MOISDON, Jean-Claude <br/><br/>
La tutelle locale sur les hôpitaux :  ses instruments et ses contraintes 

 - Paris :  IIAP,  juil./sept. 1987 
<br/><br/> The local health authorities (DDASS) are a favorite target of criticism when discussing public health. But what are their duties, limited and operating mechanisms? They oversee and coordinate the establishment of new facilities, and approve annual budgets and long-term policy for hospitals. They stand between two opposing forces, i.e. central government trying to hold dowm hospital costs through the national equipment allocation plan plus various rules and procedures, and local interests seeking to maintain and even expand hospital facilities. This has given rise to a policy of 'inching along' and compromise that bows to quantitative targets set by central government without openly opposing local demands. Likewise, they exercise their authority very cautiously, interplaying with a number of organizational factors internal to hospitals, e.g. no indicators to account for hospital activity, bookkeeping unrepresentative of institutional operations, long and unwidely reports, insufficient staffing with bureaucratizing training and hermetic career paths. The underlying conflict between national objectives and local demands will not be resolved in the medium term. The only bridle possible would be management and evaluation tools to re-orient hospital activites towards specific objectives