Дисертації з теми "Économie de la santé – Cancer – France"
Оформте джерело за APA, MLA, Chicago, Harvard та іншими стилями
Ознайомтеся з топ-50 дисертацій для дослідження на тему "Économie de la santé – Cancer – France".
Біля кожної праці в переліку літератури доступна кнопка «Додати до бібліографії». Скористайтеся нею – і ми автоматично оформимо бібліографічне посилання на обрану працю в потрібному вам стилі цитування: APA, MLA, «Гарвард», «Чикаго», «Ванкувер» тощо.
Також ви можете завантажити повний текст наукової публікації у форматі «.pdf» та прочитати онлайн анотацію до роботи, якщо відповідні параметри наявні в метаданих.
Переглядайте дисертації для різних дисциплін та оформлюйте правильно вашу бібліографію.
Bejarano, Quisoboni Daniel. "Economic burden of the long-term effects of treatments for childhood cancer." Electronic Thesis or Diss., université Paris-Saclay, 2023. http://www.theses.fr/2023UPASR010.
Повний текст джерелаChildhood cancer survivors (CCS) may require lifelong medical care due to the late effects of cancer treatments. However, little is known about their healthcare utilization and expenditures at long-term, especially in publicly funded health care system. This thesis aimed to estimate and analyse the long-term health care expenditures and hospitalisation rates among CCS in France and to study their associated factors.The research presented in this thesis was based on data from the French Childhood Cancer Survivors Study (FCCSS), which is a retrospective cohort of 7,670 5-year CCS diagnosed before the age of 21 years between 1946 and 2000 in France. The FCCSS is linked to the National Health Data System (SNDS), which contains comprehensive data on billing and reimbursement of the beneficiaries' health care expenditures since 2006.We found that the annual mean healthcare expenditures among CCS was € 4,255 (SD: 18,790). Expenditures on hospitalization and pharmacy represented ~60% of total expenditures. Our results also showed that female gender and being survivor of a central nervous system (CNS) tumour were associated with increased health care expenditures. We then estimated hospitalisation rates among CCS and detailed the hospitalisation-related clinical diagnoses compared with those of the French general population with the same gender, age and region of residence. We found that survivors were hospitalised more than twice as often as the matched reference population and they had more than three times as many in-patient bed-days. Our results showed that the highest risk for hospitalisation in CCS was related to neoplasm, followed by endocrine diseases, blood diseases, and diseases of the circulatory system. Finally, we compared the health care expenditures of the FCCSS with that of the general French population mentioned above and found that the annual mean excess healthcare expenditures for CCS compared with the median of the reference population was € 3,920 (95% CI: 3539 - 4301). A higher excess was significantly associated with having been treated before the 1990s and having survived a CNS tumour, whereas a lower excess was associated with not receiving treatment with radiotherapy.In conclusion, this thesis showed that CCS are at higher risk of health care use and expenditure, leading to considerable excess compared with the median health care expenditure of the general population of the same sex and age. This high expenditure was related to high hospitalisation rates among CCS. Older survivors, CNS tumours survivors, and those treated with radiotherapy had a higher risk of health service use and expenditure. These results led us to recommend that special attention be paid to this population, especially in terms of follow-up and prevention of complications, and to support the development of effective innovative treatments
Bien, Franck. "Essais en économie de la santé et assurance." Paris 10, 2001. http://www.theses.fr/2001PA100196.
Повний текст джерелаThe purpose of this PhD is to study agency relationship in health economics. We consider three actors: patient, doctor and regulatory-insurance in two frameworks: "French ambulatory medicine" and "health insurance". The first two chapters aim at analysing the fees in "French ambulatory medicine". Medical service is a credence good because the patient does not observe result but only action. We establish doctors are opportunist because they build their reputation on affering best quality and after the supply bad quality. The regulation of free fees of ambulatory medicine is based on doctors' opportunist actions. We can show that the properties of contracts depend on the number of honest doctors and the value of information's regulatory. The last chapters examine "health insurance". .
Pichetti, Sylvain. "La concurrence par comparaison, applications en économie de la santé." Besançon, 2002. http://www.theses.fr/2002BESA0001.
Повний текст джерелаYardstick competition is a way of regulating several regional monopolies so as to induce a form of competition that weakens individual firms' monopolies of information and hence improves the terms of the trade-off between allocative, productive and distributional efficiency. This is done by making the reward to one firm depend on its performance relative to that of other firms. This promising mechanism is however rarely applied in economics. This phenomenon can be explained by the fact that it is difficult to compare firms whose environments are heterogeneous. The DEA method is very convenient to treat this problem. The important potential of the method as a way of comparison is illustrated by two original contributions centered on health economics. The first one aims at estimating the efficiency of hospitals in order to assign to each of them a budget target. The second one aims at estimating the efficiency of health expenses at the departmental level through the DEA method
Sicsic, Jonathan. "Impacts des incitatifs économiques en médecine générale : Analyse des préférences et des motivations des médecins." Thesis, Paris 9, 2014. http://www.theses.fr/2014PA090044/document.
