2, 1998. http://www.theses.fr/1998BOR2P051.
Testo completoMolinier, Laurent. "Les analyses économiques dans la prise en charge des cancers : évaluation et modélisation des coûts application au cancer bronchopulmonaire". Toulouse 3, 2007. http://www.theses.fr/2007TOU30054.
Testo completoIn France, approximately 28 000 cases of lung cancer are diagnosed each year. This work provides new information on the evaluation and the modelling of costs of this pathology. We summarized the state of the knowledge and the reflections currently led in the fields of the economic evaluation of healthcare programs and their modelling. This aim of this work was to evaluate the costs of managing patients with lung cancer in France. Markov chains built on the different management phases were developed. This type of modelling constitutes an inexpensive tool for simulation and very instructive in its educations, particularly for understanding of the consequences of this disease. This thesis also aimed at analyzing the methodological characteristics of the studies estimating the cost of this pathology. A supplementary effort is to be realized in the field of the methodological validation
Trevisan, Laurence. "Le pied diabétique : physiopathologie, évaluation du coût thérapeutique à l'hôpital". Paris 5, 1990. http://www.theses.fr/1990PA05P117.
Testo completoMaillot, Stéphanie. "Redistribution et dépenses de santé". Besançon, 2003. http://www.theses.fr/2003BESA0004.
Testo completoThis thesis studies income redistribution. Redistribution comes from public health care finance and income taxation. Social and fiscal policies can be implemented by a benevolent State but also by self-interested politicians. The first part is a synthesis of literature. The normative and political approaches are retained to study health care finance and income redistribution. The second part studies the optimal redistributive policy when State is benevolent and offers income and health care coverage by means of a direct linear income tax. I also consider the introduction of moral hazard in a second time. The last part considers the democratic decision process : majority voting, to determine which fiscal and social policy has to be implemented, and analyzes the redistributive impact
Gaubert, Julia. "Les soins de santé transfrontaliers : Approche juridique des soins médicaux transfrontaliers dans l'Union européenne". Thesis, Montpellier 1, 2013. http://www.theses.fr/2013MON10041.
Testo completoWith only one percent of the health expenditure, cross boarder healthcare remains a marginal phenomenon but has important implications. At the interplay between national and Community competence as well as different branches of law, this notion and its regime reflect a diversity of influences. Cross boarder healthcare can be considered as a legal construct, which can be implied by two constituent material elements : the crossing of a boarder by the doctor or the patient and the chargeability of the costs of care. Cross border healthcare is organized around a triangle of players, namely the doctor and the social security body, both considered as service providers, and the patient, who acquired its own legal status. This study aims at showing the complexity and the originality of the cross boarder healthcare model. On the one hand, the European Union “forced” the application of this triangular model, but appears on the other hand to overcome this traditional model. This trend has recently been confirmed by the directive 2011/24/UE and calls the foundation of care relationship into question, well beyond the cross boarder care issues
Dubertrand, Stephane. "Evaluation et évolution de la perte d'autonomie de sujets âgés selon le modèle A. G. G. I. R. [Autonomie Gérontologique-Groupe Iso-Ressources]". Bordeaux 2, 1995. http://www.theses.fr/1995BOR2M042.
Testo completoPereira, Céline. "La régulation économique de la médecine de ville". Paris 2, 2002. http://www.theses.fr/2002PA020040.
Testo completoBarbaret, Cécile. "Détresse financière en phase palliative chez les patients atteints de cancer : vers une approche structurée des coûts de la fin de vie Financial distress in patients with advanced cancer Inequalities in financial distress, symptoms and quality of life among patients with advanced cancer in France and the United States of America The association between palliative care team follow-up and aggressiveness of cancer care near the end of life. Research Protocol on Early Palliative Care in patients with acute leukaemia after one relapse". Thesis, Université Grenoble Alpes (ComUE), 2019. https://thares.univ-grenoble-alpes.fr/2019GREAS022.pdf.
