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Azzi, Rita. "Blockchain Adoption in Healthcare : Toward a Patient Centric Ecosystem". Electronic Thesis or Diss., Institut polytechnique de Paris, 2023. http://www.theses.fr/2023IPPAT053.
Pełny tekst źródłaThe healthcare sector evolves constantly, driven by technological advancement and innovative solutions. From remote patient monitoring to the Internet of Things (IoT), Artificial Intelligence (AI), personalized medicine, mobile health, and electronic records systems, technology has improved patient outcomes and enhanced care delivery. These technologies have shifted the healthcare ecosystem to be more patient-centered, focusing on meeting the patient's needs rather than the needs of the individual organizations within it. However, this transformative shift experienced by the healthcare industry is associated with multiple challenges due to the inherent complexity and fragmentation of the healthcare ecosystem. This dissertation addresses three healthcare ecosystem challenges that significantly impact patients. The first challenge addressed is the problem of counterfeit or falsified drugs that represent a threat to public health, resulting from the vulnerabilities in the pharmaceutical supply chain, notably centralized data management and the lack of transparency. The second challenge addressed is the problem of healthcare data fragmentation that thwarts care coordination and impacts clinical efficiency. This problem results from the dynamic and complex patients' journey in the healthcare system, shaped by their unique health needs and preferences. Patient data are scattered across multiple healthcare organizations within centralized databases and are ruled by policies that hinder data sharing and patients' empowerment over their data. The third challenge addressed is the confidentiality and privacy of healthcare data that, if compromised, shatter the trust relationship between patients and healthcare stakeholders. This challenge results from the healthcare organizations' poor data governance that increases the risk of data breaches and unauthorized access to patient information.The blockchain has emerged as a promising solution to address these critical challenges. It was introduced into the healthcare ecosystem with the promise of enforcing transparency, authentication, security, and trustworthiness. Through comprehensive analysis and case studies, this dissertation assesses the opportunities and addresses the challenges of adopting the blockchain in the healthcare industry. We start with a thorough review of the state of the art covering the blockchain's role in improving supply chain management and enhancing the healthcare delivery chain. Second, we combine theoretical and real-world application studies to develop a guideline that outlines the requirements for building a blockchain-based supply chain. Third, we propose a patient-centric framework that combines blockchain technology with Semantic technologies to help patients manage their health data. Our fourth contribution presents a novel approach to data governance by developing a blockchain-based framework that improves data security and empowers patients to participate actively in their healthcare decisions. In this final contribution, we widen the scope of the proposed framework to include a roadmap for its adoption across diverse domains (banking, education, transportation, and logistics, etc.)
Jover, André-Franck. "Les métamorphoses des services de santé au travail - entre santé au travail et santé publique". Thesis, Paris 2, 2015. http://www.theses.fr/2015PA020011.
Pełny tekst źródłaHealth and security at work, occupational risk prevention (road risk, psychosocial risks), intensification of labor conditions… A number of questions that the enterprise has to take into account. Answering them assumes a variety of points of view and skills. Occupational health services, that have the exclusive mission to prevent any worker health alteration occurring from their work, contribute to this debate. Due to their unique position, as a field actor, they should be the master piece of the occupational health system ; these services are, however, victim of a collective disaffection. The delicate combination of the “medical fitness for work” concept and the occupational risk prevention concept contributes to this disaffection. Since 1942, the institution has seen deep metamorphoses, a number of them appearing from the combination (sometimes being a cause for tension) of the labor law and the public health law. After the Liberation, the incorporation of the institution to the Ministry of Labor, sealed a long domination of the Labor law. The growing power of the Public Health has been jeopardizing progressively this domination. The reform dated 20th July 2011 illustrates this change of balance. The analysis of the links between the Labor Law and the Public Health Law suggests to propose a new paradigm for the sake of the workers’ health, based upon the idea – which is also a fact – that the occupational health service cannot be compared to other providers : this service contributes to the general interest
Wu, Yaping. "Essays on health care financing and health services". Thesis, Toulouse 1, 2014. http://www.theses.fr/2014TOU10007.
Pełny tekst źródłaThe 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
Decostanzi, Arthur. "Le service public de santé de proximité". Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0495.
Pełny tekst źródłaThe realization of this right is guaranteed by the intervention of public authorities, which must act in the organization of the provision of care, as well as by the existence of social security mechanisms that allow access to healthcare that is not limited by social or geographical factors. The French system is today subject to strong tensions and uncertainties: growing inequalities in access to healthcare, compartmentalization in the organization of the health system, or the ageing of the population and the development of chronic diseases. The health system must evolve around a local public health service that is the only one able to satisfy the general interest of health protection. This objective requires a better structuration and coordination of healthcare activities between the different providers serving users in order to satisfy the requirement of equal access to quality care, transversal cooperation tools are designed to break with existing silos. The implementation of such a public service requires a clear and rational management capable of take into account territorial disparities. The emergence of regional health agencies in a territorialization phenomenon must be accentuated to meet the challenges of proximity. The regulatory means implemented still have to be renewed to respond to the challenge of health protection, the capacity of self-organisation left to the initiative of liberal professionals must be transformed into collaboration with all health providers, health administrations, health insurance, local authorities and users. All these measures permit the satisfaction of the essential trilogy of public services: equality, continuity, mutability
DE, CHERGE HILAIRE. "Servir et gerer dans le domaine socio - sanitaire : comment les professionnels de la prise en charge apprennent-ils a rendre des comptes ?" Palaiseau, Ecole polytechnique, 1992. http://www.theses.fr/1992EPXX0014.