Повний текст джерелаThis thesis addresses several issues raised by the introduction in France of economic incentives such as pay-For-Performance applied to general practice. These incentive schemes are designed to improve the quality of care, but they are discussed both in terms of effectiveness and potential side effects. Initially, we assess the impact of the CAPI scheme on various indicators of quality of care: the consultation length and cancers screening. Then, using the discrete choice experiment methodology, we reveal general practitioners (GPs) preferences for devices aimed at improving the early detection of cancers. Finally, we analyse empirically the relationship between French GPs' intrinsic and extrinsic motivations. We show that the CAPI has not had a significant impact on the selected quality indicators. In addition, GPs would be sensitive to potentially less costly nonmonetary devices. Eventually, we highlight a negative relationship between GPs' intrinsic and extrinsic motivations. Our results call for greater caution in the definition of economic incentives in general practice
Garrouste, Clémentine. "Naître et mourir en France : quatre essais en économie de la santé." Paris, EHESS, 2012. http://www.theses.fr/2012EHES0173.
Повний текст джерелаThis dissertation presents four essays related to health economics. On the one hand, we estimate the effect of activity on health and mortality, by analyzing pensions refom in France. On the other hand, we analyze the choices related to the prenatal diagnosis of Down syndrome (amniocentesis). The first essay shows that retirement has positive effects on mental and social health of seniors. The more physically impacted are the low-educated individuals. Conversly, the high-educated people are more impacted in tenus of social health. The second essay complete the first by evaluating the effect of retirement on mortality. We find that delaying the retirement age by one year increases the chances of dying within four years by 1. 5 percentage points which is equivalent to a decrease of life expectaney by 1. 68 months at age 64. This effect is heterogeneous by income groups. The third essay shows that eligibility to rembursement of amniocentesis has a largely positive effect on the probability of taking an amniocentesis test. By contrast, the sole fact of being labelled 'high-risk' by the Health system seems to have, as such, only a modest effect on subsequent choices. Building or available information on post-amniocentesis outcomes, we report new evidence suggesting that aminoocentesis increases the risk of premature birth and low weight at birth. The last essay completes the third olle by considering the trade off in amniocentesis decision to buil a decision model for pregnant women (amniocentesis requires comparing the risk of giving birth to an affected child and the risk of losing an unaffected child through amniocentesis-related miscarriage)
Mazamba, Tédie. "Éducation, santé et croissance économique." Paris 2, 2005. http://www.theses.fr/2005PA020039.
Повний текст джерелаSeguret, Fabienne. "Le dépistage du cancer du sein dans l'Hérault : méthodes d'évaluation médico-économique et analyse des résultats après 18 mois de réalisation." Montpellier 1, 1992. http://www.theses.fr/1992MON11134.
Повний текст джерелаMeynet, Robert. "Micro-économie de l'infection nosocomiale." Lyon 3, 1987. http://www.theses.fr/1987LYO33020.
Повний текст джерелаThis work has been realized in lyon which is the second largest hospital structure in france in two departments of abdominal surgery for one year and in prospective. 15,4 per cent of the sick have been infected and the cost of this infection amounts to 16. 994 french francs on average per patient 1978, that is an 80 per cent rate of increase (37. 138 20. 144) for infected sick patients as compared with non infected ones. The microeconomic infection cost includes not only invoiced postoperative hospital cost (stay, examinations, medical treatment) but also the post hospital cost, valued from the studied medical consumption angle during the six months after coming out of hospital (new hospital admissions, care, examinations, pharmacy, convalescence home). Another type of non invoiced post operative medical hospital cost valued from a difference in intensity of care between infected sick patients and non infected sick ones : this type of cost comes in addition to invoiced cost. The invoiced social cost worked out from wages paid completes the microeconomical infection cost notion. In relation to previously published international studies, this work presents a particularity in the approach of invoiced medical postoperative hospital cost and non invoiced medical postoperative cost
Sainty, François. "Mutuelles de santé et nouveaux contextes d'action : une approche par le modèle Ressources Compétences." Nice, 2001. http://www.theses.fr/2001NICE0030.
Повний текст джерелаBatifoulier, Philippe. "Incitations et conventions dans l'allocation des ressources : une application à l'économie de la santé." Paris 10, 1991. http://www.theses.fr/1991PA100017.
Повний текст джерелаMarket allocation resources in health economics is amended by incorporating institutional factors as contracts through incentive theory. However, the institutionakl framework cannot be reduced to a set of contracts between parties. The existence of cognitive rules (such as professional ethics) is an important factor of stability and efficiency of the relation between parties. The behaviour of parties is based on "activity conventions" explaining the form of the service supplied by the physician, in the framework of gift-exchange, and on "quality conventions" which guarantee the quality of this service. Main health economics politicy principles are displayed following the analysis of those conventions
Krief, Nathalie. "Les pratiques stratégiques des organisations sanitaires et sociales de service public." Lyon 2, 1999. http://www.theses.fr/1999LYO20052.
Повний текст джерелаRavoux, Vincent. "Le panier de biens et de services de santé : une approche managériale pour la France." Dijon, 2001. http://www.theses.fr/2001DIJOE002.
Повний текст джерелаBénamouzig, Daniel. "Essor et développement de l'économie de la santé en France." Paris 4, 2000. http://www.theses.fr/2000PA040269.
Повний текст джерелаPélissier, Fanny. "Le réseau en santé et l'assurance maladie." Dijon, 2003. http://www.theses.fr/2003DIJOE002.