Testo completoConcerns about costs of the palliative phase in patients with cancer has emerged. Beyond usual measures to control health expenses other ways involving clinical, teaching and research might impact costs of the palliative phase and health expenses.Methods:Association between financial distress and lower quality of life was highlighted. In order to improve patients’ quality of life, focusing on costs and financial distress seems necessary. Other studies especially one concerning aggressive cancer care near the end of life were made. Those criteria could be one source of health expenses and alteration of quality of life.Discussion: Collaboration, anticipation, quality of professionals training programs and palliative care research development are all possible solutions which could lead to decrease health expenses. In literature no study focusing on all type of cost during the palliative phase was made. All this work leads to a new research protocol concerning palliative phase costs among patients with cancer.Conclusion: Understanding specific cancer expenses for patients and their families is undoubtedly important for quality of life. Concerning a more global approach, health consumptions and quality of collaboration are possible ways to improve quality of life while respecting the individual and the collectivity. Death is inevitable but our way to die is not. Clinics, research and teaching are the three axes to focus on
Laventure, Stéphane. "Trypanosomiase humaine africaine à trypanosoma brucei gambiense : à propos d'une expérience en République Populaire du Congo : coût du dépistage". Caen, 1989. http://www.theses.fr/1989CAEN3095.
Testo completoAdoh, Adoh François. "Dépenses publiques et dépenses privées de santé en Côte d'Ivoire : faut-il une assurance maladie obligatoire?" Lyon 3, 1987. http://www.theses.fr/1987LYO33016.
Testo completoFrom colonial times on most health expenses have been financed by the ivorian state. Health care in public hospitals was then free, except for some well-off patients who would say in private rooms. The hospital was the government's best means of controlling health policy. In such conditions the new-born field of private medecine could not spread in favorable conditions to make for a stronglyrooted public health field. Yet one can notice in recent years some extension of private medecine in ivory coast. In fact the economic crisis has compelled the state to gradually free itself from economic and social affairs including field of public heath. Therefore in public hospitals health care is less and less free. As a result of such a situation it's more and more difficult for lower classes to take advantage of health care because of its high cost. The breaches in public expenses have resulted in the growth of illegal medecine through the country. In view of a better harmonisation and in view of promoting health care in ivory coast it would be fair to question the opportunity of the institution of a compulsory health insurance. Could the french system serve as a model ?
Couffinhal, Agnès. "Concurrence en assurance santé : entre efficacité et sélection". Paris 9, 1999. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=1999PA090048.
Testo completoBasterreix, Stéphanie. "Prise en charge des patients lombalgiques en médecine générale". Bordeaux 2, 1999. http://www.theses.fr/1999BOR2M072.
Testo completoTai, Glahou Jean. "L'organisation du système de santé dans les pays francophones ouest-africains, et le choix d'une diversification des sources de financement : application à la Côte d'Ivoire". Lyon 3, 1986. http://www.theses.fr/1986LYO33009.
Testo completoRiemens, Paul. "La maladie thrombo-embolique et son coût : considérations générales et en long séjour". Bordeaux 2, 1990. http://www.theses.fr/1990BOR25281.
Testo completoHrifach, Abdelbaste. "Coût du prélèvement d'organes dans le système de soins français". Thesis, Lyon, 2018. http://www.theses.fr/2018LYSE1231/document.
Testo completoIn a first part, we developed a mixed method combining top-down micro-costing and bottom-up micro-costing to accurately assess the costs of organ recovery in a French hospital group. We compared this mixed method versus full top-down micro-costing to assess potential differences. In view of illustration, we applied in a second part the results of pancreas recovery cost to value the islet transplantation procedure. During a third part, we assessed organ recovery costs based on the national hospital discharge database and a national cost study from 8 consecutive years. Results of the first and the second publication, each based on specific database, appear to be widely different. We compared, in a last part, the hospital cost accounting system in a French hospital group with the national cost study in terms of the cost of organ recovery procedures. This study highlights the cost differences existing between hospital cost accounting and the national cost study. These differences relativize and lend caution to the interpretation of the results of our previous study assessing organ recovery cost from national data. Given these differences, it is fundamental for readers, hospital managers and decision-makers to know the strengths and weaknesses of each methodological approach and the strengths and weaknesses of each database used to be able to interpret the results in an informed context
Cozic, Mariannick. "Evaluation médico-économique de stratégies thérapeutiques : le cas de la chirurgie de l'épilepsie". Montpellier 1, 2002. http://www.theses.fr/2002MON10047.
Testo completoMesatfa, Nassera. "Le paradoxe entre exercice libéral et exigences de régulation des dépenses de santé : le cas des établissements hospitaliers commerciaux". Paris 1, 1996. http://www.theses.fr/1996PA010559.
