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LU POUR VOUS DE FEVRIER 2009 : livres du mois - sites du mois - working papers

Tous les lu pour vous

LES LIVRES DU MOIS

Médecine et sciences humaines : manuel pour les études médicales.

Mouillie J.-M. éd., Lefeve C. éd., Visier L. éd.
Paris : Les Belles Lettres : 2007 : 667 p.


Cet ouvrage pluridisciplinaire est destiné à accompagner l’enseignement de sciences humaines et sociales au sein de la formation médicale. Il s’adresse aux étudiants de médecine et à tous ceux qui s’engagent dans les métiers du soin ou qui s’intéressent aux questions épistémologiques, éthiques et sociales posées par la médecine contemporaine. Les nouvelles relations entre soignants et patients, l’interrogation sur l’identité scientifique de la médecine, le développement spectaculaire des techniques médicales, l’exigence d’une sensibilisation aux enjeux éthiques et bioéthiques du soin face à l’évolution des demandes, individuelles et sociales, et aux perspectives ouvertes par les sciences du vivant appellent une réflexion spécifique. Fournir des repères historiques et conceptuels à cette réflexion, interroger les présupposés de la pensée médicale, évaluer les multiples responsabilités liées au soin, promouvoir l’indépendance du jugement, le sens des problèmes et la clairvoyance critique sont les objectifs de l’introduction des sciences humaines dans le monde médical. Sans prétention encyclopédique, cet ouvrage invite le lecteur à s’approprier les questions à partir de regards croisés et à prendre ainsi la mesure de la diversité et de la complexité des problèmes humains de la médecine. Les auteurs, médecins et non médecins, sont des spécialistes des thèmes abordés travaillant aussi bien en sciences humaines (comme anthropologues, économistes de la santé, historiens, juristes, philosophes, psychanalystes, psychologues, sociologues) que dans le monde de la santé (en biologie, cancérologie, génétique, gériatrie, médecine générale, médecine interne, neurologie, neurochirugie, psychiatrie, rééducation fonctionnelle, et dans les soins infirmiers). Le livre se compose d’une centaine d’études présentées par thématiques, de plusieurs annexes « ressources » (chronologies, références littéraires et cinématographiques, textes de référence en éthique et bioéthique) et d’un index analytique (d'après 4è de couv.).




L'accueil des immigrés vieillissants en institution.

Bartkowiak N.

Rennes : Presses de l'EHESP : 2008 : 127 p.

Les immigrés vieillissent aussi. Le vieillissement de la population immigrée est aujourd'hui en France une réalité sociale avérée. Surreprésentés chez les personnes âgées par rapport à l'ensemble de la population, les immigrés restent pourtant sous-représentés en institution. La question des immigrés âgés interroge ainsi notre contrat social au plus profond, et met en lumière une société pluriel-le et diversifiée. Le défi lancé par l'accueil des immigrés âgés en maison de retraite est celui de l'ouverture à l'interculturel, de l'alliance de l'égalité et de la différence dans une prestation de qualité. Apprivoiser la différence culturelle et l'intégrer au quotidien tout en préservant la singularité des individus : tel est l'objectif des actions concrètes proposées dans cet ouvrage.




Sickness, Disability and Work ;Breaking the barriers. Volume 3 : Denmark, Finland, Ireland and the Netherlands.
Maladie, invalidité et travail : surmonter les obstacles. Volume 3 : Danemark, Finlande, Irlande et Pays-Bas.

Organisation de coopération et de développement économiques. (OCDE). Paris. FRA.
Paris : OCDE 208 p.