Повний текст джерелаThe recent increase in the number of health-care networks calls for appropriate funding and allocation based on a meaningful evaluation of this new form of organization. The incipient restructuring of France's health-care system into networks is seeing funds decentralized and managed by regional bodies such as regional union of health insurance funds (URCAM). The creation in 1998 of the FAQSV fund for the improvement of ambulatory care to finance, inter alia, networks connecting free-market practitioners and health-care establishments, was a step down this road. But is this instrument adapted to what a "good" network should be? Beyond the issue of the FAQSV the wider question is raised of the suitability of the tools employed for restructuring the health system on a regional basis. It is the funding of the network as a whole that needs to be rethought in the light of the theoretical foundations of "managed care" as adapted to the institutional arrangements in France
Durand, Pascal. "Le service médical du régime général et la régulation des dépenses de santé : une approche économique des missions des médecins-conseils en termes de modes de coordination." Dijon, 2000. http://www.theses.fr/2000DIJOE020.
Повний текст джерелаRabier, Christelle. "Les chirurgiens de Paris et de Londres, 1740-1815 : économie, identités, savoirs." Paris 1, 2008. http://www.theses.fr/2008PA010691.
Повний текст джерелаChevalier, Julie. "Mesure de l’utilité attachée aux états de santé : valorisation de l’index d’utilité EQ-5D et évolution de l’échelle actuelle en France." Paris 9, 2010. https://bu.dauphine.psl.eu/fileviewer/index.php?doc=2010PA090021.
Повний текст джерелаIn cost-utility analysis results are often processed in terms of QALY (Quality Adjusted Life Year). The duration of a given health state is weighted with a coefficient calculated based on its associated quality of life. Using such an indicator assumes two things: knowing the health state of the patient and the utility level associated to that state. In this purpose preference-based indexes have been developed. The EQ-5D is one of the most frequently used indexes. It has been developed and validated in many countries, including France, but the French utility function has not been calculated. This function gives a weight to each health state taking into account the local populations’ preferences. In absence of set of national population-based utility weights, a foreign value-set is used. However preferences for different heath states may not necessarily be all-purpose. Several studies have backed up this assumption pointing out that utilities function estimated in different countries could present some differences. Thus, utility values should be developed locally. The dissertation has several objectives: to provide a value-set for the EQ-5D health states in the French context, to develop a revised version of the EQ-5D with 5 levels for each dimension and to test a new valuation method called Scoring
Buron, Catherine. "Utilité et préférences en univers certain et en univers risqué : une application de la théorie multiattribut en économie de la santé." Paris 2, 1999. http://www.theses.fr/1999PA020003.
Повний текст джерелаIn this thesis that deals with the specification of qualitative structures preferences and their numerical representations for certain and risky multidimensional consequences, we focus on the multiattribute theory. This theory establishes the main representation theorems that specify the functional form (multilinear, multiplicative or additive) of the utility function when certain independence assumptions concerning the decision maker's preferences for different attributes are verified. When each alternative results in riskless or risky consequences describable in terms of multiple attributes, the multiattribute utility theory is based on utility theory or on expected utility theory. Our goal was to specify the assumptions of the relationship between multiattribute riskless utility and multiattribute risky utility and to analyse the concept of risk attitude that is derived from riskless and risky preferences. In health care, it is now admitted that description or valuation of an health state should take into account its multidimensional features. Our empirical analysis aimed to construct, in risky situations, individual multiattribute utility functions for health states, based on riskless utility functions and on a risk attitude parameter. In order to lead this analysis, we used the explicitly decomposed approach for the modelisation, the multiplicative and additive forms for multiattribute utility functions and the usual methods to reveal preferences in riskless and risky situations. Our results were discussed regarding the assumptions of the construction of multiattribute utility functions and further investigations were suggested
Brunat, Marion. "Analyse économique de l'accessibilité des soins primaires en France : la question de l'organisation de l'offre de services de santé ambulatoires." Grenoble, 2010. http://www.theses.fr/2010GRENE008.
Повний текст джерелаThe objective of this work is to bring to bear a critical reflection on the choices of public policy in the fight against health inequalities, through the utilisation of the concept of " real possibilities for access " as applied to both preventive and curative care. In a neo-institutional economic approach, we develop an analysis of the accessibility of medical care recognising the importance of the financial aspect and integrating the structural characteristics of cane supply and professional practice. We stress the limits of the CMU-C provision in an unchanged institutional and organisational system. An econometric study of logistical regression on the bases of medical consumption in 2007 by beneficiaries of CMU-C supports the position we take. Thus we stress the need for a reflection on the benefits and ways of developing an integrated and pluri-professional supply of health services (health centres and " maisons de santé "). We make use of documentation provided by semi-directive interviews with several persons of the whole health sector. These differing forms of organisation are a fruitful avenue to explore to improve coordination, continuity and global healthcare service. Nevertheless, their development depends on internal choices of organisations to achieve an economic gain in terms of the cooperation of professionals. It depends also on the rules and perceptions pertaining to the system at the institutional level. Their emergence as structured ways of supplying primary health care as a means of reducing health inequalities depends on the development of new organisational forms of outpatient healthcare supply as well as their adequate institutional recognition
Ben, Charif Ali. "Santé sexuelle après cancer en France : fréquence des troubles et prise en charge." Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM5006/document.
