French hospitalization had faced several reforms since 1970. All these reforms had the same aim to strengthened hospital efficiency according to a financing view. Quality of the health system was also debated in 1996, but since that, French government decided to focus on reduction of deficits. We can not understand French debate inside the hospitalization sector without having a short approach of what we call a public service and how it has changed since 1945. We will see a total change of paradigm since 1986. Cost, competition and market entered in the minds of civil servant. But, if aims have changed, conservatism has limited this evolution furthermore a part of public employees have the feeling that public services’ missions of cohesion where gave up.
The objectives of this lecture are those followed:
- To analyze the notion of public service and to show how important the question of financing has become,
- Then to see the gap between government goals and reality,
- Finally to analyze that the situation is blurred by general speech of competition with practices of bureaucracy.
We will conclude by a critic of the way chosen to reform French hospitals. We will see that the rules of the game are tackled.
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