Publications by authors named "Alain Jourdain"

8 Publications

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Représentations des acteurs de la mise en œuvre du projet régional de santé dans deux régions.

Sante Publique 2020 Jun;Vol. 32(1):69-86

Background: The Regional Health Project (RHP) is an important lever to build a health producing system. The RHP serves as the reference for health policies in the French regions. It is developed in three main stages, preparation, diagnosis and priorities. Different institutional actors are involved: managers, administrators, leaders for democracy and medico-social services as well as primary care professionals. How have all of these actors been involved in the three main stages of preparation of the RHP?

Aim: The aim of this article is to analyze the implementation of the RHP in two French regions and how the actors in those regions perceived that implementation.

Method: The analysis of the implementation of the RHP focused on the definition of the implementation process, the diagnosis and the identification of the problems. This later one included the development of the priorities and the objectives while taking into account the resources and the evaluation. This analysis was conducted in two medium-sized regions in France between 2011 and 2015.

Results: The formulation of the problems in the RHP is rather general. Priorities and objectives are poorly justified. Resources and evaluation are not taken into account. We attribute these weaknesses to the difficulty of crossing the administrative, managerial and democratic representations with care practices in the regions.

Conclusions: A method and process that integrates the two public policy representations should be specified in a detailed document established prior to formally engaging the planning process. Therefore, the harmonization of methodology and terms is first needed as well as the development of training and research.
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http://dx.doi.org/10.3917/spub.201.0069DOI Listing
June 2020

[The Hospital, patients, health and territories Act and the recentralisation of the social and long term care sector].

Sante Publique 2017 Jul;29(3):345-360

Hypothesis: The 2009 Hospital, Patients, Health and Territories Act crystallises a central government attempt to regain control over the social and long term care sector, which involves the utilisation of policy instruments borrowed from the hospital sector: capped budgets, agreements on targets and resources, competitive tendering or quasi-market mechanisms involving hospitals and services, etc. This paper is therefore based on the hypothesis of a recentralisation and healthicization of the social and long term care sector, with a key role for the regional health authorities. Method and data: 27 semi-structured interviews were conducted with actors operating within and outside the regional health agencies and thereafter analysed using Alceste. The aim was to describe and to analyse the positioning of the RHAs in relation to key actors of the social and long-term care sector in 2 regions in 2011. Results: Key issues for public organisations include the style of planning and knowhow transfer, while the professionals were chiefly concerned with the intensity of the ambulatory turn and needs analysis methodology. The compromises forged were related to types of democratic legitimacy, namely representative or participatory democracy. Conclusion: There is little evidence to support the initial hypothesis, namely the existence of a link between the creation of RHAs and a recentralisation of health policy between 2009 and 2013. One may rather suggest that a reconfiguration of the activities and resources of the actors operating at the centre (RHAs and conseils départementaux) and at the periphery (territorial units of the RHAs and third sector umbrella organisations) has occurred.
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July 2017

[Mobility of physicians in Europe: health policies and health care provision].

Sante Publique 2017 03;29(1):81-87

Objective: To define the place of geographical mobility of physicians in medical demography policies in EU countries. Methods: Review of international migration assumptions in national projection models of numbers of physicians by broad categories of social protection systems in the EU. Results: Some countries fail to achieve medium-term projections of the number of physicians and those that do adopt the assumption of net migration, assume that they converge to zero. Migration is not considered to be a solution to the expected shortage of physicians, but rather a problem to be solved. Discussion: Three approaches to labour mobility are discussed: liberal, normative and ethical. The last approach appears to be the most popular by combining preservation of national interests with the World Health Organisation Global Code of Practice on the International Recruitment of Health Personnel.
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March 2017

Tackling regional health inequalities in france by resource allocation : a case for complementary instrumental and process-based approaches?

Appl Health Econ Health Policy 2004 ;3(4):243-50

Ecole Nationale de la Santé Publique, Rennes, France.

This article aims to evaluate the results of two different approaches underlying the attempts to reduce health inequalities in France. In the 'instrumental' approach, resource allocation is based on an indicator to assess the well-being or the quality of life associated with healthcare provision, the argument being that additional resources would respond to needs that could then be treated quickly and efficiently. This governs the distribution of regional hospital budgets. In the second approach, health professionals and users in a given region are involved in a consensus process to define those priorities to be included in programme formulation. This 'procedural' approach is employed in the case of the regional health programmes. In this second approach, the evaluation of the results runs parallel with an analysis of the process using Rawlsian principles, whereas the first approach is based on the classical economic model.At this stage, a pragmatic analysis based on both the comparison of regional hospital budgets during the period 1992-2003 (calculated using a 'RAWP [resource allocation working party]-like' formula) and the evolution of regional health policies through the evaluation of programmes for the prevention of suicide, alcohol-related diseases and cancers provides a partial assessment of the impact of the two types of approaches, the second having a greater effect on the reduction of regional inequalities.
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http://dx.doi.org/10.2165/00148365-200403040-00007DOI Listing
April 2011

[Report of public health objectives: a real ambition without strategy of implementation?].

Sante Publique 2004 Dec;16(4):673-5

Médecin de santé publique, ENSP, Avenue du Professeur Léon-Bernard, 35043 Rennes cedex.

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http://dx.doi.org/10.3917/spub.044.0673DOI Listing
December 2004

[The effectiveness of health promotion in France: comments from a round table of French experts].

Promot Educ 2004 ;Spec no 1:36-40, 50

Conseil scientifique de la CNAMTS.

In order to comment on the situation in France, a panel of six experts originating from the academic, the governmental and the service providing worlds responded to two questions, in a format that left room for significant interaction with the participants. The first question was: According to your own experience, please identify one health promotion or health education initiative that you consider effective. The second: If there was one priority to address in relation to the issue of health promotion effectiveness in France, what would that be? This paper summarises the key elements of the experts' answers to each question.
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February 2005
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