O trabalho analisa a experiência de implantação do modelo das Organizações Sociais de Saúde (OSS) no Estado de São Paulo, buscando compreender as questões que se colocam para a adoção de modelos centrados na administração privada de unidades de saúde no âmbito do SUS, seja do ponto de vista sistêmico, seja com relação aos elementos de natureza prática relacionados a sua gestão financeira por parte do Estado. Para tanto, procura-se, inicialmente, identificar as referências teóricas que dão suporte ao modelo OSS no campo da Ciência Econômica e posicionar a experiência em relação às tendências recentes de reforma dos sistemas de saúde. Em seguida, explora-se a importância relativa desse modelo no orçamento do Estado e da Pasta Saúde e os determinantes da formação dos preços dos serviços contratados pelo Estado sob essa forma específica de gestão das unidades públicas de saúde. / This work analyses the experience of Social Health Organizations (Organizações Sociais de Saúde - OSS) implemented by the State Government of São Paulo. Its purpose is to discuss the systemic and practical issues involved in strategies of private management of health units in the Brazilian public health system (SUS) from a financial perspective. This inquiry is pursued initially by identifying the theorectical approach supporting the experience and its relation with health systems recent reforms. In paralel, the OSS model is studied in terms of its importance in the state public budget and in respect to the mechanims determining health services prices through it provided.

O trabalho analisa a experiência de implantação do modelo das Organizações Sociais de Saúde (OSS) no Estado de São Paulo, buscando compreender as questões que se colocam para a adoção de modelos centrados na administração privada de unidades de saúde no âmbito do SUS, seja do ponto de vista sistêmico, seja com relação aos elementos de natureza prática relacionados a sua gestão financeira por parte do Estado. Para tanto, procura-se, inicialmente, identificar as referências teóricas que dão suporte ao modelo OSS no campo da Ciência Econômica e posicionar a experiência em relação às tendências recentes de reforma dos sistemas de saúde. Em seguida, explora-se a importância relativa desse modelo no orçamento do Estado e da Pasta Saúde e os determinantes da formação dos preços dos serviços contratados pelo Estado sob essa forma específica de gestão das unidades públicas de saúde. / This work analyses the experience of Social Health Organizations (Organizações Sociais de Saúde - OSS) implemented by the State Government of São Paulo. Its purpose is to discuss the systemic and practical issues involved in strategies of private management of health units in the Brazilian public health system (SUS) from a financial perspective. This inquiry is pursued initially by identifying the theorectical approach supporting the experience and its relation with health systems recent reforms. In paralel, the OSS model is studied in terms of its importance in the state public budget and in respect to the mechanims determining health services prices through it provided.

Objectif : identifier de nouvelles formes d’organisation et adaptations à développer en soins primaires pour améliorer la prise en charge des personnes sans chez-soi (PSCS).Méthode : recherche mixte. une première phase a exploré les ressentis des médecins généralistes (MG) sur leur place dans la prise en charge des PSCS. La seconde phase a consisté à décrire, par une revue de la littérature, les principales composantes des programmes de soins primaires prenant en charge les PSCS, et identifier les plus pertinentes. La dernière phase a exploré le vécu et les représentations des PSCS vis-à-vis des soins premiers.Résultats : les médecins généralistes relevaient la complexité des prises en charge et le besoin d’une coordination médico-psycho-sociale renforcée. Dans la littérature, la quasi-totalité des programmes prenant en charge les personnes sans chez-soi privilégiaient cette approche pluridisciplinaire coordonnée. Les caractéristiques associées à des impacts positifs pour les PSCS étaient : la spécialisation dans leur prise en charge, l’accompagnement, les approches multidisciplinaires, l’implication d’infirmières dans la prise en charge, l’intégration de services d’aide sociale, et l’engagement dans la santé communautaire. Les entretiens auprès des PSCS ont relevé l’importance des attentes relationnelles : plus qu’une réponse médicale, ils souhaitent être écoutés, considérés et compris.Conclusion : les programmes de soins primaires souhaitant prendre en charge PSCS devraient privilégier une approche pluridisciplinaire et décloisonnée des soins de santé physique, mentale, et de la prise en charge sociale de ces patients, en privilégiant une approche centrée-patient. / Aim: to identify new forms of organization and adaptations to develop in primary care to improve the care of Homeless People (HP).Method: research by mixed methods. In the first phase we explored the views of general practitioners (GPs) about how they can provide care to HP. In the second phase we led a literature review, to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. In the third phase, we explored the experience and views of HP about primary care.Results: GPs expressed the need to develop medical and psychosocial approach with closer relation with social workers. In the litterature, almost all homelessness programs developed a multidisciplinary approach and / or offered co-located mental health, physical health and social services. Some characteristics were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. The interviews with HP showed central relational expectations of HP for their general practitioner. More than a medical response, they expected to be listened to, considered and understood.Conclusion: Primary care programs that wish to better care for HP should develop a multidisciplinary, medico-psycho-social approach. The patient-centered approach appears warranted to improve the care experience of these patients.

