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Search Results: 1 - 10 of 28963 matches for " Jean-Pierre Unger "
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Involving patients and the public: how to do it better. Second edition
Pierre de Paepe,Jean-Pierre Unger
International Journal of Integrated Care , 2005,
Involving patients and the public: how to do it better. Second edition
Paepe, Pierre de,Unger, Jean-Pierre
International Journal of Integrated Care , 2005,
International aid policy: public disease control and private curative care?
De Paepe, Pierre;Soors, Werner;Unger, Jean-Pierre;
Cadernos de Saúde Pública , 2007, DOI: 10.1590/S0102-311X2007001400016
Abstract: integrating disease control with health care delivery increases the prospects for successful disease control. this paper examines whether current international aid policy tends to allocate disease control and curative care to different sectors, preventing such integration. typically, disease control has been conceptualized in vertical programs. this changed with the alma ata vision of comprehensive care, but was soon encouraged again by the selective primary health care concept. documents are analyzed from the most influential actors in the field, e.g. world health organization, world bank, and european union. these agencies do indeed have a doctrine on international aid policy: to allocate disease control to the public sector and curative health care to the private sector, wherever possible. we examine whether there is evidence to support such a doctrine. arguments justifying integration are discussed, as well as those that critically analyze the consequences of non-integration. answers are sought to the crucial question of why important stakeholders continue to insist on separating disease control from curative care. we finally make a recommendation for all international actors to address health care and disease control together, from a systems perspective.
Las consecuencias del neoliberalismo Colombia: prueba in vivo de la privatización del sector salud en países en desarrollo
De Groote,Tony; De Paepe,Pierre; Unger,Jean-Pierre;
Revista Facultad Nacional de Salud Pública , 2007,
Abstract: the reform of the colombian health sector in 1993 was founded on the internationally advocated paradigm of privatization of health care delivery. taking into account the lack of empirical evidence for the applicability of this concept to developing countries and the documented experience of failures in other countries, colombia tried to overcome these problems by a theoretically sound, although complicated, model. some ten years after the implementation of "law 100," a review of the literature shows that the proposed goals of universal coverage and equitable access to high-quality care have not been reached. despite an explosion in costs and a considerable increase in public and private health expenditure, more than 40 percent of the population is still not covered by health insurance, and access to health care proves uncreasingly difficult. furthermore, key health indicators and disease control programs have deteriorated. these findings confirm the results in other middle- and low-income countries. the authors suggest the explanation lies in the inefficiency of contracting-out, the weak economic, technical, and political capacity of the colombian government for regulation and control, and the absence of real participation of the poor in decision-making on (health) policies
Chile's Neoliberal Health Reform: An Assessment and a Critique
Jean-Pierre Unger ,Pierre De Paepe,Giorgio Solimano Cantuarias,Oscar Arteaga Herrera
PLOS Medicine , 2008, DOI: 10.1371/journal.pmed.0050079
Disintegrated care: the Achilles heel of international health policies in low and middle-income countries
Jean-Pierre Unger,Pierre de Paepe,Patricia Ghilbert,Werner Soors
International Journal of Integrated Care , 2006,
Abstract: Purpose: To review the evidence basis of international aid and health policy. Context of case: Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources: National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion: We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.
Integrated care: a fresh perspective for international health policies in low and middle-income countries
Jean-Pierre Unger,Pierre de Paepe,Patricia Ghilbert,Werner Soors
International Journal of Integrated Care , 2006,
Abstract: Purpose: To propose a social-and-democrat health policy alternative to the current neoliberal one. Context of case: The general failure of neoliberal health policies in low and middle-income countries justifies the design of an alternative to bring disease control and health care back in step with ethical principles and desired outcomes. Data sources: National policies, international programmes and pilot experiments—including those led by the authors—are examined in both scientific and grey literature. Case description: We call for the promotion of a publicly-oriented health sector as a cornerstone of such alternative policy. We define ‘publicly-oriented’ as opposed to ‘private-for-profit’ in terms of objectives and commitment, not of ownership. We classify development strategies for such a sector according to an organisation-based typology of health systems defined by Mintzberg. As such, strategies are adapted to three types of health systems: machine bureaucracies, professional bureaucracies and divisionalized forms. We describe avenues for family and community health and for hospital care. We stress social control at the peripheral level to increase accountability and responsiveness. Community-based, national and international sources are required to provide viable financing. Conclusions and discussion: Our proposed social-and-democrat health policy calls for networking, lobbying and training as a joint effort in which committed health professionals can lead the way.
