The regulation of competition and procurement in the National Health Service 2015-2018: enduring hierarchical control and the limits of juridification

French Idiosyncratic Health-Care Reforms, Performance Management and Its Political Repercussions

Context

France has undergone major changes in social policy that made an impact on the health-care sector. The paper reminds readers of the application and shortcomings of the concept of New Public Management (NPM) in the French health system.

Problem

The paper investigates NPM health reforms in France. Reforms aimed at containing costs. What administrative restructuring was implemented? What were reform idiosyncrasies? What were their limitations? Which critical public health emergencies remain?

Methods

We examine the political and economic context of health-care reforms, the rise of the regulatory state, and its core element: the diagnostic-related group (DRG) scale. We critically examine the recentralization of health policy decisions and its impact on care providers and provide an international perspective on reforms.

Results

Reforms put priority on the use of yardsticks and also emphasized regulation and competition but rejected public–private partnerships on the Anglo-Saxon model. Central health authorities regain their authority over health policy decisions, and decentralization was weakened.

Conclusion

Restrictions in public service delivery triggered a general discontent among the population. The political repercussions of reforms eventually crystallized into the Yellow Vest movement.