Planification de l’offre de soins et télémédecine

The existence of geographical disparities in the French supply of medical care begs the question of the adjustment between needs and effective access to medical care. This access depends on the sharing out of financial resources, first between regions and second between medical infrastructures in each region. The two priorities of the government in the field of Health, which are equality in medical care access and the control of medical public spending, may obviously be conflicting. The concentration of medical activities in some regions and the agglomeration of specialized hospitals in urban centers can be observed. So the methods used by the government to plan medical supply seem to be inefficient in resolving this geographical imbalance. The use of Information and Communication Technologies (ICT) in the field of Health appears to be an innovative solution. In particular, the development of telemedicine may resolve the problem of medical supply concentration. The first contribution of the paper is to develop a theoretical model in order to explain the French disparities in hospital medical care access between urban and rural areas in the same region. It describes the allocation of public funds to hospitals in a region, which determines the medical care supply in this region. We show that the optimal allocation mechanism leads to large disparities between the two areas in terms of quality of medical care access and of utility. Second, we introduce telemedicine into our model to measure its effect on the inequality in medical care access. We show that telemedicine increases regional utility only if the urban area has a great advantage in terms of medical infrastructures. This result implies that telemedicine has to be considered as an alternative to public policies attempting to re-allocate the funds between the two areas. We then propose some public policy recommendations concerning the development of telemedicine.     

L’économie de la qualité, en ses secteurs,ses territoires et ses mythes

This text proposes a “régulationniste” framework to analyze the emergence of an “economy of quality” in the agrofood system, that is of a new productive model centered on the differentiation of the qualities. Methodological and analytical propositions of more general reach are confronted with the stylized facts which one can establish in this domain. The notion of productive model allows a joint analysis of the dynamics of the productive systems and of the institutional arrangements. The notion of “space of regulation” refers to the analysis of the “sector-based” and “territorial” dimensions of the mode of regulation. Sectors (agrofood chains considered both as productive and governance structures) and territories (considered in the same dimensions) are co-constructed. Transformation of the regime of accumulation integrating immaterial values modifies both nature and boundaries of sectors and territories. Two main lines of innovation appear, the one aiming at specifying always more in depth the functional characteristics of the food services by exploiting the scientific and technological developments, the other integrating identity attributes. Crisis of particular nature characterize this evolution.     

Amsterdam's vroedschap en de nijverheid der réfugiés

On a dit que les manufactures n'étoient point neés en Hollande, qu 'elles s'y étoient réfugiées. La richesse de la Hollande (1778) I, p. 51.     

Canal Interocéanique de Panama. Commission d'études instituéc par le Liquidateur de la Compagnie Universelle. Rapports I-IX.-I. Rapport général

Sans résumé     

L’évolution de la pensée géographique au 20e siècle

This paper traces the involvement of theoretical ideas in the history of human geography during the last century. The authors address major theoretical advances and the practices they begot both in Europe and in the US since the days of Ratzel, Reclus and Semple. The paper is also one of the last publications by Peter Gould, who died in 2000. Since Peter loved all things French, we are convinced that he would have been proud of the translated essay.     

La régulation des mouvements trans-frontières de déchets. Un dispositif à consolider

Following nasty affairs of wastes exports toward developing countries, international agreements (notably the Basel Convention) have been passed to try to regulate the international movements. A statistical overview (for the year 1998) of the official movements is given, but other traffics are existing and are very difficult to estimate. Some factors explain these exchanges and traffics, then the vulnerability of some countries; the waste movements generally follow the economic and social “slopes” (the “differentials”) between countries. More precisely, how to discover these traffics? What is the risk for the offender? The monitoring of the plan or the command-and-control process has to be improved. Moreover some legal aspects have to be clarified. Affairs (since 1990) and cases of substances and products are briefly reminded. More globally the requirements for a more effective regulation are brought into question.     

Activités immatérielles et relationnelles : quels nouveaux enjeux de régulation pour les secteurs et les territoires ?

The paper aims to shed a renewed light on structural obstacles restraining growth by focusing on the dynamics of intangible and relational activities and on the possible obstacles to their own development. This leads to consider how crucial can be the role of institutional measures in overcoming such obstacles. These measures have to do with sectors and territories considered as historical outcomes in which externalities can be dealt with. They also have consequences on the way competences and borders of these sectors and territories have been defined until now. Such a process takes place in a necessity to consider governance as the new relevant logic of action.