Reconfiguration du réseau de la Patrick sabourté et et des services sociaux au Québec: la place des regroupements intéretablissements

Sommaire: Depuis le début des années 1990, le système de santé québécois, comme celui des autres provinces, subit de profonds changements. lis se concrétisent sous la forme d'une reconfiguration majeure du système lui-meme, des services qu'il dispense et des structures qui le composent. L'article s'interesse a ce dernier aspect, plus particulierement sous l' angle des regroupements interétablissements. II appert que la Loi sur les services de santé et les services sociaux (1991, chap. 42) a bouleversé la configuration structurelle du réseau en forcant l'unification horizontale de plusieurs types d'établissements, tels les centres d'hébergement de soins de longue durée et les centres de réadaptation. Plus récemment, la décentralisation fonctionnelle accrue au profit des régies régionales de la santé et des services sociaux (rrsss), jumelée à l'annonce de compressions budgétaires sans précédent, a donné un second souffle à cette reconfiguration de structures. Une enquete a été menée a l'hiver 1995. Elle révèle qu'à ce moment, en plus des regroupements deja prévus dans la loi, un peu plus de 110 établissements socio-sanitaires, dont 60 centres hospitaliers, étaient également impliqués dans divers projets de regroupements allant de l'entente de services a la fusion. Depuis le printemps 1995, certaines rrsss étudient l' option des intégrations ou des fusions verticales, qui impliquent des établissements de mission différente. Or, une revue de la littérature démontre que l' efficacité et l' efficience de ces options ne sont pas clairement démontrées dans le secteur des soins de santé et qu'il vaudrait mieux envisager des formes moins contraignantes (partenariats, ententes de services, etc.) permettant de s'apprivoiser avant de songer au mariage. Abstract: Since the early 1990s, the Quebec health-care system, as those in other provinces, has undergone major changes. These changes involved a major reconfiguration of the system itself - its services and its structures. This article describes this reconfiguration and focuses on one particular aspect: the integration of services. The Health and Social Services Act, 1991 (c. 42) created havoc in the configuration of the system by imposing horizontal integration of several types of services, such as those of long-term care facilities and rehabilitation centres. More recently, this growing delegation in favour of the Regional Health and Social Services Boards (rhssbs) together with the announcement of unprecedented budget cuts, has led to further restructuring. A survey carried out during the winter of 1995 showed that 120 health-care establishments, including 60 hospitals, were involved in inter-establishment relationship projects, ranging from service agreements to mergers. Since the spring of 1995, some rhssbs have been studying the option of integration or of vertical mergers, i.e., how to integrate facilities with different services. However, a review of the literature shows that the effectiveness and efficiency of these options has not yet been clearly proven in the health-care sector, and that it would be wiser to consider, as a first stage, less constraining relationships (e.g., partnerships, service agreements, etc.) as a way of testing compatibility before getting involved in permanent partnerships.     

Rousseau's General Will: Freedom of a Particular Kind

Had Rousseau not been centrally concerned with freedom, some of the structural features of his political thought would be unaccountable. Above all, the notion of general will would not have become the core of his political philosophy. Rousseau's reasons for using 'general will' as his central political concept were essentially philosophical. The two terms of general will - 'will' and 'generality' - represent two main strands in his thought. 'Generality' stands for the rule of law, for civic education that draws us out of ourselves and towards the general (or common) good. 'Will' stands for Rousseau's conviction that civil association is 'the most voluntary act in the world', that 'to deprive your will of all freedom is to deprive your actions of all morality'. And if one could 'generalize' the will, so that it 'elects' only law, citizenship, and the common good, and avoids 'willful' self-love, then one would have a general will in Rousseau's particular sense. The distinctiveness of Rousseau's general will is further brought out through a comparison with Kant's 'good will' about which Rousseau would have felt severe doubts.     

The Failure of Success in Natural Resource Policy: Pacific Salmon Harvest Policy in New York State

Natural resource management policies like the Pacific salmon harvest policy developed by New York State often did not anticipate the extent of social, economic, and ethical concerns that would be generated, largely because the agency concentrated on biological considerations. The number of concerned stakeholders grew in proportion to both the success and failure of the initial policy. Had all participants been equally willing to recognize both the successes and the failures, development of a revised policy through group negotiations may have been possible, resulting in a cooperative mode of decision making. Instead, institutional mechanisms based on legislated process were ultimately the approach chosen for policy revision.     

Efficient use of reference group cues in a single dimension

If there are groups whose endorsements voters can use as positive (or negative) cues, we demonstrate that voters do not need to know anything directly about candidate positions to be able to identify the candidate whose issue positions and performance is likely to be closest to the voter's own preferences. In one dimension we show that, given certain simplifying assumptions, voters are best off adopting the choice recommended by the single reference group to which they are closest. We also show that even a decision by reference groups not to endorse any candidate may be informative to voters.     

Parental discord vs family structure: effects of divorce on the self-esteem of daughters

This study investigated the effects of family structure (parents together or not) and parental discord (ratings of the happiness of the marriage of biological parents) on the self-esteem of 199 female undergraduates. Family structure and happiness ratings were substantially related, with those separated rated as less happy. Self-esteem was significantly related to parental happiness, even with family structure controlled, but not to family structure with parental happiness controlled. With the sample divided into three groups (happy-together, unhappy-together, and separated) ANOVA showed a significant effect for group, with the unhappy-together group showing significantly lower self-esteem than the happy-together group, and the separated group intermediate. Parental discord thus appears to lower the selfesteem of daughters, whereas separation of parents does not. These findings support Heatherington's idea that children may be better off in a stable family where parents are divorced than in an intact family with much parental discord.Thanks are expressed to Susan Stevenson Cowles for her contributions to all stages of the study, and to Judith Fidati, Anita Katz, and Susanne Long for their assistance in the scoring and statistical analyses. The author is also grateful to Andrew Cherlin, Edmund Henderson, and Ruth C. Wylie for their helpful suggestions.Barbara H. Long is Professor Emeritus at Goucher College, where she has taught for 20 years. She is a social psychologist, having received her Ph.D. from the University of Delaware and has, at present, research interests in the attitudes of young women towards marriage and career.