Testo completoThe economic crisis has involved a financial crisis of the french health insurance system since the 70's. Since then, it has been necessary to balance the accounts of the health insurance by controling the increase of health expenditures. Hospital is the center of the health-care system; this sector is the most costly provider of health-care service. There are three kinds of hospitals : public hospitals, private uncommercial hospitals, private commercial hospitals. Because of the plurality, those three sectors have been unequally treated. Until the 80's, the government privileged the regulation of the public and the private uncommercial sectors. The private commercial sector regulation policy was sporadic and didn't permit to limit the increase of the expenditures in the long term. It's difficult for the government to control this sector because of its statutes. Actually, private commercial hospitals' aim is profitability and the concept of free enterprise can sometimes keep the institutional actors from controling them. The actors of the system are analysed like contradictory the ones to the others ; they have divergent objects. State, health insurance, commercial hospitals, their federations, their physicians, and patients, which actively or passively step in the system, have incompatible logics and strategies. So we can note the incoherence of the system, which has to find a compromise between the actors for the regulation. The search of this compromise is realized by a recourse to the concepts of co-ordination and negociation. The health insurance and the two federations of commercial hospitals take part in planning but they just have a consultative role; the decision belongs to the administrative supervision. On the other hand, the tariff regulation is decided by the three actors : state, health insurance and the two federations. Each year, they negociate a rate for the increase of the expenditures
Borie, Frédéric. "Prise en charge et surveillance du cancer colo-rectal : analyses médico-économiques et décisionnelles". Lyon 1, 2002. http://www.theses.fr/2002LYO10262.
Testo completoCaupenne, Odile. "Coût médical des épithéliomas cutanés de la face : évaluation au C.H.R. de Bordeaux". Bordeaux 2, 1992. http://www.theses.fr/1992BOR2M104.
Testo completoBouges, Stéphane. "Evaluation médico-économique comparée des filières de soins gériatriques chez les personnes âgées de plus de 75 ans admises aux urgences". Montpellier 1, 1996. http://www.theses.fr/1996MON11001.
Testo completoAverseng, Isabelle. "Evaluation rétrospective du coût de la prise en charge de l'anorexie mentale dans la région de Montpellier". Montpellier 1, 1997. http://www.theses.fr/1997MON11068.
Testo completoCrepon, Philippe. "La réduction des inégalités spatiales d'accès aux soins confrontés aux théories de la justice sociale". Paris 1, 1998. http://www.theses.fr/1998PA010039.
Testo completoThe social justice theories collation with health care expenditure regulation mechanisms involves methodological choices relative to the construction of a model explaining consumption. In a society characterized by the development of exclusion and by a kind of duality, which is the most adapted justice theory to account for most of the regulation perverse effects used until now? The local allocation of ressouces is based on the theoretical and effective consumption levels comparison. The construction of a theoretical level requires in regard to the chosen justice theory, to define a hierarchical order in the factors insertion and to precise the characteristics of the consumption explanatory factors according to some social protection conception : + are they merely relevant or also legitimate ? ;. A change process of the indicators that are coupled with the illegitimate factors has to be carried out in order to remove the perverse effects they generate (savings). The econometrics development shows how decisive the public sector is to face care inadequacy risks. It also shows that changes in behaviour that are brought about this process may indeed reduce over consumption practices but have no effect on under consumption ones and that it is rather difficult to say whether the process reduce or not inequalities. In this prospect, it can be useful to turn to the care function supply to make regional synthesis that point out likely expenditure inflation or inadequacy care areas
Castelli, Christel. "Modèles semi-markoviens et méthodes de régression dans les analyses de coût-efficacité : application au cancer colo-rectal". Montpellier 1, 2007. http://www.theses.fr/2007MON1T028.
Testo completoRamadan, Alyaa. "Etude de systèmes lipidiques de délivrance de principes actifs". Angers, 2010. http://www.theses.fr/2010ANGE0030.