Повний текст джерелаThe chronic nature of cancer disease and the heaviness of its treatment and follow-up have a negative impact on daily life of patients and their families. Cancer disease changes life projects even in their most intimate aspects. Sexual dysfunction is one of the most common and annoying consequences of cancer treatments. These potential sexual problems are known but insufficiently documented and inadequately explained to patients. France has no standard practice guidelines regarding this specific issue at a national level. Thus, in the context of the national effort to improve patients’ care, the aim of this work was to assess the frequency of related problems, the discussion with healthcare providers about it and the satisfaction toward this discussion, but also to identify the factors that influenced those three indicators. For this purpose, our analyses were done using the representative national VICAN survey (n=4349) and ELIPPSE40 regional cohort (n=623). These analyses highlighted a high prevalence of substantial sexual problems for all cancer sites. Healthcare inequalities were observed in relation to the age, gender, cancer site and the type of care centre. They also emphasized a low patients’ satisfaction with sexuality-related information. Overall, they allowed to better understand the patients’ need and to suggest interventions to improve care of patients regarding sexual health after cancer
Malguid, Cécile. "Les médecins face au décideur public : une approche des politiques de santé par la théorie des jeux." Paris 1, 2003. http://www.theses.fr/2003PA010001.
Повний текст джерелаBaudoin, Martine. "Le système de santé américain, un exemple d'efficacité pour la France ?" Paris 5, 1995. http://www.theses.fr/1995PA05P050.
Повний текст джерелаLupton, Sylvie. "Incertitude sur la qualité et économie des biens controversés : le marché d'épandage des boues de stations d'épuration urbaines." Paris, EHESS, 2002. https://tel.archives-ouvertes.fr/tel-00420846.
Повний текст джерелаCourbis, Thierry. "Économie de la santé et gestion de la vieillesse : le système de prise en charge des personnes agées dans les alpes-maritimes." Nice, 1988. http://www.theses.fr/1988NICE0022.
Повний текст джерелаThe problem of elderly persons recognized in france in the 1960's has been integrated in a old age policy. But the economic crisis, the increase of numbers of elderly (problem of the old age pensions, medical coasts etc) and the changes in the social image of the old age, has imposed a necessary management of the old age. That one want giving an answer to medical care and assistance needs, requiered by the elderly (study of morbidity and disability) by using a complex system (study of different institutions, services and centers constituting the overall system of distributing assistance). To measure the real efficacity of these institutional answers, we have analysed the different factors of this problem into a specific department : the maritime-alps. The study of the local demography by using existing statistics, and some projections (use of p. R. U. D. E. N. T. Evaluations c. F. I. N. S. E. E), the social and economic factors (study of incomes, housing conditions, loneliness etc) and also the elderly state of heath, explain the being of a population caracterized by important risk factors of coming in institution. Such a population cannot be taken into account by the social or sanitary system. . .
Goldzahl, Léontine. "A behavioral approach to breast cancer screening decision." Thesis, Paris 1, 2015. http://www.theses.fr/2015PA010011.
Повний текст джерелаThis thesis explores supply and demand factors associated with the use of breast cancer screening. Among the supply factors, I examine how the coexistence of organized and opportunistic screenings influences the content of the screening exam and screening regularity. Besides the usual demand factors such as socioeconomic characteristics, a special attention is being given to the possibility of explaining screening regularly by individuals’ risk and time preferences and perceptions. Based on psychological patterns identified in the literature in behavioral economics and psychology, three nudge interventions are tested in a randomized field experiment to increase the national program uptake rate
Nurok, Michael. "Entre économie technique et économie morale : le travail d'urgence vitale à Paris et à New York." Paris, EHESS, 2007. http://www.theses.fr/2007EHES0126.
Повний текст джерелаThis thesis analyses the social organization of médical work on patients outside of the hospital who will die without the rapid provision of médical technology - a state called "détresse vitale". Although it is widely recognized that the work to prevent the death of such patients must be performed with technical prowess under immense time constraints, the moral component of this work has been largely overlooked. This thesis begins with an analysis of the conditions of possibility for the historical évolution of emergency médical Systems in France and the United States. The second part of the manuscript contains a comprehensive sociological account of pre-hospital emergency work in which the structural constraints imposed by the form of each system are related to the work of resuscitation observed during ethnographie field research in the Paris and New York emergency médical services. The final part of this thesis is used to show that, based on professional and social values, emergency workers use socially garnered control over bare life to shape the trajectories of patients in "détresse vitale"
Serre, Marina. "Le "tournant néo-libéral" de la santé ? : les réformes de la protection maladie en France dans les années 1990 ou l'acclimatation d'un référentiel de marché." Paris 1, 2001. http://www.theses.fr/2001PA010345.
Повний текст джерелаGerbaud, Laurent. "Financement des services de soins hospitaliers et développement de l'évaluation de la qualité des soins." Dijon, 1999. http://www.theses.fr/1999DIJOE020.
Повний текст джерелаQuantin, Catherine. "Contribution à l'évaluation de l'activité hospitalière : une modélisation par sous-groupes homogènes pour une gestion médicalisée à l'hôpital." Dijon, 1997. http://www.theses.fr/1997DIJOE016.
