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Cet article porte sur l’importance du federalisme dans la politique de lutte contre la Covid-19 en Allemagne. Du fait des competences partagees entre le Bund et les Lander, les principales decisions ont fait l’objet de nombreuses negociations entre la chanceliere et les ministres-president(e)s des Lander. Toutefois, si la gestion de la pandemie en Allemagne s’est fortement inscrite dans le cadre du « federalisme cooperatif », elle a aussi donne a voir l’importance des concurrences entre Lander et des tensions entre certains d’entre eux et le gouvernement federal. Ces tensions sont notamment liees au renforcement de l’autorite de celui-ci depuis le debut de la pandemie, qui s’inscrit dans une dynamique de plus longue duree de centralisation progressive de la politique de sante en Allemagne.

This chapter offers an in-depth look at health politics and the national health insurance system in France. It traces the development of the French healthcare system through its series of political regimes, characterized by its unusual combination of statism and corporatism. Since the 1990s, a technocratic consensus emerged that has led to new public management reforms, tighter parliamentary control of social security budgets, and efforts to improve coverage by subsidizing supplementary voluntary health insurance coverage for low-income persons and increasing tax-financing. Other healthcare issues have been regional health inequalities, reimbursement of medical professionals, and individuals’ responsibility for their health.

This article starts with a discussion of the analytical issues of the Programmatic Action Framework (PAF); based on the hypothesis that small groups of individuals, sharing a similar analysis of a policy problem sustaining a common policy change program (including orientations, arguments, and instruments) giving them a collective identity, and behaving strategically as a collective actor, can be main drivers of policy change. We then present the methodological implications of the empirical analysis of such programmatic groups and policy change programs. The methodology of the Programmatic Action Framework combines tools coming from the sociology of elites (positional analysis, analysis of professional trajectories, relational analysis) and the sociology of the policy process. It was first applied in empirical researches on health insurance reforms in France and the United States since the 1980s, shedding the light on the key role of specialized policy elites (specialized senior civil servants in France, long‐term insiders in the United States). We conclude by stressing that, because of its systematic and encompassing empirical methodology, the Programmatic Action Framework can be used in a comparative way, in other policy sectors than health care.

International audience; Plan :- La définition des soins primaires ;- Le renforcement des soins primaires comme réponse à des évolutions structurelles ;- Une analyse multiniveaux ;- Les politiques de réorganisation des soins primaires ;- Vers de nouvelles structures coordonnées de soins primaires ;- La mise en place de nouveaux instruments d’action publique ;- Conclusion

Partant du constat de l’importance prise par l’enjeu des penuries territoriales de soins primaires, cet article cherche a repondre a deux questions : comment expliquer la saillance de cet enjeu ? Quel est le lien entre ce manque et la reorganisation des soins primaires ? Pour y repondre, l’accent est mis sur les acteurs jouant un role cle dans ces processus permettant de comprendre la mise a l’agenda de la reorganisation des soins primaires en recourant a une comparaison entre la France et l’Allemagne. Dans les deux pays, on observe un retournement du discours sur la demographie medicale au debut des annees 2000 et une mise en avant de l’enjeu de deficits territoriaux en medecins sur lesquels portent de facon croissante les politiques de sante. Les instruments mobilises pour garantir une offre de soins dans les territoires defavorises sont assez semblables et diversifies. Ils concernent principalement le zonage, la formation en medecine generale et les incitations financieres. Cependant, au niveau de l’analyse des interactions entre les acteurs, des transformations plus significatives peuvent etre mises en avant en France, avec, d’une part, l’affirmation de nouveaux acteurs locaux (les ARS et les collectivites territoriales) contribuant a une territorialisation des soins primaires et, d’autre part, le developpement du travail pluriprofessionnel dans le cadre de nouveaux modes d’organisation des soins primaires portes par des « entrepreneurs medicaux ».

This chapter provides an analysis of the different contributions of French Universities (and other academic institutions, especially the “Instituts d’Études Politiques”) to the teaching of policy analysis, to the training of policy analysis specialists, to research in policy analysis, and to policy advice. It focuses on two closely related academic disciplines in France: political science and sociology. The chapter starts by questioning the extent to which and in which ways policy analysis as a sub-discipline is integrated into the teaching of political science and sociology. The focus then turns to the development of a specialized policy analysis master in political science and sociology, which can be related to broader evolutions, including transformations in the access to top administrative positions, the development of local public policies in France, and the professionalization of French Universities. The aim here is to shed light on the kind of knowledge and skills taught and on the positions students find after leaving universities and Sciences Po. By studying the involvement of political scientists and sociologists in public commissions and specific policy expertise structures outside the academic world, it also explores the relationships between policy research and policy advice.

Series: International Library of Policy Analysis; International audience; This book lays the foundation for a more systematic understanding of policy analysis in France. In doing so, the volume discusses the role of the State and its restructuring, processes of government and governance, and State-Society relationships and policies as both a process and an outcome. In the French context, understanding ways in which knowledge of and for policies is produced within and outside the State raises two issues that we collectively address in this volume: First, we explain the process through which studies for policy process have been strictly separated from the study of policy process. Second, we illustrate why this fundamental distinction still holds – even though it has regularly been challenged by successive generations of scholars and practitioners. We argue that, in the French context, this remaining divide results from the specificity of the politico-bureaucratic system, how the academic sphere is structured, and how the policy-making process functions. Through 18 chapters contributions focus on policymakers, their practices, ideas and discourses, how they engage in sustained relationships with a large variety of market and society actors, and the concrete devices they use in order to make policy objectives operational. This is a comprehensive study of policy analysis in France that will be valuable to academics and postgraduate students researching and studying a range of policy and public management areas.

