Background: In health care services, equity is the delivery of similar care for similar needs (horizontal equity), and the delivery of more care for higher needs (vertical equity). This study assessed the extent to which primary care provision is equitable across gender, age and socioeconomic groups, and whether any observed disparity is associated with the type of primary care remuneration model to which a family practice belongs. Remuneration models include Fee For Service in which the physician is paid for each encounter, Salary where payment is fixed for the number of hours worked, and Capitation where payment is tied to the number of patients under the care of the provider, and very little or no additional compensation is provided for each patient encounter. // Methods: This thesis used data from a cross sectional study of 5,361 patients receiving care from practices (n) in which primary care providers were remunerated by Fee For Service (35), Salary (35), or Capitation (68). Multi-level linear or logistic regressions were used to assess the impact of gender, age and socioeconomic strata on quality of care. The quality of health service delivery and health promotion were assessed through surveys based on the Primary Care Assessment Tool (n=5,111). The quality of preventive care (n=4,108) and chronic disease management (n-514) were evaluated through chart abstraction using the Canadian recommendations for care as the standard. The analyses were conducted stratified by remuneration model to allow the impact of the model on the extent of disparity in quality of care between social strata to be assessed. // Results: Men and women reported similar quality of health service delivery. Women were significantly more likely to be up to date on their preventive care, but adherence to recommended guidelines for chronic disease management was better for men in the Fee For Service practices. Older individuals reported better health service delivery than younger ones. The quality of chronic disease management was also age dependent with better care delivered to individuals ages 60-69. Individuals of low income and education had better accessibility than those not disadvantaged in the Salaried model and Fee For Service, but not Capitation model. Despite their higher health risks, these individuals were not more likely to receive healthy lifestyle counseling. // Conclusions: Significant inequalities in the care of patients were found across social strata. In some cases, these inequalities are deemed appropriate; a justifiable response to differing health care needs. In other cases, they are deemed inappropriate and representing inequities in the delivery of care. Some of the observed disparities were present in one remuneration model but not others, suggesting that the payment approach may be contributing to these differences. The results raise the concern that the capitation remuneration structure may compromise accessibility.

Background: In health care services, equity is the delivery of similar care for similar needs (horizontal equity), and the delivery of more care for higher needs (vertical equity). This study assessed the extent to which primary care provision is equitable across gender, age and socioeconomic groups, and whether any observed disparity is associated with the type of primary care remuneration model to which a family practice belongs. Remuneration models include Fee For Service in which the physician is paid for each encounter, Salary where payment is fixed for the number of hours worked, and Capitation where payment is tied to the number of patients under the care of the provider, and very little or no additional compensation is provided for each patient encounter. // Methods: This thesis used data from a cross sectional study of 5,361 patients receiving care from practices (n) in which primary care providers were remunerated by Fee For Service (35), Salary (35), or Capitation (68). Multi-level linear or logistic regressions were used to assess the impact of gender, age and socioeconomic strata on quality of care. The quality of health service delivery and health promotion were assessed through surveys based on the Primary Care Assessment Tool (n=5,111). The quality of preventive care (n=4,108) and chronic disease management (n-514) were evaluated through chart abstraction using the Canadian recommendations for care as the standard. The analyses were conducted stratified by remuneration model to allow the impact of the model on the extent of disparity in quality of care between social strata to be assessed. // Results: Men and women reported similar quality of health service delivery. Women were significantly more likely to be up to date on their preventive care, but adherence to recommended guidelines for chronic disease management was better for men in the Fee For Service practices. Older individuals reported better health service delivery than younger ones. The quality of chronic disease management was also age dependent with better care delivered to individuals ages 60-69. Individuals of low income and education had better accessibility than those not disadvantaged in the Salaried model and Fee For Service, but not Capitation model. Despite their higher health risks, these individuals were not more likely to receive healthy lifestyle counseling. // Conclusions: Significant inequalities in the care of patients were found across social strata. In some cases, these inequalities are deemed appropriate; a justifiable response to differing health care needs. In other cases, they are deemed inappropriate and representing inequities in the delivery of care. Some of the observed disparities were present in one remuneration model but not others, suggesting that the payment approach may be contributing to these differences. The results raise the concern that the capitation remuneration structure may compromise accessibility.

