Stéphane David

Country report: medical education in France.

Context  The last 10 years have represented a period of significant reform within both the health care and education systems in France. In terms of its workforce, France faces a shortage of doctors, particularly in primary care.

Factors associated with failure to return for HIV test results in a free and anonymous screening centre.

Free and anonymous screening centres (CDAG: Centres de Depistage Anononyme et Gratuit) are public facilities set up for HIV infection diagnosis in France. Some people visiting CDAG fail to return for test results and are not informed of their serology. This study aimed to assess factors associated with failure to return for HIV test results. Patients visiting the Fernand-Widal CDAG (Paris) for an HIV test in January–February 2011 were eligible to take part in the study. Data were collected with an anonymous self-administered questionnaire. Factors associated with failure to return were assessed using logistic regression models. Of the 710 participants (participation rate 88%), 46 patients failed to return. Not specifying birthplace and not living in the region of Paris were associated with failure to return. Those who perceived no risk of HIV infection and those who felt they were more at risk than other people were both statistically associated with failure to return. Self-perceived risk seemed to be of chief concern for failure to return for HIV test results and should be considered during pre-test counselling.

Financement des traitements endovasculaires des anévrysmes cérébraux : La tarification à l'activité permet-elle aux établissements de santé de financer la prise en charge des patients ?

Resume Methode nous avons calcule les depenses engagees par notre centre pour l’ensemble des anevrysmes cerebraux traites au cours de l’annee 2005. Ces depenses comprennent le materiel de guidage endovasculaire (catheters, microcatheters, microguides) et les implants (coils). Nous avons compare ces depenses aux recettes engendrees par le sejour des patients et au paiement en sus. Resultats le paiement en sus ne couvre que le tiers des depenses de materiel medical utilise. Trois types de depenses ne sont pas financees : le materiel de guidage, les implants utilises mais non largues, les implants de derniere generation qui ne sont pas encore integres a la liste nationale des produits et prestations rembourses. Cette depense n’est pas non plus couverte par les recettes generees par les sejours des patients. Discussion le traitement endovasculaire est depuis quelques annees le traitement de premiere intention des anevrysmes cerebraux. Ce traitement n’est pratiquement realise que dans des centres hospitalo-universitaires mais, dans le mode de financement actuel, il constitue un surcout pour l’hopital. Conclusion cet exemple pose la question du financement des activites innovantes.