Le mandarin, le gestionnaire et le consultant

Abstract

In July 2009, the Parliament passed a law called "Hospital, Patients, Health and Territorial Divisions" that reforms both the governance of hospitals and their institutional environment. The first reform recognized and reinforced the power of the hospital director. The second established regional health agencies from the merger, at the regional level, of local public administrations and healthcare (social security) services. Inspired by a national reinterpretation of the main tenets of the "new public management" meant to make them compatible with the sectorial institutions inherited from the specific historical trajectory of the French state, this reform has been met by an unprecedented mobilization of the elites of medical practitioners and researchers. These groups have been excluded from the decision process to the benefit of other groups, both public and private, who defended a vision of hospital-based health services as an industry. Within this "modernizing" coalition, consulting firms played a key role. Thanks to the "Révision générale des politiques publiques" (RGPP), they manage to penetrate profitable markets upstream and downstream from the reform of public hospitals. The article thus focuses on the transformation of the reforming elites in the health sector within the overall context of the reform of the state symbolized by the RGPP, and on the possible disqualification of the medical elites, who owned legitimately medical issues theretofore. © 2010-2012 Cairn.info.