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.     

Ethnic relations in the People’s Republic of China: Images and social distance between Han Chinese and minority and foreign nationalities

Han people make up 93 percent of the Chinese population, but little is known in a systematic way about how they view Chinese minority nationalities or foreign peoples. This is a social scientific study of the images that Han Chinese have of nine Chinese ethnic groups and eight foreign nationalities, as well as the social distance they feel from those groups. Based on a survey of 169 Tianjin university students, it employs the Bogardus Social Distance Scale and an adjectival test. It finds that Han Chinese feel affinity for some groups, such as Overseas Chinese, Uygurs, and Americans, while they feel extreme distance from and repulsion toward others, such as Tibetans and Africans. Her book,China’s Only Child: The Family and the School, is forthcoming from the University of Wisconsin Press.     

Representative voter theorems

The representative voter is an individual whose strict preference for any alternative x over any alternative y implies 1) x strictly defeats y by majority rule, if there are an odd number of voters, and 2) x weakly defeats y otherwise. This result holds for the median voter if x is his ideal point or if preferences satisfy a generalized symmetry property, but not in general. We examine a formal condition that guarantees the existence of a representative voter and an economic model in which this condition holds. We also indicate a method for estimating representative voting behavior that is justified when a representative voter exists, and compare this with a method for deriving median voting behavior from an estimated demand curve.     

Determinants of success in African local governments: An overview

A potentially useful method for determining how to design viable and competent local government systems is to examine local authorities that function effectively. This paper synthesizes the major findings of seven case studies of ‘successful’ local governments in Sub-saharan Africa, highlighting the principal factors contributing to their success and exploring ways in which they could further improve their performance. The determinants of success identified in the studies include: location in an area with an adequate economic base; well-defined responsibilities in a satisfactory legal framework; capacity to mobilize sufficient resources; supportive central government activities; and appropriate management practices, including development of productive internal and external relations and satisfactory responsiveness to constituents. All of these factors are considered to be necessary, but none is independently sufficient to guarantee success, which is a multidimensional and cumulative process of achievement.     

Rural local government finance in Kenya: The case of Murang'a County Council

The Murang'a County Council is recognized in Kenya as one of the country's most effective rural local authorities. Compared to other county councils, Murang'a raises substantial revenues and provides a wide variety of services. This case study presents some background on the local economy of Murang'a District, details available information about the county council's excellent fiscal performance, and highlights some of the major factors behind the effectiveness of Murang'a in resource mobilization and service delivery.