Повний текст джерелаSince the early 1980s healthcare systems in the industrialized nations have been undergoing radical reform aimed at curbing overspending of hospital expenditure. After a discussion of the limits of a prospective payment due to heterogeneity of costs within DRGS, we demonstrate the ability of a novel statistical model to identify high cost patients. We derive from this statistical model an economic heuristic in order to account for high cost patients in budget allocation and a structural and contingent method is proposed as a budgeting tool. Economic analysis based on this modelling of DRG heterogeneity further reveals the potential for improving the equity and the efficiency of the prospective payment system by restricting its perverse effects. This model may also be used as a strategic management tool for hospitals or as a means for regulators to evaluate treatment and admission practices so as to improve health care provision. This statistical analysis was designed on the basis of a mixture of weibull distribution, in which proportion of high-cost patients was expressed according to the multinomial logistic regression, allowing the determination of high-cost factors. An application of the statistical model to 124 DRGS on a French reference database stresses the problem of heterogeneity of costs and length of stays within most of DRGS. An example of identification of explanatory variables of high costs is carried out on several DRGS. The economic application of the statistical model is discussed pointing out the implications, in terms of efficiency, of improving hospital management. The other advantage of this statistical model is to allow the assessment of a revision of the DRG classification from both statistical and economic point of views
Pereira, Céline. "La régulation économique de la médecine de ville." Paris 2, 2002. http://www.theses.fr/2002PA020040.
Повний текст джерелаLagasnerie, Grégoire de. "Trois essais en économie de la santé sur la régulation de la demande de soins de ville s'appuyant sur la méthode de micro-simulation." Paris, EHESS, 2013. http://www.theses.fr/2013EHES0093.
Повний текст джерелаThis thesis sheds light on various issues in health economics (reimbursement system of care, sensitivity of the demand for health care prices , prediction of the dynamics of care expenses ) through the technique of micro -simulation. This thesis is composed of three articles. The first two articles of this thesis contribute to improved understanding of the mechanism related to the regulation of health care demand through the reimbursement system. The last article analyzes the evolution of the demand for care in the medium and long term. The first article focuses on the analysis in term of equity and hedging of reform of the reimbursement system of healthcare services in France. The second article examines the implications for health insurance and the insured of changes in consumption behavior of insured following a reform of the reimbursement system of cafe in France. The third article, from the study of different methods of projections in the economic literature analyzes the dynamic of outpatient healthcare expenditure related to the ageing population
Ziani, Aouaz Amani. "L'impact de l'utilisation de la tarification à l'activité sur la qualité et l'accès aux soins à l'hôpital public en France." Paris 8, 2013. http://octaviana.fr/document/188336273#?c=0&m=0&s=0&cv=0.
Повний текст джерелаA new payment system has been introduced in French hospitals. This system has been created in the United-States and is actually used in many countries across the world. The prospective payment system based on Diagnosis Related Groups is the name of this new payment concept. Similarities exist among patients of each DRG concerning the principal diagnosis and the means used to take care about patients. This payment system is suspected to have some effect on quality and access to care. A review of the international literature showed that some effects like shortening of length of stay, quicker and sicker syndrom and increasing number of transfer to the skilled nursing facilities have been noted by many empirical studies. In France, there is no empirical studies which have been conducted to demonstrate such effects, but the personal working in hospital like doctors and nurses experience constraints and increased workload since the new payment system have been introduced. The recent experience of the new payment system in France and the absence of empirical studies do not allow such conclusions
Jeziorski, Lahbib Sarah. "Médias, cancer et médecines non conventionnelles : quelle représentation du rapport entre cancer et médecines non conventionnelles les médias français diffusent-ils dans l'espace public ?" Thesis, Paris 2, 2012. http://www.theses.fr/2012PA020044.
Повний текст джерелаOne out of two patients suffering from cancer consults a non-conventional therapist, three out four don’t ever inform their own general practitioner (GP). This research raises the question of the role of Medias in this growing use of unconventional medicine. What is the image – if any - carried out by the French Medias when informing their audience as far as cancer and non-conventional medicine are concerned? Over twelve years of daily newspapers articles as well as television programs have been the basis of this research through the screening and analysis of sociological contents.The first part defines cancer in its contemporary, unconventional medicine encompassing the diversity of practices, and the relations that these two notions have with the Medias. The second part deals with the press, showing that the different daily newspapers analyzed and discussed do not broadcast the same information on the topic: each adopting a specific point of view according to the editorial policy and the intended audience. At last, the third part shows a new evolution in the treatment of television news, both in its visual contents as well as its meaning.Finally we can but acknowledge no real difference between the Medias as far as the information is put forward. The difference has rather to be seen whether we have to deal with private channels and popular or ‘gutter’ press opposed to public television and quality press
Ben, Dhif Allah Mohamed Bilel. "Choix de localisation et développement des start-ups de hautes technologies : Le cas des biotechnologies appliquées à la santé humaine en France." Paris 9, 2007. https://portail.bu.dauphine.fr/fileviewer/index.php?doc=2007PA090057.
Повний текст джерелаLaunoy, Guy. "Le cancer de l'oesophage en France : épidemiologie et facteurs de risque alimentaires." Dijon, 1997. http://www.theses.fr/1997DIJOMU12.
Повний текст джерелаRamandraivonona, 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.
Повний текст джерелаThe 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
Mpitabakana, Judith. "Evaluation dans le domaine de la santé en France : application à l'analyse des thérapeutiques antiémétiques préventives en cancérologie." Paris 5, 1994. http://www.theses.fr/1994PA05P170.
Повний текст джерелаFerrand-Nagel, Sabine. "De l'accès aux soins au mode de production alternatif : les centres de santé dans le redéploiement de la médecine de ville." Paris 1, 1990. http://www.theses.fr/1990PA010037.
