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Tf 12 0 0 12 72.5197 659.5888 Tm 0 Tr 0 g 0.001 Tc 0 Tw [(SUMMAR)36(Y)]TJ ET Q q BT /F2 1 Tf 11 0 0 11 72.5197 630.5809 Tm 0 Tr 0 g 0.026 Tc 0.013 Tw [(Quebec\325)38(s Drug Insurance Pr)19(ogram: )19(The Challenges of a Model for)-269(a Public/Private )]TJ 0 -1.0909 TD 0.001 Tc 0 Tw [(Par)1(tnership)]TJ 1.28847 -1.60629 TD 0.002 Tc (Objectives)Tj ET Q q BT /F3 1 Tf 11 0 0 11 136.2845 600.9116 Tm 0 Tr 0 g 0.0009 Tc (:)Tj 0.54858 0 Td 0.001 Tc 0.036 Tw [(T)70(o disclose why Quebec chose to implement a universal, private-public pres-)]TJ -6.34538 -1.0909 TD 0 Tc 0.002 Tw [(cription drug insurance program that is unique in North )55(America and to discuss the challenges)]TJ 0 -1.09091 TD 0 Tw (that have faced the program since its creation ten years ago.)Tj ET Q q BT /F2 1 Tf 11 0 0 11 86.6929 559.2423 Tm 0 Tr 0 g -0.003 Tc 0 Tw (Methods)Tj ET Q q BT /F3 1 Tf 11 0 0 11 127.3252 559.2423 Tm 0 Tr 0 g -0.004 Tc (:)Tj 0.644 0 Td -0.034 Tw (Analysis of interviews with 19 decision-makers who had helped to create the pro-)Tj -5.62632 -1.09091 TD 0 Tc 0 Tw (gram or who presently manage it.)Tj ET Q q BT /F2 1 Tf 11 0 0 11 86.6929 529.5731 Tm 0 Tr 0 g 0.006 Tc 0 Tw (Results)Tj ET Q q BT /F3 1 Tf 11 0 0 11 121.3254 529.5731 Tm 0 Tr 0 g 0.0054 Tc (:)Tj 0.57074 0 Td 0.005 Tc 0.032 Tw [(Quebec\325)55(s prescription drug insurance program, implemented in 1997, is distinct)]TJ -5.00762 -1.0909 TD 0 Tc -0.03 Tw (from programs elsewhere in that participation is obligatory for all residents of the province and)Tj T* -0.037 Tw [(coverage is provided by both Quebec\325)55(s public insurer and private providers. )18(The program is the)]TJ 0 -1.09091 TD -0.014 Tc -0.023 Tw (result of a compromise that protected the interests of private insurers while avoiding a tax increase)Tj T* 0 Tc -0.022 Tw (during a time when the government was pursuing a zero-deficit policy)Tj 27.81951 0.00001 TD -0.0001 Tc (.)Tj 0.47826 0 Td 0 Tc (Over the past ten years,)Tj -28.29777 -1.09091 TD 0.037 Tw (the program 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360.3305 l 279.449 768.661 m 279.449 744.661 l 279.449 24 m 279.449 0 l 0 384.3305 m 24 384.3305 l 534.898 384.3305 m 558.898 384.3305 l 279.449 756.661 m 285.449 756.661 l 285.449 753.3473 282.7627 750.661 279.449 750.661 c 276.1353 750.661 273.449 753.3473 273.449 756.661 c 273.449 759.9747 276.1353 762.661 279.449 762.661 c 282.7627 762.661 285.449 759.9747 285.449 756.661 c 279.449 12 m 285.449 12 l 285.449 8.6863 282.7627 6 279.449 6 c 276.1353 6 273.449 8.6863 273.449 12 c 273.449 15.3137 276.1353 18 279.449 18 c 282.7627 18 285.449 15.3137 285.449 12 c 12 384.3305 m 18 384.3305 l 18 381.0168 15.3137 378.3305 12 378.3305 c 8.6863 378.3305 6 381.0168 6 384.3305 c 6 387.6443 8.6863 390.3305 12 390.3305 c 15.3137 390.3305 18 387.6443 18 384.3305 c 546.898 384.3305 m 552.898 384.3305 l 552.898 381.0168 550.2117 378.3305 546.898 378.3305 c 543.5843 378.3305 540.898 381.0168 540.898 384.3305 c 540.898 387.6443 543.5843 390.3305 546.898 390.3305 c 550.2117 390.3305 552.898 387.6443 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Elle se distingue aussi)Tj T* 0.005 Tc 0.025 Tw (par son r\216gime m\216dicaments. Le Qu\216bec est)Tj 0 -1.14715 TD 0.018 Tc 0.024 Tw (la seule province au Canada \210 avoir mis en)Tj 0 -1.14716 TD 0.029 Tc 0.013 Tw (place un r\216gime d\325assurance m\216dicaments)Tj 0 -1.14715 TD 0.018 Tc 0.024 Tw (obligatoire pour tous les r\216sidents reposant)Tj T* -0.005 Tc -0.027 Tw (sur une collaboration public/priv\216. Ce r\216gime,)Tj 0 -1.14716 TD 0.011 Tc 0.032 Tw (mis en place en 1997, est n\216 \210 la suite d\325in-)Tj 0 -1.14714 TD -0.003 Tc -0.03 Tw (tenses discussions et de forts tiraillements. En)Tj 0 -1.14716 TD -0.009 Tc 0 Tw (ef)Tj 0.74065 0.00001 TD -0.023 Tw (fet, les lois f\216d\216rales de 1957 sur l\325assurance)Tj -0.74065 -1.14716 TD 0.005 Tc -0.008 Tw (hospitalisation, puis celle sur les soins m\216di-)Tj T* 0.019 Tw (caux, en 1966, ont incit\216 les provinces et les)Tj T* 0.03 Tc 0.018 Tw (territoires du Canada \210 mettre en place un)Tj 0 -1.14715 TD 0.014 Tc 0.029 Tw (r\216gime public d\325assurance maladie, financ\216)Tj 0 -1.14716 TD -0.014 Tc -0.019 Tw (par l\325interm\216diaire de transferts f\216d\216raux, mais)Tj 0 -1.14715 TD -0.012 Tc -0.021 Tw (se cantonnant aux soins hospitaliers et aux ser-)Tj 0 -1.14716 TD 0.01 Tc 0.032 Tw [(vices of)18(ferts par les m\216decins. Dans ce sys-)]TJ T* 0.012 Tc 0.03 Tw (t\217me d\216centralis\216, les provinces et les terri-)Tj 0 -1.14715 TD 0.011 Tc 0.032 Tw (toires ont donc eu la possibilit\216 d\325of)Tj 14.9623 0 TD 0.01 Tc (frir une)Tj -14.9623 -1.14717 TD -0.01 Tc -0.023 Tw (couverture suppl\216mentaire pour d\325autres biens)Tj 0 -1.14716 TD 0.03 Tc 0.187 Tw (et services comme les m\216dicaments non)Tj T* 0.009 Tc 0.033 Tw (consomm\216s dans un \216tablissement de sant\216.)Tj T* 0.01 Tc (Cette fa\215on de concevoir le m\216dicament est)Tj T* -0.005 Tc -0.027 Tw [(dif)18(f\216rente de celle partag\216e en Europe, en par-)]TJ T* 0.005 Tc 0.032 Tw (ticulier en France, o\235 les m\216dicaments pres)Tj 17.70593 0 TD 0 Tc (-)Tj -17.70593 -1.14716 TD 0.022 Tc 0.021 Tw (crits en dehors des \216tablissements de sant\216)Tj T* -0.012 Tc -0.021 Tw (ont, d\217s le d\216part, \216t\216 introduits parmi les pres-)Tj 0 -1.14715 TD 0.016 Tc 0.027 Tw (tations couvertes par le r\216gime d\325assurance)Tj 0 -1.14716 TD 0.005 Tc 0.036 Tw (maladie [2]. Dans cet article, nous pr\216sente)Tj 17.70593 0.00001 TD 0 Tc (-)Tj -17.70593 -1.14716 TD -0.005 Tc -0.027 Tw (rons tout d\325abord en quoi le cas du Qu\216bec est)Tj T* 0.005 Tc 0.037 Tw [(dif)18(f\216rent de celui des autres provinces cana-)]TJ T* -0.02 Tc -0.013 Tw (diennes et des \203tats-Unis. Nous verrons ensuite)Tj T* -0.019 Tc -0.014 Tw (pourquoi le Qu\216bec a d\216cid\216 de mettre en place)Tj T* 0.022 Tc 0.021 Tw (ce r\216gime. Enfin, nous \216tudierons les d\216fis)Tj T* 0.001 Tc -0.034 Tw (auxquels le r\216gime a d\236 faire face au cours de)Tj T* 0.008 Tc 0.035 Tw (ces dix derni\217res ann\216es et ceux encore non)Tj T* 0.005 Tc 0 Tw (r\216solus.)Tj ET Q q BT /F2 1 Tf 12 0 0 12 287.9527 659.8496 Tm 0 Tr 0 g 0.001 Tc 0 Tw (I. SP\203CIFICIT\203 DU QU\203BEC )Tj 0 -1.08334 TD [(EN MA)75(TI\351RE DE COUVER)36(TURE)]TJ 0 -1.08333 TD -0.056 Tw [(M\203DICAMENT)-231(EN AM\203RIQUE )]TJ 0 -1.08334 TD 0 Tw (DU NORD)Tj ET Q q BT /F3 1 Tf 11 0 0 11 302.126 594.4938 Tm 0 Tr 0 g -0.001 Tc -0.037 Tw (Il existe une vari\216t\216 importante de modali-)Tj -1.28848 -1.0909 TD 0.025 Tc 0.021 Tw [(t\216s de prise en char)18(ge des m\216dicaments en)]TJ T* 0 Tc 0.008 Tw [(Am\216rique du Nord. )55(Aux \203tats-Unis, en fonc-)]TJ 0 -1.09091 TD 0.013 Tc 0.024 Tw (tion du r\216gime par lequel les individus sont)Tj T* 0 Tc -0.009 Tw [(assur\216s, la couverture m\216dicament sera dif)18<668E>-1(-)]TJ 0 -1.0909 TD 0.002 Tc 0.035 Tw [(rente. )55(Au Canada, alors qu\325il existe une pro-)]TJ T* 0.001 Tc 0.036 Tw (tection publique pour les frais hospitaliers et)Tj 0 -1.09091 TD -0.02 Tc -0.018 Tw (m\216dicaux, les m\216dicaments n\325ont pas \216t\216 inclus)Tj 0 -1.0909 TD -0.002 Tc -0.035 Tw (dans le panier de services de base [3, 4]. Nous)Tj 0 -1.09091 TD 0.013 Tc 0.025 Tw (pr\216senterons la situation actuelle aux \203tats-)Tj T* 0.019 Tc 0.018 Tw (Unis, au Canada (en dehors du Qu\216bec) et,)Tj T* 0 Tc 0 Tw (enfin, le r\216gime qu\216b\216cois.)Tj ET Q q BT /F2 1 Tf 11 0 0 11 287.9527 438.231 Tm 0 Tr 0 g -0.024 Tc 0 Tw (A. Organisation de l\325acc\217s aux m\216dicaments)Tj 0 -1.09091 TD 0.001 Tc (aux \203tats-Unis)Tj ET Q q BT /F3 1 Tf 11 0 0 11 302.126 399.8753 Tm 0 Tr 0 g 0.006 Tc 0.021 Tw (Aux \203tats-Unis, l\325employeur constitue la)Tj -1.28848 -1.09091 TD -0.031 Tc -0.016 Tw (principale source d\325acc\217s \210 une couverture m\216di)Tj 17.70578 0 TD 0 Tc (-)Tj -17.70578 -1.09091 TD -0.002 Tc 0.03 Tw (caments, particuli\217rement pour les personnes)Tj T* -0.003 Tc 0.031 Tw (syndiqu\216es travaillant au sein de compagnies)Tj T* -0.009 Tc 0.036 Tw (priv\216es [5]. Les personnes non syndiqu\216es ou)Tj T* 0.014 Tc 0.013 Tw (professionnels autonomes doivent s\325assurer)Tj T* -0.026 Tc -0.021 Tw (aupr\217s de compagnies d\325assurance priv\216es. Pour)Tj -0.0101 Tc (ce)' 1.12953 0 Td -0.01 Tc 0.022 Tw (qui est des programmes publics, le gouver)Tj 16.57639 0 TD 0 Tc (-)Tj -17.70592 -1.09091 TD 0.015 Tc 0.219 Tw [(nement f\216d\216ral of)18(fre une assurance \210 ses)]TJ T* -0.003 Tc 0.03 Tw (employ\216s f\216d\216raux, aux v\216t\216rans et membres)Tj T* -0.019 Tc -0.029 Tw (des forces arm\216es, ainsi qu\325une couverture sous)Tj 0 -1.0909 TD 0.006 Tc 0.022 Tw (forme d\325assistance aux b\216n\216ficiaires du pro-)Tj 0 -1.09091 TD -0.01 Tc -0.035 Tw (gramme Medicaid, destin\216 aux individus \210 tr\217s)Tj T* 0.013 Tc 0.014 Tw (faible revenu [6]. Des programmes pour les)Tj T* -0.018 Tc -0.03 Tw (m\216dicaments sont \216galement en place dans cer-)Tj T* 0.015 Tc 0.158 Tw (tains \203tats qui of)Tj 7.47341 0.00001 TD (frent des subventions ou)Tj -7.47341 -1.09091 TD -0.019 Tc -0.029 Tw (octroient des rabais [7]. En janvier 2007, 42 des)Tj T* -0.014 Tc -0.034 Tw [(50 \203tats of)18(fraient des programmes d\325assistance)]TJ T* -0.01 Tc -0.03 Tw (ou d\325assurance g\216n\216ralement destin\216s aux per)Tj 17.70592 0.00001 TD 0 Tc (-)Tj -17.70592 -1.09091 TD -0.004 Tc 0.031 Tw (sonnes \211g\216es, handicap\216es ou \210 faible revenu)Tj T* 0.005 Tc 0.022 Tw (qui ne se qualifiaient pas pour Medicaid. En)Tj T* -0.006 Tc 0.033 Tw (somme, la couverture \210 laquelle ont acc\217s les)Tj ET 1 g 72.52 687.637 413.858 17.008 re f Q q BT /F3 1 Tf 10 0 0 10 73.5197 696.1231 Tm 0 Tr 0 g -0.0001 Tc (M)Tj 0.88886 0.00001 TD 0 Tc 0 Tw [(.-P)111(. Pomey)65(, P)110(.-G. Forest, E.)-250(Martin, )55(A. Beresniak)]TJ ET Q q BT /F0 1 Tf 11 0 0 11 479.8779 696.1231 Tm 0 Tr 0 g 0 Tc (3)Tj ET 1 g 72.52 61.657 413.858 13.0081 re f Q q BT /F0 1 Tf 8 0 0 8 73.5197 68.1942 Tm 0 Tr 0 g 0 Tc 0 Tw [(SEPTEMBRE-NOVEMBRE 2007)-250(\320 V)30(OL.)-250(25 \320 N\241)-250(5-6)]TJ ET Q q 1 g 29 755.661 185.6 14 re f BT /F4 1 Tf 8 0 0 8 33 759.661 Tm 0 Tr 0 g 0 Tc 0 Tw (1386-8 Pomey 11/12/07 12:00 Page 3)Tj ET 0 J 0 j 10 M []0 d 0.5 w 1 G 30 768.661 m 30 744.661 l 0 738.661 m 24 738.661 l 528.898 768.661 m 528.898 744.661 l 558.898 738.661 m 534.898 738.661 l 30 0 m 30 24 l 0 30 m 24 30 l 528.898 0 m 528.898 24 l 558.898 30 m 534.898 30 l S 0.25 w 0 G 30 768.661 m 30 744.661 l 0 738.661 m 24 738.661 l 528.898 768.661 m 528.898 744.661 l 558.898 738.661 m 534.898 738.661 l 30 0 m 30 24 l 0 30 m 24 30 l 528.898 0 m 528.898 24 l 558.898 30 m 534.898 30 l S 0.5 w 1 G 255.449 756.661 m 303.449 756.661 l 255.449 12 m 303.449 12 l 12 408.3305 m 12 360.3305 l 546.898 408.3305 m 546.898 360.3305 l 279.449 768.661 m 279.449 744.661 l 279.449 24 m 279.449 0 l 0 384.3305 m 24 384.3305 l 534.898 384.3305 m 558.898 384.3305 l 279.449 756.661 m 285.449 756.661 l 285.449 753.3473 282.7627 750.661 279.449 750.661 c 276.1353 750.661 273.449 753.3473 273.449 756.661 c 273.449 759.9747 276.1353 762.661 279.449 762.661 c 282.7627 762.661 285.449 759.9747 285.449 756.661 c 279.449 12 m 285.449 12 l 285.449 8.6863 282.7627 6 279.449 6 c 276.1353 6 273.449 8.6863 273.449 12 c 273.449 15.3137 276.1353 18 279.449 18 c 282.7627 18 285.449 15.3137 285.449 12 c 12 384.3305 m 18 384.3305 l 18 381.0168 15.3137 378.3305 12 378.3305 c 8.6863 378.3305 6 381.0168 6 384.3305 c 6 387.6443 8.6863 390.3305 12 390.3305 c 15.3137 390.3305 18 387.6443 18 384.3305 c 546.898 384.3305 m 552.898 384.3305 l 552.898 381.0168 550.2117 378.3305 546.898 378.3305 c 543.5843 378.3305 540.898 381.0168 540.898 384.3305 c 540.898 387.6443 543.5843 390.3305 546.898 390.3305 c 550.2117 390.3305 552.898 387.6443 552.898 384.3305 c S 0.25 w 0 G 255.449 756.661 m 303.449 756.661 l 255.449 12 m 303.449 12 l 12 408.3305 m 12 360.3305 l 546.898 408.3305 m 546.898 360.3305 l 279.449 768.661 m 279.449 