Diffusion and reimbursement of healthcare strategies, drugs or medical devices are based on decisions made by public authorities and health authorities. In a situation of restricted resources and strict budget restrictions, decisions on innovative and costly health products must take into account not only efficacy and safety data, but also efficiency data. In France, generate health economics data to inform on efficiency can be obtain by different processes, resulting in an opportunity to develop, structure and finance health economic evaluation. However, the diversity of sources of funding and the specific requirements of each process make them difficult to understand. The aim of this article is to provide an overview of these sources, while highlighting their advantages and limitations. It also points the need to facilitate interaction between manufacturers, public authorities and the health economic evaluation organisations of health care institutions. The issue is to be able to mobilize the most appropriate system to produce relevant data at the most appropriate time.

Four years after the launch of Article 51, more than 1,000 projects have been submitted. Among them, 118 experiments have been authorized, enabling the treatment of one million patients throughout France. These experiments are very diverse and cover many of the issues facing our healthcare system. Nurses play a central role, combining care, coordination, specialized care and access to new missions.

University hospital have demonstrated their effectiveness since their creation in 1958. They have risen to the challenge of expertise in research, care and teaching, but also to the challenge of responsibility towards the health territories they serve. The context of the health crisis has prompted them to confirm this commitment while encouraging them to continue the evolution of a model that combines care, research and teaching.

Access to care has always been at the heart of the concerns of the actors of psychiatry. History reminds us of this, from the alienist Philippe Pinel and his moral treatment to the creation of the Sector in 1960. The principle of sectorisation is the very organisational intelligence of French psychiatry. By proposing a continuity of care, in and out of hospital, by the same team, and a major focus on the prevention of disorders, the Sector guarantees access to care for all. This success is now being undermined. The reduction of beds accompanied by a financial loss, budget cuts or the demographic decline of practitioners are the main ills of psychiatry, which must face the explosion of needs and demands for care.

BACKGROUND: Episode-based bundled payment model is actually opposing to fee-for-service model, intending to incentivize coordinated care. The aims of these study were to determine episode-based costs for surgery in early breast cancer patients and to propose a payment model.
METHODS: OPTISOINS01 was a multicenter prospective study including early breast cancer patients from diagnosis to one-year follow up. Direct medical costs, quality and patient reported outcomes were collected.
RESULTS: Data from 604 patients were analyzed. Episode-based costs for surgery were higher in case of: planned radical surgery (OR=9,47 ; IC95 % [3,49-28,01]; P<0,001), hospitalization during more than one night (OR=6,73; IC95% [2,59-17,46]; P<0,001), home hospitalization (OR=11,07 ; IC95 % [3,01-173][3,01-54][3,01-543][3,01-54,33]; P<0,001) and re-hospitalization (OR=25,71 ; IC95 % [9,24-89,17; P<0,001). The average cost was 5 268 € [2 947-18 461] when a lumpectomy was planned and 7408 € [4 222-22 565] in case of radical mastectomy. Bootstrap method was applied for internal validation of the cost model showing the reliability of the model with an area under the curve of 0,83 (95 % CI [0,80-0,86]). Care quality and patient reported outcomes were not related to the costs.
CONCLUSIONS: This is the first report of episode-based costs for breast cancer surgery. An external validation will be necessary to validate our payment model.

Pharmacotherapeutic care is now expanding in public mental health institutions. Annual grants are funding the public psychiatric field, hindering access to therapeutic innovation and expensive medications due to long length of stay. On the threshold of the French Healthcare & Social Services Ministry \"Ma Santé 2022\" plan (\"My Health 2022\"), there is a risk of altering the continuum of care because of the complexity of the financing of certain high added value therapies. Despite a desire to adapt the system to meet constantly changing health needs, no actions have been taken to this date in psychiatry, with no funds being allocated for valuable medication, in contrary to follow-up care and rehabilitation structures, to our knowledge. This reinforces the discrepancy with the evolution of research, and further widens the gap in inequalities between health sectors. Optimising the funding of expensive medicines in psychiatry would make it possible to reduce the stranglehold of current allocations. Following the example of recent reforms in the follow-up care and rehabilitation structures, extra funds for high value-added therapies would make it possible to reduce complex medical decisions: from prevention to reintegration, patient care continuity would be vastly guaranteed.

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ABSTRACTGrowing demand for beds in government-subsidized long-term care (LTC) homes in Ontario is causing long waitlists, which must be absorbed by other residential alternatives, including unsubsidized retirement homes. This study compares Ontario\'s LTC homes and retirement homes for care services provided, funding regimes, and implications of differential funding for seniors. Descriptive data for both types of homes were collected from public and proprietary sources regarding service offerings, availability, costs, and funding. Overlaps exist in the services of both LTC and retirement homes, particularly at higher levels of care. Although both sectors charge residents for accommodation, most care costs in LTC homes are publicly funded, whereas residents in retirement homes generally cover these expenses personally. Given waitlists in Ontario\'s LTC homes, many seniors must find residential care elsewhere, including in retirement homes. Several policy alternatives exist that may serve to improve equity of access to seniors\' residential care.

BACKGROUND: The financing of national research ethics committees for health is a decisive factor in their proper functioning and independence. Little information is available concerning the funding of these committees in West Africa.
OBJECTIVE: To analyze the funding of national research ethic committees for health in the Member States of the Economic Community of West African States.
METHODS: A review of the documents from two regional workshops with the participation of the representatives of the national ethics committees of each ECOWAS Member State was carried out. These workshops enabled the collection and validation of data on the status of national ethics committees. These data were used to conduct a descriptive analysis of the funding sources of the committees.
RESULTS: Three sources of funding for national ethics committees were identified. The first source was the support of the state or a national structure. The second source was the fee for reviewing the submitted protocols and the last source was the support of external donors. The collection of audit fees and the support of external donors were the main sources of funding for most of the national committees. In only one state, there were no fees for review of submitted protocols and all the ethic committee member were motivated by the government.
CONCLUSIONS: In order to ensure the autonomy and independence of the national committees, state support for the funding of these committees should improve. The establishment of a regional network and its recognition by the Assembly of Ministers of Health of ECOWAS allowed for advocacy by WAHO, which should help achieve better results in the future.

Living at home as long as possible, adapting \'old age\' policies to dependent elderly people, using new technologies to enable elderly people to remain at home and funding dependence are just some of the challenges facing today\'s society. The law relating to the adaptation of society to ageing was constructed around the notion of autonomy. This article presents an overview of this complex patient management.