Pełny tekst źródłaTardieu, Émilie. "Soutenir l'équité en santé dans les actions de santé publique : conditions d'utilisation d'un outil visant à la prise en compte des inégalités sociales de santé". Master's thesis, Université Laval, 2015. http://hdl.handle.net/20.500.11794/26465.
Pełny tekst źródłaRochon, Madeleine. "Vieillissement démographique, état de santé et financement des dépenses publiques de santé et de services sociaux". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0027/NQ33077.pdf.
Pełny tekst źródłaTurchetto, Eliseu Luiz. "Les hommes sans domicile fixe et leur rapport aux services de santé et services sociaux". Thesis, Université Laval, 2012. http://www.theses.ulaval.ca/2012/29546/29546.pdf.
Pełny tekst źródłaLizotte, Réal. "Les services sociaux courants en C.L.S.C. et la santé mentale". Mémoire, Université de Sherbrooke, 1992. http://hdl.handle.net/11143/9331.
Pełny tekst źródłaMshali, Haider Hasan. "Services e-santé sensibles au contexte dans les espaces intelligents". Thesis, Bordeaux, 2017. http://www.theses.fr/2017BORD0575/document.
Pełny tekst źródłaIn this thesis, we propose a new e-health monitoring system for elderly, dependent and isolated persons living alone. We provided a better understanding of the monitored person's context. We develop a context-aware framework for monitoring the person's activities of daily living (ADL) and consider the most famous scales applied in the dependency evaluation models used in the geriatric domain such as the Functional Autonomy Measurement System (SMAF). The proposed adaptive framework offers several services such as the collection of high relevant and contextual data and an evaluation of the health status (i.e. dependency level) of persons. The proposed approach allows learning the human's lifestyle regarding the achievement of the ADL and the detection of the behavioral changes that may represent a risk for the monitored person. In order get closer to real-life situations, we use a Markovian-based model built for generating long term and realistic scenarios. For the behavior detection and prediction, we propose a novel forecasting approach based on the extension of the Grey theory GM (1, 1). The performances of the proposed system are evaluated and compared to traditional monitoring approaches within different scenarios and persons' profiles. The results of our evaluations reveal an efficient monitoring that optimizes the system resources in terms of computing, energy consumption, and network. With a minimum of sensing data, our system succeeds to ensure a high accuracy regarding the evaluation of the person's dependency, behavioral patterns learning, prediction of the health condition, and the detection of abnormal situations
Villerabel, Gustave. "Le service de santé des armées". Aix-Marseille 3, 1991. http://www.theses.fr/1991AIX32010.
Pełny tekst źródłaDRAME, ALIOU. "Système de santé et ajustement structurel dans les pays en développement : cas du Sénégal". Paris 10, 1999. http://www.theses.fr/1999PA100031.
Pełny tekst źródłaBlersch, Raillard Susanne. "La régulation du système de santé allemand". Paris 9, 1996. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=1996PA090069.
Pełny tekst źródłaToday, the purpose of health care systems' regulations is to improve the efficiency of the expense allocation process while containing the expense growth. Ever since the 1970's, the German state crafts the health care policy through reforms, the most interventionist of which being the reform set up by Seehofer. Up until now, the regulation mechanisms to move the German health care system out of the crisis have respected the founding principles of the German social security established by chancellor Bismarck in 1883. In this study, the economic relationships which characterize the German health care system, have been analyzed thoroughly, the decisions of the different groups of economic interest. Up until the reforms of 1989 and 1993, the German health care system has been characterized by a neoliberal-like regulation whose process was determined by the relationships between professional unions. In the crisis context of the existing formal and decentralized regulation, the German state has acted to rescue the social security system. The purpose of this study is to show that it is possible to introduce limited free market elements in a health care system without changing its founding socio-political principles. The example of Germany shows that the instruments set up by Seehofer are aimed at inducing decentralized players (public and private payors and health care professionals) to behave in an efficient manner within strict budget guidelines. These regulation mechanisms are pushing towards a buyer's market environment fostering competition among health care suppliers. Eventually, the German health care system will be managed according to the usually prevailing rules of the "social market economy". The role the German state would, then, be to oversee the overall competitive environment and warrant health care coverage for low income citizens and the poorest among them
Médina, Gimenez Anabel. "Le contrôle des services de santé par les autochtones : vers la reconnaissance de la guérison traditionnelle". Mémoire, Université de Sherbrooke, 2012. http://hdl.handle.net/11143/6691.
Pełny tekst źródłaNkoumou, Ngoa Brice Gaston. "Essais sur la ressource humaine en santé et l’utilisation des services de santé maternelle en Afrique sub-saharienne". Thesis, Paris Sciences et Lettres (ComUE), 2017. http://www.theses.fr/2017PSLED081.