Background: In health care services, equity is the delivery of similar care for similar needs (horizontal equity), and the delivery of more care for higher needs (vertical equity). This study assessed the extent to which primary care provision is equitable across gender, age and socioeconomic groups, and whether any observed disparity is associated with the type of primary care remuneration model to which a family practice belongs. Remuneration models include Fee For Service in which the physician is paid for each encounter, Salary where payment is fixed for the number of hours worked, and Capitation where payment is tied to the number of patients under the care of the provider, and very little or no additional compensation is provided for each patient encounter. // Methods: This thesis used data from a cross sectional study of 5,361 patients receiving care from practices (n) in which primary care providers were remunerated by Fee For Service (35), Salary (35), or Capitation (68). Multi-level linear or logistic regressions were used to assess the impact of gender, age and socioeconomic strata on quality of care. The quality of health service delivery and health promotion were assessed through surveys based on the Primary Care Assessment Tool (n=5,111). The quality of preventive care (n=4,108) and chronic disease management (n-514) were evaluated through chart abstraction using the Canadian recommendations for care as the standard. The analyses were conducted stratified by remuneration model to allow the impact of the model on the extent of disparity in quality of care between social strata to be assessed. // Results: Men and women reported similar quality of health service delivery. Women were significantly more likely to be up to date on their preventive care, but adherence to recommended guidelines for chronic disease management was better for men in the Fee For Service practices. Older individuals reported better health service delivery than younger ones. The quality of chronic disease management was also age dependent with better care delivered to individuals ages 60-69. Individuals of low income and education had better accessibility than those not disadvantaged in the Salaried model and Fee For Service, but not Capitation model. Despite their higher health risks, these individuals were not more likely to receive healthy lifestyle counseling. // Conclusions: Significant inequalities in the care of patients were found across social strata. In some cases, these inequalities are deemed appropriate; a justifiable response to differing health care needs. In other cases, they are deemed inappropriate and representing inequities in the delivery of care. Some of the observed disparities were present in one remuneration model but not others, suggesting that the payment approach may be contributing to these differences. The results raise the concern that the capitation remuneration structure may compromise accessibility.

Background: In health care services, equity is the delivery of similar care for similar needs (horizontal equity), and the delivery of more care for higher needs (vertical equity). This study assessed the extent to which primary care provision is equitable across gender, age and socioeconomic groups, and whether any observed disparity is associated with the type of primary care remuneration model to which a family practice belongs. Remuneration models include Fee For Service in which the physician is paid for each encounter, Salary where payment is fixed for the number of hours worked, and Capitation where payment is tied to the number of patients under the care of the provider, and very little or no additional compensation is provided for each patient encounter. // Methods: This thesis used data from a cross sectional study of 5,361 patients receiving care from practices (n) in which primary care providers were remunerated by Fee For Service (35), Salary (35), or Capitation (68). Multi-level linear or logistic regressions were used to assess the impact of gender, age and socioeconomic strata on quality of care. The quality of health service delivery and health promotion were assessed through surveys based on the Primary Care Assessment Tool (n=5,111). The quality of preventive care (n=4,108) and chronic disease management (n-514) were evaluated through chart abstraction using the Canadian recommendations for care as the standard. The analyses were conducted stratified by remuneration model to allow the impact of the model on the extent of disparity in quality of care between social strata to be assessed. // Results: Men and women reported similar quality of health service delivery. Women were significantly more likely to be up to date on their preventive care, but adherence to recommended guidelines for chronic disease management was better for men in the Fee For Service practices. Older individuals reported better health service delivery than younger ones. The quality of chronic disease management was also age dependent with better care delivered to individuals ages 60-69. Individuals of low income and education had better accessibility than those not disadvantaged in the Salaried model and Fee For Service, but not Capitation model. Despite their higher health risks, these individuals were not more likely to receive healthy lifestyle counseling. // Conclusions: Significant inequalities in the care of patients were found across social strata. In some cases, these inequalities are deemed appropriate; a justifiable response to differing health care needs. In other cases, they are deemed inappropriate and representing inequities in the delivery of care. Some of the observed disparities were present in one remuneration model but not others, suggesting that the payment approach may be contributing to these differences. The results raise the concern that the capitation remuneration structure may compromise accessibility.

Für eine konsistente Rechtevergabe in betrieblichen Anwendungssystemen ist die Einbeziehung umfassender intra- und interorganisationeller Strukturen unabdingbar. Die Kernproblematik aktueller Ansätze beruht auf der inkonsistenten Zuweisung von Aufgabenträgern bei der Rechtevergabe. Die Problematik fällt speziell bei aufbauorganisatorischen Änderungen, wie der Einstellung, der Versetzung und dem Ausscheiden von Aufgabenträgern in Unternehmen, ins Gewicht. Das Resultat der inkonsistenten Rechtevergabe ist die Verletzung von (Sicherheits-)Richtlinien in den Unternehmen. Der Neuheitswert der Arbeit basiert vorrangig auf der Entwicklung eines aufbauorganisatorischen Metamodells und einer korrespondierenden deklarativen Anfragesprache. Diese Komposition ermöglicht die konsistente Rechtevergabe und damit einhergehend die Einhaltung der (Sicherheits-)Richtlinien in den betrieblichen Anwendungssystemen. Des Weiteren wird der Wartungsaufwand in den betrieblichen Anwendungssystemen bei den erwähnten aufbauorganisatorischen Änderungen reduziert.