Trop de travailleurs quittent pour toujours le marché du travail pour raison de santé. Et trop de personnes affectées d’un handicap se voient refuser la possibilité de travailler. C’est une tragédie à la fois sociale et économique qui frappe pratiquement l’ensemble des pays de l’OCDE ; c’est aussi un paradoxe qui mérite explication. Comment se fait-il qu’alors que l’état de santé des populations s’améliore, de plus en plus de gens en âge de travailler sont exclus de la population active et vivent de prestations maladie et invalidité de longue durée ? Ce rapport analyse les facteurs qui pourraient expliquer ce paradoxe. C’est le troisième rapport de la série d’examens de l’OCDE sur la maladie, le handicap et le travail. Les auteurs s’y intéressent plus particulièrement aux cas du Danemark, de la Finlande, de l’Irlande et des Pays-Bas et mettent en lumière le rôle des institutions et des politiques. Cet ouvrage recommande un éventail de réformes susceptibles de répondre aux défis auxquels ces quatre pays font face. L’expérience des quatre pays permet de tirer des leçons sur la façon de réduire les flux d’entrée dans les régimes d’indemnisation maladie et invalidité grâce à une bonne gestion de la maladie, aussi bien pour les travailleurs que pour les chômeurs, et sur le moyen de promouvoir le passage des prestations vers l’emploi à travers des aides ciblées, accessibles et efficaces. Dans les quatre pays retenus, des mesures supplémentaires pourraient être prises pour réduire les flux d’entrée dans les régimes d’indemnisation et pour promouvoir le retour à l’emploi des bénéficiaires de prestations. Bien des personnes souffrant de problèmes de santé ou ayant une capacité de travail réduite peuvent travailler et souhaitent réintégrer le marché du travail. Les y aider permettrait d’échapper à l’exclusion et d’augmenter leurs revenus tout en améliorant les perspectives économiques à long terme.




Managing chronic conditions. Experience in eight countries.
Gestion des maladies chroniques : l’expérience de huit pays.

Nolte E. éd., Knai C. éd., Mckee M. éd.

Copenhague : OMS - Bureau régional de l'Europe : 2008 : 14 p. + 181 p.

Health technology assessment (HTA) aims to inform health policy and decision making processes concerning health technologies on organizational, societal and ethical issues . HTA has a strong foundation in research on the health effects and broader implications of the use of technology in health care. Its potential for contributing to safer and more effective health care is widely acknowledged in Europe and interest in this field has been growing steadily. Since the establishment of the first national HTA agency in Sweden in the 1980s, the number of institutions involved in the assessment of health technologies has multiplied in Europe. Most European Member States have established a formal HTA programme or are considering the feasibility of establishing HTA intelligence to inform health policy-making. Since its inception, the HTA community has acknowledged the need for international collaboration and networking. This book has been produced as a collaboration between the EUnetHTA Project and the European Observatory on Health Systems and Policies with the aim of reviewing the relationship between HTA and policy-making from different perspectives, with a special focus on Europe. The purpose of this cooperation is to transmit the value of HTA to a wide public in decision-making and healthcare management in order to increase their awareness of HTA activities and evidence-based decision-making.




Future elderly living conditions in Europe.
L'avenir des conditions de vie des Européens âgés.

Gaymu J. éd., Festy P. éd., Poulain M. éd., Beets G. éd.
Paris : Ined : 2008 : 315 p.

From 2000 to 2030, the European population aged 75 and over will increase by three quarters, due to ageing of the baby-boom cohorts and improved survival up to beyond age 75. However, it could be grossly misleading to draw too many conclusions from such simplistic indicators, and to equate the increased "weight” of the elderly population with an increased "burden". The characteristics of this population will change over the coming decades as fundamentally as their numbers, essentially because the life course of the future elderly will have differed significantly from that of their predecessors, in terms of educational attainment, family life, working career, and so on. In FELICIE, the focus is on health of the elderly, and on the resources at their disposal to cope with the severe impairments liable to affect their quality of life. Not only personal resources -economic well-being and education attainment-but also the potential support of close kin, i.e. their partner, of course, and their children, if available. This leads to more specific question of care. One major conclusion of the FELICIE study is that the disabled older adults of the future will fare better, on average, than those of today, both on personal level, thanks to higher levels of education, and on a social level, thanks to the more frequent presence of their spouse and, at least potentially, their children. The conclusions are based on the experience of nine countries across Europe(north: Finland, Netherlands; west: Belgium, France, Germany, United Kingdom; south: Italy, Portugal; east: Czech Republic). In terms of both demographic and social indicators, the participating countries are fairly representative of their region



Sovereign virtue : the theory and practice of equality.
Vertu souveraine : la théorie de la pratique de l'égalité.

