Isabelle Guerrero | University of Montpellier (original) (raw)
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Papers by Isabelle Guerrero
HAL (Le Centre pour la Communication Scientifique Directe), Jun 28, 2021
HAL (Le Centre pour la Communication Scientifique Directe), Jul 2, 2015
HAL (Le Centre pour la Communication Scientifique Directe), 2022
HAL (Le Centre pour la Communication Scientifique Directe), Feb 25, 2015
In France, since 1996, a new actor is in charge of the hospital regulation and resource allocatio... more In France, since 1996, a new actor is in charge of the hospital regulation and resource allocation within the hospital regional system. Under the name of “ARH” (for hospital regional agency) this Institution is a mix of genuine “decentralization” and fake “deconcentration”. It is supposed to organize the restructuring of the hospital system, at the regional level, thanks to a whole set of management and regulatory tools. Among them, the five year contract that each hospital has to sign with its agency is the most important. Named COM (Objectives and resources contract), this contract is the result of internal negotiation between hospital actors (namely, physicians and managers) ; it is also the result of external negotiation as it has to take into account regional priorities (in terms of medical activities, supply reorganization, etc.). The ARH Director is supposed to coordinate those decisions and to allocate resources, among hospitals, according to those contracts. Therefore, investing in hospital is the outcome of explicit and negotiated decision making process involving a growing number of stakeholders (experts, hospital staff, physicians, managers, administrative managers, etc.). >From the whole process, policy makers expect that investment decision will be more rationale, more accurate as far as efficacy and equity are concerned. The political bet is that contractualisation, restructuration and a high level of investment will led to a cut in the number of short term beds while maintaining a high quality level. The main hypothesis tested is that there is a positive correlation between the reform implementation and the level of the investment at the regional level. Taking this context into account, this communication assesses the impact of this reform on the hospital investment. Regressions will be computed where dependent variables are the investment expenses (by region, type of hospitals, type of investment, etc.) and independent variables are proxies of hospital regional system supply (e.g. bed density by region) and the effectiveness of a regional policy (e.g. number of Contracts).
The objective of this paper is to analyze the attitude of French hospital doctors in their new ma... more The objective of this paper is to analyze the attitude of French hospital doctors in their new managerial function as heads of public hospital departments defined by the HPST Act. Methods are based on historical neo-institutionalism and build primarily on a theoretical framework built on the concepts of profession, professional change and institutional logic analysis. This analytical grid is then confronted to the situation on the ground, using archival documents and official secondary data published between 2003 and 2013. The study highlights that doctors perceive the function of head of hospital department as a mean to protect their professional autonomy through enhanced professionalism. It sheds light on the nature of the relationship between institutional change and professional change: being head of department has not been interpreted as a radical change in their profession leading to the emergence of doctors-managers. Doctors consider the new tasks of management delegated to them as the way to challenging pure managers and thus escape the risk of "deprofessionalization" posed by increasingly powerful organizations on professions.
Politiques et management public, 2000
... le facteur taille exprimé par les variables muettes, qui prennent la valeur 0 ou 1 selon que ... more ... le facteur taille exprimé par les variables muettes, qui prennent la valeur 0 ou 1 selon que le caractère qu'elles expriment est ... On constate que les effets des flux d'investissement et de revenu sur la dette sont inverses selon qu'elle est mesurée en stock ou ... Isabelle GUERRERO. ...
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2010
This article intends to understand how health risk is actually valued and managed in public healt... more This article intends to understand how health risk is actually valued and managed in public health programs through the case study of the cancer plan in France. A literature review has been carried out with a particular focus on major health risk characteristics from a multidisciplinary perspective. To assess the economic value of the cancer plan in France, the study uses secondary data on the costs of cancer that have been collected and published by the National Institute for Cancer for 2004. A model is designed to evaluate health risk components that can be classified into four main categories relating the level at which risk is analyzed (individual or population) to the main type of intervention needed (preventive or curative) to cope with it. The findings show that actions and interventions dealing with prevention, education, and research represent 3.54% of the total costs of the cancer plan in France while 96.46% relates to health care and economic losses. The proposed classifi...