Pełny tekst źródłaThis thesis studies the effect of prices on the decisions of health professionals and the use of maternal health services in sub-Saharan Africa. The first two chapters are concerned with the effect of wages on the effort choices and the multiple job holding of health professionals. Based on data collected at the peripheral level of the Cameroonian health system (Yaoundé and Douala), it appears that wages in the main job have no significant effect on the effort choice and the multiple job holding of the health professionals. Thus, a policy of high wages appears insufficient to control the shirking behaviour and the multiple job holding phenomenon of health professionals in the sub-Saharan context. The third chapter analyzes the short-term impact of the free delivery and caesarean program on the use of maternal health services in Senegal. This evaluation does not show in a short-term any positive impact of the free-of-charge measure on the use of maternal health services. The hasty scaling-up of free-of-charge policies can be then questioned in this context
Dionko, Maoundé. "Contractualisation et performance du système de santé au Tchad". Lyon 3, 2007. https://scd-resnum.univ-lyon3.fr/in/theses/2007_in_dionko_m.pdf.
Pełny tekst źródłaAfter several years of civil war and economic recession and despite the implementation of various strategies related to healthcare, the improvement of Chadian healthcare system remains one of the weakest in Africa. There are four main causing factors: insufficient healthcare infrastructures, poor healthcare organization as well as quantitative and qualitative insufficiency in healthcare staffing and lack of equipment. Vis-à-vis this incapacity of the public healthcare system to meet the needs of the populations, the government has decided to implement contracting as an instrument in order to improve the performance of the healthcare system. However, the contractual process has some backdrops that the partners believe to know exactly what is in store. Yet, in reality, they generally don't "find out” what they signed until there is a disagreement. That is why this new healthcare policy seems an excellent factor for the improvement of the performance of the healthcare system if only some legal issues are addressed. Because, if the contractual process has been until now considered as a management instrument in order to improve the performance of the healthcare system in Chad, this one could not be freed of some fundamental provisions which define the public character of its action. It can only improve in an already set legal framework that has structured the institutions, and by the same token distributed the tasks and roles, structured the authority, improved possibilities of control as well as of protection
Mariotti, Caterina. "Les services sociaux et de santé au regard des aides d’État". Thesis, Paris 2, 2019. http://www.theses.fr/2019PA020013.
Pełny tekst źródłaThe purpose of the present study is to explore the interaction between, on the one hand, EU State aid law and, on the other, social and health services. This issue – which falls within the wider debate on the “infiltration” of EU law into “national social spaces” – comes increasingly under the scrutiny of the Commission and of the EU Court of Justice (CJEU), raises new questions and is characterised by a significant degree of uncertainty. The primary objective of this research is to understand how the legal framework on services of general economic interest (SGEIs) concerning State aid is applied, and adjusted, in the field of social and health services. The analysis will however also look beyond SGEIs, investigating which other avenues are available under EU State aid law to allow public support in the welfare sector. The analysis begins by exploring the notion of “social and health services” and by outlining the EU legal framework concerning this area. After examining the concept of economic activity in EU law, it is concluded that it is likely that social and health services will increasingly be considered as activities falling within the scope of application of EU State aid law. The study then focuses on the way in which State aid law has been applied in the sectors of social housing, healthcare and social security. The overall picture is examined in light of the Lisbon Treaty and, finally, a reflection is carried out as to possible developments and actions with a view to strengthening the ability of EU State aid law to take into account the specific nature of welfare services
Fiszman, Pénélope. "Santé et recours aux soins en Belgique: disparités sociales et spartiales". Doctoral thesis, Universite Libre de Bruxelles, 2005. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210970.
Pełny tekst źródłaDuclos, Caroline. "Description des modes d'organisation des services de 1re ligne en santé mentale jeunesse dand le cadre du programme "Grandir en santé mentale en Montérégie"". Mémoire, Université de Sherbrooke, 2013. http://hdl.handle.net/11143/6297.
Pełny tekst źródłaRavoux, Vincent. "Le panier de biens et de services de santé : une approche managériale pour la France". Dijon, 2001. http://www.theses.fr/2001DIJOE002.
Pełny tekst źródłaMounassib, Riyad. "La réforme du secteur de la santé au Maroc". Perpignan, 2008. http://www.theses.fr/2008PERP0888.
Pełny tekst źródłaThe health sector in Morocco has a dual expression: on the one hand, the interpretation of health indicators shows a notable improvement in the extension of social security coverage as well as the decreasing of infant and juvenile mortality. On the other hand, there is a persisting social and regional disparity, and health care inadequacies are numerous Taking up such challenges means getting involved in a process towards a comprehensive reform, and ignoring those issues would but delay and complicate the task. It is a fact that words and good intentions must now lead to acting, and that will not be successfully performed without research work focused on the study of the current reform machinery and the search for opportunities and measures capable of achieving the sector efficiency
Boukhaïma, Sakina. "Les recompositions du système de santé en Syrie : enjeux politiques et redistribution des rôles". Aix-Marseille 3, 2002. http://www.theses.fr/2002AIX32036.