Testo completoThis thesis highlighted the importance of lipid-based carriers and their pharmaceutical implications in the delivery of drugs of different nature for dermal and oral administration. The general introduction provided an overview of the types of lipid-based delivery systems with more emphasis on solid lipid nanoparticles ( SLN ) and lipid nanocapsules ( LNC ). In the first part, Clobetasol propionate ( CP )-loaded SLNs were prepared to improve the performance of long term topical corticosteroid therapy. Skin permeation ex-vivo data indicated that the skin retention of CP increased using the SLN test hydrogel formulation more than that a commercial gel. The second part focused on LNCs. Chapter 1 of this part aimed at encapsulating the hydrophilic macromolecule, fondaparinux ( F ), into LNCs by a novel patented two microemulsion ( ME ) strategy. This is based on the incorporation of a precarrier F-loaded ME into a second ME prepared using the phase inversion temperature plus temperature cycling methodology. LNCs formulated using Imwitor/Span were the best ( 59 nm and 48% incorporation efficiency). Chapter 2 aimed at enhancing the loading of anionic F by using cationic LNCs (~50 nm and 80-100% entrapment efficiency). In vivo study in rats administered F-loaded LNCs orally in comparison with a solution market product demonstrated that caionic LNCs significantly increased F bioavaibility and anti-factor Xa effect in a dose-dependent fashion. Data provided a proof of concept for the potential oral bioavailability of F. This offers great promise for a more convenient chronic anticoagulant therapy replcing the currently used injections
Merrien, Karine. "Evaluation de l'utilisation des antibiotiques systémiques à visée curative au C. H. G. Lagny sur Marne". Paris 5, 1998. http://www.theses.fr/1998PA05P084.
Testo completoWu, Yaping. "Essays on health care financing and health services". Thesis, Toulouse 1, 2014. http://www.theses.fr/2014TOU10007.
Testo completoThe world spends a significant and increasing share of its resources on health care. The debates on the models of health care financing and the methods of payment for the physician continue all over the world. Nevertheless, there is still no consensus on the ideal choice of financing mechanisms. This thesis aims at contributing to the debates on the health care financing and health service policy. Chapter one examines the optimal non-linear compensation rule of physicians under pay-for-performance, fee-for-service and capitation in the presence of both adverse selection and moral hazard on the supply side. We found that when moral hazard is the only problem, fee-for-service can only lead to the substitution of treatment quantity to physician’s effort, which is inefficient. Consequently, fee-for-service payments should not be used in this case. However, when moral hazard is combined with the adverse selection issue, an efficient screening requires a continued use of fee-for-service for the lower productivity physicians and less pay-for-performance. The design of the use of fee-for-service effectively improves screening. We provide an argument for the criticism on the shortcomings of fee-for-service. More importantly, we also provide a rationale for the continued use of fee-for-service payment even though the serious problems with fee-for-service have been widely acknowledged. Chapter two analyzes the three-party contracting problem among the payer, the patient and the physician when the patient and the physician may collude to exploit mutually beneficial opportunities. Under the hypothesis that side transfer is ruled out, we analyze the mechanism design problem when the physician and the patient submit the claim to the payer through a reporting game. We also derive the optimal insurance payment scheme for the patient and the physician. The insurance payment scheme which is (weak) collusion-proof is such that it is sufficient that one of them tells the truth ; but the payer’s trade-offs are different when he chooses different manners of splitting incentives between the patient and the physician. Moreover, we show that if the payer is able to ask the two parties to report the diagnosis sequentially, the advantage of the veto power of the second agent allows the payer to achieve the first best outcome. My secondary field is Development Economics. The third chapter examines whether migration crowds out informal risk-sharing contracts and leads to less consumption insurance for households in Thai villages. For the theoretical motivation, our idea is that migration may be used as a cash-in-advance contract between the household and the child. The household invests upfront in exchange for future state-contingent remittance which changes the income process of the household. For the estimation, We use the panel from Townsend Thai Annual Surveys (1997-2010). The hypothesis of no selection bias is rejected at within village insurance market level, which supports our conjecture that migration changes the risk-sharing status of households within village. After the bias are corrected, our results show that migration crowds out informal risk-sharing within village and even leads to less consumption insurance for households in Thai villages
Rey, Jean-Pierre. "Critique du ticket modérateur en assurance-maladie". Bordeaux 1, 1995. http://www.theses.fr/1995BOR1D002.
Testo completoRey, Jean-Pierre. "Critique du ticket modérateur en assurance-maladie". Bordeaux 1, 1995. http://www.theses.fr/1995BOR40002.
Testo completoChenard, Kina. "Regards croisés sur les déterminants des choix de politiques publiques : Applications à trois secteurs d'intervention gouvernementale : la politique de santé, la politique de stabilisation financière et la politique d'assainissement budgétaire". Paris 1, 2009. http://www.theses.fr/2009PA010074.