The production of critical theories in Health Systems Research and Education. An epistemological approach to emancipating public research and education from private interests
Jean-Pierre Unger,Pierre De Paepe,Patrick Van Dessel,Alicia Stolkiner
Health, Culture and Society , 2011, DOI: 10.5195/hcs.2011.50
Abstract: This paper aims at offering alternative methodological perspectives in health systems research, to produce critical, theoretical knowledge in domains such as health policy and management of health care, organization of disease control, political economy of health and medical practice.We first examined the reasons to believe that worldwide economic agents have driven publicly funded schools of public health to adopt their preferred policies and to orient their priority research topics. We then studied whether this hidden leadership has also contributed to shape research methodologies, which we contrasted with the epistemological consequences of a quest for intellectual independence, that is, the researcher’s quest to critically understand the state of health systems and generalize results of related action-research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research.
Through Mintzberg?s glasses: a fresh look at the organization of ministries of health
Unger,Jean-Pierre; Macq,Jean; Bredo,Fran?ois; Boelaert,Marleen;
Bulletin of the World Health Organization , 2000, DOI: 10.1590/S0042-96862000000800010
Abstract: in 1987, district health care policies were officially adopted by a majority of developing countries. many operational problems constraining implementation of such policies have subsequently been identified, most of which are attributable to well-known characteristics of less developed countries. however, the policy of operational and administrative decentralization has often been critically obstructed by inappropriate organizational structures in ministries of health. by applying mintzberg?s analytical framework to several ministries of health, we identify structural deficiencies that make systems unfit to match their policy environment and yield the expected outcomes of functional and decentralized services. we propose a typology likely to elicit strategies for decentralizing health care administration. our analysis is based on the following steps: - a description of mintzberg?s concepts of organizational structure, generic components (strategic apex, technostructure, supporting structure, middle line, operational core) and functions (horizontal and vertical integration, liaison devices, vertical and horizontal decentralization) applied to health systems; - a discussion of divisionalized adhocracy as a suitable configuration for health organizations with a need for a high degree of regional autonomy, community participation, medical staff initiative, action research and operational research, and continuous evaluation; - a discussion of the organizational features of a number of health ministry systems and a consideration of strategies for transforming configurations towards divisionalized adhocracy.
Interface flow process audit: using the patient's career as a tracer of quality of care and of system organisation
Jean-Pierre Unger,Bruno Marchal,Sylvie Dugas,Marie-Jeanne Wuidar
International Journal of Integrated Care , 2004,
Abstract: Objectives: This case study aims to demonstrate the method's feasibility and capacity to improve quality of care. Several drawbacks attached to tracer condition and selected procedure audits oblige clinicians to rely on external evaluators. Interface flow process audit is an alternative method, which also favours integration of health care across institutions divide. Methods: An action research study was carried out to test the feasibility of interface flow process audit and its impact on quality improvement. An anonymous questionnaire was carried out to assess the participants' perception of the process. Results: In this study, interface flow process audit brought together general practitioners and hospital doctors to analyse the co-ordination of their activities across the primary-secondary interface. Human factors and organisational characteristics had a clear influence on implementation of the solutions. In general, the participants confirmed that the interface flow process audit helped them to analyse the quality of case management both at primary and secondary care level. Conclusions: The interface flow process audit appears a useful method for regular in-service self-evaluation. Its practice enabled to address a wide scope of clinical, managerial and economical problems. Bridging the primary-secondary care gap, interface flow process audit's focus on the patient's career combined with the broad scope of problems that can be analysed are particularly powerful features. The methodology would benefit from an evaluation of its practice on larger scale.
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