Pełny tekst źródłaThe health system in Syria is considered as an observatory of social change. This work takes place within a global topic that deals with the links between state and society in Syria. Considering that public health can be seen as a political challenge for the state, this work has particularly focused on the various ways the Syrian state is adapting to the social and economic change of the country. The setting of new functions and the re-definition of tye role of the state is playing within the health system constitute the main hypothesis of this work. For decades, the Syrian state has been playing a central role in the health system. The health system that can be seen in Syria nowadays can be considered as the result of the public health policies that the Syrian state has set up since the Independence. The setting of health policies led to a process known as "epidemiological transition". Nevertheless, the problem of access to the care structures has never been totally solved. In a context characterised by an important economic crisis, the financing of the health system becomes a very critical issue for the Syrian government. In regard to this, the government has set up medical strategies, and one of them deals with the Primary Health Cares programs. The evolutions of the health system can also be seen trough the evolutions of the links existing between the public and the private health sector. These links can be seen trough the new pharmaceutical industry. This work also pays a particular attention to the medical profession and the role it plays within the setting up of public health policies. And last, the association sector has been analysed in regard of the role it played in some localised health policies
Boidin, Bruno. "Les micro-unités de santé au Bénin : une analyse par les asymétries d'information". Lille 1, 1996. http://www.theses.fr/1996LIL12015.
Pełny tekst źródłaBoissinot, Michèle. "Guide pour le démarrage d'une coopérative de services de santé au Québec". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/mq26545.pdf.
Pełny tekst źródłaDourgnon, Paul. "Evaluation des politiques publiques et inégalités sociales d'accès aux services de santé". Phd thesis, Université Paris Dauphine - Paris IX, 2013. http://tel.archives-ouvertes.fr/tel-00912417.
Pełny tekst źródłaSombie, Issiaka. "Amélioration de l'utilisation des services de santé maternelle au Burkina Faso: Quelles stratégies adopter ?" Doctoral thesis, Universite Libre de Bruxelles, 2007. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210671.
Pełny tekst źródłaLa mortalité maternelle reste encore élevée dans les pays en développement notamment en Afrique où une femme parmi 16 en âge de reproduction sera touchée par cette mortalité contre 1 femme parmi 2400 dans les pays développés. Au Burkina Faso, ce risque de mortalité est de 1 parmi 12 pour une femme en âge de reproduction.
La littérature internationale montre qu’un meilleur accès aux soins qualifiés à l’accouchement et aux soins obstétricaux d’urgence est la solution majeure pour sauver la vie d’une femme au cours de la grossesse, de l’accouchement et dans le post partum. Elle montre que cet accès est limité en milieu rural par l’existence de barrières liées aux services de santé, de barrières économiques et sociales. Au milieu des années 1990, il a été montré qu’il serait possible d’améliorer l’accès des femmes aux soins qualifiés et aux soins d’urgence par des interventions locales visant à réduire ces barrières. Ces résultats ont entraîné la mise en place de plusieurs interventions en milieu rural burkinabè. L’objectif de cette thèse est d’examiner les activités mises en place au niveau du système de santé dans les districts ruraux de Houndé et d’Orodara au Burkina Faso afin de mieux comprendre ce qui a été à la base de l’évolution des indicateurs de santé maternelle.
Méthodologie
Le travail a combiné des méthodes quantitatives et qualitatives. Des études de cas, plusieurs sources d’informations (revue des documents, interview des populations, prise de notes, observation participante) ont été utilisées pour identifier au niveau du système de santé des districts les activités pouvant influencer l’utilisation des soins obstétricaux d’urgence et analyser la dynamique et la qualité de leur mise en œuvre. Des approches quantitatives (étude écologique, analyse transversale, étude avant et après) ont permis d’étudier l’évolution des indicateurs et de mettre celles-ci en parallèle avec la réalisation de certaines activités. Enfin, les résultats dans les deux districts ont été comparés avec ceux d’autres districts ayant aussi bénéficié d’une intervention en santé maternelle.
Résultats
L’analyse du système de santé a identifié l’existence d’activités d’éducation et de mobilisation des populations, d’amélioration de l’environnement de la prise en charge de la femme enceinte et de renforcement de compétence des agents de santé et des accoucheuses villageoises dans les deux districts. Dans le district de Houndé une intervention bien structurée (le projet SAREDO) avec analyse des besoins a été à la base d’une grande partie des activités de 2000 à 2003. Mais l’analyse de la mise en oeuvre des activités de ce projet a montré des écarts par rapport à ce qui avait été planifié, des retards et un manque de suivi des activités. Ces faiblesses du projet étaient liées à l’approche participative de mise en œuvre, à des faiblesses organisationnelles et à l’arrêt avant terme du financement. Dans le district d’Orodara, la mise en place des activités a démarré avec l’arrivée en 2001 d’un médecin chef en provenance du district de Houndé. Aucune intervention planifiée n’a existé. Les activités ont été mises en place à partir de décisions empiriques s’inspirant de l’expérience du projet SAREDO à Houndé. Dans les deux districts, la collaboration avec des intervenants dans et hors du district, le leadership de l’équipe de district et l’utilisation rationnelle des ressources ont été déterminants dans la mise en œuvre des activités.