Diss. Stockholm: Handelshögsk., 2002.

Qu’est-ce qui détermine la survie et le succès des organisations à travers les différents régimes institutionnels? La présente étude tente à répondre à la question en analysant l’évolution d'une institution médicale publique russe, c. à. d. l'Institution de l'Etat Fédéral « Le Complexe Intersectoriel de Recherche et Technologie « Microchirurgie de l'Œil » de Rosmedtechnologie. L’étude s’étend sur quatre périodes bien définies: 1960-1985 (la Russie Soviétique, la période de pré-perestroïka), 1986-1991 (la perestroïka de Gorbatchev), 1992-2000 (la transition), et 2001-2009 (la Russie actuelle, la période post-Fyodorov). L’analyse se centre sur une coévolution des institutions externes et de la structure organisationnelle de l'entreprise, le système de droits de propriété, les tendances d'innovation et les canaux de diffusion technologique. Les conclusions suggèrent que l'environnement institutionnel général exerce une influence sur la performance de l'entreprise en déterminant « les règles du jeu » pour les transactions économiques et en établissant un ensemble de possibilités de développement. C'est alors les processus internes à l'entreprise, ses compétences dynamiques et sa capacité à innover qui déterminent si l'organisation peut s'adapter aux changements externes, reconnaître les possibilités de développement et en profiter. Par ailleurs, la direction (le leadership), le type de technologie et le niveau de sa diffusion, l’initial soutien de l'Etat, de même que la demande jouent un rôle apparent pour soutenir la performance réussie. Une structure multi-niveaux des récompenses de performance en combinaison avec les méthodes de traitement innovatrices (c. à. d. l’usage d’un conveyor chirurgical et la production en brigades) ont amené à des volumes de procédures cliniques performées plus élevées, de même que la qualité, la complexité et la diversité de traitement plus élevées. D’autant plus, pendant les étapes plus anciennes du développement de l’entreprise, la présence des inventeurs prolifiques et la structure organisationnelle qui soutenait l’apprentissage, la production et l’accumulation des connaissances (le cycle « clinique – ingénierie – approbation – production – clinique ») étaient cruciaux pour la création d’une base d’innovation persistante. Pendant les périodes plus récentes, la combinaison d’accès aux ressources (matérielles, financières, capital humain), les collaborations externes, les méthodes innovatrices d’organisation de traitement, la diffusion extensive des technologies inter- et intra-firme ont aussi contribué à des hauts niveaux d’innovation. Au total, le travail soutient une approche interdisciplinaire à l’étude des organisations, c. à. d. une combinaison de l'analyse institutionnelle, l’économie évolutionnaire et l’économie dynamique d’organisations, le management stratégique, l’économie d'innovation, l’analyse des droits de propriété et le rôle de leadership. / What determines organizational survival and success across different institutional regimes? The present historical case study attempts to answer the question by analyzing the evolution of a Russian state medical institution, i.e. the S.N. Fyodorov “Inter-Sectoral Research and Technology Complex “Eye Microsurgery””. The study spans over four clearly defined regimes: 1960 – 1985 (Soviet Russia, pre-perestroika period), 1986 – 1991 (Gorbachev’s perestroika), 1992 – 2000 (the transition years), and 2001 – 2009 (current Russia, post-Fyodorov period). The analysis focuses on the co-evolution of the external institutions and the firm’s organizational structure, the system of property rights, innovation patterns and the channels of technological diffusion. The findings suggest that the general institutional environment exerts influence on the firm’s performance through determining the “rules of the game” for economic transactions and through establishing a set of development possibilities. It is then the firm’s internal processes, dynamic competences and the ability to innovate that determine whether the organization can adapt to external changes, recognize the development possibilities and take advantage of them. In addition, the roles of leadership, the type of technology and its diffusion scope, initial State support, as well as the extent of demand are apparent in sustaining successful performance. Multi-level high performance rewards structure in combination with novel industrialized treatment methods (e.g. the use of a surgical conveyer and team production) resulted in greater volumes of clinical procedures performed, as well as higher quality, complexity and diversity of treatment. In addition, at the earlier stages of the firm’s development, the presence of prolific innovators and the organizational structure that supported learning, knowledge production and accumulation (the “clinic – engineering – approbation – production – clinic” cycle) were crucial for creating a basis for persistent innovation. In later periods, the combination of resource availability (material, financial, human capital), external collaborations, novel ways of organizing treatment, extensive inter and intra-firm diffusion of technologies also contributed to high levels of innovation. Overall, the work provides support for an interdisciplinary approach to the study of organizations, i.e. combining institutional analysis, evolutionary and dynamic organizational economics, strategic management, the economics of innovation, the analysis of property rights and the role of leadership.