This thesis sets out to examine the place of patient choice in English health care, primarily within the National Health Service and in relationship to English law with regard to (a) informed consents and information and risk disclosure, and (b) confidentiality and privacy in relation to the access to and management of patient information. The analysis in underpinned with a limited review of the associations between choice and respect for individual autonomy. Health policy rhetoric has been laden with references to pro-patient choice in recent years and yet this research re-affirms that in law (still) it is the negative patient choice that carries weight in matters of consent to treatment. There is (still) no place for real demand. Similarly, in individual medical information access and management there is no sanction for demand, even negative patient choice is bounded. In both aspects of health care the ‘choices’ are (rightly) limited and can hardly constitute choice as the consumer-patient might see it. What the three papers contribute is the recognition that restrictions in patient choice are necessary; to be supported and for some individuals should be even more fettered than that of the general public in the interest of that general public. The papers examine the language of choice and find it lacking in transparency, with the reality dissociated from patient engagement, information dissemination and shared decision making; so compromising trust. If the health care system is to genuinely respect the individual autonomy of the capable adult and not utilise choice language as covert method of policy implementation, the language of what is on offer and why, the reasons for information acquisition and use and why, needs to be part of the patient-practitioner discussion as well as clarified in policy.

Based on an analysis of the Swedish laws in the field of healthcare, the purpose of this essay in jurisprudence is to examine whether Sweden has a need to implement the new EU-resolution on abortion. The study is based upon legal sources such as official government reports (SOU) as well as words of an Act. The subject also deals with ethical standards and more community-oriented material, and texts from both these areas are also included. The Swedish laws in health care are extensive, but still put the patient first. Care givers are able to delegate their responsibility if it means good health care which is also a key word in the Swedish health care. This means that the current laws are covering large areas of care and, as with many other laws in the country; it is up to each individual to interpret them. / Utifrån en analys av de svenska lagarna inom området vård är syftet med denna uppsats i rättsvetenskap är att undersöka om Sverige har ett behov av att implementera den nya EU-resolutionen angående abort. Studien är uppbyggd på såväl lagtext som statliga offentliga utredningar men då ämnet även tar upp etiska normer och även är mer samhällsinriktad har material inom båda dessa områden också medtagits. De svenska lagarna inom vården är omfattande men sätter ändå patienten främst. Vårgivare har möjlighet att delegera sitt ansvar om det innebär god vård vilket också är ett ledord inom den svenska vården. Detta innebär att dagens lagar täcker stora områdena inom vården och som med många andra lagar i landet är det upp till var och en att tolka dem.

Nationally and globally the public sector is exposed to new challenges. Tthe most recent is the global pandemic covid-19. The health care system faces new challenges, such as an ageing population which means that more people are in need of more care. The technological and the medical development also means an increased expenditure. As a way of handling the challenges liberal ideas on how the market should work were transferred to the public sector and New Public Management (NPM) was created. Ideas of decentralisation, privatization, demands of cost-effectiveness and the public sector competing with each other on the market are examples of NPM. The purpose of this study was to find out how NPM is expressed in health care law. The countries chosen for this comparative study were Finland, Norway and Sweden, based on a most-similar design. The study was conducted using thematic textual analysis on each country’s health care law.

本文主要運用博奕理論，分析全民健保法中各涉入者的議價行為，包括政黨及利益團體兩個層次之互動。主要探討下列問題：1、瞭解議價行為之動態賽局結構。2、參與者如何運用策略及其資源，以達到其偏好的理想點。3、如何透過議價來調節分歧的利益，規避社會衝突。4、如何透過理性的計算，如移動、反制、反反制的過程，達柏雷圖邊界。 第一章說明研究範圍與方法，及本文研究架構等。 第二章為理論基礎，先對傳統博奕理論提出修正，再介紹本文所採用之移動理論。 第三章說明本研究範圍內之行為者的立場、偏好等，並採二階賽局之觀點對兩層次之行為者的互動做一分析。 第四章把健保法立法過程依重要事件分為三段，分別運用賽局結 構分析其議價過程與結果。 第五章在針對第四章之均衡結果提出更進一步之分析，以康多賽贏家、中間選民定理、空間理論等來分析議題之社會選擇結果。 第六章提出研究限制和檢討，及本文結論。 / In the thesis , the author use game theory to analysis thebargaining behavior of the actors,including political parties and interest groups,in the Nationl Health Care Law-making. The purpose of this thesis contains four points.First of all,to figure out the structure of bargaining game.Second,how does the actors use their strategies and resourse to reach their ideal point.Third,how does the bargaining goes to come to an agreement, and avoid social conflict.forth and last,how can the rational actors use their strategies like move,counter-move,even counter counter-move to reach Pareto frontier.

Acteur essentiel du droit de la santé, le patient est au cœur du système de santé français. Néanmoins, l'assurance maladie, financeur du système de santé, est très souvent éludée lorsqu'il s'agit de s'interroger sur le patient. Or, c'est la figure même du patient assuré social qui émerge du système de santé. Aussi, les articulations entre le droit de la santé et de l'assurance maladie soulèvent des questions. Par ailleurs, le patient assuré social est également titulaire de droits qui semblent avoir pour corollaire des obligations. La compréhension de l'articulation de ces droits au regard du droit de la santé et de l'assurance maladie paraît inéluctable tout comme la nécessaire recherche et qualification d'obligations. C'est ainsi une certaine vision de notre système de santé qui se dégage de la recherche de ces normes applicables. / As an essential character in the health care law, the patient is the cornerstone of the French health care system. But the French Health Insurance, which is the financial base of this system, is often ignored in the studies dedicated to the patient. Nevertheless, a real concept of an insured patient has emerged from the French health care system. Consequently, the connections between health care law and health insurance law have to be questioned. Furthermore, the rights owned by this insured patient seem to have corollary duties ; understanding the combinations between these rights under the health care law and health insurance law is unavoidable, as well as the necessary research and qualification of related duties. In the end, it appears that the research of these rules reveals a particular conception of the health care system.