L’évolution des indicateurs de soins maternels a montré une amélioration de l’utilisation des soins maternels en général de 1999 à 2006 dans les deux districts. En 2004, si l’utilisation des services de consultation prénatale et de maternité pour l’accouchement était meilleure à Houndé qu’à Orodara, il n’existait aucune différence pour ce qui était du taux des accouchements par césarienne. Pour ce dernier indicateur, on notait une croissance linéaire dans le district de Houndé, tandis qu’à Orodara, le taux était resté stable de 1999 à 2002 et à partir de 2003 on assistait à une amélioration avec un taux atteignant celui de Houndé en 2005. La mise en parallèle de l’évolution du taux d’accouchements par césarienne et du calendrier des activités dans les deux districts montre une amélioration après la mise en place du renforcement de la qualité des soins (formation des agents et équipement) et de la réduction du coût des soins d’urgence surtout dans le district d’Orodara. Ces observations suggèrent l’existence d’une relation entre l’évolution du taux des accouchements par césarienne et, d’une part, le renforcement de la qualité des soins et d’autre part, la mise en place de la réduction du coût des soins d’urgence.
Une évaluation a relevé dans le district de Houndé que l’offre de soins était meilleure après la formation des agents de santé et l’équipement des services. Elle a aussi montré une meilleure utilisation des services de base (consultation prénatale et accouchements institutionnels) et un taux plus élevé d’évacuations obstétricales dans le groupe des centres de santé avec un responsable de la maternité ayant bénéficié de la formation que dans le groupe des centres de santé avec un agent non formé responsable de la maternité. Les proportions d’accouchements par césarienne et d’interventions obstétricales majeures réalisées pour sauver la vie de la mère étaient plus élevées dans le groupe des centres de santé avec un agent formé responsable de la maternité mais les différences n’étaient pas statistiquement significatives. Les résultats de cette évaluation montrent qu’au niveau des centres de santé de base, former les agents et équiper les services permettent d’améliorer la qualité et l’utilisation des services de base mais ne suffisent pas pour améliorer l’utilisation des soins obstétricaux d’urgence.
Au niveau de l’hôpital du district d’Orodara, après la mise en place des kits opératoires, les proportions des évacuations obstétricales à l’admission, des évacuations obstétricales prises en charge et des accouchements par césarienne à l’hôpital du district se sont améliorés significativement tandis que les proportions des complications infectieuses post césarienne et des évacuations obstétricales à l’hôpital de référence, et le coût des soins d’urgence ont été réduits. Ceci montre qu’en réduisant le coût des soins via les kits opératoires et en plus d’une formation des agents de santé, on a pu améliorer l’accès et la qualité des soins obstétricaux d’urgence dans cet hôpital.
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Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
Touam, Sami. "Le système de santé tunisien et la réforme de l'assurance-maladie". Montpellier 1, 2006. http://www.theses.fr/2006MON10065.
Pełny tekst źródłaFor the last two decades, Tunisia has been going through a period of general economic adjustments with the market playing an increasingly key role and economic liberalism becoming more vocal. Against this novel macroeconomic context marked with both demographic and epidemiological transitions, the state has to reconsider its role and the ways it intervenes in the various sectors, including the health. The series of accounting reforms initiated in the 90's to counter the rise of health spendings notice d over the last few years, was badly convincing on both macro scale (5. 6% of the GDP in 2000 against 5. 3% in 1990) and micro scale since family contributions have been steadily growing to reach 49%. Reforms of the health system implemented over the last few years in aIl countries alike regardless of their respective organizations (beveridgian, bismarkien, or liberal. . . ) tackled, are still tackling and will be tackling the issue of financing the health system and the universalization of the heaIth coverage. Decentralization along with competition have been two key ideas that have underpined public health reforms over the last period. Could we benefit from foreign experiences as far as reform is concerne ? Could they serve as a model to follow when reforming our own system? This thesis will address these self-questions with the aim of setting up a model that takes into account the current economic, social, cultural and political contexts
St-Jean, Isabelle. "L'accès des personnes âgées aux services de santé et le respect de leur dignité". Mémoire, Université de Sherbrooke, 2005. http://savoirs.usherbrooke.ca/handle/11143/5311.
Pełny tekst źródłaLecours, Esther. "Participation citoyenne et rétablissement en santé mentale au Québec". Mémoire, Université de Sherbrooke, 2012. http://hdl.handle.net/11143/5713.
Pełny tekst źródłaForti, Silvana. "Réformes, équité et droit à la santé en Amérique latine : Agendas, acteurs et alternatives au Honduras". Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/27336/27336.pdf.
Pełny tekst źródłaMendo, Me Mfou Elvire Mireille Inès. "Les micro-unités de santé informelles au Cameroun : quelle réponse aux besoins des populations les plus vulnérables ?" Thesis, Lille 1, 2013. http://www.theses.fr/2013LIL12018/document.
