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Qualitative interviews with volunteers & salaried staff participating in humanitarian medical emergency nongovernmental organizations (NGOs) illustrate the costs of professional & militant commitment. The linear concept of a "career" of commitment permits individual dispositions to be tied to a commitment's time & duration, & in this way projects the participant's social identity. The concept of career also allows analysts to better understand why people seek commitment to militantism & how they view various life periods & situations as shaping, & being shaped by, this commitment. The various costs & benefits of commitment, especially professional costs, are discussed. Adapted from the source document.

L'objet de cet article est de présenter une application de la théorie de recherche ("search theory") au marché des services médicaux. Un modèled'interaction médecin-patient dans l'incertain y est défini, et les prédictions du modèle en matière de politiques d' information du patient et de contrôle de l'activité des médecins sont vérifiées au moyen de simulations informatiques.

L'objet de cet article est de présenter une application de la théorie de recherche ("search theory") au marché des services médicaux. Un modèled'interaction médecin-patient dans l'incertain y est défini, et les prédictions du modèle en matière de politiques d' information du patient et de contrôle de l'activité des médecins sont vérifiées au moyen de simulations informatiques.

A town in lower Normandy seen from Dallas (USA). Alcohol, bread, butter, cheese, cream, sweets ; high cholesterol, but low stress and long life in Bayeux, Lower Normandy (France).

Why do the French live longer than the Americans ?
And why do the people of Bayeux live even longer than the rest of the population of France though they ingest alcohol, butter, cheese and cream, all that medical research shows to be wrong.
In fact, stress in lessened in France because of the cultural construction of the way of life ; in the same way the Normans of Bayeux live in a stable culture steeped in French tradition and have a lower incidence of cardiovascular disease. This is what this research suggests.

The principle of precaution, a fundamental, essentially legalistic, rule underpinning health care legislation in France, basically arose from environmental protection policies. This principle became the topic of a good deal of well-publicized debate following the decree concerning HIV contamination rendered in 1993 by the Conseil d'Etat, the supreme jurisdiction on legislative matters in France. This translation of a fundamental principle from one domain to another is not devoid of significance and could have an unexpected impact on the nature and meaning of health care itself. When applied to medicine, the principle of precaution must be confronted with the notion of risk, inherent in all acts of health care. This risk certainly implies patients' rights and informed consent to medical care, but also, in a reasonable search for an acceptable balance between risk and benefit, the freedom of biomedical research from overly-restrictive regulations. Consequently, in accordance with an ethical approach to medical care, legislative and judicial bodies must take into consideration the practical reality of medicine in order to integrate the scientific, economic, social, and psychological aspects of everyday medical practice into health care laws and regulations. Once faced with the reality of health care, the principle of precaution could appear contradictory to the fundamental principles of medicine. Indeed, every physician, every health care worker, makes daily evidence-based decisions that are never devoid of risk. Unrestricted application of the principle of precaution to a growing number of public domains, including medicine, as advocated by a large number of opinion leaders, could lead to an inextricable situation, in total contradiction with the goal of health care itself. In order to develop new truly ethical and adapted health care regulations, we must break down the barriers confining judges and legal representatives to a purely legalistic vision of health care and equally confining physicians to a purely ...

The principle of precaution, a fundamental, essentially legalistic, rule underpinning health care legislation in France, basically arose from environmental protection policies. This principle became the topic of a good deal of well-publicized debate following the decree concerning HIV contamination rendered in 1993 by the Conseil d'Etat, the supreme jurisdiction on legislative matters in France. This translation of a fundamental principle from one domain to another is not devoid of significance and could have an unexpected impact on the nature and meaning of health care itself. When applied to medicine, the principle of precaution must be confronted with the notion of risk, inherent in all acts of health care. This risk certainly implies patients' rights and informed consent to medical care, but also, in a reasonable search for an acceptable balance between risk and benefit, the freedom of biomedical research from overly-restrictive regulations. Consequently, in accordance with an ethical approach to medical care, legislative and judicial bodies must take into consideration the practical reality of medicine in order to integrate the scientific, economic, social, and psychological aspects of everyday medical practice into health care laws and regulations. Once faced with the reality of health care, the principle of precaution could appear contradictory to the fundamental principles of medicine. Indeed, every physician, every health care worker, makes daily evidence-based decisions that are never devoid of risk. Unrestricted application of the principle of precaution to a growing number of public domains, including medicine, as advocated by a large number of opinion leaders, could lead to an inextricable situation, in total contradiction with the goal of health care itself. In order to develop new truly ethical and adapted health care regulations, we must break down the barriers confining judges and legal representatives to a purely legalistic vision of health care and equally confining physicians to a purely ...