Le probleme essentiel consiste a reorganiser la frontiere entre le facteur travail et le facteur ... more Le probleme essentiel consiste a reorganiser la frontiere entre le facteur travail et le facteur capital dans les etats financiers des entreprises, afin de reconnaitre le role croissant des qualifications et des competences dans le processus de production, ce qui rend compte de l'essor du developpement des immobilisations et des biens immateriels dans les pays developpes. Il existe des benefices pouvant deriver du traitement de la formation en tant qu'investissement. Par ailleurs, les principes comptables a appliquer a travers l'UE permettent l'inclusion au bilan des depenses y afferentes.
Le protocole de traitement des fentes faciales peut etre considere comme un bien dont la valeur e... more Le protocole de traitement des fentes faciales peut etre considere comme un bien dont la valeur economique depend d'une part de son aptitude a satisfaire un besoin complexe et d'autre part de l'efficience de l'unite qui le produit: l'hopital. L'etude empirique menee au centre hospitalier regional de montpellier sur 166 enfants traites pour des fentes faciales montre que la production medicale est economiquement rationnelle car adaptee au besoin de traitement. Cependant, la structure hospitaliere ne semble pas fonctionner dans des conditions d'optimum economique. Les resultats obtenus ne corroborent pas la demarche du p. M. S. I. Qui tend a faire du cout par groupe homogene de malades, la base de tarification des hopitaux.
Cette recherche met en regard le degre d’integration de la logistique dans l’organisation hospita... more Cette recherche met en regard le degre d’integration de la logistique dans l’organisation hospitaliere et le niveau d'investissement ainsi que la structure de financement, dans laquelle l’endettement est predominant. A cette fin, nous analysons les pratiques logistiques hospitalieres, en distinguant d’une part le pilotage des flux physiques, et d’autre part la gestion des trajectoires de patients. Nous examinons ensuite s’il existe une correlation entre le degre d’integration logistique et l’allocation des ressources. Le principal enseignement de cette etude est qu’une meilleure organisation logistique n’a pas d’influence directe sur l’investissement hospitalier et la maniere dont il est finance. En revanche, son impact sur la performance financiere des capitaux investis est positif. La logistique aurait pour effet d’ameliorer le ratio entre capitaux investis et allocation budgetaire.
Annuaire des collectivités locales, 2008
Formation Professionnelle, 1998
Gestions Hospitalieres, 2009
Economie Societe Region, 2002
... AuteurIsabelle Guerrero[1] [1] L'auteur tient à remercier la Commission européenne... ..... more ... AuteurIsabelle Guerrero[1] [1] L'auteur tient à remercier la Commission européenne... ... Elles comprennent les dépenses censées développer la connaissance technique et scientifique ainsi que celles ... Elle bénéficie, à ce titre, d'une attention particulière, ce qui explique qu'elle est ...
HAL (Le Centre pour la Communication Scientifique Directe), Jun 28, 2021
HAL (Le Centre pour la Communication Scientifique Directe), Jul 2, 2015
HAL (Le Centre pour la Communication Scientifique Directe), 2022
HAL (Le Centre pour la Communication Scientifique Directe), Feb 25, 2015
In France, since 1996, a new actor is in charge of the hospital regulation and resource allocatio... more In France, since 1996, a new actor is in charge of the hospital regulation and resource allocation within the hospital regional system. Under the name of “ARH” (for hospital regional agency) this Institution is a mix of genuine “decentralization” and fake “deconcentration”. It is supposed to organize the restructuring of the hospital system, at the regional level, thanks to a whole set of management and regulatory tools. Among them, the five year contract that each hospital has to sign with its agency is the most important. Named COM (Objectives and resources contract), this contract is the result of internal negotiation between hospital actors (namely, physicians and managers) ; it is also the result of external negotiation as it has to take into account regional priorities (in terms of medical activities, supply reorganization, etc.). The ARH Director is supposed to coordinate those decisions and to allocate resources, among hospitals, according to those contracts. Therefore, investing in hospital is the outcome of explicit and negotiated decision making process involving a growing number of stakeholders (experts, hospital staff, physicians, managers, administrative managers, etc.). >From the whole process, policy makers expect that investment decision will be more rationale, more accurate as far as efficacy and equity are concerned. The political bet is that contractualisation, restructuration and a high level of investment will led to a cut in the number of short term beds while maintaining a high quality level. The main hypothesis tested is that there is a positive correlation between the reform implementation and the level of the investment at the regional level. Taking this context into account, this communication assesses the impact of this reform on the hospital investment. Regressions will be computed where dependent variables are the investment expenses (by region, type of hospitals, type of investment, etc.) and independent variables are proxies of hospital regional system supply (e.g. bed density by region) and the effectiveness of a regional policy (e.g. number of Contracts).