Dworkin R.
Cambridge : Harvard University Press : 2000 : 511 p.

Equality is the endangered species of political ideals. Even left-of-center politicians reject equality as an ideal: government must combat poverty, they say, but need not strive that its citizens be equal in any dimension. In his new book Ronald Dworkin insists, to the contrary, that equality is the indispensable virtue of democratic sovereignty. A legitimate government must treat all its citizens as equals, that is, with equal respect and concern, and, since the economic distribution that any society achieves is mainly the consequence of its system of law and policy, that requirement imposes serious egalitarian constraints on that distribution. What distribution of a nation's wealth is demanded by equal concern for all? Dworkin draws upon two fundamental humanist principles--first, it is of equal objective importance that all human lives flourish, and second, each person is responsible for defining and achieving the flourishing of his or her own life--to ground his well-known thesis that true equality means equality in the value of the resources that each person commands, not in the success he or she achieves. Equality, freedom, and individual responsibility are therefore not in conflict, but flow from and into one another as facets of the same humanist conception of life and politics. Since no abstract political theory can be understood except in the context of actual and complex political issues, Dworkin develops his thesis by applying it to heated contemporary controversies about the distribution of health care, unemployment benefits, campaign finance reform, affirmative action, assisted suicide, and genetic engineering.

LES SITES DU MOIS DE FEVRIER

Recherche santé

www.recherchesante.fr

















Presentation

Ce site a pour ambition d’être un portail de documentation et de partage des connaissances des acteurs de la santé afin d’apporter une aide à la décision. Il est animé par plusieurs professionnels appartenant à l’univers de l’Assurance maladie. Il propose un moteur de recherche qui indexe plus d’un millier de sites professionnels dans les champs de la santé, des soins et du secteur social. Trois modules de recherche sont actuellement à la disposition de l’internaute : - un moteur de recherche sur le web soin-santé-social; un moteur de recherche sur les dépêches d'actualité (constitué d’articles d’actualité issus d’une sélection de flux RSS de référence du domaine soin-santé-social), et un annuaire des sites indexés. Les résultats de recherche sur l’annuaire peuvent être triés selon des critères géographiques (région de France, pays), sur les sites ayant le label qualité HON-code (avec l'accord de la Fondation Health on the net) ; ou sur les mots-clés de la classification documentaire américaine du MeSH, traduite par l'Inserm. Le site offre la possibilité de constituer un historique des recherches et de les sauvegarder. On peut également proposer un site diffusant une information dédiée au domaine de la santé publique, de la prévention ou de l’éducation sanitaire. La proposition sera examinée et validée par le webmestre.

VU DE L'ETRANGER : QUELQUES WORKING PAPERS ANALYSES

Hôpital

The geography of hospital admission in a National Health Service with patient choice: evidence from Italy.

Fabbri D., Robone S.
York : HEDG : 2008/11 : 12 p.


It is evaluated that, each year, 35% out of the 10 million hospital admissions in Italy take place outside the Local Health's Authorities (LHAs) of residence. In our paper we try to give an explanation of this phenomenon making reference to the social gravity model of spatial interaction. We estimate gravity equations using a Poisson pseudo maximum likelihood method, as proposed by Santos-Silva and Tenreyro (2006). Our results suggest that the gravity model is a good framework for explaining the patient mobility phenomenon for most of the examined diagnostic groups. Our evidence suggests that the ability to contain the imports of hospital services increases with the size of the pool of enrolees. Moreover we find that the ability to export hospital services, as proxied by the ratio of export-to-internal demand, is U-shaped. Therefore our evidence suggests that there are scale effect played by the size of the pool of enrolees.

L'assistenza ospedarelia in Italia.
Le système hospitalier italien.

