The Minister of Health has been losing his independence for several years now. He now reports to the Minister of Social Affairs. Given two superiors and his liaison duties between politicians and civil servants, the post of Director of Hospital is a precarious appointment lacking adequate management tools for the proper programming and objective evaluation of his activities. This lack complicates task-sharing and relations with the minister's staff. Furthermore, social health services hold little prestige despite social and economic roles of considerable importance: they do not attract youg senior civil servants while buildings and operations hardly stimulate personnel. Recent reforms and the anti-civil service ideology that dominates French conservationism could aggravate the existing problems of the civil service, i.e., time-consuming recruitment, rigid career paths according to graduate schooling, department and position and the dire state of inter-ministerial and external relations. In addition, the simple rules of the Budget Office that apply automatically across the board must lead to inadequate government which in turn will result in increased bureaucracy. Thus, efficiency should be sought at the expense of result in increased bureaucracy. Thus, efficiency should be sought at the expense of formalism, and empirical factors should override ideological thinking.

Instead of central administration, the public limited company () with set objectives and independent means, flexible management and open to inspection would appear more suited to the tasks at hand