The dissertation examines the economic and behavioral factors influencing 'sector-switching' in Kazakhstan's health care industry. Sector-switching involves doctors moving from the national to the private system, which is not well established, thereby raising questions about why the switch occurs. It addresses the question: why health care professionals in Kazakhstan switch from the public sector to similar jobs in the private or nonprofit sectors? This study addresses a key issue in public management (sector switching) and also offers insights into the dynamics of the transition from a centralized economy to a market economy. As such, its findings have `real-world' applications beyond the particular case being studied i.e. Kazakhstan. This study is based on two simple claims. First, fundamental to the reforms that characterize transitional economies is effectively moving public sector employees to a nascent private sector. Second, such switches are unique because the risks related to transitioning to the private sector are different in transitional economies than in established market economies. Thus, the study considers: the degree to which economic and behavioral factors interact with different perceptions of sectoral risk, and subsequently shape the decision to move from the public sector to the private sector; in particular in Kazakhstan's health industry. The data supporting this study come from a survey covering approximately 1,000 health care professionals (practicing physicians working in both the public and private health care sectors) from nine regions of Kazakhstan. The data includes information about individual incentives physicians have for switching sections and their perceptions of perceived risks and uncertainties given the economic transition currently underway in Kazakhstan. The findings of the research suggest the strong support for the proposed hypotheses and have revealed some of the dynamics of sector switching behavior and the characteristics of "sector switchers" in Kazakhstan. The results demonstrate that physicians' overall job dissatisfaction, relative salary compared to physicians in a different sector, their risk-taking behavior, the national health care system's deterioration compared to previous years, as well as problems with providing medical services in the country affect physicians in making their decision to change their employment sector.

L’objectif principal du projet concerne l’étude sous contrôle IRM de nouveaux transducteurs HIFU pour la thérapie. Le premier sous-projet vise la caractérisation d’une sonde HIFU pour le traitement des varices et l’optimisation des paramètres de tir en fonction de la profondeur de la veine dans le tissu. Des mesures acoustiques avec un hydrophone ont confirmé la création d’une ligne de focalisation. Une étude ex vivo utilisant des veines humaines excisées a été réalisée avec l’IRM de température haute résolution afin d’établir des paramètres d'efficacité et de sécurité. La deuxième partie est une étude de sonde sectorielle pour le traitement du cancer de la prostate. La méthode utilisée actuellement par Ablatherm a été comparée avec la méthode sectorielle, en alternant les deux secteurs de la sonde. Les résultats montrent que la forme et les dimensions de la lésion sont les mêmes, avec un gain de temps est de 20%. Troisièmement nous avons étudié une sonde à focalisation dynamique pour le traitement du cancer de la prostate. La validation in vitro et in vivo a été effectuée. Des points focaux distants de 32 à 69mm de la sonde ont été obtenus et des séquences décrivant des lignes, des tranches et des volumes ont été testées. Les cartes de température et de dose thermique montrent que la stratégie de sonication est adéquate pour induire une dose létale homogène de la forme désirée, ce qui permet un traitement mieux adapté en fonction l’anatomie de chaque patient. L’IRM nous a permis de mesurer de façon non-invasive et en temps réel la température au sein des tissus soumis au tir ultrasonore et de visualiser le volume détruit ainsi que les tissus adjacents / The main objective of the project concerns the study of new HIFU transducers for therapy using MRI guidance. The first sub-project aims the characterization of a HIFU probe for the treatment of the varices and the optimization of the shooting parameters according to the vein depth in the tissue. Acoustic measurements with a hydrophone were carried out in order to confirm the creation of a focalization line. An ex-vivo study using human excised veins was realized using high resolution MRI temperature control in order measure efficiency and security parameters. The second part is a study of a sector switching probe for prostate cancer treatment. The method used by Ablatherm was compared with the sector switching method, by alternating the two sectors of the probe. Results show that the lesion shape and the dimensions are the same for the two methods, but the time saving is 20% for the sector switching probe. A dynamic focalization probe for the prostate cancer treatment was studied for the last experimental part. In vitro and in vivo validation was carried out. Focal points at several distances (between 32 mm and 69 mm with respect to the probe) were obtained and sequences describing lines, splits and volumes were tested. The temperature and thermal dose maps show that the sonication strategy is adequate for inducing a homogenous lethal dose of the desired form. A treatment better adapted to the anatomy of each patient can be performed with this technique. The MRI allowed us to measure in a non-invasive manner and in real time the temperature within tissues subject to ultrasonic shooting and to visualize both the ablated volume and the adjacent tissues

This master thesis investigates the public servants’ motives for switching their employment from the private to the public sector and for having a tendency to work in the public organization. It also focuses on factors they describe as job satisfaction and the challenges they have encountered after transitioning to the public-sector employment. The framework of Maslow’s Hierarchy of needs and Herzberg’s two factor theories provide an explanation for the reasons why public employees switched sectors and their perception on factors they perceived as motivation and challenges after switching into a new workplace in a new sector. A qualitative study was conducted, using semi-structured interviews to collect data from 8 respondents who are currently working for the government. All of them used to work in the private sector and later moved into the public sector. The study reveals a number of distinctive motives for them to make a sector switch. These include secure employment and pension, less workload and work-related stress, family inspiration, pride in the public sector job, career advancement, and making positive impacts to the community. The findings also identify a number of challenges faced by these sector switchers such as low wage and moonlighting, complicated hierarchy and bureaucratic structures, ineffective leadership and other management issues within the public office. The knowledge and information on these challenges have the implications for certain stakeholders, including recent graduates, employees, politicians, leaders at public institutions, and especially policy makers. Policy makers and/or politicians should consider creating employment policies that entice talented individuals to work for the government and enhance the working conditions for new civil servants. The study also has the potential to pave the way for the prospective recent graduates and employees, giving them sufficient information on which to base their choice of employment, either in private sector or for the government.