Hospital investment policy in France: Pathways to efficiency and the efficiency of the pathways

Guerrero, Isabelle; Mossé, Philippe; Rogers, Vaughan

doi:10.1016/j.healthpol.2009.05.013

Cited by 4 publications

(8 citation statements)

References 7 publications

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“…Though evidenced‐based policy aimed at shifting, at least in theory, the focus away from politics to policy and policy experts, attempts at “institutionalizing” evaluation as a core feature of policy development are increasingly questioned . The institutionalization of evaluation for budget approval led to an endless supply of evidence, ie, “an accountability overload.” Data production is almost becoming almost an end in itself . In health care, in particular, a “dizzying array” of NPM‐inspired metrics now exist to orient policies (DREES, 2009), thanks to IT developments that enabled a bottom‐up transfer of information from all hospitals to central health authorities.…”

Section: Discussionmentioning

confidence: 99%

“…59 Data production is almost becoming almost an end in itself. 60 In health care, in particular, a "dizzying array" of NPM-inspired metrics 61 now exist to orient policies (DREES, 2009), thanks to IT developments that enabled a bottom-up transfer of information from all hospitals to central health authorities. This, however, did not necessarily reduce uncertainty, as program outcomes turned out to be more difficult to evaluate.…”

Section: An Elusive Evidenced-based Policymentioning

confidence: 99%

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Technocratic recentralization in the French health care system: A critical evaluation

Simonet

2019

Health Planning & Management

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Summary The French health care system implemented several corporate management recipes such as diagnostic‐related groups (DRGs), benchmarking, and activity‐based management in a bid to restore fiscal discipline and to “reassert the center.” The government also regrouped health policy decisions with the Regional Health Agencies and opted for a top‐down line of command to ensure policy implementation. Though reforms emphasized evidenced‐based policy and outputs measurement, outcomes were below expectations in many areas and led to a shift in values. Professional autonomy and patient engagement receded. This leads us to a critical evaluation of the French audit society.

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Section: Discussionmentioning

confidence: 99%

Section: An Elusive Evidenced-based Policymentioning

confidence: 99%

Technocratic recentralization in the French health care system: A critical evaluation

Simonet

2019

Health Planning & Management

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“…ARSs have scope to wield agency, but this lies in the 'fuzziness' of the developing institutional framework, which enables leeway. Guerrero et al (2009) found that ARSs had adopted their own criteria for dispersing previous rounds of additional hospital spending (i.e. which supplemented existing T2A-derived budgets).…”

Section: The Effect Of Marketisation On the Relationship Between Regional Actors And The Centrementioning

confidence: 99%

“…By contrast, other studies show regional actors using their autonomy to frustrate rather than facilitate marketisation (Fredriksson & Winblad 2008; Schulte et al 2018). They may have a more qualitative view on service delivery (Guerrero et al 2009; Hughes et al 2011), prioritising long-standing networks above market ‘openness’ (Christiansen 1998; Rhodes 1998; Schulte et al 2018), and can be more susceptible to public mobilisations against marketisation (Krachler & Greer 2015). Marketisation may thus unleash tensions between regions and the centre, which in turn can result in further central intervention: for instance, to devise and enforce the frameworks through which organisational-level competition takes place (Bach 2000); to negotiate politically problematic outcomes of marketising policies (Cumming & Mays 2002; Tediosi et al 2009); or to discipline regional actors that implement market-oriented policies unenthusiastically (Guerrero et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Marketisation and regional planning in neoliberal public services: Evidence from French hospitals

Umney

Coderre-LaPalme

2021

Capital & Class

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Marxist scholarship has documented the implications of ‘neoliberal’ reforms to public services. This scholarship often considers these reforms as class projects which have disciplined working populations and created new opportunities for capitalist profit-making. But in this article, we shift emphasis to the internal dysfunction that shapes states’ pursuit of market-oriented policy agendas. We place closer focus on the specific levers through which marketising reforms are implemented, noting the conflicting pressures they unleash, and the cracks this may open through which a more democratic agenda can be advanced. Taking the French hospital sector as an example, we show how attempts to expand and intensify competition in public services have coincided with attempts to decentralise governance to the regional level. While ostensibly part of the same ‘reforming’ policy agenda, marketising policies have a strongly centralising logic which has in practice undermined efforts to develop meaningful regional planning. These institutional tensions have catalysed new political currents, as the relationship between public authorities and private sector actors has become more overtly conflictual. We argue that Marxist theorists of the state need to pay closer attention to the often dysfunctional relationship between different branches of the state, and that in the context of neoliberal public service reform, the tensions between central and regional states are particularly salient. We conclude that opponents of the marketisation of public services need to pay attention to the contested and ambiguous nature of ‘decentralisation’: while it is often a rhetorical cover for marketisation, there are opportunities for the left in demanding more meaningful and authentic forms of regional planning.

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“…In this process, the administrative actors gained in power and legitimacy. As a result, the ARSs have a tendency to protect the public sector hospitals from attacks coming from the private for-profit ones, nowadays organized in "chains" if not holding companies (Guerrero et al, 2009). By contrast, in most developed countries, these types of agencies have encouraged Public-Private Initiatives if not market forces.…”

Section: The Ongoing Dynamics Of the French Health Care System: From mentioning

confidence: 99%

Mental health in France, policies and actors: developing administrative knowledge in a segmented world

Mossé

Maury

Daumerie

et al. 2012

Health Planning & Management

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The new mental health care policy, which has been set up in France, involves a change of paradigm, which has been going on since the 2000s: the emphasis is shifting from psychiatry to mental health care. This shift mainly concerns the knowledge about mental health is produced and circulates among an increasingly large number of bodies. Mainly grounded on actor interview analysis, official reports and blueprints, this study shows that the results of this process are numerous. They include the development of ambulatory care and strong moves towards decentralization. More data and knowledge are therefore to be shared in this more complex system. However, the French State, in the form of the central administration, is taking advantage of this move and is still contributing significantly to the definition and implementation of the new policy. On the other hand, the new governance dynamic is not leading to standardization of medical practices, as the mental health field remains highly heterogeneous.

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Hospital investment policy in France: Pathways to efficiency and the efficiency of the pathways

Cited by 4 publications

References 7 publications

Technocratic recentralization in the French health care system: A critical evaluation

Technocratic recentralization in the French health care system: A critical evaluation

Marketisation and regional planning in neoliberal public services: Evidence from French hospitals

Mental health in France, policies and actors: developing administrative knowledge in a segmented world

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