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Les réformes en santé en 2004 et en 2014 : nouvelle grammaire du discours ou re-fondation du système de santé français?

Abstract : The repeated and persistent appearance of issues related to the Health System crisis on every political agenda justifies the interest of political science in this field of research.As the 2004 reform’s bottom line was a strong affirmation that only the government can be legitimately responsible for health policy -a statement still favored by recent reforms- numerous official speeches about the last year’s reform contain a new language, using the “ territorialisation” and “gouvernance ” words.In fact, “territorialisation” as an answer to the Welfare State crisis, and “gouvernance” as an answer to the crisis in the ways of State governing, are both well-known Political Science subjects.Yet, the health crisis is not purported to be a political issue, but due to economics rather, mainly a functional and organizational one. As a consequence, matching solutions are usely thought in an economic and administrative way.Using cognitive and pragmatic approaches, our study neither aims at defining the terms of said crisis, nor justifying its presence on the political agenda. Rather, it addresses the solutions that are brought forward in the so-called ‘reform factory’ that are political speeches, as they have the power to legitimate deciding actors or their action.The first step taken in our method will consist in reporting bibliographic references for a political and historical deconstruction of the French health system, as well as analyzing the ‘health’ concept, in order to describe the cognitive framework of health policy. Special attention vill be paid to decentralization et public health.Then, these categories should prove to be helpful to study the current trends in the 2004 and 2014 periods of health reform in a discursive analysis, as we intend to do.To further investigate health reform manufacturing, we will focus on the new themes observed in these speeches : « gouvernance » et health democracy.Our thesis is that, through the language at play among these actors, there is a semantic fight loaded with power challenges to the State role in health Policy and therefore in the place ought to be given to the various actors in health public Policy. Finally, throw reforms, a new public for democracy came forward and new issues, that are principles and goals of health policy, appeared.
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Submitted on : Monday, January 20, 2020 - 11:05:14 AM
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Faouzia Perrin. Les réformes en santé en 2004 et en 2014 : nouvelle grammaire du discours ou re-fondation du système de santé français?. Science politique. Université Grenoble Alpes, 2019. Français. ⟨NNT : 2019GREAH009⟩. ⟨tel-02445430⟩



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