The design of public transport system must take into account different dimensions to solve two main problems of optimization: the vehicles scheduling and driver scheduling. In our work, we focused on bus driver scheduling. Its objective is to minimize the number of drivers in accordance with social and environmental constraints. By its combinatorial nature, bus driver scheduling is considered a complex task in the design process of network transport. We have proposed an approach based on hyper-heuristics whose main advantage lies in their ability to adapt to different problems. We are particularly interested in a cooperative approach, which is able to take into account changes in the resolution process. We have extended the functionality and improved performance of the traditional framework of hyper- heuristics by proposing a pattern based on an organizational model. The proposed algorithm consists of a combination of several phases and several levels. The metaphor of the coalition is used to make cooperate several hyper-heuristics. The coalition is intended to favor diversified solutions and expand search capacity with decentralized control where each hyper-heuristic has certain autonomy. It is thus possible to consider different ways of cooperation between the hyper-heuristics: sharing solutions, learning by mimetism or carrying out different competitive search strategies. The experiment was carried out both on real-world instances and benchmarks. It gave good results on both quality of solution and execution time

Für eine konsistente Rechtevergabe in betrieblichen Anwendungssystemen ist die Einbeziehung umfassender intra- und interorganisationeller Strukturen unabdingbar. Die Kernproblematik aktueller Ansätze beruht auf der inkonsistenten Zuweisung von Aufgabenträgern bei der Rechtevergabe. Die Problematik fällt speziell bei aufbauorganisatorischen Änderungen, wie der Einstellung, der Versetzung und dem Ausscheiden von Aufgabenträgern in Unternehmen, ins Gewicht. Das Resultat der inkonsistenten Rechtevergabe ist die Verletzung von (Sicherheits-)Richtlinien in den Unternehmen. Der Neuheitswert der Arbeit basiert vorrangig auf der Entwicklung eines aufbauorganisatorischen Metamodells und einer korrespondierenden deklarativen Anfragesprache. Diese Komposition ermöglicht die konsistente Rechtevergabe und damit einhergehend die Einhaltung der (Sicherheits-)Richtlinien in den betrieblichen Anwendungssystemen. Des Weiteren wird der Wartungsaufwand in den betrieblichen Anwendungssystemen bei den erwähnten aufbauorganisatorischen Änderungen reduziert.

La conception d’un système de transport en commun doit prendre en compte différentes dimensions pour résoudre deux problèmes importants d’optimisation : l’ordonnancement des véhicules (le graphicage) et l’affectation des conducteurs (l’habillage). Dans nos travaux, nous nous sommes focalisés sur le problème de l'habillage. L’objectif est de minimiser le nombre de conducteurs en respectant toutes les contraintes sociales et économiques. Par sa nature combinatoire, l’habillage est considéré comme une tâche complexe du processus de conception de réseaux de transport en commun. Nous avons proposé une approche fondée sur les hyper-heuristiques dont le principal avantage réside dans leur faculté d’adaptation à différents problèmes. Nous nous sommes intéressés plus particulièrement à une approche coopérative, capable de prendre en compte les changements au cours du processus de résolution. Nous avons étendu les fonctionnalités et amélioré les performances du framework traditionnel des hyper-heuristiques. L’algorithme proposé comporte une combinaison de plusieurs phases et plusieurs niveaux. La métaphore de la coalition est utilisée pour permettre la coopération entre hyper-heuristiques. Elle est destinée à favoriser la diversification des solutions et amplifier la capacité de recherche selon un contrôle décentralisé où chaque hyper-heuristique possède une certaine autonomie. Il est ainsi possible d’envisager différents modes de coopération entre les hyper-heuristiques : partage de solutions, apprentissage par mimétisme ou encore mise en concurrence de différentes stratégies de recherche. L’expérimentation a été réalisée aussi bien sur des instances réelles que sur des benchmarks. Elle a donné de bons résultats tant sur la déviation que sur le temps d’exécution. / The design of public transport system must take into account different dimensions to solve two main problems of optimization: the vehicles scheduling and driver scheduling. In our work, we focused on bus driver scheduling. Its objective is to minimize the number of drivers in accordance with social and environmental constraints. By its combinatorial nature, bus driver scheduling is considered a complex task in the design process of network transport. We have proposed an approach based on hyper-heuristics whose main advantage lies in their ability to adapt to different problems. We are particularly interested in a cooperative approach, which is able to take into account changes in the resolution process. We have extended the functionality and improved performance of the traditional framework of hyper- heuristics by proposing a pattern based on an organizational model. The proposed algorithm consists of a combination of several phases and several levels. The metaphor of the coalition is used to make cooperate several hyper-heuristics. The coalition is intended to favor diversified solutions and expand search capacity with decentralized control where each hyper-heuristic has certain autonomy. It is thus possible to consider different ways of cooperation between the hyper-heuristics: sharing solutions, learning by mimetism or carrying out different competitive search strategies. The experiment was carried out both on real-world instances and benchmarks. It gave good results on both quality of solution and execution time