Повний текст джерелаIn a context of liberal medicine crisis and health ependiture regulation, health centers seem alernative structures. Heterogeneous and few, unequally distributed on the french territory, they locally may be real competitors for liberal doctros. Their final characteristic, in front of liberal evolutions as group practice which are integrating global medicine and team working, lies in collective management of health, combining professionals, financers and users. Their historical calling, access to health care, did not vanish with the development of a social protection system ; the development of new poverty makes a revival of this theme. A statistical study in the hauts-de-seine department shows a division of the local care market, health centers being preferably serving communes with a high density of workers, unqualified and unelployment ones
Bryere, Joséphine. "Etude de l'influence de l'environnement socioéconomique sur l'incidence des cancers en France." Caen, 2015. http://www.theses.fr/2015CAEN3149.
Повний текст джерелаCancer is in France, the cause of death that explains the most the social inequalities in health. One of the the priorities announced in the cancer plan 2014-2019, is to study the geographical and socioeconomic disparities in cancer incidence and survival according deprivation indices. The objective of this thesis was to analyse the influence of socioeconomic environment on cancer incidence in the general population in France and to study methodological limitations related to this type of study. This work aimed to determine the cancer sites whose incidence is related to social status, and to evaluate in France the proportion of cancer cases attibutable to social deprivation using an aggregate approach and the french version of an ecological index for measuring social deprivation. The analysis included 189,144 cancer cases recorded in member registries of the frech network of cancer registries between 2006 and 2009. The estimate of the proportion of cases of excess cancers found that for the most affedted cancer sites, social deprivation could lead to 30% more cases among disadvantaged individuals related of favored individuals. This work also explored certain limits and constraints related to aggregate assessment of the socioeconomic environment as misclassification bias induced by residential mobility and ecological bias caused by measurement of social status at the aggregate level. These results suggest the implementation of targeted prevention actions on the most vulnerable populations
Roullière-Le, Lidec Christine. "Evaluation économique des urgences cardiologiques : Exemple : le Syndrome Coronarien Aigu sus-ST." Paris 9, 2007. https://bu.dauphine.psl.eu/fileviewer/index.php?doc=2007PA090066.
Повний текст джерелаContext : Diversity of medical treatments for patients suffering of ST Elevation Myocardial Infarction related to different approaches, and this, with no medico-economic’s evaluation during the prehospital’s phase. Objective: Medico economic study based on different alternatives of diagnosis/treatment for patient. Method: Cost efficiency study based on Fast Mi registery datas. Efficiency criteria used is re perfusion procedure, what ever its timemesurement Results: 26% from 1714 patients follow the efficient progression. Most critical patients follow circuits that are detrimental to therapeutically eligibility. Regional results are homogenous, despite differences linked to circuits. Conclusions: A better information to patients and to referees would limit dispersion of channels and improve diagnosis and therapy processes, in a regional strategy
Naszályi, Philippe. ""La Nouvelle mutualité" : utopie ou refondation? : essai d'analyse de la gouvernance de la FNIM (Fédération nationale interprofessionnelle des mutuelles)." Littoral, 2009. http://www.theses.fr/2009DUNK0242.
Повний текст джерелаThe advent, in 1989, of a new federation of mutual health insurers in France calling itself “Nouvelle mutualité”, prompts questions to be asked of the roots in Mutualism claimed by this newcomer, in terms of the economic upheaval which led to the emergence or re-emergence of certain types of social economics, which were also trying to set themselves apart from the corporate governance models of classical economics. The creation of the FNIM (National Inter-professional Federation of Mutuals) occurs at the crossroads of this emergence and calls for a double line of questioning. Does social economics constitute an alternative mode of organization within this group ; in so much as the FNIM can be seen as a new standard in corporate governance? The thesis also analyzes to what extent “representative democracy”, as claimed by the founders, is what sets it apart from ordinary capitalist enterprises and from other forms of Mutuals. Using important original sources from social economics and the unique nature of the influences, the analysis goes on to show the authentic nature of the governance claims, by comparing the organization of corporate structures. The context of the 1990s and 2000s which bears witness to changes in power from left to right ; following a change in the very workings of health insurance due to the “Trente glorieuses”, deregulatory directives from the European Commission and the hostility of other major advocates of Mutuals, throws light on various aspects including the chosen governance scheme, meaning that hypotheses regarding its actual tangible nature can be verified. The study is wholly based on original FNIM archives dating from 1989 to 2005
Rochut, Julie. "Health care supply, payment system and medical practice : evidence from obstetric practice." Paris, EHESS, 2010. http://www.theses.fr/2010EHES0017.
Повний текст джерелаA significant share of deliveries are performed by Cesarian section (C-section) in Europe and j many developed and developing countries. The aims of this thesis are to highlight the non medical, especially economic and financial, incentives that expIain the use of C-section, as well as the medical consequences of C-section on women's health, in regard with other factors of obstetrical care quality such as hospital concentration. Our analysis focus on two countries, France and Switzerland. In the first part of the thesis, we show the influence of two non medical factors on to C-section use, namely the hospital payment system and the obstetricians behaviour, especially their demand for leisure. We show payment system and the number of obstetricians have an impact on C-section use and that the rise of C-section rate between 2003 and 2006 is mainly caused by changes in hospitals and patients features. Yet, it can show that obstetricians change their coding practises to justify the use of certain practice. Using Shelton Brown III identification strategy, we found a potential impact of obstetricians leisure preference on the use of C-section, demand for leisure has a significant impact on the resort to emergency C-section. The second part of the thesis deals with obstetric care quality , using swiss and french data to study the impact of C-section on the patients' probability of having an obstetric complication and the influence of concentration between hospitals on the quality of obstetric care. We find there are risks entailed by C-section on obstetric complications. We find that hospital concentration has a negative impact on obstetric care quality
Grolier, Jacques. "Analyse micro-economique du financement des etablissements publics de sante en france. De l'observation a la proposition d'outils quantitatifs d'optimisation." Rennes 1, 1997. http://www.theses.fr/1997REN11018.
