This book aims to redefine the requirements of an effective care for the chronic diseases, and their difficulties of implementation; to analyze the processes allowing to reinforce quality and to contain the costs and the expenditure related to this care; and to release the dynamic processes of development of an efficient care, the organisational forms and the corresponding strategies.

Table of Contents:
Acknowledgements ix Introduction xi Chapter 1 The Challenge of Chronic Diseases 1 1.1 Chronic diseases 1 1.1.1 The burden of chronic diseases 1 1.1.2 Characteristics of chronic diseases 3 1.1.3 The case of type 2 diabetes 6 1.2 Management of chronic diseases 8 1.2.1 Complex care 8 1.2.2 Characteristics of effective care 8 1.3. Organization of the health system and coordination 11 1.3.1 Organizational imbalance of the health sector 11 1.3.2 Low coordination capacities 12 1.3.3 Coordination 14 Chapter 2 Some Alternative Schemes for the Management of Chronic Diseases 17 2.1. Cooperation systems at the initiative of professionals 17 2.1.1 Care and health network 17 2.1.2 A cooperative network 18 2.1.3 Multiprofessional health home 20 2.1.4 Care teams 21 2.2 Cooperation systems at the initiative of insurers 23 2.3 Chronic care model 25 Chapter 3 Difficulties in Implementing Effective Management 29 3.1 Technical difficulties 29 3.1.1 The nature of the information 29 3.1.2 Communication processes 31 3.2 Social difficulties 32 3.2.1 Influence as a promotion means in the interest of actors 32 3.2.2 Collaboration as a threat to actors’ autonomy 33 3.2.3 Collaboration as an opportunity 35 3.3 Cultural difficulties 36 Chapter 4 Redefining Conditions for the Effective Management of Chronic Diseases 41 4.1 Quality of the activities involved in the patients’ management 41 4.1.1 Quality as an attribute of actors 41 4.1.2 Quality as balance between care abilities and requirements 42 4.2 Diversity and relevance of the range of care, services and skills that can be mobilized 44 4.3 Cooperation of actors and coordination of their interventions 47 4.3.1 Cooperation between actors 47 4.3.2 Intervention coordination for chronic disease management 48 Chapter 5 Activities Specific to an Effective Management of Chronic Diseases 53 5.1 Nature of specific activities 53 5.1.1 Specific activities linked to the quality of procedures 54 5.1.2 Specific activities linked to the range of care and services that can be mobilized 55 5.1.3 Specific activities linked to cooperation and coordination 56 5.2 Implementation and funding of specific activities 57 5.2.1 Implementation problems of specific activities 57 5.2.2 Funding of specific activities 57 Chapter 6 Dynamic Processes for the Provision of Efficient Care 59 6.1 Deadlock and efficiency 59 6.2 Care quality and costs 62 6.3 System size and costs 64 6.4 Funding of a collective system and fee-for-service 67 Chapter 7 Lump Sum Funding, Efficiency and Development 71 7.1 Different lump sum funding methods 71 7.1.1 Budget 71 7.1.2 Capitation 73 7.1.3 Overall capitation 75 7.2 Overall capitation and development 76 7.3 Endogenous development limits 78 Chapter 8 An Illustration 83 8.1 Presentation of the care network 83 8.2 Analysis of RSD operation and development 87 8.2.1 Cost reduction 88 8.2.2 Size increase 90 8.3 Illustration scope and limits 90 8.3.1 Point of the illustration 91 8.3.2 Illustration limits 93 Chapter 9 From Processes to Organizational Structures 97 9.1 An organized system 97 9.1.1 Differentiation 97 9.1.2 Coordination 99 9.2 Coordination practices 101 9.3 Steering function 104 Chapter 10 Contractual Relationship Configurations 107 10.1 Structuring relationships 107 10.1.1 Orderly coordination relationships 107 10.1.2 Complex coordination relationships 109 10.1.3 Contractual relationships 111 10.2 Organizational configuration 113 10.2.1 A structured field of action 113 10.2.2 Areas and authorities 114 10.2.3 Organizational dynamics 115 Chapter 11 Implementation Strategy 119 11.1 Two change concepts 119 11.1.1 Synoptic change 119 11.1.2 Strategic change 120 11.2 The success of a doomed reform 121 11.2.1 The 1991 British reform 121 11.2.2 A double dynamic 123 11.2.3 Determinants of the change dynamic 124 11.3 Strategy elements 125 11.3.1 Principles and action logic 126 11.3.2 Strategic management 129 11.3.3 Management authority 131 Chapter 12 IS in Health System Restructuring 135 12.1 The unbalanced organization of the health care system 135 12.1.1 An unsuitable organization 135 12.1.2 A dissociation movement 137 12.2 IS in the system organization development 138 12.2.1 Intermediary structures 138 12.2.2 Health operator model 139 12.3 Promoting IS 142 12.3.1 More or less effective measures 142 12.3.2 Structural obstacles to IS creation 144 12.3.3 Some principles for a reform 147 Bibliography 151 Index 159