Conflict and Competition in French Hospital Policy

This paper examines recent policy trends and their consequences in the French hospitals sector. It draws on around 30 key informant interviews with policymakers, hospital managers, trade unionists, academic experts, and lobbyists to give a wide-ranging but detailed account of what has happened in French hospital governance over the last decade. There is a particular emphasis on a) identifying the key policy themes and objectives of the Sarkozy and Hollande governments; b) examining the tools used to implement these; and c) explaining the kinds of reactions and obstacles that have been encountered.

The paper argues that there have been two main policy trends, which are similar to the priorities adopted in many other countries. On one hand, the liberalisation of the system, involving greater competition and private sector involvement. On the other, efforts to stimulate greater regional initiative in health planning to meet increasingly complex population needs. The paper argues that these objectives contradict each other. The first has, counter-intuitively for supporters of liberalising policies, been forced through in a highly centralised way which has weakened the policy tools available to local planners, and undermined the voices of local actors. Moreover, it is decentralised actors at local level who have been most influential in obstructing liberalising policies. This points to important tensions between the objectives of liberalisation and decentralisation, as well as internal tensions in the idea of decentralisation itself.