BackgroundThe benefits of supervised physical activity programs in cardiac rehabilitation have been amply demonstrated, but the quantity of physical activity often declines quickly once supervision ends. This trial assesses the effectiveness of an experimental intervention drawing on habit formation theory to maintain physical activity.MethodsCardiovascular patients (N = 47) were randomly assigned to one of two groups. The first group participated in two supervised physical activity (SPA) sessions per week for 20 weeks. The second group was offered a progressively autonomous physical activity (PAPA) program as follows: the same supervised program as the SPA group for 10 weeks and then a further 10 weeks with one supervised session replaced by a strategy to build and sustain the habit of autonomous physical activity. The International Physical Activity Questionnaire (IPAQ; Craig et al. Med Sci Sports Exerc 35(8):1381–1395, 2003) was used to measure the quantity of physical activity, which was the primary outcome. The number of participants was limited, and we thus took multiple IPAQ measurements (at 0, 5, 7, 9 and 12 months after the start of the intervention) and used a mixed model for analysis. Physical condition, automaticity of the physical activity behavior, motivation, and quality of life were examined for changes.ResultsNo significant between-group differences were noted for physical activity behaviors after the program, physical condition, motivation, or behavioral automaticity. The PAPA group nevertheless completed more PA sessions during the intervention, and their quality of life was significantly higher than that of the SPA group at 12 months.ConclusionAlthough the number of supervised sessions was lower, the progressively autonomous PA program resulted in the same or even higher positive outcomes than the fully supervised PA program.Trial registrationCurrent Controlled Trials ISRCTN77313697, retrospectively registered on 20 November 2015.

France has recently adopted one of the least market-oriented models for reforming its health care system, where competition does not feature at all prominently in the overall policy design. This country has a strong tradition of top-down public administration, and health professionals, trade unions and the general public are all uneasy about the idea of introducing market forces and privatising public health provision. The main reforms discussed in this article were based on planning, rationalisation, cost-containment, efficiency and equity. However, some embryonic changes and emerging practices can be detected which might seem to relate to the 'new public management' approach, and which could also serve as a basis for future market initiatives.

Data-production became almost an end in itself, threatening to undermine the objectives it sought to pursue. Nonetheless, extended deadlines entailed by ministerial intervention were appropriated as a resource by local actors, leading to ARH decisions which deviated from the official efficiency model, but resulted in increased effectiveness, taking fuller account of local conditions.

BackgroundPhysical activity programs (PAP) in patients with cardiovascular disease require evidence of cost-utility. To assess improvement in health-related quality of life (QoL) and reduction of health care consumption of patients following PAP, a randomized trial was used.MethodsPatients from a health insurance company who had experienced coronary artery disease or moderate heart failure were invited to participate (N = 1891). Positive responders (N = 50) were randomly assigned to a progressively autonomous physical activity (PAPA) program or to a standard supervised physical activity (SPA) program. The SPA group had two supervised sessions per week over 5 months. PAPA group had one session per week and support to aid habit formation (written tips, exercise program, phone call). To measure health-related quality of life EQ-5D utility score were used, before intervention, 6 months (T6) and 1 year later. Health care costs were provided from reimbursement databases.ResultsMobility, usual activities and discomfort improved significantly in both group (T6). One year later, EQ-5D utility score was improved in the PAPA group only. Total health care consumption in the intervention group decreased, from a mean of 4097 euros per year before intervention to 2877 euros per year after (p = 0.05), compared to a health care consumption of 4087 euros and 4180 euros per year, in the total population of patients (N = 1891) from the health insurance company. The incremental cost effectiveness ratio was 10,928 euros per QALYs.ConclusionA physical activity program is cost-effective in providing a better quality of life and reducing health care consumption in cardiovascular patients.Trial registrationISRCTN77313697, retrospectively registered on 20 November 2015.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0973-3) contains supplementary material, which is available to authorized users.

Objective: To describe the roots of the French Health Care System. Data synthesis: Actually, three dynamics are hidden behind the word crisis. The first dynamic was already there from the start, while the second is the result of an internal dynamic and a third dynamic can be seen as the consequence of external causes. The main recent policies are made of a mix of constraints and incentives. Most of them improve the governance of the health care system. Adaptive as well as innovative, a pragmatic attitude has been applied through compromises. Four features of which can be found: To improve the division of labor amid professionals; to move towards Beveridge like Welfare State model, giving to the central State more power; to enhance expertise through Evidence Based Medicine; to open the internal and external frontiers of the health care system. Conclusion: Those changes were mainly pulled by the moving context rather than pushed by an ideology. Therefore, since its birth, the French health care system evolves more on a muddling through like move than according to a plan given in advance. This happened to be a rather good way to avoid the worst: marketization.