The objective of this paper is to analyze the attitude of French hospital doctors in their new ma... more The objective of this paper is to analyze the attitude of French hospital doctors in their new managerial function as heads of public hospital departments defined by the HPST Act. Methods are based on historical neo-institutionalism and build primarily on a theoretical framework built on the concepts of profession, professional change and institutional logic analysis. This analytical grid is then confronted to the situation on the ground, using archival documents and official secondary data published between 2003 and 2013. The study highlights that doctors perceive the function of head of hospital department as a mean to protect their professional autonomy through enhanced professionalism. It sheds light on the nature of the relationship between institutional change and professional change: being head of department has not been interpreted as a radical change in their profession leading to the emergence of doctors-managers. Doctors consider the new tasks of management delegated to them as the way to challenging pure managers and thus escape the risk of "deprofessionalization" posed by increasingly powerful organizations on professions.
Politiques et management public, 2000
... le facteur taille exprimé par les variables muettes, qui prennent la valeur 0 ou 1 selon que ... more ... le facteur taille exprimé par les variables muettes, qui prennent la valeur 0 ou 1 selon que le caractère qu'elles expriment est ... On constate que les effets des flux d'investissement et de revenu sur la dette sont inverses selon qu'elle est mesurée en stock ou ... Isabelle GUERRERO. ...
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2010
This article intends to understand how health risk is actually valued and managed in public healt... more This article intends to understand how health risk is actually valued and managed in public health programs through the case study of the cancer plan in France. A literature review has been carried out with a particular focus on major health risk characteristics from a multidisciplinary perspective. To assess the economic value of the cancer plan in France, the study uses secondary data on the costs of cancer that have been collected and published by the National Institute for Cancer for 2004. A model is designed to evaluate health risk components that can be classified into four main categories relating the level at which risk is analyzed (individual or population) to the main type of intervention needed (preventive or curative) to cope with it. The findings show that actions and interventions dealing with prevention, education, and research represent 3.54% of the total costs of the cancer plan in France while 96.46% relates to health care and economic losses. The proposed classifi...
Le probleme essentiel consiste a reorganiser la frontiere entre le facteur travail et le facteur ... more Le probleme essentiel consiste a reorganiser la frontiere entre le facteur travail et le facteur capital dans les etats financiers des entreprises, afin de reconnaitre le role croissant des qualifications et des competences dans le processus de production, ce qui rend compte de l'essor du developpement des immobilisations et des biens immateriels dans les pays developpes. Il existe des benefices pouvant deriver du traitement de la formation en tant qu'investissement. Par ailleurs, les principes comptables a appliquer a travers l'UE permettent l'inclusion au bilan des depenses y afferentes.
Le protocole de traitement des fentes faciales peut etre considere comme un bien dont la valeur e... more Le protocole de traitement des fentes faciales peut etre considere comme un bien dont la valeur economique depend d'une part de son aptitude a satisfaire un besoin complexe et d'autre part de l'efficience de l'unite qui le produit: l'hopital. L'etude empirique menee au centre hospitalier regional de montpellier sur 166 enfants traites pour des fentes faciales montre que la production medicale est economiquement rationnelle car adaptee au besoin de traitement. Cependant, la structure hospitaliere ne semble pas fonctionner dans des conditions d'optimum economique. Les resultats obtenus ne corroborent pas la demarche du p. M. S. I. Qui tend a faire du cout par groupe homogene de malades, la base de tarification des hopitaux.
