Steering from bismarck to beveridge: the french experience

Philippe Mossé


Objective: To describe the roots of the French Health Care System. Data synthesis: Actually, three dynamics are hidden behind the word crisis. The first dynamic was already there from the start, while the second is the result of an internal dynamic and a third dynamic can be seen as the consequence of external causes. The main recent policies are made of a mix of constraints and incentives. Most of them improve the governance of the health care system. Adaptive as well as innovative, a pragmatic attitude has been applied through compromises. Four features of which can be found: To improve the division of labor amid professionals; to move towards Beveridge like Welfare State model, giving to the central State more power; to enhance expertise through Evidence Based Medicine; to open the internal and external frontiers of the health care system. Conclusion: Those changes were mainly pulled by the moving context rather than pushed by an ideology. Therefore, since its birth, the French health care system evolves more on a muddling through like move than according to a plan given in advance. This happened to be a rather good way to avoid the worst: marketization.


Health; Care; Administrative Personnel.

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Licença Creative Commons
Esta obra está licenciada sob uma licença Creative Commons Atribuição 4.0 Internacional.

Licença Creative Commons
Esta obra está licenciada com uma Licença Creative Commons Atribuição 4.0 Internacional.
Rev Bras Promoç Saúde, Fortaleza - Ceará - Brasil - e-ISSN: 1806-1230

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