744.661 l 279.449 24 m 279.449 0 l 0 384.3305 m 24 384.3305 l 534.898 384.3305 m 558.898 384.3305 l 279.449 756.661 m 285.449 756.661 l 285.449 753.3473 282.7627 750.661 279.449 750.661 c 276.1353 750.661 273.449 753.3473 273.449 756.661 c 273.449 759.9747 276.1353 762.661 279.449 762.661 c 282.7627 762.661 285.449 759.9747 285.449 756.661 c 279.449 12 m 285.449 12 l 285.449 8.6863 282.7627 6 279.449 6 c 276.1353 6 273.449 8.6863 273.449 12 c 273.449 15.3137 276.1353 18 279.449 18 c 282.7627 18 285.449 15.3137 285.449 12 c 12 384.3305 m 18 384.3305 l 18 381.0168 15.3137 378.3305 12 378.3305 c 8.6863 378.3305 6 381.0168 6 384.3305 c 6 387.6443 8.6863 390.3305 12 390.3305 c 15.3137 390.3305 18 387.6443 18 384.3305 c 546.898 384.3305 m 552.898 384.3305 l 552.898 381.0168 550.2117 378.3305 546.898 378.3305 c 543.5843 378.3305 540.898 381.0168 540.898 384.3305 c 540.898 387.6443 543.5843 390.3305 546.898 390.3305 c 550.2117 390.3305 552.898 387.6443 552.898 384.3305 c S Q endstream endobj 6 0 obj << /Length 11396 >> stream /GS0 gs q 0 0.661 558 768 re W n 1 g 0 768.661 0 0 re f Q /GS1 gs q 1 g 72.52 100.866 413.858 566.929 re f Q q BT /F3 1 Tf 11 0 0 11 72.5197 660.5117 Tm 0 Tr 0 g -0.01 Tc 0.029 Tw (Am\216ricains demeure \210 g\216om\216trie variable, les)Tj 0 -1.0909 TD -0.026 Tc -0.021 Tw [(dif)18(f\216rences entre les divers plans priv\216s et m\220me)]TJ T* 0 Tc 0.027 Tw [(entre les dif)18(f\216rents programmes de Medicaid)]TJ 0 -1.09091 TD -0.01 Tc 0 Tw (\216tant souvent importantes [5].)Tj 1.28847 -1.87551 TD -0.002 Tc 0.03 Tw (Pour sa part, le programme Medicare, qui)Tj -1.28847 -1.0909 TD -0.021 Tc -0.027 Tw [(s\325adresse aux personnes \211g\216es, n\325a jamais of)18(fert)]TJ T* -0.005 Tc 0.032 Tw (de couverture pour les m\216dicaments prescrits)Tj T* 0 Tc 0.027 Tw (et consomm\216s en milieu ambulatoire. Si cer-)Tj T* 0.001 Tc 0.026 Tw (tains retrait\216s peuvent b\216n\216ficier d\325une assu-)Tj 0 -1.09091 TD -0.022 Tc -0.025 Tw [(rance par le biais de leur ancien employeur)40(, pr\217s)]TJ 0 -1.0909 TD 0.003 Tc 0.025 Tw (du tiers des a\224n\216s et des personnes \210 revenus)Tj T* -0.027 Tc -0.02 Tw (modestes n\325ont acc\217s \210 aucune couverture m\216di-)Tj 0 -1.09091 TD -0.003 Tc 0.031 Tw [(caments [4]. )18(T)70(outefois, en d\216cembre 2003, le)]TJ T* -0.01 Tc -0.029 Tw (pr\216sident Bush a promulgu\216 la )Tj ET Q q BT /F0 1 Tf 11 0 0 11 204.7927 495.8812 Tm 0 Tr 0 g -0.01 Tc -0.029 Tw [(Medicar)37(e Pr)37(es)-1(-)]TJ -12.02482 -1.09091 TD -0.007 Tc 0.034 Tw [(cription Drug, Impr)37(ovement, and Moderniza-)]TJ T* 0.012 Tc -0.002 Tw (tion Act)Tj ET Q q BT /F3 1 Tf 11 0 0 11 108.0539 471.8811 Tm 0 Tr 0 g 0.0117 Tc (,)Tj 0.5391 0 Td 0.012 Tc 0.016 Tw (qui instaurait notamment le Part D)Tj -3.76948 -1.09091 TD -0.01 Tc 0.018 Tw (Drug Benefit, un programme entr\216 en vigueur)Tj T* -0.031 Tc -0.017 Tw (en janvier 2006. Il s\325agit d\325un programme volon-)Tj T* -0.03 Tc (taire d\325assurance m\216dicaments destin\216 aux b\216n\216-)Tj T* -0.01 Tc -0.005 Tw (ficiaires de Medicare qui, en juin 2006, comp)Tj 17.70592 0 TD 0 Tc (-)Tj -17.70592 -1.09091 TD -0.001 Tc 0.028 Tw [(tait d\216j\210 22,5 millions d\325adh\216rents [8]. )55(Ainsi,)]TJ T* -0.007 Tc 0.035 Tw (les b\216n\216ficiaires peuvent choisir de conserver)Tj T* -0.01 Tc 0.006 Tw (leur plan d\325assurance actuel, de s\325enr\231ler dans)Tj T* -0.013 Tc -0.034 Tw (le Part D s\325ils n\325ont pas d\325assurances ou encore)Tj T* 0.014 Tc 0.013 Tw (de substituer leur ancien plan par le Part D.)Tj T* -0.01 Tc -0.024 Tw (Notons que le programme pr\216voit une subven-)Tj T* 0.015 Tc 0.451 Tw (tion du gouvernement f\216d\216ral pour les)Tj T* -0.001 Tc 0.028 Tw (employeurs, allocation pour les encourager \210)Tj T* -0.01 Tc 0.001 Tw [(continuer d\325of)18(frir une protection m\216dicaments)]TJ -0.0101 Tc <88>' 0.67378 0 Td -0.01 Tc 0 Tw (leur personnel retrait\216.)Tj 0.61469 -1.87551 TD -0.013 Tc -0.024 Tw (Medicare n\325of)Tj 5.4791 0.00001 TD (fre, ni ne g\217re lui-m\220me cette)Tj -6.76757 -1.09091 TD 0 Tc -0.002 Tw (assurance, le gouvernement ayant plut\231t opt\216)Tj T* 0.015 Tw (pour l\325instauration d\325un syst\217me de comp\216ti-)Tj T* -0.008 Tc -0.029 Tw (tion entre des assureurs priv\216s r\216partis dans 39)Tj T* 0.005 Tc 0.033 Tw [(r\216gions. \313 l\325heure actuelle, 65 or)18(ganisations)]TJ T* -0.013 Tc 0 Tw (of)Tj 0.78845 0.00001 TD -0.024 Tw [(frent pr\217s de 1)-112(400 plans qui dif)18(f\217rent notam-)]TJ -0.78845 -1.09091 TD -0.003 Tc -0.034 Tw (ment au chapitre des m\216dicaments couverts et)Tj T* -0.005 Tc -0.033 Tw (du montant des franchises et des coassurances)Tj T* 0 Tc 0.009 Tw ([9]. Ces or)Tj 4.24797 0.00001 TD (ganisations se sont aussi dot\216es de)Tj -4.24797 -1.09091 TD 0.026 Tw (divers outils pour g\216rer les risques et contr\231)Tj 17.70591 0.00001 TD (-)Tj -17.70591 -1.09091 TD -0.016 Tw (ler les co\236ts, notamment par des programmes)Tj T* 0.009 Tc 0.028 Tw (d\325achats massifs ou encore en encourageant)Tj T* (leurs adh\216rents \210 importer des m\216dicaments)Tj T* -0.003 Tc -0.035 Tw (moins co\236teux en provenance du Canada, une)Tj T* -0.001 Tc -0.037 Tw (pratique ill\216gale, mais tol\216r\216e par la Food and)Tj T* 0 Tc 0 Tw (Drug )Tj 2.2498 0 TD (Administration [5, 7].)Tj ET Q q BT /F2 1 Tf 11 0 0 11 287.9527 660.5117 Tm 0 Tr 0 g -0.024 Tc 0 Tw (B. Organisation de l\325acc\217s aux m\216dicaments)Tj 0 -1.0909 TD 0.001 Tc (au Canada)Tj ET Q q BT /F3 1 Tf 11 0 0 11 302.126 621.9645 Tm 0 Tr 0 g 0 Tc 0.02 Tw (En 1947, la Saskatchewan fut la premi\217re)Tj -1.28848 -1.09091 TD -0.024 Tc -0.014 Tw (province canadienne \210 instaurer un r\216gime d\325as-)Tj 0 -1.0909 TD 0.014 Tc 0.023 Tw (surance hospitalisation qui couvrait les ser-)Tj T* 0 Tc 0.021 Tw (vices m\216dicaux, les tests diagnostiques et les)Tj 0 -1.09091 TD 0.006 Tc 0.031 Tw [(m\216dicaments en milieu hospitalier)55(. Il faudra)]TJ T* 0.003 Tc 0.035 Tw (attendre 1972 avant que toutes les provinces)Tj 0 -1.0909 TD 0 Tc -0.007 Tw (canadiennes aient instaur\216 un acc\217s universel)Tj T* 0.037 Tw (gratuit aux services m\216dicaux, dont le finan-)Tj 0 -1.09091 TD 0.01 Tc 0.027 Tw (cement sera assur\216 par un partage des co\236ts)Tj T* -0.011 Tc -0.027 Tw (entre le gouvernement f\216d\216ral et les provinces.)Tj 0 -1.0909 TD 0 Tc (T)Tj 0.5247 0.00001 TD -0.016 Tc -0.021 Tw (ous les Canadiens ont acc\217s aux m\216dicaments)Tj -0.5247 -1.09091 TD 0 Tc -0.015 Tw (prescrits \210 l\325h\231pital par le biais de ce syst\217me)Tj T* 0.019 Tw [(public. )18(T)70(outefois, les m\216dicaments dispens\216s)]TJ T* -0.029 Tw (dans le secteur ambulatoire ne sont pas inclus)Tj T* -0.004 Tc -0.034 Tw (dans le panier des services couverts au titre de)Tj T* 0 Tc 0 Tw (la )Tj ET Q q BT /F0 1 Tf 11 0 0 11 298.229 441.9645 Tm 0 Tr 0 g 0 Tc -0.037 Tw (Loi canadienne sur la sant\216)Tj ET Q q BT /F3 1 Tf 11 0 0 11 421.121 441.9645 Tm 0 Tr 0 g 0 Tc -0.037 Tw (promulgu\216e en)Tj -12.10621 -1.09091 TD 0 Tw (1984 [10].)Tj ET Q q BT /F12 1 Tf 11 0 0 11 287.9527 408.3449 Tm 0 Tr 0 g 0 Tc 0 Tw (1. Provinces canadiennes en dehors )Tj 0 -1.09091 TD (du Qu\216bec)Tj ET Q q BT /F0 1 Tf 11 0 0 11 287.9527 366.9631 Tm 0 Tr 0 g 0 Tc 0 Tw (a. la couver)Tj 4.74829 0 TD [(tur)37(e m\216dicament)]TJ ET Q q BT /F3 1 Tf 11 0 0 11 302.126 343.2505 Tm 0 Tr 0 g -0.02 Tc -0.017 Tw (La couverture m\216dicament fait l\325objet d\325une)Tj -1.28848 -1.09091 TD 0.009 Tc 0.028 Tw (gestion et d\325une prestation d\216centralis\216e, au)Tj T* -0.014 Tc -0.024 Tw (niveau des dix provinces et des trois territoires,)Tj T* 0.003 Tc 0.035 Tw (qui financent des programmes publics par le)Tj T* -0.007 Tc -0.03 Tw [(biais des imp\231ts g\216n\216raux. )55(Ainsi, la g\216n\216rosit\216)]TJ T* 0.001 Tc 0.037 Tw (de la couverture pour les m\216dicaments a lar)Tj 17.70592 0.00001 TD 0 Tc (-)Tj -17.70592 -1.09091 TD -0.037 Tw (gement repos\216 sur la capacit\216 fiscale des gou-)Tj T* 0.026 Tw (vernements et sur leurs ambitions en mati\217re)Tj T* 0.011 Tc 0.027 Tw (de politique sociale [4]. 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L)92(\325id\216e de mettre sur pied un r\216gime cana-)]TJ 0 -1.11038 TD 0 Tc 0.008 Tw (dien d\325assurance m\216dicaments a \216t\216 remis au)Tj 0 -1.11039 TD -0.01 Tc -0.027 Tw (go\236t du jour en 2002 au Comit\216 s\216natorial per)Tj 17.70578 0.00001 TD 0 Tc (-)Tj -17.70578 -1.11039 TD 0.009 Tw [(manent des )55(Af)17(faires sociales, de la science et)]TJ T* -0.017 Tc -0.021 Tw (de la technologie dirig\216 par Michael Kirby [13])Tj 0 -1.11038 TD -0.009 Tc -0.029 Tw (et lors de la Commission sur l\325avenir des soins)Tj 19.58482 45.52583 TD 0.007 Tc 0.03 Tw (de sant\216 [14]. En 2004, un comit\216 de travail)Tj 0 -1.0909 TD 0 Tc -0.008 Tw (minist\216riel a \216t\216 mis sur pied pour se pencher)Tj T* 0.019 Tc 0.019 Tw (sur cette question [10], mais n\325a jamais \216t\216)Tj 0 -1.09091 TD 0 Tc 0 Tw (suivi d\325une prise de d\216cision politique.)Tj ET Q q BT /F0 1 Tf 11 0 0 11 287.9527 601.0891 Tm 0 Tr 0 g 0 Tc 0 Tw [(b. 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Martin, )55(A. Beresniak)]TJ ET Q q BT /F0 1 Tf 11 0 0 11 479.8779 696.1231 Tm 0 Tr 0 g 0 Tc (5)Tj ET 1 g 72.52 61.657 413.858 13.0081 re f Q q BT /F0 1 Tf 8 0 0 8 73.5197 68.1942 Tm 0 Tr 0 g 0 Tc 0 Tw [(SEPTEMBRE-NOVEMBRE 2007)-250(\320 V)30(OL.)-250(25 \320 N\241)-250(5-6)]TJ ET 0 J 0 j 10 M []0 d 0.5 w 0 G 73.52 143.797 m 485.378 143.797 l S Q q BT /F3 1 Tf 8.5 0 0 8.5 73.5197 132.2085 Tm 0 Tr 0 g 0 Tc 0.003 Tw (1. La franchise est un montant fixe qui constitue la premi\217re tranche du co\236t des m\216dicaments que doit payer la personne)Tj 0 -1.11764 TD 0 Tw (assur\216e \210 l\325achat de m\216dicaments couverts.)Tj T* 0.034 Tw (2. 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Dans le)Tj 0 -1.11561 TD 0.013 Tc 0.025 Tw (cas du r\216gime public, ces param\217tres finan-)Tj 0 -1.11563 TD 0.015 Tc 0.022 Tw (ciers \(prime, franchise et pourcentage de la)Tj 0 -1.11562 TD -0.019 Tc -0.018 Tw (coassurance\) sont ajust\216s le 1)Tj ET Q q BT /F3 1 Tf 6.6 0 0 6.6 194.8436 467.4621 Tm 0 Tr 0 g -0.02 Tc 0 Tw (er)Tj ET Q q BT /F3 1 Tf 11 0 0 11 202.052 464.1621 Tm 0 Tr 0 g -0.019 Tc -0.018 Tw (juillet de chaque)Tj -11.77566 -1.11563 TD 0 Tc 0.013 Tw (ann\216e. Le minist\217re des Finances collecte les)Tj 0 -1.11562 TD -0.037 Tw (primes annuellement par l\325interm\216diaire de la)Tj 0 -1.11563 TD 0.006 Tc 0.031 Tw [(d\216claration de revenu. )55(Au 1)]TJ ET Q q BT /F3 1 Tf 6.6 0 0 6.6 197.0049 430.6465 Tm 0 Tr 0 g 0.006 Tc 0 Tw (er)Tj ET Q q BT /F3 1 Tf 11 0 0 11 205.3756 427.3465 Tm 0 Tr 0 g 0.006 Tc 0.031 Tw (juillet 2007, la)Tj -12.07781 -1.11561 TD 0 Tc 0.014 Tw (prime variait entre C$ 0 et C$ 557 par adulte)Tj 0 -1.11562 TD 0.011 Tc 0.027 Tw (en fonction du revenu de la famille. Pour le)Tj T* -0.015 Tc -0.023 Tw (r\216gime priv\216, le montant de la prime varie d\325un)Tj 0 -1.11563 TD 0 Tc -0.037 Tw (assureur \210 l\325autre et est pratiquement toujours)Tj 19.58482 25.65933 TD -0.007 Tw (inclus dans une assurance collective compor-)Tj 0 -1.0909 TD 0.002 Tc 0.035 Tw (tant aussi d\325autres services couverts, comme)Tj T* -0.013 Tc -0.025 Tw (les consultations aupr\217s de dentistes ou de pro-)Tj 0 -1.09091 TD -0.009 Tc -0.029 Tw (fessionnels param\216dicaux \(psychologue, kin\216-)Tj 0 -1.0909 TD -0.001 Tc -0.037 Tw [(sith\216rapeute, ost\216opathe,)-213(etc.