Cette recherche met en regard le degre d’integration de la logistique dans l’organisation hospita... more Cette recherche met en regard le degre d’integration de la logistique dans l’organisation hospitaliere et le niveau d'investissement ainsi que la structure de financement, dans laquelle l’endettement est predominant. A cette fin, nous analysons les pratiques logistiques hospitalieres, en distinguant d’une part le pilotage des flux physiques, et d’autre part la gestion des trajectoires de patients. Nous examinons ensuite s’il existe une correlation entre le degre d’integration logistique et l’allocation des ressources. Le principal enseignement de cette etude est qu’une meilleure organisation logistique n’a pas d’influence directe sur l’investissement hospitalier et la maniere dont il est finance. En revanche, son impact sur la performance financiere des capitaux investis est positif. La logistique aurait pour effet d’ameliorer le ratio entre capitaux investis et allocation budgetaire.
Annuaire des collectivités locales, 2008
Formation Professionnelle, 1998
Gestions Hospitalieres, 2009
Economie Societe Region, 2002
... AuteurIsabelle Guerrero[1] [1] L'auteur tient à remercier la Commission européenne... ..... more ... AuteurIsabelle Guerrero[1] [1] L'auteur tient à remercier la Commission européenne... ... Elles comprennent les dépenses censées développer la connaissance technique et scientifique ainsi que celles ... Elle bénéficie, à ce titre, d'une attention particulière, ce qui explique qu'elle est ...
At a time when population continues to increase and health care resources are strained, the push ... more At a time when population continues to increase and health care resources are strained, the push for health education and preventive care as part of the arsenal of cost-containment strategies in most health reforms in Europe and in the United States is particularly noteworthy. HPST 2009 law (Hôpital, Patient, Santé, Territoire) in France, relies heavily on prevention and integrated healthcare, from health education and promotion to chronic disease follow-up, to increase the costeffectiveness of the French health care system. In England, the Department of Health has added two specific non-clinical groups to ICD 10 --healthy individuals‖ and -social care needs‖ -to capture the costs of disease prevention programs and the costs of services that support individuals with social rather than health care needs. In the United-States, the PPACA (Patient Protection and Affordable Care Act) promotes preventive care and health-enhancing behaviors as meaningful contributions to bending the cost curve. A number of these measures entails administration and information gathering: creating administrative bodies to coordinate federal prevention efforts, establishing a national prevention strategy, expanding funds for public health programs, developing evidence-based recommendations for using clinical and community preventive services, and devising outreach campaigns for preventive benefits (Kaiser Family Foundation, 2010). These facts reveal the health policy-makers' belief that prevention has the potential to reduce loss of life and achieve cost savings (Macioseck, 2010). However, the real challenge for researchers is to find out why health policies targeting prevention have so little an impact on traditional curative care, often irrespective of their accuracy. show how stakeholders on the ground divert explicit procedures described by rules and regulations, ending up in unexpected outcomes and results. The general aim of NewHEALING is to examine the missing link between health policies and their outcomes by observing organizations in the public health and healthcare sectors.
Starting from 2002, numerous reports, publications and press kits, in France, described the tensi... more Starting from 2002, numerous reports, publications and press kits, in France, described the tensions increasingly vivid which affected the world of health as a whole and the hospital in particular: difficulties of implementing the 35-hour (new legal weekly working time), understaffing, diversion increased, delays in the reception of patients, disputed restructuring... The observations of a designated parliamentary Mission (Couanau Report on "The hospital internal organization", 2003) described the acuteness of this situation: a real loss of morale in all hospitals, difficulties in compensating for organization defects, less reactivity to the changes in health needs and techniques, a rise of complaints made to the public authorities"
Les ARH sont directement concernées par l’application des mesures définies par le plan Hôpital 20... more Les ARH sont directement concernées par l’application des mesures définies par le plan Hôpital 2012. En matière d’investissement, l’atteinte des objectifs fixés et l’évaluation
des résultats du plan seront finalement imputables aux ARH.
