Assessment of new public management in health care: the French case
- PDF / 392,370 Bytes
- 9 Pages / 595.276 x 793.701 pts Page_size
- 78 Downloads / 188 Views
COMMENTARY
Open Access
Assessment of new public management in health care: the French case Daniel Simonet
Abstract The French health care system embraced New Public Management (NPM) selectively, and crafted their own version of NPM using Diagnostic-Related-Group accounting to re-centralize the health care system. Other organizational changes include the adoption of quasi-markets, public private partnerships, and pay-for-performance schemes for General Practitioners. There is little evidence that these improved the performance of the system. Misrepresentation has remained high. With the 2009 Hospital, Patients, Health and Territories Act physician participation in hospital governance receded. Decision-making powers and health units were re-concentrated to instill greater national coherence into the health system. Keywords: Centralization, France, Hospitals, New public management
Commentary The path toward new public management
European economic integration with policies dictating that the achievement of supranational objectives prevails over national and regional policies, the adoption of a monetary convergence criteria (to illustrate the point, national budget deficits are capped at 3%), and the perception that Keynesianism failed in the 1980s, all prompted French public policy makers to adopt a new market-based paradigm to drive economic policy [1]. Under the impetus of top-politicians, consulting firms (the transfer of corporate management recipes to the public sector provided them with a steady source of income) [2], and liberal thinktanks [3,4], a new generation of civil servants from the French National School of Public Administration and the “Grandes ecoles” (i.e., the French equivalent of US Ivy League universities) – a “programmatic elite” [5] – who, like the public, wanted a delivering government [4], embraced New Public Management (NPM) [6] in a bid to improve public services delivery. Private hospitals and hospital bureaucrats who view these reforms as legal (they were voted in Parliament) and rational because they respond to a need for a more efficient allocation of resources, also supported the NPM. In contrast, the operating core (the medical profession) usually resisted NPM reforms, albeit with mixed success due to the rising Correspondence: [email protected] American University of Sharjah, Sharjah, PO Box 26666, United Arab Emirates
division of physician trade unions [7]. Local notables, such as mayors and their constituency, who oppose the closure of smaller hospitals in rural areas, also questioned this neo-liberal progressivism. As an instrumental value, ‘efficiency’ may serve competing interests and mean different things to different groups. From the government perspective, efficiency implies budget discipline and an emphasis on lower costs. For private operators, it implies market share expansion. For patients, it means shorter waiting times. That ambiguity allowed NPM to permeate the health system in a politically correct manner. EU integration was also a factor. Budget deficits, taxation
Data Loading...
