Publications by authors named "Alain Lopez"

4 Publications

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[HEALTH ECONOMIC ANALYSIS AND FAIR DECISION MAKING].

Rev Prat 2015 Sep;65(7):909-11

Health technology assessment consists in evaluating the incremental cost-benefit ratio of a medicine, a medical device, a vaccine, a health strategy, in comparison to alternative health technologies. This form of socio-eoonomic evaluation aims at optimizing resource allocation within the health system. By setting the terms of valid alternatives, it is useful to highlight public choices, but it cannot in itself make the decision as regards the public funding of patient's access to the considered technology. The decision to include such technology in the basket of health goods and sercices covered, the levels and conditions of the coverage, also result from budget constraints, from economic situation and from a political vision about health policy, social protection and public expenditure. Accordingly, health economic analysis must be implemented on specific and targeted topics. The decision making process, with its health, economic and ethical stakes, calls for a public procedure and debate, based on shared information and argument. Otherwise, health system regulation, confronted with radical and costly innovations in the coming years, will become harder to handle. This requires the development of health economic research teams able to contribute to this assessment exercise.
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September 2015

[Developing a national health policy: a realistic ambition].

Authors:
Alain Lopez

Sante Publique 2012 May-Jun;24(3):241-51

Médecin de Santé Publique, IGAS - 39-43 quai André Citroën - 75739 Paris Cedex 15.

The current national health policy in France is almost impossible to pin down and define, spread as it is across thirty or so schemes and a hundred or so targets set by a law adopted in 2004. Yet the current legislation defines the national health policy as a standard reference for public policies developed and implemented by the Ministry of Health and associated bodies. In addition, the current policy involves little consultation and is not systematically monitored and evaluated. Developing an interdepartmental health policy combining several intervention strategies and using different regulation tools may seem like an impossible task. It may also seem somewhat imprudent when it claims to define priorities and strategies. In order to overcome these difficulties and inherent contradictions, we need to develop a policy based on three key elements (a strategy, plans and policies, and policy decentralization and devolution). However, it is not enough to merely develop a framework; it is also important to define the steering and oversight plan, the consultation process and a monitoring and evaluation system. The foundations of a policy based on these principles have already been laid. The authorities simply need to continue along the lines of recent policy developments, including the creation of regional agencies (ARS), the creation of a national steering committee, and the various public health plans developed over the last 20 years.
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December 2012

[The National Health Agency: the challenge of a unified national program rejecting technocratic and centralized approaches].

Sante Publique 2012 May-Jun;24(3):229-40

Institut National du Cancer - 52 Avenue André Morizet - 92513 Boulogne-Billancout.

The creation of Regional Health Agencies precipitated the need for an overhaul of national health policy management. The National Steering Committee created as part of the HPST law is only a step in the right direction. We need to go beyond the coordination of national policy-makers in order to develop and implement an effective health policy. The creation of a National Health Agency (ANS) is generally considered to be the best way to develop a national steering mechanism capable of developing and implementing a global health policy. The purpose of this new body is not to act as a "super health agency" encompassing all existing health agencies. Rather, the ANS should aim to be an instrument of regulation acting on health care organization and funding and the quality and effectiveness of health care practices. In this sense, its role is to bring together state services and National health insurance services. However, there are two different conceptions of the agency's role ? as an autonomous technical entity based on the current model of the CNAMTS or as a body under the authority of the Ministry of Health. In both cases, the ANS may serve to increase the emphasis on technocratic and centralized approaches to health management. An intermediate solution between the ANS and the current status quo would involve increasing the authority of the Secretary-General of the Social Ministries over the central bodies of the Ministry of Health, the National health insurance services and the National Solidarity Fund for Autonomy. As part of this mission, the Secretary-General would oversee a specific body with national jurisdiction. While integrating a more coherent national policy as well as maintaining the decision-making bodies of the current administrative system, this intermediate solution would help to avoid a radical restructuring of existing national institutions at a time when current challenges in the area of population health require immediate attention.
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December 2012

[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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