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Jean Turgeon Patrick Sabourin 《Canadian public administration. Administration publique du Canada》1996,39(2):192-212
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. 相似文献
44.
Central to this article is the question, “Are tax expenditure reports used?” State legislators serving on tax committees in ten states were surveyed regarding their use and their perceptions of others' use of tax expenditure report information. Responses indicate (1) strong acceptance and broad use of report information; (2) purposes and policy stages of use characteristic of technical information use; and (3) use focused predominantly on resource acquisition (revenue) policy rather than resource allocation (budget) policy. Thus it appears that tax expenditure reporting does not operate to secure budgetary control over tax expenditures, and consequently tax expenditures continue largely to escape budget scrutiny. 相似文献
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Jean Grimshaw 《Feminist Review(on-Line)》1992,40(1):111-113
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Laura Alexandra Harris 《Feminist Review(on-Line)》1996,54(1):3-30
In this critical personal narrative Harris explores some of the gaps between conceptions of feminist thought and feminist practice. Harris focuses on an analysis of race, class, and desire divisions within feminist sexual politics. She suggests a queer black feminist theory and practice that calls into question naturalized identities and communities, and therefore what feminism and feminist practices might entail. 相似文献
49.
Lorchen Heft Carl E. Thoresen Kathleen Kirmil-Gray Sue A. Wiedenfeld Jean R. Eagleston Paul Bracke Bruce Arnow 《Journal of youth and adolescence》1988,17(6):461-475
Emotional and behavioral correlates of Type A behavior in children and adolescents were examined in 184 fifth-, seventh-, and ninth-grade students, classified as high or low Type A, using self-report, teacher ratings (fifth grade only), and structured interview procedures. Measures included the Hunter-Wolf A-B Rating Scale, Behavioral Symptoms of Stress Inventory, Dimensions of Temperament Survey, Desire for Control Scale, Eysenck Personality Inventory, and the Multiple Affect Adjective Checklist. High Type A children reported significantly more stressed-related behaviors, higher levels of depression, anger, anxiety, and cognitive disorganization, and greater reactivity than Low Type A. No differences were found on measures of temperament (activity level, attention span, adaptibility, and rhythmicity), desire for control, or introversion-extroversion. Females, in general, reported significantly more behavioral stress symptoms. However, no other gender differences were found. Possible reasons for reported differences between Type A children and adults are discussed, along with gender differences in behavioral symptoms. Need for multiple measures of Type A across situation is considered along with need for controlled longitudinal studies of Type A components and the influence of contexts.Received Ph.D. from Stanford. Research interests: Adolescent problems, stress.Received Ph.D. from Stanford. Research interests: Type A, anger/hostility; AIDS prevention.Received Ph.D. from Stanford. Research interests: child & family problems, stress disorders.Received Ph.D. from Stanford. Research interests: psychoneuroimmunology.Received Ph.D. from Stanford. Research interests: pain disorders, stress.Received Ph.D. from Stanford.Received Ph.D. from Stanford. Research interests: anxiety and phobic disorders. 相似文献
50.
Jean A. Hamilton 《Journal of youth and adolescence》1983,12(5):355-362
The first part of this two-part article argues that significant changes in both the capacity and the content of attention emerge in adolescence. Part I reviews evidence from behavioral and biological studies that the capacity for interested attention develops from late childhood into adolescence. 相似文献