Performance health administration and the return of the French second empire

In the French health care system, cost-containment strategies have become the new priority. Novel instrumental values (e.g., benchmarking, incentivization or premiums, and Diagnostic-Related Groups) and reforms of the hospital governance via the 2009 HPST Act served an austerity agenda at the expense of more patient-centered approaches (e.g., patient choice and case management). Effecting actual changes proved more difficult than collecting data on the health system. Decision-making powers are increasingly concentrated within the welfare elite at the expense of the medical profession. Hence, a return to the earlier French tradition of Jacobinism. Transparency has yet to be achieved.