\). Enfin, la loi ne)]TJ T* 0.005 Tc 0.032 Tw (permet pas que les b\216n\216ficiaires d\216boursent,)Tj 0 -1.09091 TD 0.025 Tc 0.114 Tw (en plus de leur frais d\325assurance, plus de)Tj T* -0.017 Tc -0.02 Tw [(C$)-233(903,96 par an, pour l\325achat de m\216dicaments)]TJ 0 -1.0909 TD 0.004 Tc 0.033 Tw ((voir tableau 1). Les frais au-dessus de cette)Tj T* 0.008 Tc 0.03 Tw [(limite sont pris compl\217tement en char)18(ge par)]TJ 0 -1.09091 TD 0 Tc 0 Tw (les assureurs qu\325ils soient publics ou priv\216s.)Tj ET Q q BT /F0 1 Tf 11 0 0 11 287.9527 514.4318 Tm 0 Tr 0 g 0 Tc 0 Tw (b. Le Conseil du m\216dicament du Qu\216bec)Tj ET Q q BT /F3 1 Tf 11 0 0 11 302.126 486.2589 Tm 0 Tr 0 g 0.022 Tc 0.015 Tw (En compl\216ment du dispositif pr\216sent au)Tj -1.28848 -1.09091 TD 0.019 Tc 0.018 Tw (niveau canadien, le Qu\216bec s\325est dot\216 d\325un)Tj T* -0.022 Tc -0.016 Tw (Conseil du m\216dicament (CdM) qui a pour fonc-)Tj T* 0.013 Tc 0.025 Tw (tion d\325assister le ministre de la Sant\216 et des)Tj T* 0 Tc -0.036 Tw (Services sociaux dans la mise \210 jour des listes)Tj T* -0.016 Tc -0.022 Tw (de m\216dicaments et de favoriser leur usage opti-)Tj T* 0.009 Tc 0.028 Tw [(mal. En ef)18(fet, la liste des m\216dicaments cou-)]TJ T* -0.008 Tc -0.03 Tw (verts par le R\216gime g\216n\216ral d\325assurance m\216di-)Tj T* 0.009 Tc 0.028 Tw (caments est propre au Qu\216bec et est connue)Tj T* 0.025 Tc 0.046 Tw (pour \220tre la plus g\216n\216reuse au Canada. Le)Tj ET 1 g 72.52 687.637 413.858 17.008 re f Q q BT /F3 1 Tf 10 0 0 10 73.5197 696.1231 Tm 0 Tr 0 g -0.0001 Tc (M)Tj 0.88886 0.00001 TD 0 Tc 0 Tw [(.-P)111(. Pomey)65(, P)110(.-G. Forest, E. Martin, )55(A. Beresniak)]TJ ET Q q BT /F0 1 Tf 11 0 0 11 479.8779 696.1231 Tm 0 Tr 0 g 0 Tc (7)Tj ET 1 g 72.52 61.657 413.858 13.0081 re f Q q BT /F0 1 Tf 8 0 0 8 73.5197 68.1942 Tm 0 Tr 0 g 0 Tc 0 Tw [(SEPTEMBRE-NOVEMBRE 2007)-250(\320 V)30(OL.)-250(25 \320 N\241)-250(5-6)]TJ ET Q q BT /F2 1 Tf 10 0 0 10 85.2325 357.4721 Tm 0 Tr 0 g 0 Tc (T)Tj 0.5752 0 TD 0.001 Tc 0 Tw (ableau 1)Tj 3.70849 0 TD 0.0008 Tc (:)Tj 0.58357 0 Td 0.001 Tc (Contributions \(en dollars Canadian et Eur)Tj 18.11858 0 TD (os\) des assur\216s du r\216gime public [16].)Tj ET 1 g 72.52 334.468 145.681 14.455 re f 218.201 334.468 54.524 14.455 re f 272.725 334.468 104.104 14.455 re f Q q BT /F2 1 Tf 9 0 0 9 294.6603 339.3438 Tm 0 Tr 0 g 0.001 Tc 0 Tw (Les pharmacies)Tj ET 1 g 376.829 334.468 109.049 14.455 re f BT /F2 1 Tf 9 0 0 9 421.5175 339.3438 Tm 0 g [(T)92(otal)]TJ ET 1 g 72.52 302.287 145.681 32.181 re f BT /F2 1 Tf 9 0 0 9 78.1003 321.6759 Tm 0 g [(Dif)1(f\216r)19(entes cat\216gories de personnes)]TJ 5.69653 -1.2 TD [(ouver)1(tes)]TJ ET 1 g 218.201 302.287 54.524 32.181 re f BT /F2 1 Tf 9 0 0 9 233.7217 321.6759 Tm 0 g (Prime)Tj -0.50098 -1.2 TD (annuelle)Tj ET 1 g 272.725 302.287 49.58 32.181 re f BT /F2 1 Tf 9 0 0 9 278.5207 321.6759 Tm 0 g (Franchise )Tj 0.00012 -1.2 TD (mensuelle)Tj ET 1 g 322.305 302.287 54.524 32.181 re f BT /F2 1 Tf 9 0 0 9 325.0731 321.6759 Tm 0 g (Coassurance)Tj 0.55553 -1.2 TD 0.002 Tc (maximum)Tj ET 1 g 376.829 302.287 54.525 32.181 re f BT /F2 1 Tf 9 0 0 9 378.8437 327.0759 Tm 0 g 0.001 Tc (Contribution)Tj 0.69495 -1.2 TD (mensuelle)Tj 0.02783 -1.2 TD (maximale)Tj ET 1 g 431.354 302.287 55.024 32.181 re f BT /F2 1 Tf 9 0 0 9 433.3681 327.0759 Tm 0 g (Contribution)Tj 0.99976 -1.2 TD (annuelle)Tj -0.27698 -1.2 TD (maximale)Tj ET 1 g 72.52 278.61 145.681 23.677 re f BT /F2 1 Tf 9 0 0 9 76.3543 293.2831 Tm 0 g (Adultes de 18 \210 64 ans non )Tj 0 -1.2 TD (admissibles \210 un r\216gime priv\216)Tj ET 1 g 218.201 278.61 54.524 23.677 re f Q q BT /F3 1 Tf 9 0 0 9 223.7605 288.3468 Tm 0 Tr 0 g 0 Tc 0 Tw (de $0 \210 $557)Tj ET 1 g 272.725 278.61 49.58 23.677 re f BT /F3 1 Tf 9 0 0 9 286.5573 288.3468 Tm 0 g ($14,10)Tj ET 1 g 322.305 278.61 54.524 23.677 re f BT /F3 1 Tf 9 0 0 9 341.612 288.3468 Tm 0 g (30)Tj 1.25 0.00001 TD (%)Tj ET 1 g 376.829 278.61 54.525 23.677 re f BT /F3 1 Tf 9 0 0 9 393.1337 288.3468 Tm 0 g ($75,33)Tj ET 1 g 431.354 278.61 55.024 23.677 re f BT /F3 1 Tf 9 0 0 9 451.0331 288.3468 Tm 0 g ($904)Tj ET 1 g 72.52 263.437 145.681 15.173 re f Q q BT /F2 1 Tf 9 0 0 9 76.3543 268.9216 Tm 0 Tr 0 g 0.001 Tc 0 Tw (Personnes de 65 ans et plus)Tj ET 1 g 218.201 263.437 54.524 15.173 re f 272.725 263.437 49.58 15.173 re f 322.305 263.437 54.524 15.173 re f 376.829 263.437 54.525 15.173 re f 431.354 263.437 55.024 15.173 re f 72.52 248.263 145.681 15.174 re f Q q BT /F3 1 Tf 9 0 0 9 76.3543 253.6292 Tm 0 Tr 0 g 0 Tc 0 Tw (Ne recevant aucun SRG)Tj ET Q q BT /F3 1 Tf 5.4 0 0 5.4 163.0628 256.3293 Tm 0 Tr 0 g 0 Tc (a)Tj ET Q q BT /F3 1 Tf 9 0 0 9 167.7096 253.6292 Tm 0 Tr 0 g 0 Tc 0 Tw [(\(0)-250(%\))]TJ ET 1 g 218.201 248.263 54.524 15.174 re f BT /F3 1 Tf 9 0 0 9 223.7605 253.7483 Tm 0 g (de $0 \210 $557)Tj ET 1 g 272.725 248.263 49.58 15.174 re f BT /F3 1 Tf 9 0 0 9 286.5573 253.7483 Tm 0 g ($14,10)Tj ET 1 g 322.305 248.263 54.524 15.174 re f BT /F3 1 Tf 9 0 0 9 341.612 253.7483 Tm 0 g [(30)-250(%)]TJ ET 1 g 376.829 248.263 54.525 15.174 re f BT /F3 1 Tf 9 0 0 9 393.1337 253.7483 Tm 0 g ($75,33)Tj ET 1 g 431.354 248.263 55.024 15.174 re f BT /F3 1 Tf 9 0 0 9 451.0331 253.7483 Tm 0 g ($904)Tj ET 1 g 72.52 233.09 145.681 15.173 re f BT /F3 1 Tf 9 0 0 9 76.3543 238.5751 Tm 0 g -0.025 Tc [(Recevant le SRG)-225(partiel \(de 1)-225(% \210 93)-225(%\))]TJ ET 1 g 218.201 233.09 54.524 15.173 re f BT /F3 1 Tf 9 0 0 9 223.7605 238.5751 Tm 0 g 0 Tc (de $0 \210 $557)Tj ET 1 g 272.725 233.09 49.58 15.173 re f BT /F3 1 Tf 9 0 0 9 286.5573 238.5751 Tm 0 g ($14,10)Tj ET 1 g 322.305 233.09 54.524 15.173 re f BT /F3 1 Tf 9 0 0 9 341.612 238.5751 Tm 0 g [(30)-250(%)]TJ ET 1 g 376.829 233.09 54.525 15.173 re f BT /F3 1 Tf 9 0 0 9 393.1337 238.5751 Tm 0 g ($75,33)Tj ET 1 g 431.354 233.09 55.024 15.173 re f BT /F3 1 Tf 9 0 0 9 451.0331 238.5751 Tm 0 g ($904)Tj ET 1 g 72.52 209.413 145.681 23.677 re f BT /F3 1 Tf 9 0 0 9 76.3543 224.6817 Tm 0 g -0.025 Tc (Recevant le SRG)Tj 6.73682 0.00001 TD (presque maximal )Tj -6.73682 -1.21612 TD (\(de 94)Tj 2.60166 0.00001 TD -0.0251 Tc (%)Tj 1.03287 0 Td <88>Tj 0.64387 0 Td -0.025 Tc (99)Tj 1.17492 0.00001 TD (%\))Tj ET 1 g 218.201 209.413 54.524 23.677 re f BT /F3 1 Tf 9 0 0 9 242.3801 219.1499 Tm 0 g 0 Tc ($0)Tj ET 1 g 272.725 209.413 49.58 23.677 re f BT /F3 1 Tf 9 0 0 9 294.4323 219.1499 Tm 0 g ($0)Tj ET 1 g 322.305 209.413 54.524 23.677 re f BT /F3 1 Tf 9 0 0 9 343.862 219.1499 Tm 0 g 0.25 Tc (0%)Tj ET 1 g 376.829 209.413 54.525 23.677 re f BT /F3 1 Tf 9 0 0 9 401.0087 219.1499 Tm 0 g 0 Tc ($0)Tj ET 1 g 431.354 209.413 55.024 23.677 re f BT /F3 1 Tf 9 0 0 9 455.5331 219.1499 Tm 0 g ($0)Tj ET 1 g 72.52 194.24 145.681 15.173 re f BT /F3 1 Tf 9 0 0 9 76.3543 199.7115 Tm 0 g -0.025 Tc [(Recevant le SRG)-225(maximal \(100)-225(%\))]TJ ET 1 g 218.201 194.24 54.524 15.173 re f BT /F3 1 Tf 9 0 0 9 242.3801 199.7248 Tm 0 g 0 Tc ($0)Tj ET 1 g 272.725 194.24 49.58 15.173 re f BT /F3 1 Tf 9 0 0 9 294.4323 199.7248 Tm 0 g ($0)Tj ET 1 g 322.305 194.24 54.524 15.173 re f BT /F3 1 Tf 9 0 0 9 343.862 199.7248 Tm 0 g (0)Tj 0.75 0.00001 TD (%)Tj ET 1 g 376.829 194.24 54.525 15.173 re f BT /F3 1 Tf 9 0 0 9 401.0087 199.7248 Tm 0 g ($0)Tj ET 1 g 431.354 194.24 55.024 15.173 re f BT /F3 1 Tf 9 0 0 9 455.5331 199.7248 Tm 0 g ($0)Tj ET 1 g 72.52 179.067 145.681 15.173 re f Q q BT /F2 1 Tf 9 0 0 9 76.3543 184.5515 Tm 0 Tr 0 g 0.001 Tc 0 Tw [(P)-1(r)19(estatair)18(es de l\325assistance-emploi)]TJ ET 1 g 218.201 179.067 54.524 15.173 re f 272.725 179.067 49.58 15.173 re f 322.305 179.067 54.524 15.173 re f 376.829 179.067 54.525 15.173 re f 431.354 179.067 55.024 15.173 re f 72.52 163.893 145.681 15.174 re f Q q BT /F3 1 Tf 9 0 0 9 76.3543 169.3783 Tm 0 Tr 0 g 0 Tc 0 Tw (Sans contraintes s\216v\217res \210 l\325emploi)Tj ET 1 g 218.201 163.893 54.524 15.174 re f BT /F3 1 Tf 9 0 0 9 242.3801 169.3783 Tm 0 g ($0)Tj ET 1 g 272.725 163.893 49.58 15.174 re f BT /F3 1 Tf 9 0 0 9 288.8073 169.3783 Tm 0 g ($8,33)Tj ET 1 g 322.305 163.893 54.524 15.174 re f BT /F3 1 Tf 9 0 0 9 341.612 169.3783 Tm 0 g [(25)-250(%)]TJ ET 1 g 376.829 163.893 54.525 15.174 re f BT /F3 1 Tf 9 0 0 9 393.1337 169.3783 Tm 0 g ($16,66)Tj ET 1 g 431.354 163.893 55.024 15.174 re f BT /F3 1 Tf 9 0 0 9 451.0331 169.3783 Tm 0 g ($200)Tj ET 1 g 72.52 148.72 145.681 15.173 re f BT /F3 1 Tf 9 0 0 9 76.3543 154.205 Tm 0 g (A)Tj 0.64795 0.00001 TD (vec contraintes s\216v\217res \210 l\325emploi)Tj ET 1 g 218.201 148.72 54.524 15.173 re f BT /F3 1 Tf 9 0 0 9 242.3801 154.205 Tm 0 g ($0)Tj ET 1 g 272.725 148.72 49.58 15.173 re f BT /F3 1 Tf 9 0 0 9 294.4323 154.205 Tm 0 g ($0)Tj ET 1 g 322.305 148.72 54.524 15.173 re f BT /F3 1 Tf 9 0 0 9 343.862 154.205 Tm 0 g (0)Tj 0.75 0.00001 TD (%)Tj ET 1 g 376.829 148.72 54.525 15.173 re f BT /F3 1 Tf 9 0 0 9 401.0087 154.205 Tm 0 g ($0)Tj ET 1 g 431.354 148.72 55.024 15.173 re f BT /F3 1 Tf 9 0 0 9 455.5331 154.205 Tm 0 g ($0)Tj ET 1 g 72.52 125.0431 145.681 23.677 re f Q q BT /F2 1 Tf 9 0 0 9 76.3543 140.1798 Tm 0 Tr 0 g 0.001 Tc 0 Tw (Adultes de 18 \210 64 ans admissibles )Tj 0 -1.2 TD 0.0008 Tc <88>Tj 0.75067 0 Td 0.001 Tc (un r\216gime priv\216)Tj ET 1 g 218.201 125.0431 54.524 23.677 re f Q q BT /F3 1 Tf 9 0 0 9 244.6301 134.7798 Tm 0 Tr 0 g 0 Tc Tj ET 1 g 272.725 125.0431 49.58 23.677 re f BT /F3 1 Tf 9 0 0 9 296.6823 134.7798 Tm 0 g (*)Tj ET 1 g 322.305 125.0431 54.524 23.677 re f BT /F3 1 Tf 9 0 0 9 341.612 134.7798 Tm 0 g 0 Tw [(29)-250(%)]TJ ET 1 g 376.829 125.0431 54.525 23.677 re f BT /F3 1 Tf 9 0 0 9 393.1337 134.7798 Tm 0 g Tj 0.75 0 Td ($881)Tj ET 1 g 431.354 125.0431 55.024 23.677 re f 72.52 100.866 413.358 24.177 re f Q q BT /F3 1 Tf 4.8 0 0 4.8 73.5197 118.4303 Tm 0 Tr 0 g 0 Tc (a)Tj ET Q q BT /F3 1 Tf 8 0 0 8 77.6502 116.0303 Tm 0 Tr 0 g 0 Tc 0 Tw (Suppl\216ment de revenu garanti.)Tj -0.5163 -1.2 TD (*)Tj 0.7322 0 TD (V)Tj 0.6111 0 TD (arie en fonction de la prime.)Tj ET 0 J 0 j 10 M []0 d 1 w 0 G 73.02 348.923 m 73.02 100.866 l S 218.201 348.923 m 218.201 124.5431 l S 272.725 348.923 m 272.725 124.5431 l S 322.305 334.968 m 322.305 124.5431 l S 376.829 348.923 m 376.829 124.5431 l S 431.354 334.968 m 431.354 124.5431 l S 485.878 348.923 m 485.878 100.866 l S 72.52 348.423 m 486.378 348.423 l S 72.52 334.468 m 486.378 334.468 l S 72.52 302.287 m 486.378 302.287 l S 72.52 278.61 m 486.378 278.61 l S 72.52 263.437 m 486.378 263.437 l S 72.52 248.263 m 486.378 248.263 l S 72.52 233.09 m 486.378 233.09 l S 72.52 209.413 m 486.378 209.413 l S 72.52 194.24 m 486.378 194.24 l S 72.52 179.067 m 486.378 179.067 l S 72.52 163.893 m 486.378 163.893 l S 72.52 148.72 m 486.378 148.72 l S 72.52 125.0431 m 486.378 125.0431 l 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re W n 1 g 0 768.661 0 0 re f Q /GS1 gs q 1 g 72.52 100.866 413.858 566.929 re f Q q BT /F3 1 Tf 11 0 0 11 72.5197 660.5117 Tm 0 Tr 0 g -0.008 Tc -0.03 Tw (Conseil, en compl\216ment, a aussi pour fonction)Tj 0 -1.0909 TD 0 Tc -0.02 Tw (de faire des recommandations au ministre sur)Tj T* -0.024 Tc -0.014 Tw (l\325\216tablissement et l\325\216volution des prix des m\216di-)Tj 0 -1.09091 TD -0.003 Tc -0.035 Tw (caments ainsi que sur toute autre question que)Tj 0 -1.0909 TD -0.006 Tc -0.031 Tw (celui-ci lui soumet. En 2007, le gouvernement)Tj 0.0249 Tc (a)' 0.79229 0 Td 0.025 Tc 0.048 Tw (adopt\216 une politique du m\216dicament qui)Tj -0.79229 -1.09091 TD 0.018 Tc 0.02 Tw [(confie une mission plus \216lar)18(gie au Conseil,)]TJ T* -0.009 Tc -0.029 Tw (comme nous le verrons dans le cadre de la dis-)Tj 0 -1.0909 TD 0.025 Tc 0.03 Tw (cussion. En compl\216ment, le bon usage des)Tj T* -0.017 Tc -0.02 Tw (m\216dicaments est laiss\216 en grande majorit\216 dans)Tj 0 -1.09091 TD 0 Tc 0 Tw (les mains des professionnels de la sant\216.)Tj 1.28847 -1.69744 TD -0.01 Tc -0.028 Tw (En proposant au CdM un m\216dicament pour)Tj -1.28847 -1.09091 TD -0.002 Tc -0.036 Tw (inscription au formulaire \210 un prix X, le fabri-)Tj 0 -1.0909 TD 0.025 Tc 0.307 Tw (cant soumet les \216tudes qui appuient sa)Tj 0 -1.09091 TD -0.022 Tc -0.016 Tw (demande. Le CdM \216value ces \216tudes et d\325autres)Tj T* 0.006 Tc 0.032 Tw (auxquelles il a acc\217s et fait sa recommanda-)Tj T* 0 Tc -0.013 Tw (tion au ministre \(acceptation sur la liste r\216gu-)Tj T* -0.001 Tc -0.037 Tw (li\217re, acceptation sur la liste des m\216dicaments)Tj T* 0.003 Tc 0.034 Tw (d\325exception, refus, ou report de la d\216cision\).)Tj T* -0.004 Tc -0.033 Tw (Le ministre peut accepter ou refuser la recom)Tj 17.70598 0.00001 TD 0 Tc (-)Tj -17.70598 -1.09091 TD 0.015 Tc 0.022 Tw (mandation du CdM. Sa d\216cision est ensuite)Tj T* 0 Tc -0.019 Tw (transmise