The quest for a better performing health system: Public expertise and corporate management recipes in France

Abstract

Though the government pledged to cut the public deficit from 7.7% of the gross domestic product in 2010 to 3% by 2013, thereby responding to EU Normative power, health expenditures continue to rise, because public demands are higher and more social problems are handled in the health care setting. With French budget deficit threatening France's credit rating, novel instruments were needed. These included corporate management recipes (e.g., pay for performance contracts, patient volume targets, and management by objectives), new compensation mechanisms (e.g., activity‐based accounting and a nationwide scale of health care costs) and far‐reaching laws (e.g., the 2009 HPST bill). Our approach investigates some critical elements of the French health care system. We focus on primary (e.g., family physicians and General Practitioners) and secondary (e.g., hospital and specialty) care. We explore how policies such as the standardization of health services, the regrouping of health policy decisions within the larger Regional Health Agencies, affected citizens' engagement and physicians' autonomy. A French welfare elite pursued a hybrid strategy, regulating quasi‐markets of care providers in a postcompetitive government, while creating supportive conditions for a vibrant private hospital sector. Reforms also emphasized evidenced‐based policy, outputs‐rather than outcome‐measurement, and performance evaluation in a bid to streamline the delivery of health services.

Health Care Reforms, Power Concentration, and Receding Citizen Participation

“…It is beneficial to incorporate public values such as the involvement of patients and local stakeholders (city mayor, patient association), accountability to the public, and transparency into performance evaluation. 41 In order for this to become a reality, it is important for the general public to prioritize healthcare and view medical needs as a regular part of life rather than a rare event. This would prevent health care from taking a backseat on the governmental agenda.…”

“…It is beneficial to incorporate public values such as the involvement of patients and local stakeholders (city mayor, patient association), accountability to the public, and transparency into performance evaluation. 41 In order for this https://doi.org/10.2147/RMHP.S421397…”