The principle of precaution, a fundamental, essentially legalistic, rule underpinning health care legislation in France, basically arose from environmental protection policies. This principle became the topic of a good deal of well-publicized debate following the decree concerning HIV contamination rendered in 1993 by the Conseil d'Etat, the supreme jurisdiction on legislative matters in France. This translation of a fundamental principle from one domain to another is not devoid of significance and could have an unexpected impact on the nature and meaning of health care itself. When applied to medicine, the principle of precaution must be confronted with the notion of risk, inherent in all acts of health care. This risk certainly implies patients' rights and informed consent to medical care, but also, in a reasonable search for an acceptable balance between risk and benefit, the freedom of biomedical research from overly-restrictive regulations. Consequently, in accordance with an ethical approach to medical care, legislative and judicial bodies must take into consideration the practical reality of medicine in order to integrate the scientific, economic, social, and psychological aspects of everyday medical practice into health care laws and regulations. Once faced with the reality of health care, the principle of precaution could appear contradictory to the fundamental principles of medicine. Indeed, every physician, every health care worker, makes daily evidence-based decisions that are never devoid of risk. Unrestricted application of the principle of precaution to a growing number of public domains, including medicine, as advocated by a large number of opinion leaders, could lead to an inextricable situation, in total contradiction with the goal of health care itself. In order to develop new truly ethical and adapted health care regulations, we must break down the barriers confining judges and legal representatives to a purely legalistic vision of health care and equally confining physicians to a purely ...

The principle of precaution, a fundamental, essentially legalistic, rule underpinning health care legislation in France, basically arose from environmental protection policies. This principle became the topic of a good deal of well-publicized debate following the decree concerning HIV contamination rendered in 1993 by the Conseil d'Etat, the supreme jurisdiction on legislative matters in France. This translation of a fundamental principle from one domain to another is not devoid of significance and could have an unexpected impact on the nature and meaning of health care itself. When applied to medicine, the principle of precaution must be confronted with the notion of risk, inherent in all acts of health care. This risk certainly implies patients' rights and informed consent to medical care, but also, in a reasonable search for an acceptable balance between risk and benefit, the freedom of biomedical research from overly-restrictive regulations. Consequently, in accordance with an ethical approach to medical care, legislative and judicial bodies must take into consideration the practical reality of medicine in order to integrate the scientific, economic, social, and psychological aspects of everyday medical practice into health care laws and regulations. Once faced with the reality of health care, the principle of precaution could appear contradictory to the fundamental principles of medicine. Indeed, every physician, every health care worker, makes daily evidence-based decisions that are never devoid of risk. Unrestricted application of the principle of precaution to a growing number of public domains, including medicine, as advocated by a large number of opinion leaders, could lead to an inextricable situation, in total contradiction with the goal of health care itself. In order to develop new truly ethical and adapted health care regulations, we must break down the barriers confining judges and legal representatives to a purely legalistic vision of health care and equally confining physicians to a purely scientific vision of their mission.

Since the early 1980s healthcare systems in the industrialized nations have been undergoing radical reform aimed at curbing overspending of hospital expenditure. After a discussion of the limits of a prospective payment due to heterogeneity of costs within DRGs, we demonstrate the ability of anovel statistical model to identify high cost patients. We derive from this statistical model an economic heuristic in order to account for high cost patients in budget allocation and a Structural and Contingent method is proposed as a budgeting tool. Economic analysis based on this modeling of DRG heterogeneity further reveals the potential for improving the equity and the efficiency of the prospective payment system by restricting its perverse effects. This model may also be used as a strategic management tool for hospitals or as a means for regulators to evaluate treatment andadmission practices so as to improve health care provision. This statistical analysis was designed on the basis of a mixture of Weibull distribution, inwhich proportion of high-cost patients was expressed according to the multinomial logistic regression, allowing the determination of high-cost factors. An application of the statistical model to 124 DRGs on a French reference database stresses the problem o f heterogeneity of costs and length ofstays within most of DRGs. An example of identification of explanatory variables of high costs is carried out on several DRGs. The economic application of the statistical model is discussed pointing out the implications, in terms of efficiency, of improving hospital management. The other advantageof this statistical model is to allow the assessment of a revision of the DRG classification from both statistical and economic point of views. ; Cette recherche a pour objectif de modéliser l'hétérogénéité de l'activité hospitalière afin d'améliorer la régulation hospitalière tant en externe qu'en interne dans une double perspective d'efficacité et d'équité. La première partie, rappelle les fondements théoriques d'une telle régulation et débouche sur l'élaboration d'un modèle pour l'analyse de l'hétérogénéité des coûts intra-GHM. Dans le chapitre 1, nous rappelons que la procédure du paiement à la pathologie s'appuie sur une contractualisation qui tend à contrecarrer les comportements opportunistes en repérant les établissements sur et sous dotés. Toutefois, la catégorisation des séjours en GHM engendre une nouvelle asymétrie d'information qui résulte de la diversité des pathologies et des prises en charge dans un GHM. Il s'ensuit un risque de sélection adverse des activités rentables et un risque moral de sous-consommation pour les patients coûteux. Pour assainir les coûts par GHM et obtenir une orientation plus incitative de la politique hospitalière, nous proposons au chapitre 2 une modélisation statistique par mélange de distributions qui repose sur l'hypothèse que l'hétérogénéité intra-GHM est le fait de la coexistence de souspopulations de patients qui diffèrent tant sur le plan clinique que sur le plan des coûts. La deuxième partie de cette recherche est consacrée à l'application de cette modélisation. Dans le chapitre 3, nous utilisons les sous-groupes de GHM pour modéliser la régulation hospitalière en interne comme en externe par la méthode dite de "Compensation Structurelle et Conjoncturelle". En ce qui concerne la gestion externe (chapitre 4), à partir de l'étude de 125 GHM extraits de la base nationale de l'étude de coûts, nous montrons que le problème de l'hétérogénéité des coûts concerne laplupart des GHM et nous estimons ses répercussions financières pour les établissements selon leur catégorie. Pour déterminer si ces surcoûts peuvent être expliqués par le recrutement de patients cliniquement plus coûteux et non pas par une inefficacité économique, une recherche de facteursexplicatifs des surcoûts est entreprise sur quelques GHM. Dans le chapitre 5 consacré à la gestion interne, nous discutons de l'intérêt de la modélisation par sous-groupes pour l'analyse des écarts entre les dépenses réelles et théoriques d'un service, à partir de l'exemple du service d'hématologie du CHU de Dijon.

