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11	La transmission des données personnelles de santé : analyse et proposition d'évolution. Le cas du contrôle de l'assurance maladie / The transmission of personal health data. Analysis and proposals for changes : the case of medical supervision of the Health Insurance Stamm, Eric 12 July 2011 (has links) L’évolution du secret médical vers un secret professionnel concernant de nombreuses professions soulève la question de la transmission des données personnelles de santé. Étudiant les fondements juridiques de cette transmission et s’appuyant sur des exemples pratiques relevés au cours de l’activité des praticiens conseils au sein de l’assurance maladie, ce travail développe les droits de l’individu sur la maîtrise du secret et les possibilités de transmissions des données dans le respect du droit des autres personnes que sont les ayants droits et les employeurs comme les droits de la défense. La possibilité d’une prédominance de la société sur la personne est envisagée dans le cadre de la protection de la santé, de la justice et de la gestion économique des dépenses de santé.Des propositions d’évolution des pratiques et de la législation visent à permettre l’encadrement des transmissions des données personnelles de santé dans le respect des droits des personnes. / Medical secrecy is moving towards a professional secrecy, which concerns numerous professions, raising the question of transmission of personnel health data.This thesis, based on practical examples taken from professional activities of practitioners advisers in the Health insurance, studies legal foundations of this transmission and develops individual rights on how to control secrecy and possibilities of transmission of data according to the respect of the rights of other people such as eligible parties and employers. The fact that a society can be more prominent than a person is contemplated in the context of health protection, justice and economic management of health spending.Evolutions of practices and legislation are suggested and aim at allowing the supervision of transmission of personal health data according to people’s rights. Secret médical Secret professionnel Transmission Données personnelles de santé Droits de l’Homme Droits de la défense Dépenses de santé Medical secrecy Professional secrecy Transmission Personnel health data Human rights Defence rights Health spending
12	L’investissement en santé publique dans les provinces canadiennes de 1975 à 2018 : un désengagement à géométrie variable? Ben Jelili, Emna 08 1900 (has links) Au-delà de la capacité des systèmes à faire face aux crises sanitaires, investir en prévention devrait se lire « investir pour la santé » dans la perspective plus large d’une amélioration du bien-être des populations. Plusieurs études démontrent que les programmes de santé publique contribuent à prévenir la mortalité, améliorent la qualité de vie et réduisent les coûts des soins de santé sur le court et long terme (Dyakova et al. 2017 ; Masters et al. 2017). Pourtant, le portrait des dépenses de santé dans la plupart des pays suggère un sous-financement inquiétant des dépenses préventives en santé. Ce mémoire propose un cadre formel pour démystifier les dynamiques politiques et financières sous-jacentes à la prise de décision des gouvernements en place en matière d’investissement en santé préventive. Plus précisément, il est question d’analyser les variations des dépenses en santé publique dans les provinces canadiennes de 1975 à 2018. En s’intéressant à l’organisation du système de santé dans son ensemble et au gré des réformes politiques et structurelles des provinces, les résultats de l’analyse qualitative montrent que l’émergence du nouveau management public (NMP) dans les années 1990 a globalement contribué à la diminution accordée à la prévention. L’analyse quantitative quant à elle, énonce les éléments conjoncturels et structurels financiers qui participent à la variation des dépenses en santé publique. En considérant le financement en santé publique comme un investissement à long terme, il a été démontré que les dépenses préventives ne sont pas aussi largement soutenues et constituent des investissements à long terme discrets avec peu d’appuis dans la société. Cela implique, du point de vue financier, que ce type de dépenses est plus propice aux coupures budgétaires, surtout en période de récession et de crise économique. / Beyond the capacity of systems to deal with health crises, investing in prevention should read “investing for health” in the broader perspective of improving the well-being of populations. Several studies demonstrate that public health programs help prevent mortality, improve quality of life and reduce health care costs in the short and long term (Dyakova et al. 2017; Masters et al. 2017). However, the portrait of health expenditure in most countries suggests a worrying underfunding of preventive health expenditure. This thesis proposes a formal framework to demystify the political and financial dynamics underlying the decision-making of governments in place in terms of investment in public health. More specifically, we analyze the variations in public health expenditure in the Canadian provinces from 1975 to 2018. By focusing on the organization of the health system as a whole, according to political and structural reforms over time, the results of the qualitative analysis show that the emergence of new public management (NPM) in the early 1990 contributed overall to the reduction granted to prevention. The quantitative analysis, for its part, sets out the economic and structural financial elements that contribute to the variation in public health expenditure. Viewing public health funding as a long-term investment, it has been shown that preventive spending is not as widely supported and is a discrete long-term investment with little support in society. This implies, from a financial point of view, that this type of spending is more prone to budget cuts, especially in times of recession and economic crisis. santé publique investissement à long terme dépenses de santé politiques d'austérité nouveau management public coupures budgétaires public health long-term investment health spending austerity policies new public management budget cuts
13	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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