New public management and the reform of French public hospitals

• Date: 01 August 2013
• DOI: http://doi.org/10.1002/pa.1465
• Published date: 01 August 2013
• Author: Daniel Simonet

■Academic Paper

New public management and the reform

of French public hospitals

Daniel Simonet*

School of Business, American University of Sharjah, Sharjah, United Arab Emirates

New public management (NPM) is not only an Anglo-Saxon debate but also a French one, with some of its elements

constituting structural components of the French state apparatus. How did it make its way into French hospitals?

What core mechanism was at the center of NPM implementation in hospitals? We discuss the redisorganization of

the health system under NPM, as it attempted to reassert the central government’s power over regions and how it

alienated the medical profession. The paper highlights inherent contradictions and other false promises within

NPM. It was unable to contained cost, could no enhance accountability or increase civil participation. We then

investigate post-NPM reforms in French healthcare. Copyright © 2013 John Wiley & Sons, Ltd.

NEW PUBLIC MANAGEMENT

THEORETICAL BACKGROUND

New public management (NPM) is group of hetero-

geneous axioms derived from a variety of economic

theories such as the public choice theory (Niskanen,

1971; Buchanan, 1986), some elements of new

institutional economics (Williamson, 1981), the

agency theory (Jensen and Meckling, 1976; Pratt,

1985), and the property rights theory (Demsetz,

1967), rating agencies downgrading debt; Western

governments we re forced to borrow at higher rates ,

thus had to put their finance in order. These theo-

ries also demonstrate influence from ideological

roots, for example, Reaganomics. Government in-

tervention was deemed uneconomic and politically

illegitimate. Emphasis was put on rolling back the

state, as exemplified by the Thatcher reforms of

the early 1980s that aimed at reducing costs,

wastage, and employment in the public sector.

NPM adoption signaled a victory of the liberal

market economies approach (i.e., a coordination

of activities primarily through competitive

biddings, market forces, and contracts where ‘the

state still plays an active, albeit much reduced role’,

and where ‘...labor relations have become much

more market-reliant’) (Schmidt, 2004) over the co-

ordinated market economies approach that gives

a central role to long-term, non-market relations,

and stable cooperation between stakeholders (e.g.,

trade unions and local governments) (Hall and

Soskice, 2001; Amable, 2003). In the developing

world, recommendations from international orga-

nizations (OECD, World Bank, and IMF) helped

to further popularize NPM.

Rather than a structured and coherent paradigm,

NPM is a set of instruments, many of which origi-

nate from the corporate world, as well as general

principles and governance mechanisms that entail

a strong implementation component. ‘...at the

higher level, it (NPM) is a general theory or doctrine

that the public sector can be improved by the impor-

tation of business concepts, techniques and values,

while at the more mundane level it is a bundle of

specific concepts and practices’(Pollitt, 2007, p. 110).

INTERNATIONAL NEW PUBLIC

MANAGEMENT EXPERIMENTS

There are significant NPM variations across coun-

tries (Mônks, 1998; Christensen and Laegreid,

*Correspondence to: Daniel Simonet, School of Business, Ameri-

can University of Sharjah, Sharjah 26666, United Arab Emirates.

E-mail: dsimonet@aus.edu

Journal of Public Affairs

Volume 13 Number 3 pp 260–271 (2013)

Published online 01 July 2013 in Wiley Online Library

(www.wileyonlinelibrary.com) DOI: 10.1002/pa.1465

Copyright © 2013 John Wiley & Sons, Ltd.