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Changer d’angle de vue pour concevoir autrement l’action publique ? Le cas des déserts médicaux au prisme des parcours de soins

Abstract : This dissertation deals with the concept of medical desert. Despite widespread use of the word by the media and political representatives, identifying medical deserts is far from easy for public authorities. Spotting inequalities in access to health services requires to identify users’ needs wherever they live. However, health needs are individualized. Besides, an individual does not fully know his needs. We must therefore understand how public authorities themselves appreciate this object and how they design actions accordingly to regulate care access. This is our purpose in this dissertation. We led an action research with the Regional Health Agency of Corsica in order to analyze how public actions are designed to regulate care access inequalities. We show in particular how the care pathway approach can highlight the diversity of inequalities in a medical desert thanks to a more global modeling of health needs. Fighting medical deserts is no longer limited to guaranteeing the presence of health professionals locally. It also relies on ensuring equality between citizens in the continuity of their care pathway. Yet, territories and individuals specificities suggest a strong heterogeneity between these pathways, which is difficult to manage at a national level. We then evaluate feasibility of a bottom-up innovative public action to reduce inequalities in care access. Through a slow, fragile and complex process, local actions can still address territorial specificities without ignoring a national regulatory and institutional framework. However, multiplying these proximity experiments requires new national-level criteria to select and rank projects. Hence, we recommend methods often used to manage the exploration of the unknown.
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Submitted on : Tuesday, March 9, 2021 - 3:58:26 PM
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  • HAL Id : tel-03164009, version 1

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Igor Giusti. Changer d’angle de vue pour concevoir autrement l’action publique ? Le cas des déserts médicaux au prisme des parcours de soins. Gestion et management. Université Paris sciences et lettres, 2020. Français. ⟨NNT : 2020UPSLM054⟩. ⟨tel-03164009⟩

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