Main description:

This book aims to redefine the requirements of an effective care for the chronic diseases, and their difficulties of implementation; to analyze the processes allowing to reinforce quality and to contain the costs and the expenditure related to this care; and to release the dynamic processes of development of an efficient care, the organisational forms and the corresponding strategies.

Contents:

Acknowledgements ix

Introduction xi

Chapter 1. The Challenge of Chronic Diseases 1

1.1. Chronic diseases 1

1.1.1. The burden of chronic diseases 1

1.1.2. Characteristics of chronic diseases 3

1.1.3. The case of type 2 diabetes 6

1.2. Management of chronic diseases 8

1.2.1. Complex care 8

1.2.2. Characteristics of effective care 8

1.3. Organization of the health system and coordination 11

1.3.1. Organizational imbalance of the health sector 11

1.3.2. Low coordination capacities 12

1.3.3. Coordination 14

Chapter 2. Some Alternative Schemes for the Management of Chronic Diseases 17

2.1. Cooperation systems at the initiative of professionals 17

2.1.1. Care and health network 17

2.1.2. A cooperative network 18

2.1.3. Multiprofessional health home 20

2.1.4. Care teams 21

2.2. Cooperation systems at the initiative of insurers 23

2.3. Chronic care model 25

Chapter 3. Difficulties in Implementing Effective Management 29

3.1. Technical difficulties 29

3.1.1. The nature of the information 29

3.1.2. Communication processes 31

3.2. Social difficulties 32

3.2.1. Influence as a promotion means in the interest of actors 32

3.2.2. Collaboration as a threat to actors' autonomy 33

3.2.3. Collaboration as an opportunity 35

3.3. Cultural difficulties 36

Chapter 4. Redefining Conditions for the Effective Management of Chronic Diseases 41

4.1. Quality of the activities involved in the patients' management 41

4.1.1. Quality as an attribute of actors 41

4.1.2. Quality as balance between care abilities and requirements 42

4.2. Diversity and relevance of the range of care, services and skills that can be mobilized 44

4.3. Cooperation of actors and coordination of their interventions 47

4.3.1. Cooperation between actors 47

4.3.2. Intervention coordination for chronic disease management 48

Chapter 5. Activities Specific to an Effective Management of Chronic Diseases 53

5.1. Nature of specific activities 53

5.1.1. Specific activities linked to the quality of procedures 54

5.1.2. Specific activities linked to the range of care and services that can be mobilized 55

5.1.3. Specific activities linked to cooperation and coordination 56

5.2. Implementation and funding of specific activities 57

5.2.1. Implementation problems of specific activities 57

5.2.2. Funding of specific activities 57

Chapter 6. Dynamic Processes for the Provision of Efficient Care 59

6.1. Deadlock and efficiency 59

6.2. Care quality and costs 62

6.3. System size and costs 64

6.4. Funding of a collective system and fee-for-service 67

Chapter 7. Lump Sum Funding, Efficiency and Development 71

7.1. Different lump sum funding methods 71

7.1.1. Budget 71

7.1.2. Capitation 73

7.1.3. Overall capitation 75

7.2. Overall capitation and development 76

7.3. Endogenous development limits 78

Chapter 8. An Illustration 83

8.1. Presentation of the care network 83

8.2. Analysis of RSD operation and development 87

8.2.1. Cost reduction 88

8.2.2. Size increase 90

8.3. Illustration scope and limits 90

8.3.1. Point of the illustration 91

8.3.2. Illustration limits 93

Chapter 9. From Processes to Organizational Structures 97

9.1. An organized system 97

9.1.1. Differentiation 97

9.1.2. Coordination 99

9.2. Coordination practices 101

9.3. Steering function 104

Chapter 10. Contractual Relationship Configurations 107

10.1. Structuring relationships 107

10.1.1. Orderly coordination relationships 107

10.1.2. Complex coordination relationships 109

10.1.3. Contractual relationships. 111

10.2. Organizational configuration 113

10.2.1. A structured field of action 113

10.2.2. Areas and authorities 114

10.2.3. Organizational dynamics. 115

Chapter 11. Implementation Strategy 119

11.1. Two change concepts 119

11.1.1. Synoptic change 119

11.1.2. Strategic change 120

11.2. The success of a doomed reform 121

11.2.1. The 1991 British reform 121

11.2.2. A double dynamic 123

11.2.3. Determinants of the change dynamic 124

11.3. Strategy elements 125

11.3.1. Principles and action logic 126

11.3.2. Strategic management 129

11.3.3. Management authority 131

Chapter 12. IS in Health System Restructuring 135

12.1. The unbalanced organization of the health care system 135

12.1.1. An unsuitable organization 135

12.1.2. A dissociation movement 137

12.2. IS in the system organization development 138

12.2.1. Intermediary structures 138

12.2.2. Health operator model 139

12.3. Promoting IS 142

12.3.1. More or less effective measures 142

12.3.2. Structural obstacles to IS creation 144

12.3.3. Some principles for a reform 147

Bibliography 151

Index 159