au fabricant. Il n\325y a pas a de n\216go-)Tj T* 0.029 Tw [(ciation of)18(ficielle entre le fabricant et le CdM)]TJ T* -0.005 Tw (ou le ministre sur le m\216dicament ou son prix.)Tj T* -0.001 Tc -0.037 Tw (Mais, notons qu\325un fabricant peut exercer des)Tj T* -0.006 Tc -0.032 Tw (pressions politiques sur le ministre de la Sant\216)Tj T* -0.008 Tc -0.03 Tw (et des Services sociaux ou le premier ministre,)Tj T* 0 Tc -0.002 Tw (en faisant valoir l\325importance des emplois ou)Tj T* 0.026 Tw (des investissements qu\325il g\216n\217re dans la pro-)Tj T* -0.003 Tc -0.034 Tw [(vince. Ce genre d\325ar)18(gument peut jouer dans la)]TJ T* 0.015 Tc 0.023 Tw (d\216cision du ministre de la Sant\216 et des Ser)Tj 17.70589 0 TD 0 Tc (-)Tj -17.70589 -1.09091 TD -0.037 Tw (vices sociaux ou du gouvernement d\325accepter)Tj T* 0.004 Tc 0.033 Tw (un m\216dicament ou non, ind\216pendamment de)Tj T* 0 Tc 0 Tw (la recommandation du CdM.)Tj ET Q q BT /F0 1 Tf 11 0 0 11 72.5197 235.5918 Tm 0 Tr 0 g 0 Tc 0 Tw (c. \203valuation des co\236ts du r\216gime)Tj ET Q q BT /F3 1 Tf 11 0 0 11 86.6929 211.2505 Tm 0 Tr 0 g 0.007 Tc 0.03 Tw (En 2005, le co\236t des m\216dicaments repr\216)Tj 16.41738 0.00001 TD 0 Tc (-)Tj -17.70585 -1.09091 TD 0.013 Tw [(sentait 20)-263(% des d\216penses totales de sant\216 au)]TJ T* 0.025 Tc 0.033 Tw (Qu\216bec, compar\216 \210 17,5)Tj 10.64708 0.00001 TD 0.0249 Tc (%)Tj 1.166 0 Td 0.025 Tc [(au Canada. )55(Au)]TJ -11.81308 -1.09091 TD 0.015 Tc 0.022 Tw (cours de cette m\220me ann\216e, l\325augmentation)Tj T* 0 Tc -0.011 Tw (des co\236ts de l\325assurance m\216dicaments pris en)Tj T* -0.008 Tc 0 Tw (char)Tj 1.67102 0.00001 TD -0.03 Tw (ge par la partie publique et priv\216e du Qu\216-)Tj -1.67102 -1.09091 TD 0.012 Tc 0.025 Tw (bec a augment\216 de 3)Tj 8.78114 0.00001 TD (%, moins que pour les)Tj -8.78114 -1.09091 TD -0.006 Tc -0.032 Tw [(autres plans canadiens (voir tableau 2). L)92(\325aug-)]TJ T* -0.025 Tc -0.013 Tw (mentation annuelle des co\236ts au Qu\216bec a beau-)Tj T* 0.013 Tc 0.025 Tw (coup fluctu\216 entre 1998 et 2005, passant de)Tj ET 1 g 72.52 673.4641 413.858 31.181 re f Q q BT /F0 1 Tf 11 0 0 11 73.5197 696.1231 Tm 0 Tr 0 g 0 Tc (8)Tj ET Q q BT /F3 1 Tf 10 0 0 10 262.7315 696.1231 Tm 0 Tr 0 g -0.0001 Tc (L)Tj 0.61089 0.00001 TD (e)Tj 0.69379 0 Td 0 Tc 0 Tw (r\216gime g\216n\216ral d\325assurance m\216dicaments au Qu\216bec)Tj ET 1 g 72.52 61.157 413.858 13.008 re f Q q BT /F0 1 Tf 8 0 0 8 357.5615 67.6942 Tm 0 Tr 0 g 0 Tc 0 Tw [(JOURNAL)-232(D\325\203CONOMIE M\203DICALE)]TJ ET Q q BT /F2 1 Tf 0 10 -10 0 295.7911 103.1843 Tm 0 Tr 0 g 0 Tc (T)Tj 0.5602 0 TD -0.0141 Tc (a)Tj 0.48493 0 TD (b)Tj 0.54093 0 TD (l)Tj 0.26293 0 TD (e)Tj 0.42893 0 TD (a)Tj 0.48493 0 TD (u)Tj 0.77686 0 TD (2)Tj 0.594 0 TD -0.0142 Tc (:)Tj 0.55369 0 TD (D)Tj 0.70684 0 TD <8E>Tj 0.42884 0 TD (p)Tj 0.54084 0 TD (e)Tj 0.42884 0 TD (n)Tj 0.54084 0 TD (s)Tj 0.37384 0 TD (e)Tj 0.42884 0 TD (s)Tj 0.60969 0 TD (e)Tj 0.42884 0 TD (n)Tj 0.77669 0 TD (m)Tj 0.81684 0 TD <8E>Tj 0.42884 0 TD (d)Tj 0.54084 0 TD (i)Tj 0.26284 0 TD (c)Tj 0.42884 0 TD (a)Tj 0.48484 0 TD (m)Tj 0.81684 0 TD (e)Tj 0.42884 0 TD (n)Tj 0.54084 0 TD (t)Tj 0.31784 0 TD (s)Tj 0.60969 0 TD (p)Tj 0.54084 0 TD (e)Tj 0.42884 0 TD (r)Tj 0.64519 0 TD (c)Tj 0.42881 0 TD (a)Tj 0.48481 0 TD (p)Tj 0.54081 0 TD (i)Tj 0.26281 0 TD (t)Tj 0.31781 0 TD (a)Tj 0.48481 0 TD (,)Tj 0.47162 0 TD (p)Tj 0.54081 0 TD (a)Tj 0.48481 0 TD (r)Tj 0.64518 0 TD -0.0138 Tc (s)Tj 0.37422 0 TD (o)Tj 0.48522 0 TD (u)Tj 0.54122 0 TD (r)Tj 0.41019 0 TD -0.0142 Tc (c)Tj 0.42879 0 TD (e)Tj 0.66459 0 TD (d)Tj 0.54079 0 TD (e)Tj 0.66459 0 TD (f)Tj 0.31779 0 TD (i)Tj 0.26279 0 TD (n)Tj 0.54079 0 TD (a)Tj 0.48479 0 TD (n)Tj 0.54079 0 TD (c)Tj 0.42879 0 TD (e)Tj 0.42879 0 TD (m)Tj 0.81679 0 TD (e)Tj 0.42879 0 TD (n)Tj 0.54079 0 TD (t)Tj 0.55359 0 TD (e)Tj 0.42879 0 TD (t)Tj 0.55359 0 TD (p)Tj 0.54079 0 TD (a)Tj 0.48479 0 TD (r)Tj 0.64518 0 TD -0.0139 Tc (r)Tj 0.42911 0 TD <8E>Tj 0.42911 0 TD (p)Tj 0.54111 0 TD (a)Tj 0.48511 0 TD (r)Tj 0.428 0 TD -0.0142 Tc (t)Tj 0.31778 0 TD (i)Tj 0.26278 0 TD (t)Tj 0.31778 0 TD (i)Tj 0.26278 0 TD (o)Tj 0.48478 0 TD (n)Tj 0.77656 0 TD (p)Tj 0.54078 0 TD (u)Tj 0.54078 0 TD (b)Tj 0.54078 0 TD (l)Tj 0.26278 0 TD (i)Tj 0.26278 0 TD (x)Tj 0.48478 0 TD (/)Tj 0.26278 0 TD (p)Tj 0.54078 0 TD (r)Tj 0.42878 0 TD (i)Tj 0.26278 0 TD (v)Tj 0.48478 0 TD <8E>Tj 0.66456 0 TD (a)Tj 0.48478 0 TD (u)Tj 0.77656 0 TD (Q)Tj 0.76178 0 TD (u)Tj 0.54078 0 TD <8E>Tj 0.42878 0 TD (b)Tj 0.54078 0 TD (e)Tj 0.42878 0 TD (c)Tj 0.66456 0 TD (e)Tj 0.42878 0 TD (t)Tj 0.55356 0 TD (a)Tj 0.48478 0 TD (u)Tj 0.77656 0 TD (C)Tj 0.70678 0 TD (a)Tj 0.48478 0 TD (n)Tj 0.54078 0 TD (a)Tj 0.48478 0 TD (d)Tj 0.54078 0 TD (a)Tj 0.72056 0 TD ([)Tj 0.31778 0 TD (1)Tj 0.48478 0 TD (9)Tj 0.48478 0 TD (])Tj 0.31778 0 TD (.)Tj ET 1 g 304.3406 100.8659 69.069 36.924 re f Q q BT /F2 1 Tf 0 9 -9 0 341.2266 105.5812 Tm 0 Tr 0 g 0.0011 Tc (A)Tj 0.72207 0 TD (n)Tj 0.55607 0 TD (n)Tj 0.55607 0 TD <8E>Tj 0.44407 0 TD (e)Tj 0.44407 0 TD (s)Tj ET 1 g 304.3409 137.7901 27.617 198.564 re f BT /F2 1 Tf 0 9 -9 0 320.5007 175.0838 Tm 0 g 0 Tc (T)Tj 0.5752 0 TD 0.0009 Tc (o)Tj 0.49988 0 TD (u)Tj 0.55588 0 TD (s)Tj 0.63977 0 TD (l)Tj 0.27788 0 TD (e)Tj 0.44388 0 TD (s)Tj 0.63977 0 TD (m)Tj 0.83188 0 TD <8E>Tj 0.44388 0 TD (d)Tj 0.55588 0 TD (i)Tj 0.27788 0 TD (c)Tj 0.44388 0 TD (a)Tj 0.49988 0 TD (m)Tj 0.83188 0 TD (e)Tj 0.44388 0 TD (n)Tj 0.55588 0 TD (t)Tj 0.33288 0 TD (s)Tj 0.63977 0 TD (p)Tj 0.55588 0 TD (e)Tj 0.44388 0 TD (r)Tj 0.67517 0 TD 0.0011 Tc (c)Tj 0.44407 0 TD (a)Tj 0.50007 0 TD (p)Tj 0.55607 0 TD (i)Tj 0.27807 0 TD (t)Tj 0.33307 0 TD (a)Tj ET 1 g 304.3408 336.3537 54.734 99.283 re f BT /F2 1 Tf 0 9 -9 0 328.6593 349.8766 Tm 0 g 0.001 Tc (%)Tj 1.25005 0 TD (d)Tj 0.55603 0 TD Tj 0.33302 0 TD (a)Tj 0.50002 0 TD (u)Tj 0.55603 0 TD (g)Tj 0.50002 0 TD (m)Tj 0.83202 0 TD (e)Tj 0.44402 0 TD (n)Tj 0.55603 0 TD (t)Tj 0.33302 0 TD (a)Tj 0.50002 0 TD (t)Tj 0.33302 0 TD (i)Tj 0.27802 0 TD (o)Tj 0.50002 0 TD (n)Tj -7.65227 -1.19999 TD 0.0009 Tc (a)Tj 0.49989 0 TD (n)Tj 0.55589 0 TD (n)Tj 0.55589 0 TD (u)Tj 0.55589 0 TD (e)Tj 0.44389 0 TD (l)Tj 0.27789 0 TD (l)Tj 0.27789 0 TD (e)Tj 0.69479 0 TD (a)Tj 0.49989 0 TD (u)Tj 0.80678 0 TD (Q)Tj 0.77689 0 TD (u)Tj 0.55589 0 TD <8E>Tj 0.44389 0 TD (b)Tj 0.55589 0 TD (e)Tj 0.44389 0 TD (c)Tj ET 1 g 304.34 435.6359 54.735 99.283 re f BT /F2 1 Tf 0 9 -9 0 328.6593 449.1588 Tm 0 g 0.001 Tc (%)Tj 1.25005 0 TD (d)Tj 0.55603 0 TD Tj 0.33302 0 TD (a)Tj 0.50002 0 TD (u)Tj 0.55603 0 TD (g)Tj 0.50002 0 TD (m)Tj 0.83202 0 TD (e)Tj 0.44403 0 TD (n)Tj 0.55602 0 TD (t)Tj 0.33303 0 TD (a)Tj 0.50003 0 TD (t)Tj 0.33303 0 TD (i)Tj 0.27803 0 TD (o)Tj 0.50003 0 TD (n)Tj -7.70856 -1.19999 TD 0.0009 Tc (a)Tj 0.49987 0 TD (n)Tj 0.55587 0 TD (n)Tj 0.55587 0 TD (u)Tj 0.55587 0 TD (e)Tj 0.44387 0 TD (l)Tj 0.27787 0 TD (l)Tj 0.27787 0 TD (e)Tj 0.69473 0 TD (a)Tj 0.49987 0 TD (u)Tj 0.80674 0 TD (C)Tj 0.72187 0 TD (a)Tj 0.49987 0 TD (n)Tj 0.55587 0 TD (a)Tj 0.49987 0 TD (d)Tj 0.55587 0 TD (a)Tj ET 1 g 304.3401 534.9182 54.735 66.189 re f BT /F2 1 Tf 0 9 -9 0 312.4592 547.644 Tm 0 g 0.0012 Tc (%)Tj 1.25038 0 TD (p)Tj 0.55619 0 TD (a)Tj 0.50019 0 TD (r)Tj 0.44299 0 TD 0.0009 Tc (t)Tj 0.3329 0 TD (a)Tj 0.4999 0 TD (g)Tj 0.4999 0 TD <8E>Tj -4.52717 -1.2 TD (d)Tj 0.55589 0 TD (e)Tj 0.44389 0 TD (s)Tj 0.63977 0 TD (d)Tj 0.55589 0 TD <8E>Tj 0.44389 0 TD (p)Tj 0.55589 0 TD (e)Tj 0.44389 0 TD (n)Tj 0.55589 0 TD (s)Tj 0.38889 0 TD (e)Tj 0.44389 0 TD (s)Tj -3.70792 -1.2 TD (t)Tj 0.33288 0 TD (o)Tj 0.49988 0 TD (t)Tj 0.33288 0 TD (a)Tj 0.49988 0 TD (l)Tj 0.27788 0 TD (e)Tj 0.44387 0 TD (s)Tj -4.42827 -1.19999 TD (d)Tj 0.55594 0 TD (e)Tj 0.69488 0 TD (m)Tj 0.83194 0 TD <8E>Tj 0.44394 0 TD (d)Tj 0.55594 0 TD (i)Tj 0.27794 0 TD (c)Tj 0.44394 0 TD (a)Tj 0.49994 0 TD (m)Tj 0.83194 0 TD (e)Tj 0.44394 0 TD (n)Tj 0.55594 0 TD (t)Tj 0.33294 0 TD (s)Tj -5.30368 -1.2 TD 0.001 Tc (a)Tj 0.50001 0 TD (u)Tj 0.80703 0 TD (Q)Tj 0.77701 0 TD (u)Tj 0.55602 0 TD <8E>Tj 0.44401 0 TD (b)Tj 0.55602 0 TD (e)Tj 0.44401 0 TD (c)Tj ET 1 g 304.3403 601.1063 54.734 66.189 re f BT /F2 1 Tf 0 9 -9 0 312.4593 613.8323 Tm 0 g 0.0012 Tc (%)Tj 1.25038 0 TD (p)Tj 0.55619 0 TD (a)Tj 0.50019 0 TD (r)Tj 0.44299 0 TD 0.0009 Tc (t)Tj 0.3329 0 TD (a)Tj 0.4999 0 TD (g)Tj 0.4999 0 TD <8E>Tj -4.52717 -1.19999 TD (d)Tj 0.55589 0 TD (e)Tj 0.44389 0 TD (s)Tj 0.63977 0 TD (d)Tj 0.55589 0 TD <8E>Tj 0.44389 0 TD (p)Tj 0.55589 0 TD (e)Tj 0.44389 0 TD (n)Tj 0.55589 0 TD (s)Tj 0.38889 0 TD (e)Tj 0.44389 0 TD (s)Tj -3.70792 -1.2 TD (t)Tj 0.33288 0 TD (o)Tj 0.49988 0 TD (t)Tj 0.33288 0 TD (a)Tj 0.49988 0 TD (l)Tj 0.27788 0 TD (e)Tj 0.44387 0 TD (s)Tj -4.42827 -1.2 TD (d)Tj 0.55594 0 TD (e)Tj 0.69488 0 TD (m)Tj 0.83194 0 TD <8E>Tj 0.44394 0 TD (d)Tj 0.55594 0 TD (i)Tj 0.27794 0 TD (c)Tj 0.44394 0 TD (a)Tj 0.49994 0 TD (m)Tj 0.83194 0 TD (e)Tj 0.44394 0 TD (n)Tj 0.55594 0 TD (t)Tj 0.33294 0 TD (s)Tj -5.35996 -1.19999 TD 0.001 Tc (a)Tj 0.49995 0 TD (u)Tj 0.80691 0 TD (C)Tj 0.72195 0 TD (a)Tj 0.49995 0 TD (n)Tj 0.55596 0 TD (a)Tj 0.49995 0 TD (d)Tj 0.55596 0 TD (a)Tj ET 1 g 331.9579 137.7898 27.117 99.282 re f BT /F2 1 Tf 0 9 -9 0 347.6178 159.6904 Tm 0 g 0.0009 Tc (A)Tj 0.72188 0 TD (u)Tj 0.80676 0 TD (Q)Tj 0.77688 0 TD (u)Tj 0.55588 0 TD <8E>Tj 0.44388 0 TD (b)Tj 0.55588 0 TD (e)Tj 0.44388 0 TD (c)Tj 0.69476 0 TD (\()Tj 0.33288 0 TD ($)Tj 0.49988 0 TD (\))Tj ET 1 g 331.9571 237.0719 27.118 99.282 re f BT /F2 1 Tf 0 9 -9 0 347.6178 258.466 Tm 0 g 0.0008 Tc (A)Tj 0.72184 0 TD (u)Tj 0.80669 0 TD (C)Tj 0.72184 0 TD (a)Tj 0.49984 0 TD (n)Tj 0.55584 0 TD (a)Tj 0.49984 0 TD (d)Tj 0.55584 0 TD (a)Tj 0.75068 0 TD (\()Tj 0.33284 0 TD ($)Tj 0.49984 0 TD (\))Tj ET 1 g 359.0746 137.7898 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3436 142.087 Tm 0 g 0.001 Tc (P)Tj 0.61103 0 TD (u)Tj 0.55603 0 TD (b)Tj 0.55603 0 TD (l)Tj 0.27803 0 TD (i)Tj 0.27803 0 TD (c)Tj ET 1 g 359.0748 170.8838 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3437 177.1871 Tm 0 g 0.0011 Tc (P)Tj 0.61109 0 TD (r)Tj 0.44409 0 TD (i)Tj 0.27809 0 TD (v)Tj 0.50009 0 TD <8E>Tj ET 1 g 359.0749 203.9779 14.334 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3437 210.6888 Tm 0 g 0 Tc (T)Tj 0.5752 0 TD 0.0012 Tc (o)Tj 0.5002 0 TD (t)Tj 0.3332 0 TD (a)Tj 0.5002 0 TD (l)Tj ET 1 g 359.0749 237.072 14.334 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3436 241.3692 Tm 0 g 0.001 Tc (P)Tj 0.61103 0 TD (u)Tj 0.55603 0 TD (b)Tj 0.55603 0 TD (l)Tj 0.27803 0 TD (i)Tj 0.27803 0 TD (c)Tj ET 1 g 359.075 270.1661 14.334 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3438 276.4694 Tm 0 g 0.0011 Tc (P)Tj 0.61109 0 TD (r)Tj 0.44409 0 TD (i)Tj 0.27809 0 TD (v)Tj 0.50009 0 TD <8E>Tj ET 1 g 359.0751 303.2602 14.334 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3437 309.9711 Tm 0 g 0 Tc (T)Tj 0.5752 0 TD 0.0012 Tc (o)Tj 0.5002 0 TD (t)Tj 0.3332 0 TD (a)Tj 0.5002 0 TD (l)Tj ET 1 g 359.0751 336.3543 14.334 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3436 340.6515 Tm 0 g 0.001 Tc (P)Tj 0.61103 0 TD (u)Tj 0.55603 0 TD (b)Tj 0.55603 0 TD (l)Tj 0.27803 0 TD (i)Tj 0.27803 0 TD (c)Tj ET 1 g 359.0742 369.4483 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3437 375.7516 Tm 0 g 0.0011 Tc (P)Tj 0.61109 0 TD (r)Tj 0.44409 0 TD (i)Tj 0.27809 0 TD (v)Tj 0.50009 0 TD <8E>Tj ET 1 g 359.0743 402.5423 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3437 409.2532 Tm 0 g 0 Tc (T)Tj 0.5752 0 TD 0.0012 Tc (o)Tj 0.5002 0 TD (t)Tj 0.3332 0 TD (a)Tj 0.5002 0 TD (l)Tj ET 1 g 359.0743 435.6365 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3436 439.9337 Tm 0 g 0.001 Tc (P)Tj 0.61103 0 TD (u)Tj 0.55603 0 TD (b)Tj 0.55603 0 TD (l)Tj 0.27803 0 TD (i)Tj 0.27803 0 TD (c)Tj ET 1 g 359.0744 468.7306 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3436 475.0338 Tm 0 g 0.0011 Tc (P)Tj 0.61109 0 TD (r)Tj 0.44409 0 TD (i)Tj 0.27809 0 TD (v)Tj 0.50009 0 TD <8E>Tj ET 1 g 359.0745 501.8246 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3437 508.5354 Tm 0 g 0 Tc (T)Tj 0.5752 0 TD 0.0012 Tc (o)Tj 0.5002 0 TD (t)Tj 0.3332 0 TD (a)Tj 0.5002 0 TD (l)Tj ET 1 g 359.0746 534.9186 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3437 539.2158 Tm 0 g 0.001 Tc (P)Tj 0.61104 0 TD (u)Tj 0.55604 0 TD (b)Tj 0.55604 0 TD (l)Tj 0.27803 0 TD (i)Tj 0.27803 0 TD (c)Tj ET 1 g 359.0746 568.0127 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3436 574.316 Tm 0 g 0.0011 Tc (P)Tj 0.61109 0 TD (r)Tj 0.44409 0 TD (i)Tj 0.27809 0 TD (v)Tj 0.50009 0 TD <8E>Tj ET 1 g 359.0747 601.1069 14.335 33.094 re f BT /F2 1 Tf 0 9 -9 0 368.3436 605.404 Tm 0 g 0.001 Tc (P)Tj 0.61104 0 TD (u)Tj 0.55604 0 TD (b)Tj 0.55604 0 TD (l)Tj 0.27803 0 TD (i)Tj 0.27803 0 TD (c)Tj ET 1 g 359.0748 634.201 14.334 33.594 re f BT /F2 1 Tf 0 9 -9 0 368.3437 640.5043 Tm 0 g 0.0011 Tc (P)Tj 0.61109 0 TD (r)Tj 0.44409 0 TD (i)Tj 0.27809 0 TD (v)Tj 0.50009 0 TD <8E>Tj ET 1 g 373.4093 100.8661 14.059 36.924 re f BT /F2 1 Tf 0 9 -9 0 382.4132 111.995 Tm 0 g 0.0013 Tc (1)Tj 0.50033 0 TD (9)Tj 0.50033 0 TD (9)Tj 0.50033 0 TD (8)Tj ET 1 g 373.4093 137.7902 14.059 33.094 re f Q q BT /F3 1 Tf 0 9 -9 0 382.5402 149.0042 Tm 0 Tr 0 g 0 Tc (1)Tj 0.5 0 TD (4)Tj 0.5 0 TD (1)Tj ET 1 g 373.4094 170.8842 14.0579 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5403 182.0981 Tm 0 g (2)Tj 0.5 0 TD (5)Tj 0.5 0 TD (2)Tj ET 1 g 373.4095 203.9783 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5403 215.1922 Tm 0 g (3)Tj 0.5 0 TD (9)Tj 0.5 0 TD (3)Tj ET 1 g 373.4095 237.0724 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5402 248.2863 Tm 0 g (1)Tj 0.5 0 TD (3)Tj 0.5 0 TD (3)Tj ET 1 g 373.4096 270.1664 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5403 281.3803 Tm 0 g (2)Tj 0.5 0 TD (8)Tj 0.5 0 TD (2)Tj ET 1 g 373.4097 303.2605 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5403 314.4744 Tm 0 g (4)Tj 0.5 0 TD (1)Tj 0.5 0 TD (5)Tj ET 1 g 373.4097 336.3546 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5402 346.4435 Tm 0 g (1)Tj 0.5 0 TD (4)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 373.4088 369.4487 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5403 381.7876 Tm 0 g (2)Tj 0.5 0 TD (,)Tj 0.25 0 TD (3)Tj ET 1 g 373.4089 402.5427 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5403 414.8816 Tm 0 g (6)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 373.4089 435.6368 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5402 445.8916 Tm 0 g (1)Tj 0.46313 0 TD (1)Tj 0.5 0 TD (,)Tj 0.25 0 TD (6)Tj ET 1 g 373.409 468.7309 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5402 481.0698 Tm 0 g (9)Tj 0.5 0 TD (,)Tj 0.25 0 TD (0)Tj ET 1 g 373.4091 501.8249 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5403 514.1638 Tm 0 g (9)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 373.4092 534.9191 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5403 545.008 Tm 0 g (3)Tj 0.5 0 TD (5)Tj 0.5 0 TD (,)Tj 0.25 0 TD (9)Tj ET 1 g 373.4092 568.0131 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5402 578.102 Tm 0 g (6)Tj 0.5 0 TD (4)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 373.4093 601.1072 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 382.5402 611.1961 Tm 0 g (3)Tj 0.5 0 TD (2)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 373.4094 634.2012 14.058 33.594 re f BT /F3 1 Tf 0 9 -9 0 382.5403 644.2901 Tm 0 g (6)Tj 0.5 0 TD (7)Tj 0.5 0 TD (,)Tj 0.25 0 TD (9)Tj ET 1 g 387.4679 100.8656 14.059 36.924 re f Q q BT /F2 1 Tf 0 9 -9 0 396.5989 111.9951 Tm 0 Tr 0 g 0.0013 Tc (1)Tj 0.50033 0 TD (9)Tj 0.50033 0 TD (9)Tj 0.50033 0 TD (9)Tj ET 1 g 387.4679 137.7896 14.059 33.094 re f Q q BT /F3 1 Tf 0 9 -9 0 396.5988 149.0041 Tm 0 Tr 0 g 0 Tc (1)Tj 0.5 0 TD (6)Tj 0.5 0 TD (7)Tj ET 1 g 387.468 170.8836 14.0579 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5989 182.0981 Tm 0 g (2)Tj 0.5 0 TD (8)Tj 0.5 0 TD (5)Tj ET 1 g 387.468 203.9777 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5988 215.1922 Tm 0 g (4)Tj 0.5 0 TD (5)Tj 0.5 0 TD (2)Tj ET 1 g 387.4681 237.0719 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5988 248.2864 Tm 0 g (1)Tj 0.5 0 TD (5)Tj 0.5 0 TD (1)Tj ET 1 g 387.4682 270.1659 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5989 281.3804 Tm 0 g (2)Tj 0.5 0 TD (9)Tj 0.5 0 TD (4)Tj ET 1 g 387.4683 303.2599 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5989 314.4745 Tm 0 g (4)Tj 0.5 0 TD (4)Tj 0.5 0 TD (5)Tj ET 1 g 387.4683 336.354 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5988 346.4435 Tm 0 g (1)Tj 0.5 0 TD (8)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 387.4674 369.4481 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5989 379.5376 Tm 0 g (1)Tj 0.5 0 TD (3)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 387.4675 402.5421 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5989 412.6316 Tm 0 g (1)Tj 0.5 0 TD (5)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 387.4675 435.6363 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5988 445.7257 Tm 0 g (1)Tj 0.5 0 TD (3)Tj 0.5 0 TD (,)Tj 0.25 0 TD (7)Tj ET 1 g 387.4676 468.7303 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5988 481.0699 Tm 0 g (5)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 387.4677 501.8244 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5989 514.1639 Tm 0 g (7)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 387.4677 534.9184 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5988 545.0079 Tm 0 g (3)Tj 0.5 0 TD (7)Tj 0.5 0 TD (,)Tj 0.25 0 TD (0)Tj ET 1 g 387.4678 568.0125 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5988 578.102 Tm 0 g (6)Tj 0.5 0 TD (3)Tj 0.5 0 TD (,)Tj 0.25 0 TD (0)Tj ET 1 g 387.4679 601.1066 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 396.5988 611.1961 Tm 0 g (3)Tj 0.5 0 TD (3)Tj 0.5 0 TD (,)Tj 0.25 0 TD (9)Tj ET 1 g 387.468 634.2007 14.058 33.594 re f BT /F3 1 Tf 0 9 -9 0 396.5989 644.2902 Tm 0 g (6)Tj 0.5 0 TD (6)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 401.5265 100.866 14.059 36.924 re f Q q BT /F2 1 Tf 0 9 -9 0 410.6575 111.995 Tm 0 Tr 0 g 0.0013 Tc (2)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (0)Tj ET 1 g 401.5265 137.79 14.059 33.094 re f Q q BT /F3 1 Tf 0 9 -9 0 410.6574 149.0041 Tm 0 Tr 0 g 0 Tc (2)Tj 0.5 0 TD (0)Tj 0.5 0 TD (3)Tj ET 1 g 401.5266 170.8841 14.0579 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6575 182.0982 Tm 0 g (3)Tj 0.5 0 TD (0)Tj 0.5 0 TD (5)Tj ET 1 g 401.5266 203.9781 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 215.1922 Tm 0 g (5)Tj 0.5 0 TD (0)Tj 0.5 0 TD (8)Tj ET 1 g 401.5267 237.0722 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6573 248.2863 Tm 0 g (1)Tj 0.5 0 TD (7)Tj 0.5 0 TD (4)Tj ET 1 g 401.5268 270.1663 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6575 281.3804 Tm 0 g (3)Tj 0.5 0 TD (1)Tj 0.5 0 TD (8)Tj ET 1 g 401.5268 303.2604 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 314.4745 Tm 0 g (4)Tj 0.5 0 TD (9)Tj 0.5 0 TD (2)Tj ET 1 g 401.5269 336.3544 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 346.4435 Tm 0 g (2)Tj 0.5 0 TD (1)Tj 0.5 0 TD (,)Tj 0.25 0 TD (9)Tj ET 1 g 401.526 369.4485 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6575 381.7876 Tm 0 g (7)Tj 0.5 0 TD (,)Tj 0.25 0 TD (6)Tj ET 1 g 401.526 402.5426 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 412.6317 Tm 0 g (1)Tj 0.5 0 TD (2)Tj 0.5 0 TD (,)Tj 0.25 0 TD (9)Tj ET 1 g 401.5261 435.6366 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 445.7257 Tm 0 g (1)Tj 0.5 0 TD (6)Tj 0.5 0 TD (,)Tj 0.25 0 TD (5)Tj ET 1 g 401.5262 468.7308 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 481.0699 Tm 0 g (9)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 401.5262 501.8248 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 512.0798 Tm 0 g (1)Tj 0.46313 0 TD (1)Tj 0.5 0 TD (,)Tj 0.25 0 TD (6)Tj ET 1 g 401.5263 534.9188 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 545.0079 Tm 0 g (4)Tj 0.5 0 TD (0)Tj 0.5 0 TD (,)Tj 0.25 0 TD (0)Tj ET 1 g 401.5264 568.0129 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 578.102 Tm 0 g (6)Tj 0.5 0 TD (0)Tj 0.5 0 TD (,)Tj 0.25 0 TD (0)Tj ET 1 g 401.5265 601.107 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 410.6574 611.196 Tm 0 g (3)Tj 0.5 0 TD (5)Tj 0.5 0 TD (,)Tj 0.25 0 TD (4)Tj ET 1 g 401.5266 634.2012 14.058 33.594 re f BT /F3 1 Tf 0 9 -9 0 410.6575 644.2902 Tm 0 g (6)Tj 0.5 0 TD (4)Tj 0.5 0 TD (,)Tj 0.25 0 TD (6)Tj ET 1 g 415.585 100.8654 14.059 36.924 re f Q q BT /F2 1 Tf 0 9 -9 0 424.716 111.995 Tm 0 Tr 0 g 0.0013 Tc (2)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (1)Tj ET 1 g 415.5851 137.7894 14.059 33.094 re f Q q BT /F3 1 Tf 0 9 -9 0 424.716 149.0041 Tm 0 Tr 0 g 0 Tc (2)Tj 0.5 0 TD (3)Tj 0.5 0 TD (4)Tj ET 1 g 415.5851 170.8835 14.0579 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 182.0982 Tm 0 g (3)Tj 0.5 0 TD (2)Tj 0.5 0 TD (6)Tj ET 1 g 415.5852 203.9776 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 215.1922 Tm 0 g (5)Tj 0.5 0 TD (6)Tj 0.5 0 TD (0)Tj ET 1 g 415.5853 237.0716 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 248.2863 Tm 0 g (1)Tj 0.5 0 TD (9)Tj 0.5 0 TD (7)Tj ET 1 g 415.5853 270.1657 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 281.3803 Tm 0 g (3)Tj 0.5 0 TD (4)Tj 0.5 0 TD (0)Tj ET 1 g 415.5854 303.2598 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 314.4744 Tm 0 g (5)Tj 0.5 0 TD (3)Tj 0.5 0 TD (7)Tj ET 1 g 415.5855 336.3538 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 346.4434 Tm 0 g (1)Tj 0.5 0 TD (5)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 415.5845 369.4479 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 381.7875 Tm 0 g (7)Tj 0.5 0 TD (,)Tj 0.25 0 TD (4)Tj ET 1 g 415.5846 402.542 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 412.6317 Tm 0 g (1)Tj 0.5 0 TD (0)Tj 0.5 0 TD (,)Tj 0.25 0 TD (7)Tj ET 1 g 415.5847 435.6361 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 445.7257 Tm 0 g (1)Tj 0.5 0 TD (4)Tj 0.5 0 TD (,)Tj 0.25 0 TD (6)Tj ET 1 g 415.5848 468.7301 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 481.0697 Tm 0 g (8)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 415.5848 501.8242 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 424.716 511.9138 Tm 0 g (1)Tj 0.5 0 TD (0)Tj 0.5 0 TD (,)Tj 0.25 0 TD (4)Tj ET 1 g 415.5849 534.9183 14.059 33.0941 re f BT /F3 1 Tf 0 9 -9 0 424.716 545.0079 Tm 0 g (4)Tj 0.5 0 TD (1)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 415.585 568.0123 14.059 33.0941 re f BT /F3 1 Tf 0 9 -9 0 424.716 578.1019 Tm 0 g (5)Tj 0.5 0 TD (8)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 415.5851 601.1064 14.059 33.0941 re f BT /F3 1 Tf 0 9 -9 0 424.716 611.196 Tm 0 g (3)Tj 0.5 0 TD (6)Tj 0.5 0 TD (,)Tj 0.25 0 TD (7)Tj ET 1 g 415.5851 634.2005 14.058 33.594 re f BT /F3 1 Tf 0 9 -9 0 424.716 644.2901 Tm 0 g (6)Tj 0.5 0 TD (3)Tj 0.5 0 TD (,)Tj 0.25 0 TD (3)Tj ET 1 g 429.6436 100.8659 14.059 36.924 re f Q q BT /F2 1 Tf 0 9 -9 0 438.7746 111.9951 Tm 0 Tr 0 g 0.0013 Tc (2)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (2)Tj ET 1 g 429.6436 137.7898 14.059 33.094 re f Q q BT /F3 1 Tf 0 9 -9 0 438.7745 149.0041 Tm 0 Tr 0 g 0 Tc (2)Tj 0.5 0 TD (6)Tj 0.5 0 TD (0)Tj ET 1 g 429.6437 170.8839 14.0579 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 182.0982 Tm 0 g (3)Tj 0.5 0 TD (5)Tj 0.5 0 TD (5)Tj ET 1 g 429.6438 203.978 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 215.1923 Tm 0 g (6)Tj 0.5 0 TD (1)Tj 0.5 0 TD (5)Tj ET 1 g 429.6438 237.0721 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7744 248.2864 Tm 0 g (2)Tj 0.5 0 TD (2)Tj 0.5 0 TD (0)Tj ET 1 g 429.6439 270.1661 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 281.3803 Tm 0 g (3)Tj 0.5 0 TD (6)Tj 0.5 0 TD (8)Tj ET 1 g 429.644 303.2602 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 314.4745 Tm 0 g (5)Tj 0.5 0 TD (8)Tj 0.5 0 TD (8)Tj ET 1 g 429.6441 336.3543 14.058 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 346.6094 Tm 0 g (1)Tj 0.46313 0 TD (1)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 429.6431 369.4483 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 381.7875 Tm 0 g (9)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 429.6432 402.5424 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 412.6317 Tm 0 g (1)Tj 0.5 0 TD (0)Tj 0.5 0 TD (,)Tj 0.25 0 TD (7)Tj ET 1 g 429.6433 435.6365 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 445.7257 Tm 0 g (1)Tj 0.5 0 TD (2)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 429.6433 468.7305 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7745 481.0697 Tm 0 g (9)Tj 0.5 0 TD (,)Tj 0.25 0 TD (4)Tj ET 1 g 429.6434 501.8246 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 511.9138 Tm 0 g (1)Tj 0.5 0 TD (0)Tj 0.5 0 TD (,)Tj 0.25 0 TD (6)Tj ET 1 g 429.6435 534.9187 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7746 545.0079 Tm 0 g (4)Tj 0.5 0 TD (2)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 429.6435 568.0129 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7745 578.1021 Tm 0 g (5)Tj 0.5 0 TD (7)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 429.6436 601.1069 14.059 33.094 re f BT /F3 1 Tf 0 9 -9 0 438.7745 611.1961 Tm 0 g (3)Tj 0.5 0 TD (7)Tj 0.5 0 TD (,)Tj 0.25 0 TD (4)Tj ET 1 g 429.6437 634.2009 14.058 33.594 re f BT /F3 1 Tf 0 9 -9 0 438.7746 644.2901 Tm 0 g (6)Tj 0.5 0 TD (2)Tj 0.5 0 TD (,)Tj 0.25 0 TD (6)Tj ET 1 g 443.7022 100.8652 14.059 36.924 re f Q q BT /F2 1 Tf 0 9 -9 0 452.8332 111.995 Tm 0 Tr 0 g 0.0013 Tc (2)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (3)Tj ET 1 g 443.7022 137.7893 14.059 33.095 re f Q q BT /F3 1 Tf 0 9 -9 0 452.8331 149.0041 Tm 0 Tr 0 g 0 Tc (2)Tj 0.5 0 TD (9)Tj 0.5 0 TD (2)Tj ET 1 g 443.7023 170.8833 14.0579 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8332 182.0981 Tm 0 g (3)Tj 0.5 0 TD (6)Tj 0.5 0 TD (9)Tj ET 1 g 443.7024 203.9774 14.058 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8332 215.1922 Tm 0 g (6)Tj 0.5 0 TD (6)Tj 0.5 0 TD (1)Tj ET 1 g 443.7024 237.0715 14.058 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8331 248.2863 Tm 0 g (2)Tj 0.5 0 TD (4)Tj 0.5 0 TD (2)Tj ET 1 g 443.7025 270.1655 14.058 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8332 281.3803 Tm 0 g (3)Tj 0.5 0 TD (9)Tj 0.5 0 TD (3)Tj ET 1 g 443.7026 303.2596 14.058 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8332 314.4745 Tm 0 g (6)Tj 0.5 0 TD (3)Tj 0.5 0 TD (5)Tj ET 1 g 443.7026 336.3537 14.058 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8331 346.4436 Tm 0 g (1)Tj 0.5 0 TD (3)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 443.7017 369.4478 14.059 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8332 381.7876 Tm 0 g (4)Tj 0.5 0 TD (,)Tj 0.25 0 TD (4)Tj ET 1 g 443.7018 402.5418 14.059 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8332 414.8816 Tm 0 g (8)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 443.7018 435.6359 14.059 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8331 445.8916 Tm 0 g (1)Tj 0.46313 0 TD (1)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 443.7019 468.73 14.059 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8331 481.0699 Tm 0 g (8)Tj 0.5 0 TD (,)Tj 0.25 0 TD (0)Tj ET 1 g 443.702 501.824 14.059 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8332 514.1638 Tm 0 g (9)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 443.7021 534.9182 14.059 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8332 545.0079 Tm 0 g (4)Tj 0.5 0 TD (4)Tj 0.5 0 TD (,)Tj 0.25 0 TD (2)Tj ET 1 g 443.7021 568.0121 14.059 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8331 578.102 Tm 0 g (5)Tj 0.5 0 TD (5)Tj 0.5 0 TD (,)Tj 0.25 0 TD (8)Tj ET 1 g 443.7022 601.1063 14.059 33.095 re f BT /F3 1 Tf 0 9 -9 0 452.8331 611.1961 Tm 0 g (3)Tj 0.5 0 TD (8)Tj 0.5 0 TD (,)Tj 0.25 0 TD (1)Tj ET 1 g 443.7023 634.2004 14.058 33.595 re f BT /F3 1 Tf 0 9 -9 0 452.8332 644.2902 Tm 0 g (6)Tj 0.5 0 TD (1)Tj 0.5 0 TD (,)Tj 0.25 0 TD (9)Tj ET 1 g 457.7608 100.8657 14.059 36.924 re f Q q BT /F2 1 Tf 0 9 -9 0 466.8918 111.9951 Tm 0 Tr 0 g 0.0013 Tc (2)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (0)Tj 0.50033 0 TD (4)Tj ET 1 g 457.7608 137.7898 14.059 33.094 re f Q q BT /F3 1 Tf 0 9 -9 0 466.8917 149.0042 Tm 0 Tr 0 g 0 Tc (3)Tj 0.5 0 TD (1)Tj 0.5 0 TD (4)Tj ET 1 g 457.7609 170.8839 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L)92(\325augmen-)]TJ 0 -1.0909 TD 0.02 Tw (tation la plus importante au Qu\216bec a eu lieu)Tj 0 -1.09091 TD 0.008 Tc 0.03 Tw [(entre 1999 et 2001, alors qu\325elle se chif)18(frait)]TJ T* 0 Tc 0.002 Tw [(en moyenne autour de 18,8)-252(% pour le r\216gime)]TJ 0 -1.0909 TD -0.011 Tc -0.026 Tw (public. 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Nos sources)]TJ T* -0.011 Tc -0.026 Tw (sont d\325anciens ministres de la Sant\216 et des Ser)Tj 17.70606 0.00001 TD 0 Tc (-)Tj -17.70606 -1.09091 TD 0.029 Tw (vices sociaux \(n =)Tj 7.62259 0.00001 TD (2\), des professionnels tra)Tj 10.08334 0.00001 TD (-)Tj -17.70593 -1.09092 TD -0.003 Tc -0.034 Tw (vaillant dans des compagnies d\325assurance pri-)Tj 0 -1.09091 TD 0.025 Tc 0.034 Tw (v\216e \(n =)Tj 3.86261 0.00001 TD (2\), des gestionnaires travaillant \210)Tj -3.86261 -1.09091 TD -0.007 Tc -0.031 Tw (l\325administration du programme \210 la RAMQ \(n)Tj T* -0.01 Tc -0.027 Tw [(=)-212(2\), des chercheurs \(n =)-213(2\), des personnes tra-)]TJ T* 0.019 Tc 0.018 Tw (vaillant dans l\325industrie pharmaceutique \(n)Tj 0 Tc (=)' 0.7523 0 TD -0.024 Tc -0.013 Tw (2\), des fonctionnaires du minist\217re de la Sant\216)Tj 18.83255 50.6601 TD -0.023 Tc -0.014 Tw [(et des Services sociaux \(n =)-213(4\), et des personnes)]TJ 0 -1.0909 TD -0.019 Tc -0.018 Tw (travaillant dans des associations ou des groupes)Tj T* 0.009 Tc 0.028 Tw [(d\325int\216r\220t \(n =)-288(5\). )18(T)70(ous ces entretiens ont \216t\216)]TJ 0 -1.09091 TD -0.018 Tc -0.02 Tw (r\216alis\216s en personne par deux chercheurs \(MPP)Tj 0 -1.0909 TD 0 Tc -0.006 Tw (et EM\) et la plupart \216taient faits sur le lieu de)Tj T* -0.003 Tc -0.035 Tw (travail des personnes interrog\216es \210 l\325aide d\325un)Tj 0 -1.09091 TD -0.007 Tc -0.03 Tw (guide d\325entretien semi-structur\216 (appendice 1))Tj T* -0.014 Tc -0.024 Tw (reprenant les trois phases du processus de prise)Tj 0 -1.0909 TD -0.023 Tw [(de d\216cision politique d\216crits par Kingdon [22])-111(:)]TJ T* -0.023 Tc -0.015 Tw ((1) l\325agenda gouvernemental (2), l\325agenda d\216ci-)Tj 0 -1.09091 TD 0 Tc -0.029 Tw (sionnel, (3) le choix d\325une politique. En com-)Tj T* 0.006 Tc 0.031 Tw [(pl\216ment, une quatri\217me phase a \216t\216 ajout\216e)-131(:)]TJ 0 -1.0909 TD 0 Tc 0.027 Tw (les d\216fis rencontr\216s par le r\216gime et les solu-)Tj T* -0.01 Tc -0.027 Tw (tions apport\216es. Le guide a \216t\216 pr\216-test\216 aupr\217s)Tj T* -0.014 Tc -0.024 Tw (de deux r\216pondants pour la compr\216hension des)Tj 0 -1.09091 TD -0.001 Tc -0.037 Tw (questions. Les entretiens ont \216t\216 r\216alis\216s entre)Tj T* 0.008 Tc 0.029 Tw (mars et septembre 2004. Chaque entretien a)Tj T* -0.002 Tc -0.036 Tw (dur\216 entre 60 et 90 minutes et a \216t\216 enregistr\216.)Tj T* -0.011 Tc -0.027 Tw (Les entrevues ont \216t\216 retranscrites par une pro)Tj 17.7058 0.00001 TD 0 Tc (-)Tj -17.7058 -1.09091 TD 0.005 Tc 0.032 Tw (fessionnelle. Chaque personne vue en entre-)Tj T* 0 Tc -0.021 Tw (tien a sign\216 un formulaire de consentement et)Tj -0.0086 Tc (a)' 0.6478 0 Td -0.009 Tc -0.029 Tw (eu la possibilit\216 de revoir la transcription. En)Tj -0.6478 -1.09091 TD 0 Tc -0.024 Tw (compl\216ment, nous avons consult\216 l\325ensemble)Tj T* -0.027 Tw (des documents of)Tj 6.92686 0 TD (ficiels et de travail ainsi que)Tj -6.92686 -1.09091 TD -0.015 Tw (les articles ou rapports publi\216s en lien avec la)Tj T* 0.011 Tc 0.026 Tw (r\216forme, de 1970 \210 nos jours. L)Tj 12.9722 0.00001 TD (\325analyse des)Tj -12.9722 -1.09091 TD 0.004 Tc 0.034 Tw (entretiens et des documents a \216t\216 r\216alis\216e de)Tj T* 0.025 Tc 0.098 Tw (mani\217re chronologique en reprenant les 4)Tj T* 0 Tc 0 Tw (p\216riodes qui nous int\216ressaient.)Tj ET Q q BT /F2 1 Tf 12 0 0 12 287.9527 294.854 Tm 0 Tr 0 g 0.001 Tc 0 Tw (III. D\203TERMINANTS DE MISE EN)Tj 0 -1.08333 TD (PLACE D\325UN NOUVEAU MOD\351LE)Tj ET Q q BT /F3 1 Tf 11 0 0 11 302.126 253.6219 Tm 0 Tr 0 g 0.025 Tc 0.013 Tw (Le r\216gime d\325assurance m\216dicaments du)Tj -1.28848 -1.09091 TD 0.023 Tc 0.015 Tw (Qu\216bec a \216t\216 implant\216 apr\217s des ann\216es de)Tj T* 0 Tc 0.006 Tw [(d\216bats dif)18(ficiles. Il est donc n\216cessaire d\325\216tu-)]TJ T* 0.01 Tw (dier les fondements historiques de la mise en)Tj T* 0.017 Tw (place du r\216gime pour comprendre les raisons)Tj T* 0.025 Tc 0.026 Tw (qui ont abouti au choix d\325un r\216gime mixte)Tj T* 0 Tc 0 Tw (public/priv\216.)Tj ET Q q BT /F2 1 Tf 11 0 0 11 287.9527 155.4827 Tm 0 Tr 0 g 0.001 Tc 0 Tw (A. Constat d\325iniquit\216)Tj ET Q q BT /F3 1 Tf 11 0 0 11 302.126 127.2505 Tm 0 Tr 0 g 0 Tc -0.011 Tw (Lorsqu\325en 1962, le Qu\216bec a mis en place)Tj -1.28848 -1.09091 TD 0.013 Tc 0.024 Tw (son assurance hospitalisation permettant un)Tj T* -0.011 Tc -0.027 Tw (acc\217s gratuit \210 toutes prestations r\216alis\216es dans)Tj ET 1 g 72.52 687.637 413.858 17.008 re f Q q BT /F3 1 Tf 10 0 0 10 73.5197 696.1231 Tm 0 Tr 0 g -0.0001 Tc (M)Tj 0.88886 0.00001 TD 0 Tc 0 Tw [(.-P)111(. Pomey)65(, P)110(.-G. Forest, E. Martin, )55(A. Beresniak)]TJ ET Q q BT /F0 1 Tf 11 0 0 11 479.8779 696.1231 Tm 0 Tr 0 g 0 Tc (9)Tj ET 1 g 72.52 61.657 413.858 13.0081 re f Q q BT /F0 1 Tf 8 0 0 8 73.5197 68.1942 Tm 0 Tr 0 g 0 Tc 0 Tw [(SEPTEMBRE-NOVEMBRE 2007)-250(\320 V)30(OL.)-250(25 \320 N\241)-250(5-6)]TJ ET Q q 1 g 29 755.661 185.6 14 re f BT /F4 1 Tf 8 0 0 8 33 759.661 Tm 0 Tr 0 g 0 Tc 0 Tw (1386-8 Pomey 11/12/07 12:00 Page 9)Tj ET 0 J 0 j 10 M []0 d 0.5 w 1 G 30 768.661 m 30 744.661 l 0 738.661 m 24 738.661 l 528.898 768.661 m 528.898 744.661 l 558.898 738.661 m 534.898 738.661 l 30 0 m 30 24 l 0 30 m 24 30 l 528.898 0 m 528.898 24 l 558.898 30 m 534.898 30 l S 0.25 w 0 G 30 768.661 m 30 744.661 l 0 738.661 m 24 738.661 l 528.898 768.661 m 528.898 744.661 l 558.898 738.661 m 534.898 738.661 l 30 0 m 30 24 l 0 30 m 24 30 l 528.898 0 m 528.898 24 l 558.898 30 m 534.898 30 l S 0.5 w 1 G 255.449 756.661 m 303.449 756.661 l 255.449 12 m 303.449 12 l 12 408.3305 m 12 360.3305 l 546.898 408.3305 m 546.898 360.3305 l 279.449 768.661 m 279.449 744.661 l 279.449 24 m 279.449 0 l 0 384.3305 m 24 384.3305 l 534.898 384.3305 m 558.898 384.3305 l 279.449 756.661 m 285.449 756.661 l 285.449 753.3473 282.7627 750.661 279.449 750.661 c 276.1353 750.661 273.449 753.3473 273.449 756.661 c 273.449 759.9747 276.1353 762.661 279.449 762.661 c 282.7627 762.661 285.449 759.9747 285.449 756.661 c 279.449 12 m 285.449 12 l 285.449 8.6863 282.7627 6 279.449 6 c 276.1353 6 273.449 8.6863 273.449 12 c 273.449 15.3137 276.1353 18 279.449 18 c 282.7627 18 285.449 15.3137 285.449 12 c 12 384.3305 m 18 384.3305 l 18 381.0168 15.3137 378.3305 12 378.3305 c 8.6863 378.3305 6 381.0168 6 384.3305 c 6 387.6443 8.6863 390.3305 12 390.3305 c 15.3137 390.3305 18 387.6443 18 384.3305 c 546.898 384.3305 m 552.898 384.3305 l 552.898 381.0168 550.2117 378.3305 546.898 378.3305 c 543.5843 378.3305 540.898 381.0168 540.898 384.3305 c 540.898 387.6443 543.5843 390.3305 546.898 390.3305 c 550.2117 390.3305 552.898 387.6443 552.898 384.3305 c S 0.25 w 0 G 255.449 756.661 m 303.449 756.661 l 255.449 12 m 303.449 12 l 12 408.3305 m 12 360.3305 l 546.898 408.3305 m 546.898 360.3305 l 279.449 768.661 m 279.449 744.661 l 279.449 24 m 279.449 0 l 0 384.3305 m 24 384.3305 l 534.898 384.3305 m 558.898 384.3305 l 279.449 756.661 m 285.449 756.661 l 285.449 753.3473 282.7627 750.661 279.449 750.661 c 276.1353 750.661 273.449 753.3473 273.449 756.661 c 273.449 759.9747 276.1353 762.661 279.449 762.661 c 282.7627 762.661 285.449 759.9747 285.449 756.661 c 279.449 12 m 285.449 12 l 285.449 8.6863 282.7627 6 279.449 6 c 276.1353 6 273.449 8.6863 273.449 12 c 273.449 15.3137 276.1353 18 279.449 18 c 282.7627 18 285.449 15.3137 285.449 12 c 12 384.3305 m 18 384.3305 l 18 381.0168 15.3137 378.3305 12 378.3305 c 