Patient empowerment in public healthcare funding system reform: a power network perspective
Bibliographic record
Abstract
This paper examines a reform of the French healthcare system that aimed to empower patients and improve their access to care but led to various adverse consequences for patients. Specifically, already socio-economically disadvantaged groups of patients found their positions becoming even more precarious. Conceptually, we draw upon Emerson’s power dependence theory and find that, rather than empowering patients, the reform resulted in private health insurance providers emerging as critical actors and primary beneficiaries of power network changes. This healthcare system-level analysis highlights the need for patients to be the direct focus of healthcare system reform and the importance of considering their position within the power network for understanding reform outcomes. This attention to the power network adds to the extant theorisation on the effects of funding mechanism reform on the nature of patient empowerment and access to healthcare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.016 |
| Scholarly communication | 0.006 | 0.010 |
| Open science | 0.001 | 0.005 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".