Contenu du sommaire

John R. Kimberly, Laura R. Renshaw, Scott D. Ramsey, Alan L. Hillman, J. Sanford Schwartz: DRGs and the diffusion of health technology in the USA: the case of MRI. The context of the emergence of MRI in the USA has been one of strong uncertainties. First, there was uncertainty on the level of payment of this new technology with DRGs. Payment by case has also intensified competition among care providers. Moreover the technique itself generated strong turbulences. Its real medical benefits were questioned, and the suppliers themselves were in a phase of unstable competition. We have found that such uncertainties may not have slowed down the diffusion of this new technique, when compared to that of CT scanners. But providers of care have coped with turbulences by creating a variety of new arrangements to purchase and manage MRI. In particular, hospitals have not always been in control of the acquisition of this costly, sophisticated technique.

Jean-Louis Lanoé, Yves Souteyrand: The health smart card in France: factors and obstacles of its diffusion. The article is focused on diffusion analysis, in the French Health Care System, of the health card used as a portable medical record. Potentials for this new data medium seemed to guarantee, for this specific function, a promissing future. After the initial experimentations, the expected development has not been achieved although for each category of actors concerned by health cards (patients, medical professionals, hospitals, health care financing institutions...), the balance between the pros and cons appears to be positive. The main reasons for this failure are too be seeked in the indepth contradictions opposing the actors' individual strategies. Without creating new specifie problems, the health card appears to be an excellent "tracer" of yet unsolved questions concerning, in France, medical information, freedoms associated to liberal practice as well as the status of medical files in ambulatory practice.

Pascale Bourret, Pierre Huard: Creation, appropriation, recomposition: innovative processes in the production of neonatal diagnosis. This article deals with twin production processes, on one hand, of a new activity and, on the other hand, of corresponding resources (such as knowledge, knowhow and organization). The studied activity is the one of prenatal diagnosis of genetic anomalies ; the rising, development and transformation of which are looked at in seven specialized centers. These case studies allow to focus on apprenticeship, appropriation and reorganization. This leads to an endogeneous view of innovation opposite to the current one which emphasizes the diffusion process. From this view point, technical and social dimensions cannot be neither separated nor told apart.

Caroline Weill: Professional attitudes and diffusion of scientific knowledge: are the consensus conférences able to change physicians' behaviors? The effectiveness of the Consensus Development Program of the National Institute of Health has been recently assessed. The assessment has focused on the means of dissemination of the program, in order to investigate its effects on physician behavior. Results showed that the conferences mostly failed to stimulate changes in physician practice, despite moderate success in reaching the appropriate target audience. In this article, we discuss the policy implications of those results, at a moment when, in France particularly, the medical community's concern tends to focus on organizing Consensus Development Conferences : would it make sense to improve the dissemination process of the conferences, in order to improve their effectiveness in encouraging changes in medical practice ? We find it necessary to emphasize the factors that determine changes in medical practice, so that they could be taken in account for the definition of successful information transfer programs and appropriate follow-ups.