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L'évaluation des politiques publiques : cadres conceptuel et étude de son utilisation par les décideurs des institutions régionales de santé en France

Abstract : Context: Despite the willingness showed in texts and procedures, evaluation in France is little integrated in the decision making process. However, in the health sector which faces multiple challenges, evaluation should be a useful approach to select choices. The use of evaluation depends on multiple factors such as, knowledge and its production process, characteristics of decision makers and others users, and the political and institutional context of the evaluation Objective: The objectives were: to assess the use of evaluation on health policies; to identify levers associated with use; to assess the capacity of evaluation to fit with decision-makers needs and to enhance usability. Method: Literature review allowed to enrich the understanding of the concept of use and to identify the main influent factors as well as the related issues. Regarding evaluation as a complex system, a model based on a systemic approach was built and tested in evaluations of regional public health plans (PRSP) in 4 steps: (1) global analysis of 16 evaluations; (2) relation process/use in on region; (3) use at short/medium term in 9 regions; (4) case studies and multicriteria analysis in 5 regions. Results: A first analysis enlighted the context and the contribution of the PRSP to the coherence of regional policies. A deeper process analysis carried out in one region pointed out the relation between final aims, management and evaluation use. The examination of evaluation consequences conducted in nine regions identified different forms of use and the major factors associated with them. The dynamic of change has been apprehended as a whole through the interactions between context, users and evaluation in five regions. Discussion: The effects of evaluation are more obvious in terms of knowledge building and evolution of practice than in radical change of policies. Context, evaluation credibility, actors’ commitment and motivation are key factors. Future research should help to better understand how to foster the culture and the capacities of evaluation. These are important prerequisites to a wider use of evaluation
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Françoise Jabot. L'évaluation des politiques publiques : cadres conceptuel et étude de son utilisation par les décideurs des institutions régionales de santé en France. Médecine humaine et pathologie. Université de Lorraine, 2014. Français. ⟨NNT : 2014LORR0201⟩. ⟨tel-01751168⟩

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