At the crossroads of the administration and the professions

Special report. Tools for managerial reforms and professional organization
Jurisdictional competition and alliances around hospital financing
By Renaud Gay

The article analyzes the conception and the transformations of the financing tools that aim to control hospital expenditure since the 1960s. It deals with the alliances supporting these tools between physicians, hospital directors, and administrators at the French Ministry of Health. It considers these tools as a hinge between the state ecology and the professional one. These tools are given different meanings in each ecology, where they contribute to offensive and defensive jurisdictional tactics. The article distinguishes three historical sequences that explain the evolution of these alliances and the related changes of financing tools, from a sophisticated bed-day price to a prospective payment system.

  • hospital
  • health administration
  • policy instrument
  • new public management
  • health professions
  • socio-history of public action
  • financing tools
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