Recentralization and vertical alignment in the French health‐care system

Abstract

In foreign exemplars, key new public management (NPM) features such as decentralization and devolution of health-care responsibilities had outcomes below expectations. Other NPM traits such as the patient as overseer of reforms or the empowerment of patient remained elusive. In France, the integration of public values such as greater participation of patients and local actors (NGOs and elected officials) and NPM-driven private values such as performance evaluation has yet to be seen. Taking advantage of NPM's failings and austerity agenda, a French welfare elite regained control over health-care policy decisions at the expense of regions and other local actors. NPM outcomes were below expectations. Austerity cures led to weakening of the regional decision spaces, which can be explained under the principal-agent relationship. Accountability shifted to managerial (the professionalization of hospital managers) and legal (governance via regulations) forms in a bid to restore central government control. A democratic recess results from the lack of public engagement in recent health reforms.

Coordination and crisis management. The case of the federal Government and two sub-national governments in Mexico

“…This situation was repeated in the hospitals of 24 States, which in February 2020 agreed to sign an agreement for INSABI to be responsible for hiring new health personnel, medicines, assuming responsibility for the administration and provision of health services 8 . These actions allowed us to glimpse the possibilities of creating a Unified Health System of a public, universal and free , opening the debate on the areas in decentralization processes (Falleti, 2010;Tulchin, 2012) its efficiency (Gallego, 2016) and political implications (Aalen and Muriaas, 2017;Simonet, 2016) and the processes of recentralization of functions under various forms (Riedl and Dickovick, 2014;Dickovick and Eaton, 2013).…”

The (mis)fit of policy programs to political institutions and its influence on programmatic action – How crisis has differently hit French and German health policy

“…However, policies adopted after 2010 still followed the policy program promoted by the programmatic group. Although the reforms made use of new public management tools, the general tendency towards a re‐centralization of competences remained (Simonet, 2017), even though there are some recent tendencies of marketization of the private health insurance, though unintended (BenoÎt & Coron, 2019). The regulatory mechanisms remain consistent with the political system in France, and the consistency of objectives and instruments is ensured as the measures taken still aim at increasing efficiency in health care spending, being oriented towards prevention and digitalization, and strengthening the state (Lombrail, 2015).…”

Mexico City´s boroughs: not yet local governments

“…In view of the meager results, the policies used in certain countries show that decentralization can move forward or backward when the national government yields or recovers functions because the process is ultimately an expression of political struggle (Dardanelli, 2018;Aalen & Muriaas, 2017). Evidence of recentralization processes has emerged recently in different parts of the world, which has been documented by Leonard, Nazarov, and Vakulenko (2016) in the Russian Federation; Simonet (2016) concerning the health care system in France, or Malesky, Nietz, and Tran (2014) in Vietnam, who highlighted improvements in transportation, health, and communications taking place after the recentralization process of the provision of public services by eliminating the Popular Councils in 99 districts throughout the country. Cravacuore (2014) has reported on a recentralizing trend in Latin America.…”