The French Regional Health Agencies: Shaking the Professional Ranks, Shaping New Professional Figures?

In April 2010 the French Health administration was reformed: in each of the 22 French regions were created les Agences Régionales de Santé– the Regional Health Agencies from the merger of seven institutions. This reform was legitimated as a decompartmentalization and an increase of local democracy on health issues. However, it worked more in a centralization direction: it strengthened the regional institutions and weakened the former departmental units in charge with all the local health issues. This paper is a part of a political science PhD in progress. We question the capacity of these new regional health agencies, as they result from an institutional merger, to build a common administrative culture (Peters, 2001). In this respect, a qualitative methodology (participant observation and in-depth interviews) provide empirical evidence. Our first findings seem to reveal the institutional merger as an opportunity to create new professional positions at a regional level. Being in charge with the preparation of the crisis local devices (Lascoumes, Le Galès, 2010) named “Plans” and with their monitoring, these agents performing some “métiers flous”(Jeannot, 2005) - “blurred occupations” - are the interface between central, regional, local levels of health administration. These positions are held by traditional civil servants (administrative, medical) occupying new positions and also by new agents recruited on fixed-term contracts. Old and emerging forms of professionalization coexist. Two notions often confront each-other: occupation and duty (civil service). We mobilize a theoretical frame using the French sociology of institution (Lagroye), the sociology of professions (Abbott, 1988) to shed light on the new figures of health administration: the Regional Health Agencies. They are considered here as institutional figures of the ''risk regulation regimes” (Hood, Rothstein, Baldwin, 2001) linking, through these new professional positions, the French State to other institutions in forms of national and international nodality (Hood, Margetts, 2007).