01228nam a2200145   4500008004100000100002000041245009600061260000900157300001700166520076900183650002700952650002600979650002601005773005101031190510b           ||||| |||| 00| 0 eng d  aSimonet, Daniel  aVertical alignment, elite power, and the democratic recess in the French health care system  c2018  ap.1095-1106.  aThe article critically examines administrative restructuring of the French health care system. Despite calculated benefits of New Public Management (NPM) reforms, conflicts between values escalated. NPM-endorsed decentralization never took off in France. Instead, a re-concentration of health policy decisions benefited a Ministry-level welfare elite that sought to restore fiscal discipline rather than responsiveness to users. That process triggered a clash of culture with the medical profession and was at the expense of democratic participation. The role of citizens as reform overseers, although initially contained in the NPM doctrinal puzzle, never materialized. Key issues such as greater accountability and responsibility remain unresolved. - Reproduced.  aAdministrative reforms  aPublic administration  aNew Public Management  aInternational Journal of Public Administration