Concurrence par comparaison et transformations quasi-marchandes

Juven, Pierre-André

doi:10.4000/regulation.11219

Cited by 7 publications

(2 citation statements)

References 17 publications

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“…In some cases, the barrier to moving psychiatry into general hospitals came from other doctors, who perceived a mismatch between their habitus and those of psychiatrists. In other disciplines, the system of payment by the act pushed doctors to become managers and marketers as they competed with one another to get more patients with less costly conditions (Juven 2015). These doctors felt public psychiatrists resisted this imperative.…”

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confidence: 99%

A Discipline Like No Other: Marginalized Autonomy and Institutional Anchors in French Public Psychiatry (1945–2016)

Barnard

2024

Comp Stud Soc Hist

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Research on psychiatry in the United States has shown how, since the 1980s, the discipline has sought to increase its prestige and preserve its jurisdiction by embracing biomedical models of treatment and arguing it is a medical specialty like any other. While this strategy is consistent with what the literature on professions would expect, this paper analyzes an alternative case: French public psychiatry, which has remained in a position of marginalized autonomy, combining low status and economic precarity with state recognition of its specificity. Drawing on Bourdieu’s theory of fields, I analyze how the persistence of specialized psychiatric hospitals in France—most of which have closed in the United States—has shaped the conflict between psychiatrists favoring autonomy and actors in university hospitals and the Ministry of Health seeking to reduce it. These specialized hospitals have functioned as institutional anchors that contribute to maintaining the discipline’s autonomous position in the medical field in three ways: by socializing psychiatrists into viewing themselves as a distinctive branch of medicine, linking psychiatry to powerful actors in the state interested in maintaining the discipline’s distinctive role in social control, and concentrating a population of chronically ill persons not amenable to traditional medical interventions. This analysis expands on the literature on professionals and field theory by emphasizing the role of institutions in structuring the reorganization of jurisdictions and relationships between fields.

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Section: (Figurementioning

confidence: 99%

A Discipline Like No Other: Marginalized Autonomy and Institutional Anchors in French Public Psychiatry (1945–2016)

Barnard

2024

Comp Stud Soc Hist

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“…Le système de santé, traversé par des transformations organisationnelles telles que l'instauration de la contrainte budgétaire au travers de l'Objectif National des Dépenses d'Assurance Maladie, et celle de mécanismes incitatifs avec la Tarification à l'activité, est alors poussé vers une recherche d'économie et d'efficience. Ces évolutions de l'hôpital public sont étudiées par la littérature sous l'angle du néolibéralisme, de la privatisation (interne et externe) et de la création d'un quasi-marché (Belorgey, 2010, Juven, 2015, André et al, 2016, Batifoulier et al, 2017a, 2017b, Vincent, 2016.…”

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Les transformations du capitalisme hospitalier français – Un secteur aux mains de la finance de marché

Allès¹

2022

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Market reforms in the French healthcare system: between regulation and yardstick competition

Simonet

Katsos

2020

Public Money & Management

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French cost-containment measures that traditionally consisted of price-control and a reduction in health care benefits have had a limited impact on the growth of health expenditures. Though the government pledged to cut the public deficit from 7.7% of the gross domestic product (GDP) in 2010 to 3% by 2013, thereby responding to EU Normative power (Diez, 2013), health expenditures continue to rise, since public demands are higher and more social problems are handled in the health care setting. With French budget deficit threatening France's credit rating, and therefore its membership within the EEC, novel instruments were needed. These included corporate management recipes (e.g. pay for performance contracts, patient volume targets, management by objectives, strict medical reviews and guidelines), new compensation mechanisms (e.g. activity-based accounting; a nationwide scale of health care costs) and far-reaching laws (e.g. the 2009 HPST bill). In the restructuring of health services, a French welfare elite pursued a hybrid strategy, regulating quasi-markets of care providers while creating supportive conditions for a vibrant private hospital sector and endeavored to streamline the delivery -rather than the financing -of health services.

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Concurrence par comparaison et transformations quasi-marchandes

Cited by 7 publications

References 17 publications

A Discipline Like No Other: Marginalized Autonomy and Institutional Anchors in French Public Psychiatry (1945–2016)

A Discipline Like No Other: Marginalized Autonomy and Institutional Anchors in French Public Psychiatry (1945–2016)

Les transformations du capitalisme hospitalier français – Un secteur aux mains de la finance de marché

Market reforms in the French healthcare system: between regulation and yardstick competition

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