Lozzi M.
Roma : Banca d’Italia : 2008


Over the last decade two reforms have affected the Italian hospital system, one introducing market mechanisms, the other concerning the tools of planning and expense control assigned to the regional governments. The paper summarizes these institutional changes and describes the evolution of the structure and the activity of the hospital system, with a focus on the differences between regions. It highlights the following: (1) the reduction in the number of hospitals and hospital beds and the gap between regions in terms of hospital beds per capita; (2) the growth in personnel compared with the number of hospital beds; (3) the stationarity of admissions since the end of the nineties and the growth in the share of those in day hospital; (4) the greater number of admissions in southern regions, especially for inappropriate or less complex treatment, and the high level of migration towards northern hospitals; (5) with reference to costs, increasing returns to scale up to a given hospital size, which is larger, the more complex the courses of treatment provided; (6) the differences between regions in costs which are affected by the size of facilities and their type of specialization.

Hospital productivity and the Norwegian ownership reform – A Nordic

Kittelsen S.A.C., Magnussen J., Anthun K.S., Hakkinen U., Linna M., Medin E., Olsen K.R., Rehnberg C.
University of Oslo. Health Economics Research Programme. (H.E.R.O.). Oslo. NOR


In a period where decentralisation seemed to be the prominent trend, Norway in 2002 chose to re-centralise the hospital sector. The reform had three main aims; cost control, efficiency and reduced waiting times. This study investigates whether the hospital reform has improved hospital productivity using the other four major Nordic countries as controls. Hospital productivity measures are obtained using data envelopment analysis (DEA) on a comparable dataset of 728 Nordic hospitals in the period 1999 to 2004. First a common reference frontier is established for the four countries, enveloping the technologies of each of the countries and years. Bootstrapping techniques are applied to the obtained productivity estimates to assess uncertainty and correct for bias. Second, these are regressed on a set of explanatory variables in order to separate the effect of the hospital reform from the effects of other structural, financial and organizational variables. A fixed hospital effect model is used, as random effects and OLS specifications are rejected. Robustness is examined through alternate model specifications, including stochastic frontier analysis (SFA). The SFA approach in performed using the Battese & Coelli (1995) one stage procedure where the inefficiency term is estimated as a function of the set of explanatory variables used in the second stage in the DEA approach. Results indicate that the hospital reform in Norway seems to have improved the level of productivity in the magnitude of approximately 4 % or more. While there are small or contradictory estimates of the effects of case mix and activity based financing, the length of stay is clearly negatively associated with estimated productivity. Results are robust to choice of efficiency estimation technique and various definition of when the reform effect takes place.

Médicaments

Pharmaceutical Industry, Drug Quality and Regulation: Evidence from US and Italy.
Industrie pharmaceutique, qualité des médicaments et régulation : résultats obtenus aux Etats-Unis et en Italie.

Bhattacharya J., Carbonari L.
Cambridge : NBER : 2008/12 : 30 p.


The aim of this article is to analyze the relationship between drug price and drug quality and how it varies across two of the most common regulatory regimes in the pharmaceutical market: Minimum Efficacy Standards (MES) and Price Controls (PC). We develop a model of adverse selection where a pharmaceutical company can charge different prices to a heterogeneous group of buyers for its (innovative) drug, and we evaluate the properties of the equilibria under the two regimes. We model consumer heterogeneity stemming from differences in the willingness-to-pay for drug quality, measured through ex-post efficacy. The theoretical analysis provides two main results. First, the average drug quality delivered is higher under the MES regime than in the PC regime or a in combination of the two. Second, PC regulation reduces the difference in terms of high-low quality drug prices. The empirical analysis based on Italian and US data corroborates these results.

The Effects of Pharmaceutical Marketing and Promotion on Adverse Drug Events and Regulation.
Les effets du marché pharmaceutique et de la promotion des médicaments sur les effets indésirables des médicaments et la régulation.