Pełny tekst źródłaThis thesis focuses on the success of informal micro-care units (IMCUs) in urban Cameroon at a time when other initiatives such as formal primary health care promoted by the World Health Organization are implemented to improve access of vulnerable populations to care. We seek to first, understand the extent to which IMCUs better meet the health needs of some disadvantaged populations than other health services, and second draw lessons on the possible place of the IMCUs in an expanded health policy. We rely on the literature to explain the motivations of suppliers and care-seeker in health economics and in the informal economy. We also rely on quantitative and qualitative surveys we conducted in Yaounde with suppliers and care-seeker. We highlight a number of variables that determine the selection for the IMCUs by the care-seeker. Our thesis shows that in the context of informal micro-market in which IMCUs operate, the market mechanisms are insufficient to explain actors’ behavior, while economics of convention and the capabilities approach are relevant grids of analysis. The conventions illustrate the process of adjustment of supply to demand subjected to high constraints. The prospects of integrating the MUSIs to national health policy stem from their potential contribution, under certain conditions, to the expansion of primary health care
Velasco, Ferrin Laura Sofia. "Analyse organisationnelle des services de santé offerts aux populations réfugiées dans la région de la Capitale-Nationale". Thesis, Université Laval, 2012. http://www.theses.ulaval.ca/2012/28909/28909.pdf.
Pełny tekst źródłaPlastiras, Athanase. "Création et répartition de la valeur globale de l'entreprise : entre performance et régulation : cas des cliniques privées de soins médicaux en Grèce". Caen, 2009. http://www.theses.fr/2009CAEN0645.
Pełny tekst źródłaBoyer, Sylvie. "Décentralisation et performance des services de prise en charge des personnes vivant avec le VIH/SIDA dans les pays à faibles ressources : l'expérience du Cameroun". Thesis, Aix-Marseille 2, 2010. http://www.theses.fr/2010AIX24011/document.
Pełny tekst źródłaIn order to reach the largest population throughout the whole territory of a country, scaling-up access to ART requires both the decentralization of HIV care from central to more local services at the district level, together with care and antiretroviral treatment being economically accessible for households affected by HIV/AIDS. The recent issues raised by ART scaling-up policies in low income countries have led to a revival of interest in operational research and provide the opportunity for an in-depth assessment of decentralization policies from a point of view hitherto unexplored in applied economics.The present thesis work, which forms part of a large programme of operational research conducted in Cameroon, aimed to assess the performance of the decentralization policy in the field of HIV, particularly in terms of services’ effectiveness and economic accessibility for households.The first part of the thesis was dedicated to the assessment of the relationships between decentralization of the healthcare delivery for HIV care and the effectiveness of the services provided. Using multilevel regression models, the analysis showed that decentralized services at the district level not only achieved outcomes as good as those in centralized services, but performed even better for certain outcomes such as adherence to ART and mental health related quality of life. The results also highlighted that healthcare supply characteristics, including in particular the availability of qualified human resources and the workload of health professionals, played a significant role in explaining the differences observed inservices performance.The second part of the thesis dealt with the economic accessibility of care and treatment for HIV infection. The analysis of the determinants of access to ART highlighted inequalities in access related both to socio-economic and structural factors. Results also showed that the direct costs of the illness are considerable compared to households’ resources, that their distribution in terms of income is regressive and that numerous socio-economic factors limited HIV care effectiveness.With respect to the objectives of the global fight against HIV/AIDS, the Cameroonian experience shows the feasibility and pertinence of implementing an ART scaling-up strategy based on the decentralization of the health care supply. However this can only be fully effective if the health system as a whole is strengthened, especially in terms of human resources, and if strong financing reforms are implemented in order to substantially reduce out-of-pocket payments for affected households
De, Souza Givanilda Aquino. "Faible présence de la population démunie dans les centres de santé : quelques aspects socio-économiques et culturels : une recherche participative développée au Brésil". Nancy 2, 1992. http://www.theses.fr/1992NAN21016.
Pełny tekst źródłaAntoinette, Nicolle. "L'analyse socio-économique de la santé dans les pays sous-développés : le cas de la Guyane". Bordeaux 1, 1986. http://www.theses.fr/1986BOR1D304.
Pełny tekst źródłaDíaz-Romeral, Gomez Alberto. "La responsabilidad por asistencia sanitaria en los ordenamientos español y francés". Bordeaux 4, 2009. http://www.theses.fr/2009BOR40072.
Pełny tekst źródłaA comparative research on Spanish and French public health care liability systems and on their national health systems. These two systems are built on different basis; however, throught different ways, they both provide a similar level of protection to national health system's users. The most difficult issues are those related to risk in health care. It is not possible to separate health care and risk, -l'aléa médical-, and this means that dammages may occur even though no fault has caused them. That's why it is imperative to draw a clear borderline between liability and other forms of social protection that only the parliament may grant
Mansour, Amal. "La place de l' infirmière dans le système de santé au Liban". Bordeaux 2, 2001. http://www.theses.fr/2001BOR20838.