8.6863 378.3305 6 381.0168 6 384.3305 c 6 387.6443 8.6863 390.3305 12 390.3305 c 15.3137 390.3305 18 387.6443 18 384.3305 c 546.898 384.3305 m 552.898 384.3305 l 552.898 381.0168 550.2117 378.3305 546.898 378.3305 c 543.5843 378.3305 540.898 381.0168 540.898 384.3305 c 540.898 387.6443 543.5843 390.3305 546.898 390.3305 c 550.2117 390.3305 552.898 387.6443 552.898 384.3305 c S Q endstream endobj 12 0 obj << /Length 12278 >> stream /GS0 gs q 0 0.661 558 768 re W n 1 g 0 768.661 0 0 re f Q /GS1 gs q 1 g 72.52 100.866 413.858 566.929 re f Q q BT /F3 1 Tf 11 0 0 11 72.5197 660.5117 Tm 0 Tr 0 g 0.017 Tc 0.02 Tw (une structure hospitali\217re, les m\216dicaments)Tj 0 -1.0909 TD 0.006 Tc 0.032 Tw (prescrits en dehors d\325un \216tablissement n\325ont)Tj T* 0 Tc -0.019 Tw [(pas \216t\216 inclus [23]. )55(Aussi, dans les ann\216es 70,)]TJ 0 -1.09091 TD -0.037 Tw (lorsque le co\236t des m\216dicaments a commenc\216)Tj 0 -1.0909 TD -0.0001 Tc <88>Tj 0.66505 0 Td 0 Tc -0.029 Tw (augmenter et \210 prendre une part plus impor-)Tj -0.66505 -1.0909 TD -0.005 Tc -0.033 Tw (tante des d\216penses de soins, les prestataires de)Tj 0 -1.09091 TD 0.004 Tc 0.034 Tw (la s\216curit\216 du revenu et les a\224n\216s b\216n\216ficiant)Tj T* 0.015 Tc 0.023 Tw (du revenu minimum garanti ont obtenu une)Tj 0 -1.0909 TD -0.007 Tc -0.031 Tw (couverture gratuite pour les m\216dicaments. Les)Tj T* 0.012 Tc 0.025 Tw (autres personnes \211g\216es devaient payer C$ 2)Tj 0 -1.09091 TD -0.003 Tc -0.035 Tw (par prescription jusqu\325\210 un plafond de C$ 100)Tj T* 0.012 Tc 0.025 Tw [(par ann\216e. En 1973, la circulaire \307)-288(Malades)]TJ 0 -1.0909 TD -0.011 Tc -0.026 Tw [(sur pied)-213(\310 a \216t\216 mise en place afin de permettre)]TJ -0.0127 Tc <88>' 0.64367 0 Td -0.013 Tc -0.025 Tw (des personnes atteintes de pathologies graves)Tj -0.64367 -1.0909 TD 0.013 Tc 0.024 Tw [(de pouvoir continuer \210 b\216n\216ficier)40(, \210 la suite)]TJ 0 -1.09091 TD 0.011 Tc 0.027 Tw (d\325une hospitalisation)Tj ET Q q BT /F3 1 Tf 6.6 0 0 6.6 167.2276 483.8117 Tm 0 Tr 0 g 0 Tc (6)Tj ET Q q BT /F3 1 Tf 11 0 0 11 170.598 480.5117 Tm 0 Tr 0 g 0.0106 Tc (,)Tj 0.54794 0 Td 0.011 Tc 0.027 Tw (de m\216dicaments gra)Tj 8.24185 0 TD 0 Tc (-)Tj -17.706 -1.09091 TD 0.021 Tw [(tuits. )18(T)70(outefois, des malades atteints d\325autres)]TJ T* 0.025 Tc 0.087 Tw (maladies pour lesquelles les m\216dicaments)Tj T* 0 Tc 0.035 Tw (\216taient tout aussi co\236teux n\325avaient pas droit)Tj -0.0001 Tc <88>' 0.67842 0 Td 0 Tc -0.015 Tw [(une couverture hors de l\325h\231pital. Or)40(, devant)]TJ -0.67842 -1.09091 TD 0.005 Tc 0.032 Tw (le manque de transparence des crit\217res utili)Tj 17.70584 0 TD 0 Tc (-)Tj -17.70584 -1.09091 TD -0.004 Tc -0.033 Tw (s\216s pour l\325inclusion d\325une maladie dans la cir)Tj 17.70596 0.00001 TD 0 Tc (-)Tj -17.70596 -1.09091 TD -0.014 Tc -0.023 Tw (culaire, un probl\217me d\325\216quit\216 et d\325\216thique s\325est)Tj T* -0.002 Tc -0.036 Tw (pos\216 puisque la circulaire agissait comme une)Tj T* 0 Tc 0.023 Tw [-273(loterie des maladies)-273(\310. Il \216tait donc devenu)]TJ T* 0.037 Tw (n\216cessaire de remplacer rapidement la circu)Tj 17.706 0.00001 TD (-)Tj -17.706 -1.09091 TD -0.004 Tw (laire \307)Tj 2.76779 0.00001 TD (Malades sur pied)Tj 7.06807 0.00001 TD -0.0001 Tc Tj 0.74568 0 Td 0 Tc (par un r\216gime plus)Tj -10.58154 -1.09091 TD 0.014 Tc 0.024 Tw (\216quitable. De plus, la r\216forme Rochon)Tj ET Q q BT /F3 1 Tf 6.6 0 0 6.6 247.1288 339.8117 Tm 0 Tr 0 g 0 Tc (7)Tj ET Q q BT /F3 1 Tf 11 0 0 11 250.52 336.5117 Tm 0 Tr 0 g 0.0138 Tc (,)Tj 0.55123 0 Td 0.014 Tc 0 Tw (qui)Tj -16.73307 -1.09091 TD -0.006 Tc -0.031 Tw (\216tait alors instaur\216e, avait comme pierre angu)Tj 17.70582 0 TD 0 Tc (-)Tj -17.70582 -1.09091 TD -0.021 Tc -0.017 Tw (laire le \307)Tj 3.46935 0.00001 TD 0 Tw (virage)Tj 2.58632 0 TD -0.0208 Tc Tj 0.6916 0 Td -0.021 Tc -0.017 Tw (ambulatoire. Cependant, pour)Tj -6.74726 -1.09091 TD -0.017 Tc -0.021 Tw (que la r\216forme puisse \220tre mise en place, il \216tait)Tj T* 0 Tc 0.004 Tw (n\216cessaire que les personnes puissent b\216n\216fi-)Tj T* 0.003 Tc 0.034 Tw (cier des m\220mes avantages, qu\325ils soient trai)Tj 17.70581 0.00001 TD 0 Tc (-)Tj -17.70581 -1.09091 TD 0.009 Tc 0.029 Tw (t\216s au sein d\325un \216tablissement de sant\216 qu\325\210)Tj T* -0.015 Tc -0.023 Tw [(l\325ext\216rieur)55(. )55(Aussi, la cr\216ation d\325un r\216gime d\325as-)]TJ T* 0 Tc 0.025 Tw (surance m\216dicaments devenait une condition)Tj T* 0 Tw (sine qua non de la r\216ussite de cette r\216forme.)Tj 1.28847 -1.82439 TD -0.01 Tw (Plusieurs commissions ont alors \216t\216 mises)Tj -1.28847 -1.09091 TD -0.018 Tc -0.019 Tw (en place. En 1996, le Comit\216 d\325experts sur l\325as-)Tj 0 -1.0909 TD -0.015 Tc -0.023 Tw (surance m\216dicaments, connu aussi sous le nom)Tj 0 -1.09091 TD -0.013 Tc -0.024 Tw (de comit\216 Castonguay [24] a \216tudi\216 quatre sc\216-)Tj 19.58482 44.33199 TD 0 Tc -0.033 Tw [(narios)-125(: (1) un r\216gime universel public)-125(; (2) un)]TJ 0 -1.0909 TD -0.003 Tc -0.034 Tw [(r\216gime universel priv\216)-122(; (3) un r\216gime \307)-213(catas-)]TJ 0 -1.09091 TD -0.007 Tc -0.03 Tw [(trophe)-213(\310 prot\216geant contre les d\216penses exces)1(-)]TJ T* 0 Tc 0 Tw [(sives)-125(; (4) un r\216gime mixte public/priv\216.)]TJ ET Q q BT /F2 1 Tf 11 0 0 11 287.9527 597.2434 Tm 0 Tr 0 g 0.001 Tc 0 Tw [(B. Recher)19(che d\325un compr)18(o)-1(m)-1(i)-1(s)]TJ ET Q q BT /F3 1 Tf 11 0 0 11 302.126 568.4434 Tm 0 Tr 0 g -0.007 Tc -0.031 Tw (La proposition d\325un r\216gime universel priv\216)Tj -1.28848 -1.0909 TD 0.01 Tc 0.028 Tw (a, d\217s le d\216part, \216t\216 rejet\216e par une majorit\216)Tj T* -0.014 Tc -0.024 Tw (d\325acteurs. Les compagnies d\325assurance ne sou-)Tj 0 -1.09091 TD -0.004 Tc -0.034 Tw [(haitaient pas devoir prendre en char)18(ge les per-)]TJ T* -0.002 Tc -0.035 Tw (sonnes peu ou pas solvables. Le r\216gime catas-)Tj 0 -1.0909 TD -0.019 Tc -0.018 Tw (trophe reprenait trop la structure de la circulaire)Tj T* 0.006 Tc 0.032 Tw [-287(Malades sur pied)-288(\310 en couvrant seulement)]TJ 0 -1.09091 TD 0 Tc 0.021 Tw (les m\216dicaments les plus co\236teux. Le r\216gime)Tj T* 0.025 Tc 0.023 Tw (universel public \216tait le sc\216nario favori du)Tj T* -0.007 Tc -0.031 Tw (ministre de la Sant\216 et des Services sociaux de)Tj T* -0.001 Tc -0.037 Tw (l\325\216poque, Jean Rochon, des pharmaciens hos)Tj 17.70598 0.00001 TD 0 Tc (-)Tj -17.70598 -1.09091 TD -0.021 Tc -0.017 Tw [(pitaliers et des groupes sociaux de gauche. )18(T)69(ou-)]TJ T* 0 Tc -0.034 Tw (tefois, les assureurs priv\216s y \216taient farouche)Tj 17.70593 0 TD (-)Tj -17.70593 -1.09091 TD -0.017 Tc -0.021 Tw (ment oppos\216s car ils perdaient ainsi des assur\216s)Tj T* 0 Tc -0.037 Tw [-213(int\216ressants)-213(\310. De plus, l\325arriv\216e massive de)]TJ T* -0.011 Tw (personnes dans le r\216gime public aurait oblig\216)Tj T* 0.025 Tc 0.119 Tw (le gouvernement \210 augmenter de mani\217re)Tj T* 0 Tc 0.017 Tw (importante les imp\231ts pour r\216cup\216rer C$ 895)Tj T* 0.014 Tc 0.024 Tw (millions que co\236teraient les primes. Finale)Tj 17.70604 0.00001 TD 0 Tc (-)Tj -17.70604 -1.09091 TD 0.012 Tw (ment, le r\216gime mixte permettait un compro)Tj 17.70593 0.00001 TD (-)Tj -17.70593 -1.09091 TD -0.005 Tc -0.032 Tw (mis en m\216nageant les assureurs priv\216s, en \216vi-)Tj T* 0.017 Tc 0.02 Tw (tant une augmentation des imp\231ts dans une)Tj T* 0.025 Tc 0.263 Tw (p\216riode o\235 le gouvernement cherchait \210)Tj T* 0.115 Tw (atteindre un d\216ficit z\216ro, en renflouant la)Tj T* 0 Tc -0.029 Tw (RAMQ par la participation de nouveaux coti)Tj 17.70592 0.00001 TD (-)Tj -17.70592 -1.09091 TD 0.021 Tc 0.016 Tw (sants tout en permettant \210 l\325ensemble de la)Tj T* 0.023 Tc 0.014 Tw (population de b\216n\216ficier d\325une couverture.)Tj T* -0.005 Tc -0.033 Tw (Suite au d\216p\231t du rapport Castonguay en mars)Tj T* 0 Tc 0.03 Tw (1996 [24], le ministre de la Sant\216 et des Ser-)Tj T* 0.026 Tw (vices sociaux a, en juin 1996, d\216pos\216 \210 l\325As-)Tj T* -0.002 Tc -0.036 Tw (sembl\216e Nationale son projet de loi proposant)Tj T* -0.018 Tc -0.019 Tw (un r\216gime mixte. 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Il s\325agit ici d\325une r\216forme men\216e dans le milieu des ann\216es 1990 par le ministre de la Sant\216 et des Services sociaux de)Tj T* 0 Tw [(l\325\216poque, Jean Rochon. 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Politique du m\216dicament)Tj ET Q q BT /F3 1 Tf 11 0 0 11 86.6929 271.2505 Tm 0 Tr 0 g 0.025 Tc 0.133 Tw (Une des critiques les plus persistantes)Tj -1.28847 -1.09091 TD 0 Tc -0.034 Tw [(envers le r\216gime qu\216b\216cois est la dif)18(ficult\216 de)]TJ T* -0.003 Tc -0.035 Tw (ma\224triser ses co\236ts. Entre 1997 et 2003, l\325aug)Tj 17.70602 0.00001 TD 0 Tc (-)Tj -17.70602 -1.09091 TD 0.004 Tc 0.033 Tw (mentation du co\236t des m\216dicaments a \216t\216 en)Tj T* -0.008 Tc -0.029 Tw (moyenne de 15)Tj 6.1554 0.00001 TD -0.0084 Tc (%)Tj 1.03701 0 Td -0.008 Tc (par an [29]. Une des raisons)Tj -7.19241 -1.09091 TD 0 Tc 0.015 Tw (\216voqu\216es est l\325absence de mesures cherchant)Tj -0.0054 Tc <88>' 0.65101 0 Td -0.005 Tc -0.032 Tw (introduire un bon usage du m\216dicament. Les)Tj -0.65101 -1.09091 TD -0.01 Tc -0.027 Tw (Qu\216b\216cois ont un des taux de prescriptions par)Tj T* 0.002 Tc 0.036 Tw (personne les plus \216lev\216s du Canada [30]. De)Tj T* -0.009 Tc -0.028 Tw (plus, une \216tude r\216alis\216e en 2004 aupr\217s de per-)Tj T* 0.007 Tc 0.03 Tw (sonnes \211g\216es vivant dans la ville de Qu\216bec)Tj T* 0.015 Tc 0.022 Tw (montrait que dans 54,7)Tj 9.85694 0.00001 TD 0.0153 Tc (%)Tj 1.1357 0 Td 0.015 Tc (des cas, les pres)Tj 6.7134 0.00001 TD 0 Tc (-)Tj -17.70604 -1.09092 TD -0.015 Tc -0.023 Tw (criptions \216taient non pertinentes en raison d\325in-)Tj T* 0.008 Tc 0.029 Tw (teractions m\216dicamenteuses, de dur\216e ou de)Tj T* 0.002 Tc 0.035 Tw (dosage faux ou encore inappropri\216s [31]. En)Tj 19.58482 50.66011 TD 0.006 Tc 0.031 Tw (ce qui concerne le co\236t des m\216dicaments, le)Tj 0 -1.10287 TD -0.003 Tc -0.035 Tw (Qu\216bec a, depuis 1994, mis en place une poli-)Tj T* 0.003 Tc 0.034 Tw (tique tr\217s controvers\216e de non-augmentation)Tj 0 -1.10288 TD 0 Tc 0.035 Tw (du prix des m\216dicaments [28] qui concernait)Tj 0 -1.10286 TD 0.011 Tw (les m\216dicaments d\216j\210 inscrits sur la Liste des)Tj 0 -1.10287 TD -0.002 Tw (m\216dicaments remboursables. En revanche, le)Tj T* -0.008 Tw (prix des nouveaux m\216dicaments \216tait prot\216g\216)Tj T* 0.025 Tc 0.041 Tw (pour 15 ans, en accord avec la r\217gle selon)Tj T* 0.001 Tc 0.037 Tw (laquelle un m\216dicament inscrit sur la Liste y)Tj T* -0.004 Tc -0.033 Tw (reste au moins 15 ans \(c\325est-\210-dire que le gou-)Tj T* 0 Tc 0.026 Tw (vernement rembourse le prix du m\216dicament)Tj T* -0.006 Tc -0.031 Tw (d\325origine\), m\220me si le brevet expire et que des)Tj T* -0.017 Tc -0.021 Tw (g\216n\216riques apparaissent sur le march\216 \210 un prix)Tj T* 0.013 Tc 0.024 Tw (plus bas. Finalement, alors que les pharma-)Tj T* 0 Tc 0.033 Tw (ciens au Qu\216bec ont le droit de substituer un)Tj 0 -1.10288 TD 0.01 Tc 0.028 Tw (m\216dicament de marque contre un g\216n\216rique)Tj 0 -1.10287 TD 0 Tc -0.036 Tw ((sauf notification du m\216decin), la substitution)Tj 0 -1.10288 TD -0.021 Tc -0.017 Tw (th\216rapeutique \(i.e. la substitution pour une autre)Tj 0 -1.10287 TD -0.018 Tc -0.02 Tw (formule pharmacologique\) n\325a jamais vraiment)Tj T* 0.002 Tc 0.035 Tw (\216t\216 d\216battue, malgr\216 les avantages potentiels)Tj T* 0 Tc 0 Tw (en terme de co\236ts.)Tj 1.28848 -2.13366 TD 0.025 Tc 0.353 Tw (En f\216vrier 2007, le gouvernement a)Tj -1.28848 -1.10287 TD 0.015 Tc 0.023 Tw (annonc\216, en contexte pr\216\216lectoral, le lance)Tj 17.70605 0 TD 0 Tc (-)Tj -17.70605 -1.10288 TD 0.011 Tc 0.027 Tw (ment de la Politique qu\216b\216coise du m\216dica)Tj 17.70591 0 TD 0 Tc (-)Tj -17.70591 -1.10288 TD -0.017 Tc -0.02 Tw (ment [28]. Cette politique