David G., Markowitz S., Richards S.
Cambridge : NBER : 2009/01


This paper analyzes the relationship between postmarketing promotional activity and reporting of adverse drug events by modeling the interaction between a welfare maximizing regulator (the FDA) and a profit maximizing firm. In our analysis demand is sensitive to both promotion and regulatory interventions. Promotion-driven market expansions enhance profitability yet may involve the risk that the drug would be prescribed inappropriately, leading to adverse regulatory actions against the firm. The model exposes the effects of the current regulatory system on consumer and producer welfare. Particularly, the emphasis on safety over benefits distorts the market allocation of drugs away from some of the most appropriate users. We then empirically test the relationship between drug promotion and reporting of adverse reactions using an innovative combination of commercial data on pharmaceutical promotion and FDA data on regulatory interventions and adverse drug reactions. We provide some evidence that increased levels of promotion and advertising lead to increased reporting of adverse medical events for certain conditions

Personnes handicapées

Disability benefits and paying for care.
Les prestations aux handicapés et le financement des soins.

Berthoud R., Hancock R.
Colchester : ISER : 2008/11 : 18 p.


Attendance Allowance and the care component of Disability Living Allowance are paid to nearly four million elderly or disabled people who need to help in their daily lives. In the course of recent debate about financing the growing demand for social care services, the Wanless report (2006) suggested that these disability benefits paid by the social security system should be curtailed, releasing resources that could used by social workers to pay directly for care. This paper uses some new findings about the needs and resources of disabled claimants to comment on that proposal. It considers six issues of principle about the balance between cash and care in the delivery of support to disabled people. A decision to change policy would need to take account of the costs to the losers, as well as of the benefits to the gainers.

Soins de longue durée

Long term care in Spain: extent, costs and challenges.
Soins de longue durée en Espagne : ampleur, coûts et défis.

Albarran Lozano I.
Alcala : Universidad de Alcalá. Departamento de Estadística, Estructura Económica y Organización


The passing of Act 39/2006, of 14th December, on the Promotion of Personal Autonomy and Care for Dependent Persons (known as the Dependent Care Law) has created the fourth pillar of Welfare State in Spain. In order to achieve its efficient implementation, we need to know who and how many individuals should be attended and how much money is needed for the attention. However, the answers to these two questions given until now suggest that a lot of work is still to be done in order to reach the objectives proposed by the Law.

Soins primaires

On the Sorting of Physicians across Medical Occupations

National Bureau of Economic Research. (N.B.E.R.). Cambridge MA. USA
Cambridge : NBER : 2008/11 : 33 p.


We model the sorting of medical students across medical occupations and identify a mechanism that explains the possibility of differential productivity across occupations. The model combines moral hazard and matching of physicians and occupations with pre-matching investments. In equilibrium assortative matching takes place; more able physicians join occupations less exposed to moral hazard risk, face more powerful performance incentives, and are more productive. Under-consumption of health services relative to the first best allocation increases with occupational (moral hazard) risk. Occupations with risk above a given threshold are not viable. The model offers an explanation for the persistence of distortions in the mix of health care services offered the differential impact of malpractice risk across occupations, and the recent growth in medical specialization.

Who Pays What for Primary Health Care? Patterns and Determinants of the Fees Paid by Patients in a Mixed Public-Private Financing Model.
Qui paie quoi en matière de soins primaires ? Caractéristiques et déterminants des honoraires payés par les patients dans un modèle mixte de financement public/privé.

Cumming J., Stillman S., Poland M.
Wellington : Motu Economic and Public Policy Research. : 2009/01 : 32 p.


The New Zealand government introduced a Primary Health Care Strategy (PHCS) in 2001 aimed at improving access to primary health care, improving health, and reducing inequalities in health. The Strategy represented a substantive increase in health funding by government and a move from a targeted to a universal funding model. This paper uses representative national survey data to examine the distribution of fees paid for primary health care by different individuals under the mixed public-private financing model in place prior to the introduction of PHCS. Using multivariate regression analysis, we find that fees do vary, with people who might be expected to have greater needs paying less. However, apart from people with diabetes, there is no direct link between self-reported health status and fees paid. The findings indicate that a mixed public-private financing model can result in a fee structure which recognises differences across different population groups. The findings also provide a baseline against which changes in funding brought about by the PHCS can be evaluated.