This chapter provides a general overview of the study and practice of policy analysis in France. Drawing on the book’s content, it explains why and how the fundamental distinction between knowledge for and of policy process still holds in the French context, even though it was regularly challenged by successive generations of scholars and practitioners. The chapter begins with a brief overview of what policy studies means and how it is studied in the French context. Then the bulk of the introduction highlights and provides some explanation for the enduring gap between academic knowledge and policy practices, which characterizes policy analysis in the French context. Last but not least, it discusses the added value of policy studies for understanding State restructuring and policy developments in France. In the remaining and fourth section, it introduces the book outline into more details.

International audience; This article proposes an endogenous perspective on policy change, combining the analysis of the policy process (policy framing, decision and implementation) with the analysis of the transformation of professional groups and their organizational representation. It deals with the case of territorial undersupply in primary care provision, which has become a key issue in healthcare policies in France and Germany since 2000 (the analysis goes up to 2018). Policy changes in these two health insurances systems cannot be explained only by the salience of the problem, framed as “medical deserts” in France and as “lack of physicians” in Germany. We propose an explanation based on the internal fragmentation of the medical profession, playing a paradoxical role: as limiters of change (for the established and institutionalized organizations) and as promoters of change (for the medical entrepreneurs shaping new organizations defining and supporting new primary care service structures).

Dans cet article nous pointons deux types de tensions qui conduisent a une forme de dilution de l’analyse de l’action publique europeenne : dans la litterature anglo-saxonne on peut constater un decalage entre des travaux empiriques renvoyant aux preoccupations et aux decoupages institutionnels existants et ceux cherchant a appliquer des cadres theoriques generaux dans une logique de normalisation ; dans les travaux francais la place prise par des travaux de sociologie politique permettant une meilleure connaissance des acteurs present dans les arenes europeennes a conduit a faire passer au second plan la question de leur action sur les enjeux de politiques publiques. C’est pourquoi nous plaidons ici pour un double decloisonnement : d’une part, entre differents modeles theoriques, d’autre part entre les perspectives dominantes de la litterature internationale (meso et macro) et celles des recherches francaises (plus micro).

Dossier policy transfer, diffusion and circulation; International audience

The French welfare system is usually classified as a case of a corporatist–conservative welfare regime because its main components clearly reflect the Bismarckian tradition of social insurance. The economic, social, and political functions of the French welfare system developed after 1945 explain the subsequent difficulties in transforming it following the economic crisis of the 1970s. We show that until the 1990s the main goal of welfare policies was the rescue of the French model based on financial measures. It is only since the end of the twentieth century that French social programs and institutions have been progressively (and partly) reformed to adapt to the new economic and social environment. This reform trajectory has been changed only slightly since the 2008 crisis, despite growing European intrusiveness.

L’analyse des syndicats de medecins de ville francais dans la longue duree conduit a souligner une forme de paradoxe puisque, d’une part, on peut mettre en avant une grande permanence dans la defense des principes de la medecine liberale datant de 1927, et, d’autre part, un paysage syndical marque par de fortes transformations tant en termes de composition organisationnelle (avec un processus continu de creation de nouveaux syndicats depuis les annees 1960) que de rapports entre les differentes organisations qui alternent des periodes marquees par de fortes tensions (en particulier entre la CSMF et MG France) et des periodes d’unite par l’affirmation d’un « front liberal », toutefois plus dans la contestation que dans la negociation. Dans cet article, il est rendu compte de cette double dynamique en nous focalisant sur la derniere decennie qui correspond a la fois a un deplacement progressif de l’agenda des politiques d’Assurance maladie de la maitrise des depenses aux enjeux d’organisation des soins, a l’adoption de deux lois au perimetre large (la loi Hopital, patients, sante et territoire [HPST] en 2009 et la loi de modernisation de 2016), auxquelles s’ajoutent les projets recents du gouvernement dans la cadre de la strategie « Ma sante 2022 », et a deux negociations conventionnelles nationales (en 2011 et en 2016).

L’europeanisation des systemes de sante tient d’abord a l’adoption de normes juridiquement contraignantes liees a la mise en place du marche interieur europeen. Ces normes ont permis la circulation europeenne des professionnels de sante, des produits pharmaceutiques ainsi que celle des patients. La logique du marche interieur a egalement un impact non negligeable au niveau de la sante publique (dans la lutte contre le tabagisme en particulier). Cette institutionnalisation d’une Europe de la sante a aussi facilite la circulation de savoirs, de principes d’action et de pratiques s’inscrivant dans une europeanisation plus cognitive et operee en douceur (autrement dit non contraignante). Elle participe, enfin, d’une dynamique de convergence des systemes de sante europeens que l’Union europeenne accompagne plus qu’elle n’impulse.