The role of mutuals and community-based insurance in social health protection systems: International experience on delegated functions

L’architecture institutionnelle sur laquelle repose la protection sociale de la santé varie selon les pays, de même que les acteurs et organismes impliqués. Dans certains pays, les sociétés mutualistes et organismes d’assurance maladie communautaire jouent un rôle central. Dans les années 1990, ces structures ont été promues, notamment parce qu’elles constituaient un moyen d’étendre la couverture de la sécurité sociale, en particulier en Afrique subsaharienne. Aujourd’hui, l’adoption du Programme de développement durable à l’horizon 2030 et une nouvelle volonté politique de parvenir à la couverture universelle ont conduit à s’interroger sur le rôle des mutuelles et organismes d’assurance maladie communautaire. Toutefois, peu d’études ont été consacrées à leur place dans les systèmes nationaux de sécurité sociale. Cette étude exploratoire, qui repose sur l’analyse de 49 documents couvrant 18 pays répartis dans le monde entier, est axée sur la délégation de fonctions en faveur des mutuelles/organismes d’assurance maladie communautaire dans les systèmes nationaux de protection sociale de la santé. Ses résultats révèlent la dynamique de cette délégation au fil du temps et des processus de mise en œuvre. Ils mettent en lumière des pistes de réflexion de nature à éclairer la formulation de l’action publique. -- Mots-clés : Mutualité ; protection sociale ; santé ; régimes de sécurité sociale ; assurance maladie; international

Nature and determinants of social actions during a mass shooting

If collective reactions to danger have long been portrayed as antisocial and self-preservative, research has shown that prosociality is maintained and sometimes fostered in life-threatening circumstances. In this research, we interviewed 32 survivors of the attacks at ‘Le Bataclan’ (on the evening of 13-11-2015 in Paris, France) with the aims of offering a typology of social behaviors undertaken in the context of a mass shooting in a close environment, and examining the situational factors favoring the emergence of socially supportive behaviors among hostages. Consistent with previous findings, we found that socially supportive behaviors were frequently reported, and they were more common than socially unsupportive behaviors in the narratives of the respondents. We also found that the occurrence of socially supportive actions is dependent on key contextual factors, namely the impossibility to egress, increased distance and/or minimal protection from the source of danger, and emotional fusion with other crowd members. Finally, although supportive behaviors can be served by a variety of motives (individualistic, cooperative or altruistic), we found that supportive actions were more often described by respondents as reflecting genuine altruism, i.e. involving a cost to oneself at the benefit of others. Those results bring evidence of the maintenance of socially supportive actions in the context of a mass shooting. It also calls for establishing a clear-cut distinction between the social strategies (asocial, socially supportive, or socially unsupportive) and the psychological motivations underlying them (individualism, cooperation or genuine altruism) in future research

Nature and determinants of social actions during a mass shooting

International audienceReactions to danger have been depicted as antisocial but research has shown that supportive behaviors (e.g., helping injured others, giving information or reassuring others) prevail in life-threatening circumstances. Why is it so? Previous accounts have put the emphasis on the role of psychosocial factors, such as the maintenance of social norms or the degree of identification between hostages. Other determinants, such as the possibility to escape and distance to danger may also greatly contribute to shaping people's reactions to deadly danger. To examine the role of those specific physical constraints, we interviewed 32 survivors of the attacks at 'Le Bataclan' (on the evening of 13-11-2015 in Paris, France). Consistent with previous findings, supportive behaviors were frequently reported. We also found that impossibility to egress, minimal protection from danger and interpersonal closeness with other crowd members were associated with higher report of supportive behaviors. As we delved into the motives behind reported supportive behaviors, we found that they were mostly described as manifesting cooperative (benefits for both interactants) or altruistic (benefits for other(s) at cost for oneself) tendencies, rather than individualistic (benefits for oneself at cost for other(s)) ones. Our results show that supportive behaviors occur during mass shootings, particularly if people cannot escape, are under minimal protection from the danger, and feel interpersonal closeness with others. Crucially, supportive behaviors underpin a diversity of motives. This last finding calls for a clear-cut distinction between the social strategies people use when exposed to deadly danger, and the psychological motivations underlying them

A Molecular Model for Axon Guidance Based on Cross Talk between Rho GTPases

To systematically understand the molecular events that underlie biological phenomena, we must develop methods to integrate an enormous amount of genomic and proteomic data. The integration of molecular data should go beyond the construction of biochemical cascades among molecules to include tying the biochemical phenomena to physical events. For the behavior and guidance of growth cones, it remains largely unclear how biochemical events in the cytoplasm are linked to the morphological changes of the growth cone. We take a computational approach to simulate the biochemical signaling cascade involving members of the Rho family of GTPases and examine their potential roles in growth-cone motility and axon guidance. Based on the interactions between Cdc42, Rac, and RhoA, we show that the activation of a Cdc42-specific GEF resulted in switching responses between oscillatory and convergent activities for all three GTPases. We propose that the switching responses of these GTPases are the molecular basis for the decision mechanism that determines the direction of the growth-cone expansion, providing a spatiotemporal integration mechanism that allows the growth cone to detect small gradients of external guidance cues. These results suggest a potential role for the cross talk between Rho GTPases in governing growth-cone movement and axon guidance and underscore the link between chemodynamic reactions and cellular behaviors