Notre intervention a donc d’abord eu pour objectif de porter appui à une ARH pendant la phase d’analyse et de sélection des dossiers des établissements. Le but était de mettre au
jour et d’évaluer la méthode visant à optimiser le plan d’investissement hospitalier de la Région, d’un point de vue économique, social et sanitaire. Ce travail a été réalisé sur la base d’un examen des projets portés par chaque établissement de la Région et de leurs impacts
prévisibles, conjointement avec l’ARH. Les données utilisées ont donc été quantitatives (financières et économiques) et qualitatives (participation aux réunions de concertation
organisées par l’ARH, entretiens avec les chargés de mission, etc.).
La contractualisation, l’accréditation, les méthodes rénovées d’allocation des ressources, le rôl... more La contractualisation, l’accréditation, les méthodes rénovées d’allocation des ressources, le rôle central des ARH, autant de phénomènes nouveaux qui modifient les conditions de la décision d’investissement et engendrent la multiplication de ces acteurs. De fait, les ressources et leurs allocations sont, plus qu’auparavant , explicitement liées à des priorités. Or celles-ci sont l’objet de négociations qui tracent pour le moyen terme (cinq ans le plus souvent) un horizon commun aux différents protagonistes. Au moins au plan théorique, cette configuration est favorable à la posture de l’investisseur car elle réduit (un tant soit peu) l’incertitude. Toutefois, d’autres éléments viennent, au niveau de l’établissement comme à celui du secteur, contrecarrer cette dynamique. Il en résulte le sentiment d’un écart entre les besoins (croissants) et les ressources limitées. Pour essayer de décrire et d’interpréter la nature et l’impact des ces tensions sur le niveau de l’investissement, l’étude s’appuie sur une problématique en forme de questionnement. Celui-ci, qui sera exposé dans une première partie, met l’accent sur la diversité que ces tensions produisent.
Treatment of cleft lip and palate may be considered as a good which economic value depends on its... more Treatment of cleft lip and palate may be considered as a good which economic value depends on its ability to satisfy a need from one hand and on the efficiency of the unit where it is produced : hospital, from the other hand. From the research carried out at the Academic Hospital of Montpellier (France) on 166 children treated for cleft, it appears that medical production is adapted to the need for treatment. Nevertheless, hospital as a whole does not seem to function to the best economic way. Results obtained are analyzed through factor analysis and discriminant analysis. They do confirm that prepayment system based on costs by D.R.G. is not adapted to set up a fair mode to hospitals’ financing if the severity and complexity of illness is not taken care of.
Working paper, 2018
Les chefs de pôle (CP) perçoivent le pôle comme un centre d'activité cohérent favorable à la comm... more Les chefs de pôle (CP) perçoivent le pôle comme un centre d'activité cohérent favorable à la communication, tant à l'intérieur du pôle qu'avec les autres échelons de la gouvernance de l'hôpital y compris l'ARS. Ils émettent néanmoins d'importantes réserves sur les modalités de gestion du pôle et sur l'effectivité de leur rôle de chef de pôle. Leurs critiques portent essentiellement sur leur absence d'autonomie et sur le verrouillage de leur action au nom de l'équilibre financier. Cette étude permet de mieux comprendre la représentation que les CP ont du « management », qu'ils assimilent avant tout au suivi budgétaire et au contrôle de gestion, domaines dans lesquels ils affirment ne pas avoir de compétence. En revanche, les CP démontrent une aptitude réelle pour piloter les activités de leur pôle et mobiliser les ressources humaines, ce qui constitue pourtant la partie la plus complexe du management. Ce manque de clarté nuit aux relations médecins-gestionnaires et génère confusions et incompréhensions en dépit d'une communication favorisée par la création des pôles.