Article: Regional Health Agencies and Social Care: the First Years

Hervé HUDEBINE*, Alain JOURDAIN** et Jorge MUNOZ***

* MCF sociologie, Université de Bretagne Occidentale, Brest, LABERS EA 3149, UFR LSH, 20 rue Duquesne, CS 93837, 29238 Brest Cedex 3
** Professeur, démographie, École des Hautes Études en Santé Publique, Avenue du Professeur Léon-Bernard, 35043 Rennes
*** MCF sociologie, Université de Bretagne Occidentale, Brest, LABERS EA 3149, UFR LSH, 20 rue Duquesne, CS 93837, 29238 Brest Cedex 3

Abstract

Regional Health Agencies have been set up in 2010, with the aim to ensure the implementation of national policy objectives regarding the reduction of inequalities and the improvement of both efficiency and democracy in the health field. The missions of the RHAs also involve social care. Historically, this sector is characterized by bottom up initiatives with regard to the construction services, with a joint control exercised by the field services of the state and local government (conseils généraux). The aim of this paper is to understand the consequences of this reform with regard to the governance of social care policies at the regional level, with a focus on the autonomy margins of the actors involved. To this end, an exploratory research based on 32 interviews in two regions and the analysis of documents has been conducted. Executives of the RHAs initially exploit their autonomy margins to play by the rules of health democracy as is exemplified by their decisions regarding the delimitation of geographical areas of intervention organization the consultative process aimed at the preparation of regional health projects. The impact of national authorities control tools becomes apparent in the following phase; making the limitations of the strategic and financial autonomy of the RHAs executives obvious. It also becomes obvious, however, that both the effectiveness and the legitimacy of social care policies at the regional level depend on the acknowledgement of the financial and political interdependencies with the conseils généraux, whether at the beginning or at the end of the process.