The Hippocratic Collection presents this remarkable feature that technical medical texts are strewn with ethical precepts with no apparent link between the two registers. The essay that I am submitting attempts to support the following hypothesis: if the Hippocratic doctors did not distinguish, in their writings, ethics and technique, it is because these ethical precepts are derived from medicine in the same way as the techniques of care .Hence the general question of my work: What is Hippocratic medicine, as long as it produces not only healing techniques, but also ethics? What is this ethics, insofar as it is produced by medical thought?The essay is primarily devoted to the first of these two questions. He tries to show that Hippocratic medicine is not a simple technique which would have recourse to philosophy, morals, religion or politics with regard to the relative problems, upstream, to its epistemological foundations or those relating, downstream, to the regulation of its applications.Indeed, unlike techniques, Hippocratic medicine cannot produce a defined object. Medical concepts apply in all fields. The only possible definition of Hippocratic medicine concerns its end: human health. Hippocratic physicians have developed a thought which enables them to attempt to give human life the greatest amplitude and the longest duration. Medicine as a whole is an ethic of health. This attitude which I call the medical resolution is opposed, in my opinion, to the philosophical approach which arose around the same time. Indeed, only medicine is the human assumption of the value promoted by life itself, namely health. Philosophy, for its part, seeks to justify life by enclosing it in a network of logos which exceeds it on all sides.All medical thought is directed towards this end: to give life its widest range. Now, if it is true that we do not treat man, but the individual, medicine has had to develop a method targeting the singular. Plato testifies, in the Phaedrus, of this method. It is a matter of relating the part ...

The Hippocratic Collection presents this remarkable feature that technical medical texts are strewn with ethical precepts with no apparent link between the two registers. The essay that I am submitting attempts to support the following hypothesis: if the Hippocratic doctors did not distinguish, in their writings, ethics and technique, it is because these ethical precepts are derived from medicine in the same way as the techniques of care .Hence the general question of my work: What is Hippocratic medicine, as long as it produces not only healing techniques, but also ethics? What is this ethics, insofar as it is produced by medical thought?The essay is primarily devoted to the first of these two questions. He tries to show that Hippocratic medicine is not a simple technique which would have recourse to philosophy, morals, religion or politics with regard to the relative problems, upstream, to its epistemological foundations or those relating, downstream, to the regulation of its applications.Indeed, unlike techniques, Hippocratic medicine cannot produce a defined object. Medical concepts apply in all fields. The only possible definition of Hippocratic medicine concerns its end: human health. Hippocratic physicians have developed a thought which enables them to attempt to give human life the greatest amplitude and the longest duration. Medicine as a whole is an ethic of health. This attitude which I call the medical resolution is opposed, in my opinion, to the philosophical approach which arose around the same time. Indeed, only medicine is the human assumption of the value promoted by life itself, namely health. Philosophy, for its part, seeks to justify life by enclosing it in a network of logos which exceeds it on all sides.All medical thought is directed towards this end: to give life its widest range. Now, if it is true that we do not treat man, but the individual, medicine has had to develop a method targeting the singular. Plato testifies, in the Phaedrus, of this method. It is a matter of relating the part ...

Men, women and death in Alsace : a way of life called into question
Compared to other parts of France, Alsace is at a disadvantage because of death rates and the causes of death. Men die younger than elsewhere, of tumours, and women of cardiovascular disease. Yet Alsace has a very good medical infrastmcture and these high and premature death rates seem due to the way of life and reveal social and sexual disparities. The plans of action drawn up aim at prevention and education and rely on a network of associations to make people aware of their own responsability.