Pełny tekst źródłaThe objective of this thesis is to study the situation of nurses in Lebanon based on a long experience in this field in this country. We decide to seek the causes of this occultation and list the encountered problem. We have started in 1996 study that has shown that nurses in Lebanon belong to a young, single female population with a very short professional carrier averaging 5 years. Nurses live badly due work conditions described, as stressful and hard. The load is both physical and mental. The burn out syndrome affects the majority, of this group. Adding to their lifestyle, the lack of esteem to their not well defined profession. This social group was unable to find structures that will help him to be organized. The study helps us to identify the problems that impeach this group from having its well-defined identity. We were able to formulate four major causes : - The immaturity of the young nurses. - The lack of the elaboration of their specific science. - The lack of structure. Suggestions, that can help this social group to find itself and acquire a real identity, the structures that well help this group to be organized. The reorientation of teaching programs towards specific knowledge, consequently, towards an essential role able to repond to health needs of the human being
Tcheriatchoukine, Anne. "Les aspects juridiques de la psychiatrie en prison". Paris 2, 1995. http://www.theses.fr/1995PA020078.
Pełny tekst źródłaGlavany-Godet, Isabelle. "Le concept de système sanitaire est-il cohérent à un niveau infranational? : un terrain d'étude : la Bretagne". Paris 1, 1986. http://www.theses.fr/1986PA010036.
Pełny tekst źródłaKouadio, Kotchi Jérôme. "La carte sanitaire de la région sud de la Côte d'Ivoire dans le système de santé ivoirien". Paris 8, 2000. http://www.theses.fr/2000PA083623.
Pełny tekst źródłaThe difficulties experienced by Ivory Coast in the setting up of a healthcare map are a result of the malfunctioning of the country's health service, due to the centralisation of healthcare administration which restricts competent intervention from services outside the Ministry of Health and those of the State in the running of healthcare infrastructures for which they are responsible in the regions. Each healthcare sector, whether public or private, is free to set up its own infrastructures without taking into account the notion of public service in the hospital domain. In spite of improvements in recent years in the health sector, present-day healthcare policies prevent any hope of regulating the healthcare system, with the result that the population's access to care is falling and healthcare facilities vary from region to region. Proposed solutions for a rational sharing of healthcare take into account local needs within each sector and require that the creation of healthcare infrastructures as a whole be under the legislation of a central hospital system so that both sectors may be more efficiently controlled and more rationally shared out
Ammar, Walid. "Système de santé et réforme au Liban". Bordeaux 2, 2001. http://www.theses.fr/2001BOR28837.
Pełny tekst źródłaThe objective of this thesis is to study the situation of nurses in Lebanon based on a long experience in this field in this country. We decide to seek the causes of this occultation and list the encountered problem. We have started in 1996 study that has shown that nurses in Lebanon belong to a young, single female population with a very short professional carrier averaging 5 years. Nurses live badly due work conditions described, as stressful and hard. The load is both physical and mental. The burn out syndrome affects the majority, of this group. Adding to their lifestyle, the lack of esteem to their not well defined profession. This social group was unable to find structures that will help him to be organized. The study helps us to identify the problems that impeach this group from having its well-defined identity. We were able to formulate four major causes : - The immaturity of the young nurses. - The lack of the elaboration of their specific science. - The lack of structure. Suggestions, that can help this social group to find it self and acquire a real identity, the structures that well help this group to be organized. The reorientation of teaching programs towards specific knowledge, consequently, towards an essential role able to health needs of the human being
Demers, Karine. "L'influence des préoccupations des personnes âgées face à la santé sur l'utilisation des services de santé pour des symptômes de détresse psychologique". Mémoire, Université de Sherbrooke, 2004. http://savoirs.usherbrooke.ca/handle/11143/2372.
Pełny tekst źródłaHaddad, Slim. "Utilisation des services de santé en pays de développement : une étude longitudinale dans la zone de santé rurale de Nioki au Zaïre". Lyon 1, 1992. http://www.theses.fr/1992LYO19001.
Pełny tekst źródłaSbayou, Mariem. "Modélisation et simulation des systèmes de production de services : application à un système de sante". Thesis, Bordeaux, 2018. http://www.theses.fr/2018BORD0422/document.
Pełny tekst źródłaThe rapid growth of the services sector, especially modern services, is a remarkable trend around the world. The complexity of conceptualizing services is often related to their modeling, their design, and the management of possible interactions between the customer and the provider. One of the fundamental public services is health services, the major challenges faced by health services are: governance, coordination and accessibility to care. The accessibility of care is usually linked to an unbalanced geographic distribution of doctors and a high waiting time. In this context, an approach based on Modeling and Simulation taking into account the possible heterogeneity of modeling environments is proposed in order to analyze the problems related to the management of a service territory. This approach aims to give a global vision of the functioning of the service system studied, by taking into account the related factors impacting both the choice of service users and the process of service production
Couture, Éva Marjorie. "L’association entre la littératie en santé, l’activation du patient ou la qualité de vie reliée à la santé chez les grands utilisateurs de services de santé avec maladies chroniques". Mémoire, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/10173.
Pełny tekst źródłaAbbasgholizadeh, Rahimi Samira. "Prioritization of patients' access to health care services". Doctoral thesis, Université Laval, 2017. http://hdl.handle.net/20.500.11794/27499.
