A case of weak architecture : the french ministry of health
By: BRIATTE, François
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ArticlePublisher: Oxford : Wiley-Blackwell, April 2010Social Policy & Administration 44, 2, p. 155-171Abstract: This article asks whether the public administration of health in France fits the general description of French state institutions as autonomous, powerful bureaucracies. Existing sources on the French Ministry of Health indicate that three types of processes have shaped its institutional structure, its official mandate and its actual policy influence since its inception in the 1920s. Faced with the rise of private-practice medicine, the Ministry first emerged as a resource-poor institution, and still remains an endemically weak ministerial portfolio by virtue of institutional path dependence. Since the 1980s, it has aligned itself on cognitive influences from other ministries, and has been especially sensitive to the pressure exerted by spending ministries to control health expenditure. Finally, in the light of recent health scandals, the creation of several health agencies has contested its effective mandate over public health issues. As a result, the current Ministry struggles to redefine its role in the competitive landscape of French health policy formulation
This article asks whether the public administration of health in France fits the general description of French state institutions as autonomous, powerful bureaucracies. Existing sources on the French Ministry of Health indicate that three types of processes have shaped its institutional structure, its official mandate and its actual policy influence since its inception in the 1920s. Faced with the rise of private-practice medicine, the Ministry first emerged as a resource-poor institution, and still remains an endemically weak ministerial portfolio by virtue of institutional path dependence. Since the 1980s, it has aligned itself on cognitive influences from other ministries, and has been especially sensitive to the pressure exerted by spending ministries to control health expenditure. Finally, in the light of recent health scandals, the creation of several health agencies has contested its effective mandate over public health issues. As a result, the current Ministry struggles to redefine its role in the competitive landscape of French health policy formulation
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