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L'équité dans le modèle de "concurrence organisée" pour la régulation d'un système de santé

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  • Claude Schneider-Bunner
  • Maryse Gadreau
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    Abstract

    [eng] Equity in the "Planned Competition" Model of Regulating a Health System by Maryse Gadreau and Claude Schneider-Bunner . The distributive logic of European health systems (contribution depending on income and use depending on need) is indicative of the importance attached to the principle of equal access to health-care. However, reforms introducing competition are arousing interest in Europe and have been piloted in the United Kingdom and the Netherlands. To what extent is equity still maintained? This paper uses a threefold typology of justice theories (egalitarian, liberal and Rawlsian) to analyse the "planned competition" model and its European pilots. The underlying conception of equity is ambiguous: all three dimensions are present, indicating the hesitations of equity policy and reflecting the pluralism of the principles in whose name the health system players are acting. [fre] L'équité dans le modèle de "concurrence organisée" pour la régulation d'un système de santé par Maryse Gadreau et Claude Schneider-Bunner . La logique distributive des systèmes de santé européens (contribution selon les moyens, utilisation selon les besoins) est significative de l'importance accordée au principe d'égalité d'accès aux soins. Pourtant, des réformes introduisant la concurrence suscitent l'intérêt en Europe et ont été expérimentées au Royaume-Uni et aux Pays-Bas. Dans quelle mesure l'objectif d'équité reste-t-il atteint ? Cet article se propose d'évaluer, à l'aide d'une typologie des théories de la justice en trois pôles -égalitariste, libéral, rawlsien- le modèle de " concurrence organisée " et ses expérimentations européennes. La conception de l'équité sous-jacente est ambiguë : les trois dimensions sont présentes, témoignant des hésitations de la politique d'équité et reflétant le pluralisme des principes au nom desquels les acteurs des systèmes de santé agissent.

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    File URL: http://dx.doi.org/doi:10.3406/ecop.1997.5875
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    File URL: http://www.persee.fr/articleAsPDF/ecop_0249-4744_1997_num_129_3_5875/ecop_0249-4744_1997_num_129_3_5875.pdf?mode=light
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    Bibliographic Info

    Article provided by Programme National Persée in its journal Économie & prévision.

    Volume (Year): 129 (1997)
    Issue (Month): 3 ()
    Pages: 221-237

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    Handle: RePEc:prs:ecoprv:ecop_0249-4744_1997_num_129_3_5875

    Note: DOI:10.3406/ecop.1997.5875
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    Web page: http://www.persee.fr/web/revues/home/prescript/revue/ecop

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    1. Fleurbaey, Marc, 1995. "Equal Opportunity or Equal Social Outcome?," Economics and Philosophy, Cambridge University Press, vol. 11(01), pages 25-55, April.
    2. Lise Rochaix & Claire Lachaud, 1995. "Équité dans le financement et la prestation de soins de santé en Europe," Revue d'Économie Financière, Programme National Persée, vol. 34(3), pages 367-393.
    3. Rawls, John, 1974. "Some Reasons for the Maximin Criterion," American Economic Review, American Economic Association, vol. 64(2), pages 141-46, May.
    4. Michel Mougeot, 1993. "Concurrence et incitations dans le système hospitalier," Revue Française d'Économie, Programme National Persée, vol. 8(2), pages 109-131.
    5. Fleurbaey, Marc, 1995. "Equality and responsibility," European Economic Review, Elsevier, vol. 39(3-4), pages 683-689, April.
    6. Lise Rochaix & Jacques Chaperon, 1996. "Les réformes du service national de santé britannique : la fin d'un mythe ?," Économie et Statistique, Programme National Persée, vol. 291(1), pages 87-102.
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