consiste tout d\325abord)Tj 0 -1.10287 TD -0.0001 Tc <88>Tj 0.66511 0 Td 0 Tc -0.029 Tw (assouplir et \210 rendre plus transparent le pro)Tj 17.04083 0.00001 TD (-)Tj -17.70593 -1.10288 TD 0.01 Tc 0.027 Tw (cessus d\325inscription des m\216dicaments sur la)Tj 0 -1.10287 TD 0.004 Tc 0.034 Tw (liste du r\216gime en favorisant la participation)Tj T* 0.016 Tc 0.021 Tw (des cliniciens et des citoyens. Elle abolit la)Tj T* 0.012 Tc 0.026 Tw (politique de non-augmentation des prix \210 la)Tj T* 0.001 Tc 0.036 Tw (suite des pressions faites par les compagnies)Tj T* 0 Tc 0.015 Tw (pharmaceutiques qui avaient menac\216 le Qu\216-)Tj 0 -1.10288 TD -0.018 Tc -0.019 Tw (bec de retirer du march\216 certains de leurs m\216di-)Tj 0 -1.10287 TD 0 Tc -0.02 Tw (caments. \313 l\325heure actuelle, les ententes avec)Tj T* 0.025 Tc 0.054 Tw (les fabricants de m\216dicaments ne sont pas)Tj T* -0.01 Tc -0.028 Tw [(encore connues. )18(T)69(outefois, l\325augmentation des)]TJ T* -0.003 Tc -0.035 Tw (prix permise ne doit pas d\216passer le taux d\325in)Tj 17.70602 0.00001 TD 0 Tc (-)Tj -17.70602 -1.10288 TD 0.003 Tc 0.034 Tw (flation annuelle, sauf dans le cas de m\216dica-)Tj 0 -1.10287 TD 0 Tc 0.003 Tw (ments uniques. Le prix du m\216dicament g\216n\216-)Tj T* 0.025 Tc 0.323 Tw (rique sera fix\216 en fonction du prix du)Tj T* -0.006 Tc -0.032 Tw (m\216dicament de marque. Le premier g\216n\216rique)Tj -0.0212 Tc <88>' 0.63516 0 Td -0.021 Tc -0.016 Tw [(appara\224tre b\216n\216ficiera d\325un prix limit\216 \210 60)-213(%,)]TJ -0.63516 -1.10287 TD -0.015 Tc -0.023 Tw (le deuxi\217me et suivant \210 54)Tj 10.61775 0.00001 TD (%. De plus, on pr\216)Tj 7.0882 0.00001 TD 0 Tc (-)Tj -17.70596 -1.10288 TD 0.008 Tc 0.029 Tw (voit qu\325un service t\216l\216phonique, Info-M\216di)Tj 17.70593 0.00001 TD 0 Tc (-)Tj -17.70593 -1.10288 TD 0.011 Tc 0.026 Tw (caments, sera accessible en tout temps pour)Tj 0 -1.10287 TD -0.005 Tc -0.033 Tw (renseigner les personnes qui ont des questions)Tj ET 1 g 72.52 673.4641 413.858 31.181 re f Q q BT /F0 1 Tf 11 0 0 11 73.5197 696.1231 Tm 0 Tr 0 g 0 Tc 0 Tw (12)Tj ET Q q BT /F3 1 Tf 10 0 0 10 262.7315 696.1231 Tm 0 Tr 0 g -0.0001 Tc (L)Tj 0.61089 0.00001 TD (e)Tj 0.69379 0 Td 0 Tc 0 Tw (r\216gime g\216n\216ral d\325assurance m\216dicaments au Qu\216bec)Tj ET 1 g 72.52 61.157 413.858 13.008 re f Q q BT /F0 1 Tf 8 0 0 8 357.5615 67.6942 Tm 0 Tr 0 g 0 Tc 0 Tw [(JOURNAL)-232(D\325\203CONOMIE M\203DICALE)]TJ ET Q q 1 g 29 755.661 190.4 14 re f BT /F4 1 Tf 8 0 0 8 33 759.661 Tm 0 Tr 0 g 0 Tc 0 Tw (1386-8 Pomey 11/12/07 12:00 Page 12)Tj ET 0 J 0 j 10 M []0 d 0.5 w 1 G 30 768.661 m 30 744.661 l 0 738.661 m 24 738.661 l 528.898 768.661 m 528.898 744.661 l 558.898 738.661 m 534.898 738.661 l 30 0 m 30 24 l 0 30 m 24 30 l 528.898 0 m 528.898 24 l 558.898 30 m 534.898 30 l S 0.25 w 0 G 30 768.661 m 30 744.661 l 0 738.661 m 24 738.661 l 528.898 768.661 m 528.898 744.661 l 558.898 738.661 m 534.898 738.661 l 30 0 m 30 24 l 0 30 m 24 30 l 528.898 0 m 528.898 24 l 558.898 30 m 534.898 30 l S 0.5 w 1 G 255.449 756.661 m 303.449 756.661 l 255.449 12 m 303.449 12 l 12 408.3305 m 12 360.3305 l 546.898 408.3305 m 546.898 360.3305 l 279.449 768.661 m 279.449 744.661 l 279.449 24 m 279.449 0 l 0 384.3305 m 24 384.3305 l 534.898 384.3305 m 558.898 384.3305 l 279.449 756.661 m 285.449 756.661 l 285.449 753.3473 282.7627 750.661 279.449 750.661 c 276.1353 750.661 273.449 753.3473 273.449 756.661 c 273.449 759.9747 276.1353 762.661 279.449 762.661 c 282.7627 762.661 285.449 759.9747 285.449 756.661 c 279.449 12 m 285.449 12 l 285.449 8.6863 282.7627 6 279.449 6 c 276.1353 6 273.449 8.6863 273.449 12 c 273.449 15.3137 276.1353 18 279.449 18 c 282.7627 18 285.449 15.3137 285.449 12 c 12 384.3305 m 18 384.3305 l 18 381.0168 15.3137 378.3305 12 378.3305 c 8.6863 378.3305 6 381.0168 6 384.3305 c 6 387.6443 8.6863 390.3305 12 390.3305 c 15.3137 390.3305 18 387.6443 18 384.3305 c 546.898 384.3305 m 552.898 384.3305 l 552.898 381.0168 550.2117 378.3305 546.898 378.3305 c 543.5843 378.3305 540.898 381.0168 540.898 384.3305 c 540.898 387.6443 543.5843 390.3305 546.898 390.3305 c 550.2117 390.3305 552.898 387.6443 552.898 384.3305 c S 0.25 w 0 G 255.449 756.661 m 303.449 756.661 l 255.449 12 m 303.449 12 l 12 408.3305 m 12 360.3305 l 546.898 408.3305 m 546.898 360.3305 l 279.449 768.661 m 279.449 744.661 l 279.449 24 m 279.449 0 l 0 384.3305 m 24 384.3305 l 534.898 384.3305 m 558.898 384.3305 l 279.449 756.661 m 285.449 756.661 l 285.449 753.3473 282.7627 750.661 279.449 750.661 c 276.1353 750.661 273.449 753.3473 273.449 756.661 c 273.449 759.9747 276.1353 762.661 279.449 762.661 c 282.7627 762.661 285.449 759.9747 285.449 756.661 c 279.449 12 m 285.449 12 l 285.449 8.6863 282.7627 6 279.449 6 c 276.1353 6 273.449 8.6863 273.449 12 c 273.449 15.3137 276.1353 18 279.449 18 c 282.7627 18 285.449 15.3137 285.449 12 c 12 384.3305 m 18 384.3305 l 18 381.0168 15.3137 378.3305 12 378.3305 c 8.6863 378.3305 6 381.0168 6 384.3305 c 6 387.6443 8.6863 390.3305 12 390.3305 c 15.3137 390.3305 18 387.6443 18 384.3305 c 546.898 384.3305 m 552.898 384.3305 l 552.898 381.0168 550.2117 378.3305 546.898 378.3305 c 543.5843 378.3305 540.898 381.0168 540.898 384.3305 c 540.898 387.6443 543.5843 390.3305 546.898 390.3305 c 550.2117 390.3305 552.898 387.6443 552.898 384.3305 c S Q endstream endobj 15 0 obj << /Length 12199 >> stream /GS0 gs q 0 0.661 558 768 re W n 1 g 0 768.661 0 0 re f Q /GS1 gs q 1 g 72.52 100.866 413.858 566.929 re f Q q BT /F3 1 Tf 11 0 0 11 72.5197 660.5117 Tm 0 Tr 0 g -0.001 Tc -0.037 Tw (sur les m\216dicaments et leurs usages. Un enca-)Tj 0 -1.0909 TD 0.001 Tc 0.037 Tw (drement plus s\216v\217re de la promotion et de la)Tj T* -0.004 Tc -0.034 Tw (publicit\216 des m\216dicaments est aussi pr\216vu. De)Tj 0 -1.09091 TD -0.001 Tc -0.036 Tw (plus, une campagne grand public, bas\216e sur le)Tj 0 -1.0909 TD 0.013 Tc 0.024 Tw (mod\217le fran\215ais de sensibilisation aux bons)Tj T* -0.014 Tc -0.024 Tw (usages du m\216dicament, est pr\216vue. Enfin, \216tant)Tj 0 -1.09091 TD -0.013 Tc (donn\216 que le Qu\216bec se distingue d\325autres pro-)Tj T* -0.017 Tc -0.021 Tw (vinces canadiennes par la multiplicit\216 de si\217ges)Tj 0 -1.0909 TD 0.008 Tc 0.029 Tw (sociaux de grandes compagnies pharmaceu-)Tj T* 0 Tc 0 Tw (tiques)Tj ET Q q BT /F3 1 Tf 6.6 0 0 6.6 98.7924 555.8117 Tm 0 Tr 0 g 0 Tc (8)Tj ET Q q BT /F3 1 Tf 11 0 0 11 102.0924 552.5117 Tm 0 Tr 0 g -0.0001 Tc (,)Tj 0.52001 0 Td 0 Tc 0.02 Tw (la loi de protection des brevets de 15)Tj -3.20844 -1.09091 TD 0.016 Tw (ans est maintenue. On ne peut donc pas vrai-)Tj T* 0.01 Tw (ment dire ici que la Politique du m\216dicament)Tj 0 -1.0909 TD 0.025 Tc 0.081 Tw (au Qu\216bec soit particuli\217rement agressive)Tj T* 0 Tc 0.018 Tw (quand on la compare \210 celle de la France. La)Tj T* -0.008 Tw (Colombie-Britannique est la seule province \210)Tj 0 -1.09091 TD -0.017 Tc -0.021 Tw (avoir introduit une politique coh\216rente de r\216gu)Tj 17.70585 0 TD 0 Tc (-)Tj -17.70585 -1.09091 TD -0.013 Tc -0.024 Tw (lation comportant simultan\216ment une politique)Tj T* -0.01 Tc -0.028 Tw (d\325inscription et de n\216gociation de prix avec les)Tj T* -0.019 Tc -0.019 Tw (entreprises pharmaceutiques [32]. Gr\211ce \210 cette)Tj T* -0.001 Tc -0.036 Tw (approche, l\325inscription d\325un nouveau m\216dica-)Tj T* 0 Tc -0.013 Tw (ment est conditionnelle \210 la mise en \216vidence)Tj T* -0.013 Tc -0.025 Tw (scientifique d\325un apport r\216el en termes de mor)Tj 17.70604 0.00001 TD 0 Tc (-)Tj -17.70604 -1.09091 TD -0.036 Tw (bidit\216 et de mortalit\216 et une n\216gociation sur le)Tj T* 0.006 Tc 0.032 Tw (prix du m\216dicament est en relation avec son)Tj T* 0.025 Tc 0.027 Tw (degr\216 d\325innovation. D\325apr\217s certains cher-)Tj T* 0 Tc -0.013 Tw (cheurs, cette politique aurait permis d\325\216cono)Tj 17.70592 0.00001 TD (-)Tj -17.70592 -1.09091 TD 0.022 Tc 0.015 Tw (miser jusqu\325\210 14)Tj 7.34247 0.00001 TD 0.0224 Tc (%)Tj 1.14287 0 Td (du)Tj 1.33231 0 Td 0.022 Tc (co\236t du programme)Tj -9.81765 -1.09091 TD 0 Tc 0 Tw (dans cette province [33, 34].)Tj 1.28847 -1.79478 TD -0.01 Tc -0.016 Tw (Malgr\216 leurs dif)Tj 6.23123 0.00001 TD (f\216rences, les syst\217mes qu\216)Tj 10.18622 0 TD 0 Tc (-)Tj -17.70592 -1.09091 TD -0.021 Tc -0.027 Tw (b\216cois et ceux des autres provinces canadiennes)Tj T* -0.023 Tc -0.024 Tw (ou encore des \203tats am\216ricains, sont soumis aux)Tj T* -0.019 Tc -0.028 Tw (m\220mes d\216fis d\325acc\217s des populations aux m\216di)Tj 17.70591 0 TD 0 Tc (-)Tj -17.70591 -1.09091 TD 0.002 Tc 0.026 Tw (caments innovants, de solidarit\216 et libert\216 de)Tj T* -0.001 Tc 0.028 Tw (march\216. Chaque syst\217me essayant de trouver)Tj T* -0.021 Tc -0.026 Tw (un compromis, arbitrage n\216cessairement impar-)Tj T* 0.001 Tc 0.026 Tw (fait car ne pouvant optimiser chacun des cri)Tj 17.70583 0.00001 TD 0 Tc (-)Tj -17.70583 -1.09091 TD -0.006 Tc 0.034 Tw (t\217res [35]. Il est aussi int\216ressant de constater)Tj T* 0.015 Tc 0.014 Tw (que les syst\217mes europ\216ens sont confront\216s)Tj T* 0.014 Tc 0.013 Tw (exactement aux m\220mes probl\216matiques que)Tj T* 0.009 Tc 0.018 Tw [(celles en )55(Am\216rique du Nord [36]. Les dif)18<668E>-1(-)]TJ T* -0.006 Tc 0.033 Tw [(rences d\325or)18(ganisation d\325acc\217s au m\216dicament)]TJ T* -0.013 Tc -0.034 Tw (rel\217vent encore en partie du fruit de l\325\216volution)Tj T* -0.009 Tc 0.036 Tw (de leur propre syst\217me de sant\216, mais tendent)Tj T* -0.01 Tc -0.016 Tw [(toutes \210 conver)18(ger vers un acc\217s garanti centr\216)]TJ 19.58482 47.61296 TD -0.022 Tc -0.026 Tw (sur les risques majeurs, au d\216triment des risques)Tj 0 -1.10728 TD -0.033 Tc -0.015 Tw [(mineurs. La Grande-Bretagne of)18(fre ainsi le choix)]TJ 0 -1.10727 TD -0.03 Tc -0.017 Tw (entre un syst\217me totalement public ouvert \210 tous,)Tj 0 -1.10728 TD -0.007 Tc 0.034 Tw (le National Health Service (NHS), cohabitant)Tj 0 -1.10727 TD -0.011 Tc -0.036 Tw [(avec un syst\217me totalement priv\216. Les dif)18(f)1(i)1(c)1(u)1(l)1(-)]TJ 0 -1.10728 TD -0.006 Tc 0.033 Tw [(t\216s de prise en char)18(ge des m\216dicaments inno-)]TJ T* -0.01 Tc 0.019 Tw [(vants ont conduits le NHS \210 cr\216er)40(, en 1999, le)]TJ 0 -1.10727 TD -0.026 Tc -0.022 Tw (National Institute of Clinical Excellence (NICE))Tj 0 -1.10728 TD -0.01 Tc -0.027 Tw (dont la responsabilit\216 est d\325\216mettre des recom-)Tj 0 -1.10727 TD -0.006 Tc 0.034 Tw (mandations en mati\217re d\325\216valuation des tech-)Tj 0 -1.10728 TD 0.015 Tc 0.014 Tw (nologies en sant\216 prenant th\216oriquement en)Tj 0 -1.10727 TD -0.013 Tc -0.034 Tw (compte les besoins de sant\216 publique, les avan-)Tj 0 -1.10728 TD -0.002 Tc 0.029 Tw (tages cliniques des nouveaux produits et leur)Tj 0 -1.10727 TD -0.031 Tc -0.017 Tw (int\216r\220t m\216dico-\216conomique. Le probl\217me auquel)Tj 0 -1.10728 TD -0.017 Tc -0.03 Tw (est confront\216 le NICE reste le choix des crit\217res)Tj 0 -1.10727 TD 0.015 Tc 0.229 Tw (d\325\216valuation, dont les fameux indicateurs)Tj 0 -1.10728 TD -0.004 Tc 0.032 Tw [-277(QAL)100(Y)-241(\310 \(Quality )55(Adjusted Life )37(Y)100(ears\), qui)]TJ 0 -1.10727 TD -0.01 Tc -0.036 Tw (permettent \210 cet institut de ne recommander au)Tj 0 -1.10728 TD -0.019 Tc -0.029 Tw (remboursement que les produits qui auraient un)Tj T* -0.01 Tc 0.023 Tw (co\236t par QAL)Tj 5.37877 0.00001 TD 0 Tc (Y)Tj 0.93786 0 TD -0.01 Tc (inf\216rieur \210 30)Tj 5.40616 0 TD [(000)-263(\243. Non seu-)]TJ -11.72279 -1.10728 TD 0.015 Tc 0.322 Tw (lement la validit\216 m\216thodologique de la)Tj T* -0.021 Tc -0.027 Tw [(construction des indicateurs QAL)100(Ys est tr\217s lar-)]TJ 0 -1.10727 TD -0.017 Tc -0.03 Tw (gement d\216battue dans le monde scientifique car)Tj 0 -1.10728 TD -0.01 Tc -0.031 Tw (les valeurs obtenues d\216pendent directement du)Tj 0 -1.10727 TD 0.035 Tw (choix de la technique de mesure de l\325utilit\216 et)Tj 0 -1.10728 TD 0.015 Tc 0.08 Tw (ne sont donc pas comparables. 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