Décentralisation des systèmes de santé : un éclairage international

Polton, Dominique

doi:10.3917/rfas.044.0267

Cited by 17 publications

(12 citation statements)

References 14 publications

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“…Health professionals are thus confronted with a demand for both interprofessional and interorganizational collaboration [ 1 - 3 ], implying a new division of clinical labour between professionals in different disciplines and between different types of primary-, secondary- and tertiary-care institutions. In these new forms of organization, responsibility for coordination is shifted to the care providers and must therefore become more explicit and transparent [ 4 ]. Health professionals must consequently shoulder more and more of the burden of the collaborative and coordinating activities required in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

A model and typology of collaboration between professionals in healthcare organizations

D’Amour

Goulet

Labadie

et al. 2008

BMC Health Serv Res

408

444

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BackgroundThe new forms of organization of healthcare services entail the development of new clinical practices that are grounded in collaboration. Despite recent advances in research on the subject of collaboration, there is still a need for a better understanding of collaborative processes and for conceptual tools to help healthcare professionals develop collaboration amongst themselves in complex systems. This study draws on D'Amour's structuration model of collaboration to analyze healthcare facilities offering perinatal services in four health regions in the province of Quebec. The objectives are to: 1) validate the indicators of the structuration model of collaboration; 2) evaluate interprofessional and interorganizational collaboration in four health regions; and 3) propose a typology of collaborationMethodsA multiple-case research strategy was used. The cases were the healthcare facilities that offer perinatal services in four health regions in the province of Quebec (Canada). The data were collected through 33 semi-structured interviews with healthcare managers and professionals working in the four regions. Written material was also analyzed. The data were subjected to a "mixed" inductive-deductive analysis conducted in two main stages: an internal analysis of each case followed by a cross-sectional analysis of all the cases.ResultsThe collaboration indicators were shown to be valid, although some changes were made to three of them. Analysis of the data showed great variation in the level of collaboration between the cases and on each dimension. The results suggest a three-level typology of collaboration based on the ten indicators: active collaboration, developing collaboration and potential collaboration.ConclusionThe model and the typology make it possible to analyze collaboration and identify areas for improvement. Researchers can use the indicators to determine the intensity of collaboration and link it to clinical outcomes. Professionals and administrators can use the model to perform a diagnostic of collaboration and implement interventions to intensify it.

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Section: Introductionmentioning

confidence: 99%

A model and typology of collaboration between professionals in healthcare organizations

D’Amour

Goulet

Labadie

et al. 2008

BMC Health Serv Res

408

444

View full text Add to dashboard Cite

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“…Os efeitos da distribuição vertical de poder e recursos para a implantação e operação de serviços de saúde e para a garantia de maior eficiência na gestão e equidade no acesso também foram analisados por Polton (2004), para quem não há evidências de que a descentralização traz maior eficácia produtiva, resultado sanitário ou controle das despesas de saúde. O autor enfatiza as características organizacionais como fator estratégico para o resultado dos sistemas de saúde.…”

Section: Tabelaunclassified

Autonomia, integralidade e desafios de coordenação no SUS

Jaccoud,

Vieira

2020

Coordenação E Relações Intergovernamentais Nas Políticas Sociais Brasileiras

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As publicações do Ipea estão disponíveis para download gratuito nos formatos PDF (todas) e EPUB (livros e periódicos). Acesse: http://www.ipea.gov.br/portal/publicacoes As opiniões emitidas nesta publicação são de exclusiva e inteira responsabilidade dos autores, não exprimindo, necessariamente, o ponto de vista do Instituto de Pesquisa Econômica Aplicada ou do Ministério da Economia. É permitida a reprodução deste texto e dos dados nele contidos, desde que citada a fonte. Reproduções para fins comerciais são proibidas.

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“…We can draw some evidence and suggestions from the history of the INHS and from recent developments in similar health-care systems. 30 There seem to be three major issues:…”

Section: Disentangling the Paradox Of Centralization–decentralizationmentioning

confidence: 99%

The rise of governmentality in the Italian National Health System: physiology or pathology of a decentralized and (ongoing) federalist system?

Lega

Sargiacomo²,

Ianni³

2010

Health Serv Manage Res

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In this paper, we aim to discuss the implications and lessons that can be learnt from the ongoing process of federalism affecting the Italian National Health System (INHS). Many countries are currently taking decisions concerning the decentralization or re-centralization of their health-care systems, with several key issues that are illustrated in the recent history of the INHS. The decentralization process of INHS has produced mixed results, as some regions took advantage of it to strengthen their systems, whereas others were not capable of developing an effective steering role. We argue that the mutual reinforcement of the decentralization and recentralization processes is not paradoxical, but is actually an effective way for the State to maintain control over the equity and efficiency of its health-care system while decentralizing at a regional level. In this perspective, we provide evidence backing up some of the assumptions made in previous works as well as new food-for thought - specifically on how governmentality and federalism should meet - to reshape the debate on decentralization in health care.

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Décentralisation des systèmes de santé : un éclairage international

Cited by 17 publications

References 14 publications

A model and typology of collaboration between professionals in healthcare organizations

A model and typology of collaboration between professionals in healthcare organizations

Autonomia, integralidade e desafios de coordenação no SUS

The rise of governmentality in the Italian National Health System: physiology or pathology of a decentralized and (ongoing) federalist system?

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