Made available in DSpace on 2010-04-20T20:20:40Z (GMT). No. of bitstreams: 1 163077.pdf: 678052 bytes, checksum: 0acedae2e7d216fb7caa46ff6c9e9cc3 (MD5) Previous issue date: 2007-04-10T00:00:00Z / This Master’s dissertation aims at analyzing the understanding of company staff observed concerning matters associated to the theme intrapreneurialism, as well as its application within the company. In this study, the existence of corporate practices will also be verified that aim towards the encouragement of intrapreneurialism. Using interview techniques, it is intended to verify the level of staff knowledge about the concepts associated to intrapreneurialism. With the intention of identifying the existence or not of a homogenous understanding, the results of the interviews will be compiled and analyzed through four perspectives: hierarchic levels (top executives and middle management) and the areas of actuation (operational and commercial). The human resource corporate programs and the cultural change will be analyzed through the light of the characteristics of an intra-entrepreneurial organization with the purpose of identifying the existence or not of institutional incentive. This study does not aim to categorize if the company is intrapreneurial or not, as the focus will be to present the current stage the company finds itself in accordance with the practices that they actually use to encourage intrapreneurialism. / Trabalho de dissertação de mestrado que visa analisar o entendimento dos funcionários da empresa estudada sobre os assuntos associados ao tema intra-empreendedorismo bem como sua aplicabilidade na empresa. Neste trabalho, será verificada também a existência de práticas corporativas que visam incentivar o intra-empreendedorismo. Através da técnica de entrevistas, pretende-se verificar o grau de conhecimento dos funcionários sobre os conceitos associados ao intra-empreendedorismo. Com a finalidade de identificar a existência ou não de homogeneidade de entendimento, os resultados das entrevistas serão compilados e analisados através de quatro perspectivas: níveis hierárquicos (alto executivo e média gerência) e áreas de atuação (operacional e de negócios). Os programas corporativos de recursos humanos e de mudança cultural serão analisados a luz das características de uma organização intra-empreendedora com objetivo de identificar a existência ou não de incentivo institucional. O trabalho não tem como objetivo categorizar se a empresa é intra-empreendedora ou não, pois o foco será de apresentar o estágio atual em que a empresa se encontra quanto às práticas que visam incentivar o intra-empreendedorismo.

Face aux nouvelles missions confiées aux universités françaises, une nécessaire évolution de leurs pratiques de pilotage comptable et financier a été amorcée. Dans ce cadre, nous proposons d’analyser le degré de cohérence existant entre le modèle organisationnel actuel du Pilotage Financier Universitaire Français (PFUF) et les évolutions contextuelles auxquelles il est confronté. Pour cela, tout d’abord, nous mettons en exergue trois dimensions d’étude, à savoir celles instrumentale, de gouvernance collective et de gouvernance individuelle, permettant la construction d’une grille d’analyse globale du PFUF. Ensuite, nous mobilisons des approches de terrain complémentaires, dont des études de cas dans 5 universités françaises et une analyse quantitative des réponses de 33 universités à un questionnaire national. Au final, nous observons que le PFUF semble encore reposer sur des outils de gestion financière court-termistes et globaux, suivant une logique élémentaire de surveillance, ainsi que sur une structure mécaniste, liée à un processus décisionnel centralisé, et perturbée par la présence de jeux de pouvoir. Ces résultats permettent non seulement de conclure que le PFUF ne paraît donc pas encore répondre aux nouveaux enjeux actuels, mais aussi de proposer des logiques d’évolution adaptées / Faced with new missions entrusted to French universities, a necessary change of their accounting and financial management practices has been initiated. Within this framework, we propose to analyze the level of consistency between the current organizational model of French University Financial Management (FUFM) and contextual changes it faces. First of all, for that purpose, we highlight three research dimensions, namely instrumental, collective governance and individual governance, permitting to build a global analysis table of FUFM. Then, we mobilize complementary field-based approaches, among them case studies in five French universities and a quantitative analysis of 33 universities responses to a national survey. In the end, we observe that FUFM still seems based on short-termist and global financial management tools, following a basic logic of monitoring, and on a mechanistic structure, linked to centralized decision-making process, and disturbed by the presence of power games. These results permit not only to conclude that FUFM seems not meet the new current challenges, but also to propose adapted evolution axis.