Abstract

A case study of nineteen “establishments and services of aid through work” (ESAT) in the Rhône-Alpes region of France serves to bring under question the thesis of the commodification of medical and social services. This analysis focuses on the capacity for action of the directors of these ESATs, which articulate a social with an economic purpose. The directors work out a strategy for diversifying the activities of their establishments, adapt the organization and modify their positions in relation to partners (public authorities and users).