L’évolution des rapports de pouvoirs dans un système bismarckien : le cas de la France

Since the 1980s, there has been an increasing technocratization of the health insurance system in France, linked with the emergence of an administrative elite in favour of strengthening the role of government over that of the social partners. In this sense, the Juppé Plan (1996) and the 2004 health insurance reform were significant steps in terms of increasing the role played by the director of health insurance and control over social security funding bills by the social security directorate, as well as creating new administrative institutions (regional hospitalization agencies, National Authority for Health, etc.) However, the autonomy of these high-level civil servants is limited, in terms of decision-making and getting plans onto the agenda, by the authority of government actors and, in terms of implementation, by the medical profession.