Повний текст джерелаThe financing of french public hospitals has been essentially based on a search for macroeconomic equilibrium. The shift from day rate to overall bud- get and finally pathology based reimbursement with restricting budget reflects the determination to limit health expenditure (1). Confrontied with budgets which are becoming more and more restricting, the managers of public hospi- tals have used the advantage in wich assymetric information over their financing sources to fund their discretionary budgets and gain some flexibility, as a result of moral hasard and adverse selection. These budgets allow them to finance hospital equipment, lessen the impact of budget limita- tions and contribute to more efficient, although non-standard, management practices (2). Hospital economist helped build up these " unattached " finan- cial funds by adapting for-profit optimisation tolls to not for profit hospitals. The role played by hospital economists is further reinforced by the order of april 1996 which can turn the discretionary budget into an indicator of mana- gement performance through the use of incintative contracts. Moving the dis- cretionary budget from opacity to transparency can be the mainspring for health expenditure limitation based on medical and not on accounting deci- sions (3)
Ginsbourger, Thomas. "Exister dans le monde de la santé : Sociologie des jeux de savoir et de pouvoir des experts « activité physique et cancers » en France." Thesis, Toulouse 3, 2015. http://www.theses.fr/2015TOU30175.
Повний текст джерелаPhysical activity is a topical issue in the field of public health, especially regarding cancer prevention. Indeed, it has many benefits such as reducing the risks of cancer or their recurrences as well as improving the quality of life. The issue of the relationship between physical activity and cancer emerged in France in the 90's, at a time when a series of health crises, the increasing mobilisation of patients, the criticism of a cold and technical medicine and the global concept of health promoted by the WHO, seemed to give non-medical actors the opportunity to invest a world of health which had so far been dominated by physicians. So, we tried to find out who are the experts recognized as legitimate to tell the truth about the relationship between physical activity and cancer. We then noticed that these experts feel a lack of consideration in the world of health and experience difficulties for existing compared to conventional medicine, believing that what they do is for example 'looked down', 'not a priority' or 'downgraded'. We have updated - beyond the finding of the grip of preventive on curative in our health system - the possible reasons that these experts feel like belonging to a 'small village of indomitable Gauls'. Finally, we were interested at the debates that animate these experts when participating in collective expert assessments - where there are especially representatives of the biomedical and human and social sciences - and their ways to conciliate or not their arguments and interests. This allowed us to understand how they manage to exist compared to conventional medicine and how they work together
Diarte, Elsa. "Les informations sanitaires à visée économique relatives à la spécialité pharmaceutique remboursable émanant de la Direction des études et de l'information pharmaco-économiques." Bordeaux 2, 1999. http://www.theses.fr/1999BOR2P054.
Повний текст джерелаLaurent-Costentin, Charlotte. "Trajectoires de santé des patients avec carcinome hépatocellulaire : apport des bases de données de santé Geographical Disparities of Outcomes of Hepatocellular Carcinoma in France: The Heavier Burden of Alcohol Compared to Hepatitis C." Thesis, Université Grenoble Alpes, 2020. http://www.theses.fr/2020GRALS012.
Повний текст джерелаPrimary liver cancer (PLC) is the fourth leading cause of cancer death worldwide with an increasing incidence in the past decades. Hepatocellular carcinoma (HCC) represents 90% of all PLC and usually arises on chronic liver diseases that have been progressing, often silently, for years. Implementation of interventions at different times of the liver disease natural history is likely to modify either the trajectory of progression towards HCC or the prognosis after diagnosis of HCC. Identifying specific trajectories and their determinants is critical to optimize individual management of patients at an early stage of the disease to improve the long-term prognosis. The objective of this thesis is to leverage data available in multicenter medical databases to study, on the one hand, health trajectories of patients with HCC taking into account social determinants of health and care pathways, with a focus on alcoholic etiology, and on the other hand design simple and robust tools for risk stratification of recurrence of HCC after curative treatment.Thus, this thesis aims at answering four questions about the evolution of HCC and patients health trajectories. First, what is the part of the underlying etiology of HCC on the geographical discrepancies of incidence, management and survival? To answer this question, a first work, published in Digestive Diseases and Sciences, has shown that the geographical disparities in treatment and prognosis are particularly marked for alcohol-associated HCCs, and suggests, as a way to mitigate these disparities, to promote the care of HCC patients within expert centers in HCC management. The second question was to determine whether alcohol-associated HCC is a homogeneous entity. For this, an article in the final process for submission shows, using a latent class analysis, that five homogeneous phenotypes of HCC associated with alcohol can be identified and are associated with distinct prognoses. The third question addressed in this thesis search to assess the impact of social determinants and non take-up of healthcare resources on HCC management and prognosis. Considering the lack of data to address this issue in available databases, it was decided to increase the knowledge in this field through two distinct projects for which applications for funding were submitted: 1) the “RESONANCE” project proposes to analyze the indirect consequences of the sanitary situation linked to Covid-19, imposing delays in management and treatment, on the incidence rate of severe forms of chronic liver disease, including HCC diagnosed at an advanced stage not amenable to curative treatment options 2) the “Social-CHIEF” project aims to study for the first time in France the impact of social determinants of health on the management of patients with a recent diagnosis of HCC, as part of the ongoing national cohort of patients with HCC (CHIEF cohort).At the other end of patients health trajectories, this time after HCC diagnosis, robust tools are needed to predict the recurrence of HCC after curative treatment in order to guide surveillance and design of clinical trials testing adjuvant treatment options. To address this medical need, two new HCC recurrence prediction scores (Recurrence Risk Reassessment (R3) score after liver transplantation and Early Recurrence Score (ERS) after resection) were built and validated.In conclusion, leveraging a wide range of health databases, this thesis provides new elements to understand health trajectories of patients with HCC. The results obtained open up perspectives for the implementation of interventions aiming at “reprogramming” of health trajectories towards more favorable outcomes for chronic liver diseases. New questions are also emerging that will need to be addressed through transdisciplinary collaborations at the crossroads of medicine, social sciences, public health and biology
Le, Corroller-Soriano Anne-Gaëlle. "Apports et limites de l'évaluation économique des innovations biomédicales : l'exemple de la thérapie cellulaire en cancérologie." Paris 2, 1999. http://www.theses.fr/1999PA020048.