Pełny tekst źródłaAccess to health care services and long waiting times are one of the main issues in most of the countries including Canada and the United States. Health care organizations cannot increase their limited resources nor treat all patients simultaneously. Then, patients’ access to these services should be prioritized in a way that best uses the scarce resources, and to ensure patients’ safety. In fact, patients’ prioritization is an essential but forgotten practice in health care systems internationally. Some challenging aspects in patients’ prioritization problem are: considering multiple conflicting criteria, incomplete and imprecise data, associated risks that threaten patients on waiting lists, uncertainties in clinicians’ decisions, involving a group of decision makers’ opinions, and health system’s dynamic behavior. Inappropriate prioritization of patients waiting for treatment, affects directly on inefficiencies in health care delivery, quality of care, and most importantly on patients’ safety and their satisfaction. Inspired by these facts, in this thesis, we propose novel hybrid frameworks to prioritize patients by addressing a number of main shortcomings of current prioritization methods in the literature and in practice. Specifically, we first consider group decision-making, multiple prioritization criteria, these criteria’s importance weights and their interdependencies in the patients’ prioritization procedure. Then, we work on involving associated risks that threaten patients on waiting lists and handling existing uncertainties in the prioritization procedure with the aim of improving patients’ safety. Finally, we introduce a comprehensive framework focusing on all previously mentioned aspects plus involving patients in the prioritization, and considering dynamic aspects of the system in the patients’ prioritization. Through the application of the proposed comprehensive framework in the orthopedic surgery ward at Shohada University Hospital, and in an augmentative and alternative communication (AAC) clinical program called PACEC at the Institute for Disability Rehabilitation in Physics of Québec (IRDPQ), we show the effectiveness of our approaches comparing the currently used ones. The implementation results prove that this framework could be adopted easily and effectively in different health care organizations. Notably, clinicians that participated in the study concluded that the framework produces a precise and reliable prioritization that is more effective than the currently in use prioritization methods. In brief, the results of this thesis could be beneficial for health care professionals to: i) evaluate patients’ priority more accurately and easily, ii) determine policies and guidelines for patients’ prioritization and scheduling, iii) manage waiting lists properly, vi) decrease the time required for patients’ prioritization, v) increase equity and justice among patients, vi) diminish risks that could threaten patients during waiting time, vii) consider all of the decision makers’ opinions in the prioritization procedure to prevent possible biases in the decision-making procedure, viii) involve patients and their families in the prioritization procedure, ix) handle available uncertainties in the decision-making procedure, and x) increase quality of care.
Moro, François. "L'administration du système de santé : les effets de la création de l'agence régionale de santé". Thesis, Montpellier 1, 2014. http://www.theses.fr/2014MON10002/document.
Pełny tekst źródłaThe administration of the health care system was deeply changed with the introduction of health agencies. The implementation of the ARS in 2009 contributes to unify the health action at the local level, what was missing under the influence of the ARH. The introduction of the ARS solely expresses a supposed simplification of the health care system, at the confluence of a classic health agency and of a local administration of the State. This new agency appears then as an unprecedented territorial agency what is proved by its intervention on the health care system. The appropriation of regulating instruments by this agency, which can be embodied in the contract, shows a renewal in health action. The ARS carries out a local regulation of health system which is original. This reform of health action is far away from being completed. Relationships between the ARS and public health institutions reveal this partial efficiency. The addition of functions awarded to the ARS harms the readability and the efficiency of its intervention on the health care system. The ARS has to be self-sufficient to become the main regulator of the health care system
Petit, Johann. "Organiser la continuité du service : intervention sur l'organisation d'une mutuelle de santé". Bordeaux 2, 2005. http://www.theses.fr/2005BOR21235.
Pełny tekst źródłaThe main objective of this research is to show that service is produced by means of a continuous process. Basing himself on an ergonomic intervention in a mutual health insurance company, the author emphasizes the fact that an organization that completely splits front office and back office tasks has negative impacts, as regards both the operators' activity and the quality of service. This research gives prominence to the limitations of many organizational approaches, stemming from industry, in service situations : they usually underestimate the collective activity. The division between front office and back office deeply changes the determinants of this continuous organizational redesign. The author proposes ways to set new cooperation forms between front office and back office, in order to assure a continuity of service by possible forms of the ergonomist's intervention on organizational project management : the relevance of activity analysis as a source of change scenarios
René-Le, Bris Sophie. "L'engagement en santé : modèle d'engagement, engagement modèle". Rennes 1, 2008. http://www.theses.fr/2008REN1B112.
Pełny tekst źródłaNew forms of governance, including citizen’s participation, are emerging in the field of public health. This thesis considers the reasons why citizens, who are involved in non governmental organisations (NGOs), are interested in new approaches of participation such as citizen's juries. The author uses theories of social movement and explores the theoretical model developed by Florence Passy for the altruistic commitment. She focuses on the parameters and determinants of the health commitment with the different objects and forms. Thirty non direct interviews were conducted with citizens. These citizens were involved in NGO health projects, neighbourhood health community workers or were involved in new mechanisms of participation like citizen's juries. She shows how the citizens legitimise and rationalise the reasons of their commitment. The author explores the specific characteristics of this commitment which question the classic dualities: individual/ collective, lay person/expert, voluntary helper/paid worker. She shows that a person who wishes to improve health reflects a mixture of the classic sociological models of militancy. The author concludes that a commitment by these people can push back frontiers and possibility is a model of future participation