Systèmes de santé

Regulatory Competition between European Health Systems as an Engine of Change?
La compétition par la régulation au sein des systèmes de santé européens : moteur de changement ?

Eckardt M.
Ausburg : ISRICH : 2008 : 32 p.


The health care systems of EU member states suffer from a variety of problems, making health policy reforms a permanent item on the political agenda. Since intrajurisdictional political com-petition shows a lot of wellknown problems, with agency problems due to imperfect and asymmetric information being prominent leading to policy blockades. This paper asks whether regulatory competition between the EU member states might work as an engine of reform for national health care systems. For yardstick competition, locational competition and regulatory rule competition we analyze the potential impact on improving resource allocation, controlling rentseeking activities and generating innovations. We find that so far none of these three types of regulatory competition is intense. However, within an appropriate framework, regulatory competition could exhibit an overall positive effect on national health policy reforms.

Elites and Agency in Institutional Change: The Case of Health Care Reform.
Elites et agences dans le changement institutionnel : le cas de la réforme du système de santé.

Hederer C.
Ausburg : ISRICH : 2008 : 28 p.


Over the last decades, health care reform has been a central concern of economic policy makers around the globe. It is therefore a particularly interesting example for the application, and further development, of theoretical approaches to institutional change. Based on a brief overview of the literature concerned with such applications, the paper shows that a differentiated analysis of agency in health care reform, and in particular elite decision making and its determinants, is relatively underdeveloped compared to different strands of more structure-oriented approaches. Using examples from the comparative literature, some avenues are outlined along which such an analysis could proceed.

Tabagisme

The effects of public place smoking restrictions on individual smoking behaviour in Australia.
Les effets de l'interdiction de fumer dans les lieux publics sur le comportement tabagique en Australie.

Yoo H.I.
Sidney : Australian school of business : 2008/11 : 34 p.


While smoking remains the leading preventable cause of death in Australia, existing policy options, except for bans on smoking at public places, seem to have limited scope for expansion. Eight new smoking bans, introduced in six different Australian jurisdictions over 2003 and 2005, provide a basis for evaluation. The analysis extends a popular two-part model of smoking behaviour by GLM and correlated random effect models. Difference-in-differences estimation using 4 waves of the Household, Income, Labour Dynamics Australia Survey indicates that neither the probability nor the intensity of smoking was affected. The results are robust to alternative specifications and estimation methods.

Vieillissement

Population Ageing: Crisis or Opportunity?
Le vieillissement de la population : crise ou opportunité ?

Ermisch J.
Colchester : ISER : 2008/11 : 38 p.


Population ageing reduces the working population relative to the number of pensions by one-third over next 30 years. The challenge presented by this development is how best to support pensioners’ incomes without suppressing the net incomes of the working population and capital accumulation too much. The ability of private savings and occupational pensions to meet this challenge is doubtful. There is a related issue of inter-generational equity: how do we share the burden of population ageing between generations, rather than passing it on to future generations. Given the uncertainty about future demographic and economic developments, it is important to have adaptable or self-correcting policies to address population ageing.

Dynamic Programming Model of Health and Retirement .
Un modèle de programmation dynamique de la santé et de la retraite.

Iskhakov F.
Oslo : University of Oslo : 2008 : 116 p.


A structural dynamic programming model is applied for modeling labour market transitions among older age workers in Norway in 1992–2003. Special attention is given to early retirement pension and disability pension as two major exit routes from the labour force. Health status is represented by a latent variable reflecting the eligibility for participating in disability programs. Incomplete information maximum likelihood method is used in several stages to facilitate the estimation. The model is used to investigate the degree of potential substitution of the early retirement and retirement through the disability insurance scheme. Estimates of the structural parameters of the concealed health process allow for forecasting the individual "eligibility" for the disability and thus facilitate the assessment of the potential substitution between the two exit routes from the labour force. Performed policy simulation of the complete elimination of the early retirement program indicates nearly complete return of the otherwise early pensioners back to the labour market.

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24 janvier 2009