Health networks : an innovation in the territorial offer of medical cares in France

The variety of changes in the modes of producing have led us to re-discover the active and structuring part played by territories in the present economic dynamics, particularly the new reticular organizations - including within the public service, and especially in the health sector. The latter has recently developed some changes that have allowed to go beyond the existing territorial divisions. The main change may be seen in the substitution of a more clinical medicine for an offer of more and more technical medical cares, in the context of a necessary health cost control, and also a development of an equitable access to the care services. Consequently, new innovative organizations have been set up which have raised more and more various forms of partnership between the care providers, between these providers and other actors such as the territorial communities and the associative sector. These forms of partnerships initiate territorial links which coincide less and less with the institutional boundaries - notably urban boundaries - so as to play a significant part in the dynamics of recombining in urban spaces. This is particularly the case of cancer treatments in the Rhône-Alpes region, which have been partly organized according to this new reticular mode, built on a pivot-institution : the Lyons Léon Bérard Centre. Especially through the cancer network in Rhône-Alpes (ONCORA), this centre sets relationships between various actors of health in the ambulatory and hospital sectors - either with a public or private status - located in about twenty towns of the Rhône-Alpes region and its periphery. In this specific case, the urban network is structuring cancerology in the framework of medical disciplines, situating it at the crossing of the organ specialities (vertical specialities) and, while giving it its disciplinary legibility, contributes to contributes to re-combining the territories through the urban centres concerned, from the Lyons city to the medium-sized towns. In this paper, we propose to analyse the changing of medical and territorial trajectories, while considering a sample of patients set up at two different dates, one before the foundation of the network, the other afterwards ; then, we will study and evaluate, in terms of economic efficiency and social justice, the effects of this innovative network - ONCORA - in the regional offer of care.