Title Details

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