Testo completoSeror, Valérie. "L'évaluation économique des politiques de prévention dans le domaine de la santé : l'exemple du dépistage prénatal". Paris 1, 1992. http://www.theses.fr/1992PA010051.
Testo completoThe issue of an optimal allocation of collective ressources for health prevention primary prevention (in order to induce changing behaviours) and secondary prevention (in order to early treat according to a classical distinction of the w. H. O. , is in the heart of the economic matter in drawing up public policies. Choices in health policies are a matter of the social rentability criterium ; i. E. The benefit which is expected by the collectivity, compared to efforts necessitated and ressources consumed. Economic measurement raises methodological difficulties, more stressed when applied to health. These issues are illustrated in two particuliar contexts : genetical handicap prevention and prevention of perinatal transmission of aids. The terms raised in social debates make clear that the approach applied to health will find its legitimacy in its ability to make explicit the multiple choices according to values and social preferences, often refered to as esthical choices, and which are used as reference for tutelary decisions. The thesis upheld is that a normative approach of public economics may help to this clarification
Michel, Claude. "Les déterminants de la régulation régionale de l'offre de soins hospitaliers publics : l'exemple de la région Languedoc-Roussillon". Montpellier 1, 1999. http://www.theses.fr/1999MON10028.
Testo completoGuerrero, Isabelle. "Évaluation économique du protocole de traitement des fentes faciales". Montpellier 1, 1986. http://www.theses.fr/1986MON10053.
Testo completoCleft lip and palate treatment may be considered as a good which economic value depends on its ability to satisfy a need and on the efficency of the unit where it is produced : the hospital. From the research carried out at the regional hospital of montpellier on 166 children treated for cleft, it appears that the clinical production is adapted to the need for treatment. Nevertheless, the hospital as a whole does not seem to function in the best economic way. The results obtained do not confirm the case-mix analysis by which the cost by d. R. G. Should be used as the new basis of hospital tariffs
Ningada, Bobelem Gokoyo. "La demande de santé et ses déterminants en Afrique centrale". Lyon 3, 1987. http://www.theses.fr/1987LYO33004.
Testo completoRamandraivonona, Rova. "Dépenses de santé et arrêts maladie en France entre 2009 et 2012". Thesis, Paris Sciences et Lettres (ComUE), 2016. http://www.theses.fr/2016PSLED016/document.
Testo completoThe purpose of this dissertation is to define the role of French healthcare expenditures, and to identify whether care represent a cost or an investment. We use the inter-relationships between care and sick leaves for more than a hundred thousand employees. Results show a combination of preventive and curative impact of any care expenditure.By regressing additional care cost on having declared a sick leave, we highlight the significant cost of care that can be likened to consumption.With a zero inflated Poisson model, we also investigate sick leave’s key factors. In particular we focus on sectors and find that working conditions differentiate probability of sick leave, whereas employment conditions and social environment discriminate between sick leave’s durations.We then examine the preventive role of care, reducing significantly the number of sick leave days for the next year : A Poisson regression model is used where the initial condition problem has been taken into account.In our last approach, we statically classify health care and sick leave behavior to finally show that health capital can be viewed as a continuum for which investments are realized
Mohamed, Lemine Koita. "Espaces, hommes et santé : géographie médicale de la Mauritanie". Poitiers, 1998. http://www.theses.fr/1998POIT5014.
Testo completoMeyer, Christine. "La régulation de la diffusion des innovations dans le système de santé : l'exemple de l'imagerie médicale". Paris 1, 1992. http://www.theses.fr/1992PA010028.
Testo completoThe developped countries aim at managing the health structures developpment and to limit the health expenditure growth induced by technical and medical innovations diffusion in the health system. So, they directly operate in the system. But the french policy (price fixing or budgeting system or investment control), is primarily organized to limit this diffusion. And it is not efficient. During the last ten years diagnostic imaging grew at the same rythm than the whole medical expenditures. Though investment is controlled, the ct-scanner's looks like if it was not. When the examinations are paid by unit, we argue that there are induced profits, while in hospitals with limited budget local deficits are hidded. Even if the system might be made more efficient by technical ways, those public actions have to be built on economical criteria and take in account conditions and effects of those diffusion, for example the learning costs and the externalities