French idiosyncratic health-care reforms, performance management and its political repercussions

Context: France has undergone major changes in social policy that made an impact on the health-care sector. The paper reminds readers of the application and shortcomings of the concept of New Public Management (NPM) in the French health system. Problem: The paper investigates NPM health reforms in France. Reforms aimed at contain-ing costs. What administrative restructuring was implemented? What were reform idiosyn-crasies? What were their limitations? Which critical public health emergencies remain? Methods: We examine the political and economic context of health-care reforms, the rise of the regulatory state, and its core element: the diagnostic-related group (DRG) scale. We critically examine the recentralization of health policy decisions and its impact on care providers and provide an international perspective on reforms. Results: Reforms put priority on the use of yardsticks and also emphasized regulation and competition but rejected public–private partnerships on the Anglo-Saxon model. Central health authorities regain their authority over health policy decisions, and decentralization was weakened. Conclusion: Restrictions in public service delivery triggered a general discontent among the population. The political repercussions of reforms eventually crystallized into the Yellow Vest movement.