Mayotte département d’outre-mer français depuis 2011, fait partie de l’archipel des Comores ; elle est séparée des îles de l’État de l’Union des Comores depuis 1975. L’instauration d’un visa en 1995 et l’ordonnance n° 2002-688 du 12 juillet 2004 entréeen vigueur le 1er avril 2005 relative à l’extension de la sécurité sociale à Mayotte exclut les malades étrangers du système de santé mahorais. Ceci entraine des processus d’évacuation sanitaire par la voie d’une immigration clandestine qui provoque des naufrages et des violations des droits du patient. L’attrait de Mayotte et de la France métropolitaine pour les populations défavorisées occasionne des situations de conflits et de concurrence pour l’accès à la protection sanitaire et sociale. Les populations défavorisées de Mayotte, qui se battent pour combler leur retard par rapport à la métropole, vivent mal cette concurrence ; tandis que les populations immigrées vivant dans la clandestinité et sous la menace d’une expulsion imminente, rencontrent des difficultés pour faire valoir leur droit aux soins et au bénéfice à l’assistance du système social. Les obstacles sont nombreux et souvent considérables, dus notamment à la discrimination, à une disparité de difficultés sociales et économiques et à leurs conditions de vie généralement très difficiles. La maîtrise des flux migratoires et la lutte contre l’immigration irrégulière demeurent des priorités de la politique du gouvernement français en matière d’immigration. Laspécificité de la situation du département de Mayotte ainsi que l’importance des flux migratoires qui y sont constatés ont conduit les autorités sanitaires à gérer les flux migratoires liés aux évacuations sanitaires par la voie illégale. La France mène une politique sanitaire en continuant de soutenir l’Union des Comores dans l’amélioration de l’accessibilité et de laqualité des soins, à travers les programmes d’appui au secteur de la santé. Ces programmes auront pour finalité l’amélioration de la santé des mères et des enfants, notamment la réduction des mortalités maternelle et néonatale. La France à travers son organisme Agence française de développement (AFD) entend appuyer le ministère de la Santé dans l’élaboration et la mise en oeuvre des politiques publiques et contribuer au renforcement du cadre institutionnel et juridique du secteur. Il s’agira notamment d’appuyer l’État comorien dans la mise en place de mécanismes de régulation du service privé dans le secteur public et de réformer la pharmacie nationale. Cette recherche pointe les enjeux liés au droit de la protection sociale et au droit de la santé des étrangers sur le territoire national, aussi bien en France métropolitaine qu’à Mayotte. La diversité des droits nationaux applicables à Mayotte constitue une entrave sérieuse face aux dispositifs locaux relatifs à l'accompagnement sanitaire et social. Il est donc indispensable de chercher des solutions juridiques relatives à l’uniformisation de ce droit sanitaire et social afin d’améliorer le système de santé. Les résultats de cette recherche ont montré que les dispositifs locaux tels que le « bon rose » et le « bon AGD » ne sont pas du tout équivalents aux dispositifs nationaux (l'AME et la CMUc). / Mayotte a French overseas department since 2011, is part of the comorian archipelago from which it was separated from the State of Union of the Comoros islands since 1975. The introduction of a visa in 1995 and the order n° 2002-688 delivered on 12 july 2004 and entered into force on April 1st 2005 with regard to the extension of social security in Mayotte exclude the foreign sick from Mayotte's health system. This leads to a process of medical evacuation following an illegal immigration way that causes shipwrecks and the violation of the patient's rights. The attraction of Mayotte and Mainland France for disadvantaged populations lead to conflict situations and competition in the access to health and social protection. Mayotte's disadvantaged populations, who are struggling to catch up with the mainland, do not get along with that competition. At the same time the illegal immigrants living clandestinely and with the threat of expulsion are facing difficulties to assert their right to health care and to benefit from social system assistance. Obstacles are numerous and most of the time considerable, mainly because of discrimination, because of their judicial status, of disparity in their social and economical difficulties and because of their generaly very hard living conditions. The control of migratory flow and the fight against illegal immigrant remain the top priorities of the French government policy as far as immigration is concerned. The singularity of the situation in the department of Mayotte and the huge migratory flows that have been observed led healthcare authorities to handle migratory movements related to illegal medical evacuations. France has a healthcare policy and continues to support the Union of Comoros in the effort to improve healthcare access and quality, through support programs to health sector. These programs aim at improving the health of mothers and children, mainly in reducing maternal mortality. Through its organisation AFD, France aims at supporting health ministry in elaborating and implementing public policies and helping comorian state to put in place regulatory mechanisms of a private service within public sector and to reform the national pharmacy. This work focus on the issues related to the right to social protection and the health law for foreigners on the national territory, in mainland France and in Mayotte as well. Diversity of national laws applicable in Mayotte is a significant barrier to local devices in terms of medical and social assistance. It is necessary to seek legal solutions related to standardization of this health and social law in order to better the healthcare system. During our field research we observed that local devices such as the "pink warrant" and the "good AGD" are not at all equivalent to the national devices (AME and CMUc).