Changes of the health care system and logic of pathway : complexity, coordination and public action issues ; Mutations du système de santé et logique de parcours : enjeux de complexité, de coordination et d'action publique

Abstract

This thesis is dedicated to the characterization of the logic of pathway in the health field. The commonplace use of this notion, which seems to be consistent with the development of walking cases' treatment and the emergence of new needs, related to the ageing of the population and the growth of chronic diseases, tends to elude the need to define its scope of validity and the types of organization and operationalization that it covers. The thesis seeks to address this issue, by characterizing the logic of pathway, the organizational and public policy issues that it raises, and by studying the modalities of its implementation and the changes of public action that it involves. On a theorical level, the thesis takes place at the crossing of two fields of academic literature, one relating to the organizational issues of health pathways and the other one relating to public management, which it links to analyse the paradigm shift towards this new logic. As part of a partnership with the Ile-de-France Regional Health Agency, the research was based on the study and support of various projects aimed at improving the management of health pathways. The thesis proposes a typology of the patients' situations and their care processes, according to evaluation methods of the needs and the types of coordination that they require. It shows that behind the generic name of logic of pathway, different approaches are implemented, depending on the degree of complexity of the situations they are applied. Supported by the public authorities, the development of the logic of pathway needs a renewal of the doctrine and instrumentation of health public action, still under construction. ; Cette thèse est consacrée à la caractérisation de la logique de parcours dans le champ sanitaire. L'usage banalisé de cette notion, qui apparaît cohérent avec le développement des prises en charge ambulatoires et l'émergence de nouveaux besoins, liés au vieillissement de la population et à l'essor des maladies chroniques, tend à éluder la nécessité de ...