Повний текст джерелаThe thesis studies how public economics tools (mainly the cost-benefit analysis) can be used for the evaluation of biomedical innovations and for the optimisation of their technological diffusion. In a first part, we discuss the main methodological questions of the application of different tools, based on the cost-benefit analysis, in the health care field, and more precisely on the field of biomedical innovations. In a second part, we present different empirical works about the economic evaluation of the peripheral blood stem cell transplantation. The pbpc transplantation is a major innovation in the field of cell therapy for the treatment of cancer. The empirical works try to illustrate the methodological questions raised in the first part. Our research programme leads to question the foundation of cost-benefit analysis and its relationship with cost-effectiveness and cost-utility analyses. The main interest of cost-effectiveness analysis and cost-utility analysis for our empirical work was to allowed early evaluations based on surrogate endpoints. Early economic evaluation can give early economic arguments that can be used in the decision making process of the adoption of an innovation. We show, with the example of pbpc transplantation that economic evaluation can interact with the diffusion of a biomedical innovation, if it is realised early in the development and diffusion process. The empirical works presented in this thesis were realised in the context of a very close collaboration with biologists and clinicians. We hope that the more general lessons coming from this experience will contribute to a reconciliation of economic analysis and medical practice
Braverman, Louis. "La fabrique du sujet vulnérable : étude sur l'expérience du cancer de la prostate." Thesis, Paris, EHESS, 2017. http://www.theses.fr/2017EHES0060.
Повний текст джерелаThis research focuses on the experience of prostate cancer. Its aims to document the lived experience and the medical care of this illness from a sociological perspective that enters into the making of subjects. To what extent can men with prostate cancer and relatives produce new forms of subjectivity given the vulnerability they are enduring? To answer this question, the study relies mainly on the articulation of ethnographic observations carried out over a period of five months in four public hospitals with a corpus of 70 semi-directive interviews conducted with patients, relatives and health professionals. Firstly, the adoption of a socio-historical approch allows us to highlight the situated expression of subjectivities and opens the way to an analysis of processes of subjectivation in the age of biomedicine. Secondly, the experience of prostate cancer is described as intertwined with knowledges and practices of biomedicine. Thirdly, the lived experience of prostate cancer in everyday life is analysed. Besides the contributions of this reaserch to the sociology of cancer and masculinities studies, the conclusion focuses on the construction of vulnerable subjects
Loretti, Aurore. "Les inégalités sociales face au cancer dans le Nord–Pas-de-Calais : étude du processus de mise en forme des inégalités à travers une analyse comparée des trajectoires de malades atteints du cancer." Thesis, Lille 1, 2017. http://www.theses.fr/2017LIL12023.
Повний текст джерелаThis study is focused on the issue of social inequalities in cancer in the context of the Nord-Pas-de-Calais region. It aims at reporting the rising inequalities through a comparative analysis of cancer trajectories, and it is based on an empirical investigation associating ethnographic observations and interviews. Such a sociologic and qualitative approach allowed us to study the social dimension of individual behaviors as well as the effects of social structures and social relationships. We tried to explain the contexts and processes involved in specific attitudes and behaviors adopted by patients and caregivers, resulting in the multiplicity of cancer trajectories. In other words, we have intended to describe logic in action and “the rooting of the attitudes into the constraints of their conditions of life” (Drulhe, 1996, p. 280). All along that study, it appeared that persons living in and experiencing different contexts do not and cannot present similar cancer trajectories. Patients do not dispose of the same action capacities to modulate their trajectories and negotiate with caregivers. This is why this thesis insists on the diversity of cancer experiences, mainly linked to the patients’ social environment ; it also integrates the analysis of other social relationships, such as gender
Perez-Ellis, Carole. "Apports et limites des analyses coût-efficacité dans le développement des innovations biomédicales : l'exemple du Trastuzumab dans le cancer du sein." Aix-Marseille 2, 2009. http://www.theses.fr/2009AIX20714.
Повний текст джерела