Hospital investment policy in France: pathways to efficiency and the efficiency of the pathways

This article examines the ambivalent notion of New Public Management as applied to health policy in France, by investigating the implementation of the efficiency-driven hospital investment plan, Hôpital 2012, conceived at national level, but implemented through regional hospital authorities (ARHs), with formal responsibility for selecting successful funding applications.

The methodology combines qualitative and quantitative analysis, in order to highlight and explain discrepancies between goals and results.

Despite formal adherence to objective efficiency indicators, certain decisions were based on incomplete information and others on considerations out with initially established criteria. Competition from the private sector was perceived as a threat to public hospitals and the public sector emerged as a major beneficiary of the investment plan. Central ministerial intervention emphasising financial and quantitative considerations led the ARHs to focus more on individual hospital performance than on wider healthcare needs.

Data-production became almost an end in itself, threatening to undermine the objectives it sought to pursue. Nonetheless, extended deadlines entailed by ministerial intervention were appropriated as a resource by local actors, leading to ARH decisions which deviated from the official efficiency model, but resulted in increased effectiveness, taking fuller account of local conditions.